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Babaei HA, Ferdosi M, Masoumi G, Rezaei F. A comparative study on specialized services in pre-hospital emergencies in Iran and selected countries. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:414. [PMID: 38333162 PMCID: PMC10852191 DOI: 10.4103/jehp.jehp_232_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/01/2023] [Indexed: 02/10/2024]
Abstract
The quality of emergency services is one of the indicators describing the health status of countries. Moreover, the specialization of services and targeted response to any accident or disease has been the priority of pre-hospital emergency operations in some leading countries. This study aimed to compare the special services provided in the emergency department of several selected countries. This was a comparative study that was done in Isfahan in 2022. Data were collected by reviewing the literature provided by libraries and emergency websites of selected countries. We selected countries based on the accessibility of information in two groups of developed countries and countries with the same income and population as Iran including Germany, France, The United States, Australia, Britain, Malaysia, and Turkey. Data were classified and compared based on staff, vehicles, and specialized services. Emergency staffs in most countries were of different skill and training levels. Ambulances varied in equipment types in various land, air, and sea forms and dimensions. Developed countries had more modern ambulances and equipment. France and Germany were operating more especially. Specialized teams are dispatched only in the United States and Germany. Existing studies have shown the adequacy and effectiveness of these teams in reducing complications and mortality and improving the prognosis of patients. The use of specialized teams appropriate to each emergency based on the specific and targeted response is effective in improving the prognosis of patients. The results of this study are suggested to beneficiaries to improve the quality of emergency care and reduce complications and potential causalities.
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Affiliation(s)
- Habib Allah Babaei
- Department of Health in Disasters and Emergencies, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Ferdosi
- Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamraza Masoumi
- Health in Emergency and Disaster Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Emergency Management Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Health in Disasters and Emergencies, Health Management and Economics Research Centers, Isfahan University of Medical Sciences, Isfahan, Iran
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Renberg M, Dahlberg M, Gellerfors M, Rostami E, Günther M. Prehospital and emergency department airway management of severe penetrating trauma in Sweden during the past decade. Scand J Trauma Resusc Emerg Med 2023; 31:85. [PMID: 38001526 PMCID: PMC10675952 DOI: 10.1186/s13049-023-01151-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 11/11/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Prehospital tracheal intubation (TI) is associated with increased mortality in patients with penetrating trauma, and the utility of prehospital advanced airway management is debated. The increased incidence of deadly violence in Sweden warrants a comprehensive evaluation of current airway management for patients with penetrating trauma in the Swedish prehospital environment and on arrival in the emergency department (ED). METHODS This was an observational, multicenter study of all patients with penetrating trauma and injury severity scores (ISSs) ≥ 15 included in the Swedish national trauma register (SweTrau) between 2011 and 2019. We investigated the frequency and characteristics of prehospital and ED TI, including 30-day mortality and patient characteristics associated with TI. RESULT Of 816 included patients, 118 (14.5%) were intubated prehospitally, and 248 (30.4%) were intubated in the ED. Patients who were intubated prehospitally had a higher ISS, 33 (interquartile range [IQR] 25, 75), than those intubated in the ED, 25 (IQR 18, 34). Prehospital TI was associated with a higher associated mortality, OR 4.26 (CI 2.57, 7.27, p < 0.001) than TI in the ED, even when adjusted for ISS (OR 2.88 [CI 1.64, 5.14, p < 0.001]). Hemodynamic collapse (≤ 40 mmHg) and low GCS score (≤ 8) were the characteristics most associated with prehospital TI. Traumatic cardiac arrests (TCAs) occurred in 154 (18.9%) patients, of whom 77 (50%) were intubated prehospitally and 56 (36.4%) were intubated in the ED. A subgroup analysis excluding TCA showed that patients with prehospital TI did not have a higher mortality rate than those with ED TI, OR 2.07 (CI 0.93, 4.51, p = 0.068), with OR 1.39 (0.56, 3.26, p = 0.5) when adjusted for ISS. CONCLUSION Prehospital TI was associated with a higher mortality rate than those with ED TI, which was specifically related to TCA; intubation did not affect mortality in patients without cardiac arrest. Mortality was high when airway management was needed, regardless of cardiac arrest, thereby emphasizing the challenges posed when anesthesia is needed. Several interventions, including whole blood transfusions, the implementation of second-tier EMS units and measures to shorten scene times, have been initiated in Sweden to counteract these challenges.
