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Performance of the medical priority dispatch system in correctly classifying out-of-hospital cardiac arrests as appropriate for resuscitation. Resuscitation 2022; 181:123-131. [PMID: 36375652 DOI: 10.1016/j.resuscitation.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Emergency dispatch centres receive emergency calls and assign resources. Out-of-hospital cardiac arrests (OHCA) can be classified as appropriate (requiring emergent response) or inappropriate (requiring non-emergent response) for resuscitation. We sought to determine system accuracy in emergency medical services (EMS) OHCA response allocation. METHODS We analyzed EMS-assessed non-traumatic OHCA records from the British Columbia (BC) Cardiac Arrest registry (January 1, 2019-June 1, 2021), excluding EMS-witnessed cases. In BC the "Medical Priority Dispatch System" is used. We classified EMS dispatch as "emergent" or "non-emergent" and compared to the gold standard of whether EMS personnel decided treatment was appropriate upon scene arrival. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV), with 95% CI's. RESULTS Of 15,371 non-traumatic OHCAs, the median age was 65 (inter quartile range 51-78), and 4834 (31%) were women; 7152 (47%) were EMS-treated, of whom 651 (9.1%) survived). Among EMS-treated cases 6923/7152 had an emergent response (sensitivity = 97%, 95% CI 96-97) and among EMS-untreated cases 3951/8219 had a non-emergent response (specificity = 48%, 95% CI, 47 to 49). Among cases with emergent dispatch, 6923/11191 were EMS-treated (PPV = 62%, 95% CI 61-62), and among those with non-emergent dispatch, 3951/4180 were EMS-untreated (NPV = 95%, 95% CI 94-95); 229/4180 (5.5%) with a non-emergent dispatch were treated by EMS. CONCLUSION The dispatch system in BC has a high sensitivity and moderate specificity in sending the appropriate responses for OHCAs deemed appropriate for treatment by paramedics. Future research may address strategies to increase system specificity, and decrease the incidence of non-emergent dispatch to EMS-treated cases.
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Establishment of disaster medical assistance team standards and evaluation of the teams' disaster preparedness: An experience from Taiwan. J Formos Med Assoc 2021; 121:815-823. [PMID: 34657769 DOI: 10.1016/j.jfma.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 07/26/2021] [Accepted: 08/24/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND/PURPOSE Taiwan set up disaster medical assistance teams (DMATs) after the Chi-Chi earthquake, but these teams lack unified standards. METHODS This study was divided into two phases. Phase I was a Delphi study conducted in 2019 with 26 experts who were invited to establish Taiwan's DMAT standards by modifying the World Health Organization Emergency Medical Team (WHO EMT) type I fixed standards. Phase II was a cross-sectional study conducted in 2020. A questionnaire was used to evaluate the disaster preparedness of DMATs by standards set in phase I. RESULTS In phase I, Taiwan's DMAT standards were established after three rounds of Delphi consensus, with a response rate of 88.5%. The major departures from the WHO EMT standards were the exclusion of obstetric care, mental health, rehabilitation, and laboratory and blood transfusion standards and the addition of an ultrasound standard. During phase II, a total of 32 teams were invited, and the response rate was 96.9%. The overall standard achievement rate was 56.9%, and the three lowest achievement rates corresponded to sanitation (22.6%), medical malpractice insurance (25.8%), and pharmacy and drug supply (25.8%). The national DMATs, official DMATs, DMATs funded by government, and DMATs with ≥10 years of experience had significantly higher achievement rates for partial or overall standards. CONCLUSION Using localized standards to evaluate the disaster preparedness of each team, DMATs were found to have many shortcomings mainly due to the lack of unified government announcement standards, legal protection, and adequate financial support.
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A 36-Hour Unplugged Full-Scale Exercise: Closing the Gaps in Interagency Collaboration between the Disaster Medical Assistance Team and Urban Search and Rescue Team in Disaster Preparedness in Taiwan. Emerg Med Int 2021; 2021:5571009. [PMID: 33880192 PMCID: PMC8046556 DOI: 10.1155/2021/5571009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 02/04/2021] [Accepted: 03/28/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction Disaster medical assistance team (DMAT) and urban search and rescue team (USAR) need to cooperate seamlessly to save lives in disasters, but related research is limited. Objectives To estimate the disaster preparedness of the DMAT and the barriers affecting interagency cooperation between the DMAT and the USAR team. Methods This was an observational study of a full-scale exercise conducted in Taiwan from November 16 to 18, 2018. The exercise scenario simulated a magnitude 7 earthquake in Tainan City. DMATs from other counties were deployed and cooperated with local USAR teams to carry out disaster relief. Our study invited 7 experts to evaluate DMATs on disaster preparedness capabilities and the interagency collaboration between DMATs and USAR. Results A total of eight DMATs, consisting of 30 physicians, 65 nurses, 74 logisticians, 5 health bureau personnel, and 85 USAR teams, participated in this exercise. During the mission, 176 patients were treated. The capabilities of each team were generally consistent with the basic technical standards for type I emergency medical teams, but the compliance rates for basic local anesthesia, cold chain equipment for medication, rapid blood test tools, and sterilization devices were only 50%, 12.5%, 12.5%, and 9%, respectively. In addition, 53% of participants reported abnormal vital signs, indicating that it was a high-stress situation. Moreover, the main barriers to interagency collaboration were differing perspectives and poor mutual understanding. Conclusion A full-scale exercise carried out jointly with DMATs and USAR teams was valuable for disaster preparedness, particularly in terms of understanding the weaknesses of those teams and the barriers to interagency collaboration.
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Lin MW, Pan CL, Wen JC, Lee CH, Wu ZP, Chang CF, Chiu CW. An innovative emergency transportation scenario for mass casualty incident management: Lessons learnt from the Formosa Fun Color Dust explosion. Medicine (Baltimore) 2021; 100:e24482. [PMID: 33725935 PMCID: PMC7982245 DOI: 10.1097/md.0000000000024482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 12/31/2020] [Indexed: 01/05/2023] Open
Abstract
The purpose of this research is to analyze and introduce a new emergency medical service (EMS) transportation scenario, Emergency Medical Regulation Center (EMRC), which is a temporary premise for treating moderate and minor casualties, in the 2015 Formosa Fun Color Dust Party explosion in Taiwan. In this mass casualty incident (MCI), although all emergency medical responses and care can be considered as a golden model in such an MCI, some EMS plans and strategies should be estimated impartially to understand the truth of the successful outcome.Factors like on-scene triage, apparent prehospital time (appPHT), inhospital time (IHT), and diversion rate were evaluated for the appropriateness of the EMS transportation plan in such cases. The patient diversion risk of inadequate EMS transportation to the first-arrival hospital is detected by the odds ratios (ORs). In this case, the effectiveness of the EMRC scenario is estimated by a decrease in appPHT.The average appPHTs (in minutes) of mild, moderate, and severe patients are 223.65, 198.37, and 274.55, while the IHT (in minutes) is 18384.25, 63021.14, and 83345.68, respectively. The ORs are: 0.4016 (95% Cl = 0.1032-1.5631), 0.1608 (95% Cl = 0.0743-0.3483), and 4.1343 (95% Cl = 2.3265-7.3468; P < .001), respectively. The appPHT has a 47.61% reduction by employing an EMRC model.Due to the relatively high appPHT, diversion rate, and OR value in severe patients, the EMS transportation plan is distinct from a prevalent response and develops adaptive weaknesses of MCIs in current disaster management. Application of the EMRC scenario reduces the appPHT and alleviates the surge pressure upon emergency departments in an MCI.
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Affiliation(s)
- Ming-Wei Lin
- Graduate School of Engineering Science and Technology
| | - Chih-Long Pan
- Bachelor Program in Interdisciplinary Studies, College of Future
| | - Jet-Chau Wen
- Department and Graduate School of Safety Health and Environmental Engineering
- Research Center for Soil & Water Resources and Natural Disaster Prevention (SWAN), National Yunlin University of Science & Technology, 123, Section 3, University Road, Douliu, Yunlin 640
| | - Cheng-Haw Lee
- Department of Resources Engineering, National Cheng Kung University, 1, University Road, East District, Tainan city 701
| | - Zong-Ping Wu
- Graduate School of Disaster Management, Central Police University, 56, Shujen Road, Kueishan District, Taoyuan City 333
| | - Chin-Fu Chang
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan, ROC
| | - Chun-Wen Chiu
- Department of Emergency and Critical Care Medicine, Changhua Christian Hospital, 135, Nan-Hsiao Street, Changhua 500, Taiwan, ROC
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Park SH, Cha WC, Kim G, Lee TR, Hwang SY, Shin TG, Sim MS, Jo IJ. Effect of typhoons on the Korean national emergency medical service system. Clin Exp Emerg Med 2018; 5:272-277. [PMID: 30571906 PMCID: PMC6301860 DOI: 10.15441/ceem.17.255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/12/2017] [Indexed: 11/23/2022] Open
Abstract
Objective While the effect of typhoons on emergency medicine has been evaluated, data are scarce on their effects on the emergency medical service (EMS). This study evaluated the effect of typhoons on EMS patients and performance. Methods The study period was January 2010 to December 2012. Meteorological data regarding typhoons were provided by the Korean Meteorological Administration. EMS data were retrieved from the EMS database of the national emergency management agency. The database includes ambulance run sheets, which contain clinical and operational data. In this case-crossover study, the cases and controls were EMS calls on the day of typhoon warnings and calls one week prior to the typhoon warnings, respectively. Results During the study period, 11 typhoons affected Korea. A total of 14,521 cases were selected for analysis. Overall, there were no obvious differences between the case and control groups. However, there were statistically significant differences in age, place, and time requests. There were fewer patients between 0 and 15 years of age (P=0.01) and more unconscious patients (P=0.01) in the case group. The EMS operational performance, as measured by the times elapsed between call to start, call to field, and call to hospital did not differ significantly. There was also no significant difference in the time from hospital arrival between the cases (28.67, standard deviation 16.37) and controls (28.97, standard deviation 28.91) (P=0.39). Conclusion Typhoons did not significantly affect the EMS system in this study. Further study is necessary to understand the reasons for this finding.
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Affiliation(s)
- Soo Hyun Park
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Won Chul Cha
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Giwoon Kim
- Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Tae Rim Lee
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Sung Yeon Hwang
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Tae Gun Shin
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Min Seob Sim
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Seoul, Korea
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Ghazali DA, Guericolas M, Thys F, Sarasin F, Arcos González P, Casalino E. Climate Change Impacts on Disaster and Emergency Medicine Focusing on Mitigation Disruptive Effects: an International Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1379. [PMID: 29966379 PMCID: PMC6069477 DOI: 10.3390/ijerph15071379] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Revised: 06/11/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
Abstract
In recent decades, climate change has been responsible for an increase in the average temperature of the troposphere and of the oceans, with consequences on the frequency and intensity of many extreme weather phenomena. Climate change’s effects on natural disasters can be expected to induce a rise in humanitarian crises. In addition, it will surely impact the population’s long-term general health, especially among the most fragile. There are foreseeable health risks that both ambulatory care organizations and hospitals will face as global temperatures rise. These risks include the geographic redistribution of infectious (particularly zoonotic) diseases, an increase in cardiac and respiratory illnesses, as well as a host of other health hazards. Some of these risks have been detailed for most developed countries as well as for some developing countries. Using these existing risk assessments as a template, organizational innovations as well as implementation strategies should be proposed to mitigate the disruptive effects of these health risks on emergency departments and by extension, reduce the negative impact of climate change on the populations they serve.
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Affiliation(s)
- Daniel Aiham Ghazali
- Emergency Department and EMS, University Hospital of Bichat, Paris 75018, France.
- Ilumens Simulation Center, University of Paris-Diderot, Paris 75018, France.
| | | | - Frédéric Thys
- Acute Care Division & Emergency Department, Grand Hôpital de Charleroi, Charleroi 6040, Belgium.
- Faculty of Public Health & Medicine, Catholic University of Louvain, Brussels 1348, Belgium.
| | - François Sarasin
- Emergency Department, University Hospital of Geneva, Geneva 44041, Switzerland.
- University of Geneva Medical School, Geneva 1205, Switzerland.
| | - Pedro Arcos González
- Unit for Research in Emergency and Disaster, Department of Medicine, University of Oviedo, Oviedo 33006, Spain.
| | - Enrique Casalino
- Emergency Department and EMS, University Hospital of Bichat, Paris 75018, France.
- University of Paris Diderot, Sorbonne Paris Cité, EA 7334 Recherche clinique coordonnée ville-hôpital, Méthodologies et Société (REMES), Paris 75018, France.
- Study Group for Efficiency and Quality of Emergency Departments and Non-Scheduled Activities Departments, Paris 75018, France.
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Pan CL, Lin CH, Lin YR, Wen HY, Wen JC. The Significance of Witness Sensors for Mass Casualty Incidents and Epidemic Outbreaks. J Med Internet Res 2018; 20:e39. [PMID: 29396388 PMCID: PMC5816259 DOI: 10.2196/jmir.8249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 10/30/2017] [Accepted: 11/22/2017] [Indexed: 11/26/2022] Open
Abstract
Due to the increasing number of natural and man-made disasters, mass casualty incidents occur more often than ever before. As a result, health care providers need to adapt in order to cope with the overwhelming patient surge. To ensure quality and safety in health care, accurate information in pandemic disease control, death reduction, and health quality promotion should be highlighted. However, obtaining precise information in real time is an enormous challenge to all researchers of the field. In this paper, innovative strategies are presented to develop a sound information network using the concept of “witness sensors.” To overcome the reliability and quality limitations of information obtained through social media, researchers must focus on developing solutions that secure the authenticity of social media messages, especially for matters related to health. To address this challenge, we introduce a novel concept based on the two elements of “witness” and “sensor.” Witness sensors can be key players designated to minimize limitations to quality of information and to distinguish fact from fiction during critical events. In order to enhance health communication practices and deliver valid information to end users, the education and management of witness sensors should be further investigated, especially for implementation during mass casualty incidents and epidemic outbreaks.
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Affiliation(s)
- Chih-Long Pan
- Research Center for Soil & Water Resources and Natural Disaster Prevention, National Yunlin University of Science & Technology, Douliou, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yan-Ren Lin
- Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan.,School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Hsin-Yu Wen
- Department of Clinical Medicine, West China School of Medicine, Sichuan University, Sichuan, China
| | - Jet-Chau Wen
- Research Center for Soil & Water Resources and Natural Disaster Prevention, National Yunlin University of Science & Technology, Douliou, Taiwan.,Department and Graduate School of Safety and Environment Engineering, National Yunlin University of Science & Technology, Douliou, Taiwan
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Saving the On-Scene Time for Out-of-Hospital Cardiac Arrest Patients: The Registered Nurses' Role and Performance in Emergency Medical Service Teams. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5326962. [PMID: 28280734 PMCID: PMC5322439 DOI: 10.1155/2017/5326962] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 11/23/2016] [Accepted: 01/19/2017] [Indexed: 12/01/2022]
Abstract
For out-of-hospital cardiac arrest (OHCA) patients, every second is vital for their life. Shortening the prehospital time is a challenge to emergency medical service (EMS) experts. This study focuses on the on-scene time evaluation of the registered nurses (RNs) participating in already existing EMS teams, in order to explore their role and performance in different EMS cases. In total, 1247 cases were separated into trauma and nontrauma cases. The nontrauma cases were subcategorized into OHCA (NT-O), critical (NT-C), and noncritical (NT-NC) cases, whereas the trauma cases were subcategorized into collar-and-spinal board fixation (T-CS), fracture fixation (T-F), and general trauma (T-G) cases. The average on-scene time of RN-attended cases showed a decrease of 21.05% in NT-O, 3.28% in NT-C, 0% in NT-NC, 18.44% in T-CS, 13.56% in T-F, and 3.46% in T-G compared to non-RN-attended. In NT-O and T-CS cases, the RNs' attendance can notably save the on-scene time with a statistical significance (P = .016 and .017, resp.). Furthermore, the return of spontaneous circulation within two hours (ROSC2 h) rate in the NT-O cases was increased by 12.86%. Based on the findings, the role of RNs in the EMTs could save the golden time in the prehospital medical care in Taiwan.
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