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Affiliation(s)
- Mattias Renberg
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken, 10, S1 SE-118 83, Stockholm, Sweden.
| | - Martin Dahlberg
- Department of Surgery, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Rapid Response Car, Capio, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Swedish Air Ambulance (SLA), Mora, Sweden
| | - Elham Rostami
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Medical Sciences, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Mattias Günther
- Department of Anesthesiology and Intensive Care, Södersjukhuset, Sjukhusbacken, 10, S1 SE-118 83, Stockholm, Sweden
- Experimental Traumatology Unit, Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Kawai Y, Yamamoto K, Miyazaki K, Asai H, Fukushima H. Machine learning-based analysis of regional differences in out-of-hospital cardiopulmonary arrest outcomes and resuscitation interventions in Japan. Sci Rep 2023; 13:15884. [PMID: 37741881 PMCID: PMC10518013 DOI: 10.1038/s41598-023-43210-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 09/21/2023] [Indexed: 09/25/2023] Open
Abstract
Refining out-of-hospital cardiopulmonary arrest (OHCA) resuscitation protocols for local emergency practices is vital. The lack of comprehensive evaluation methods for individualized protocols impedes targeted improvements. Thus, we employed machine learning to assess emergency medical service (EMS) records for examining regional disparities in time reduction strategies. In this retrospective study, we examined Japanese EMS records and neurological outcomes from 2015 to 2020 using nationwide data. We included patients aged ≥ 18 years with cardiogenic OHCA and visualized EMS activity time variations across prefectures. A five-layer neural network generated a neurological outcome predictive model that was trained on 80% of the data and tested on the remaining 20%. We evaluated interventions associated with changes in prognosis by simulating these changes after adjusting for time factors, including EMS contact to hospital arrival and initial defibrillation or drug administration. The study encompassed 460,540 patients, with the model's area under the curve and accuracy being 0.96 and 0.95, respectively. Reducing transport time and defibrillation improved outcomes universally, while combining transport time and drug administration showed varied efficacy. In conclusion, the association of emergency activity time with neurological outcomes varied across Japanese prefectures, suggesting the need to set targets for reducing activity time in localized emergency protocols.
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Affiliation(s)
- Yasuyuki Kawai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan.
| | - Koji Yamamoto
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Keita Miyazaki
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hideki Asai
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
| | - Hidetada Fukushima
- Department of Emergency and Critical Care Medicine, Nara Medical University, 840 Shijo-Cho, Kashihara, Nara, 634-8522, Japan
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Tern PJW, Vaswani A, Yeo KK. Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries. Korean Circ J 2023; 53:594-605. [PMID: 37653695 PMCID: PMC10475691 DOI: 10.4070/kcj.2023.0169] [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: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 09/02/2023] Open
Abstract
Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.
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Affiliation(s)
- Paul Jie Wen Tern
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Amar Vaswani
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore.
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Bardhan R, Byrd T. Psychosocial Work Stress and Occupational Stressors in Emergency Medical Services. Healthcare (Basel) 2023; 11:healthcare11070976. [PMID: 37046903 PMCID: PMC10093884 DOI: 10.3390/healthcare11070976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 03/31/2023] Open
Abstract
Emergency medical service (EMS) professionals often experience work stress, which escalated during COVID-19. High job demand in the EMS profession may lead to progressive decline in physical and mental health. We investigated the prevalence of psychosocial job stress in the three levels of EMS: basic, advanced, and paramedic, before and during the COVID-19 pandemic. EMS professionals (n = 36) were recruited from EMS agencies following the Institutional Review Board approval. Participants took surveys on demographics, personal characteristics, chronic diseases, and work schedules. Job stress indicators, namely the effort–reward ratio (ERR) and overcommitment (OC), were evaluated from survey questionnaires using the effort–reward imbalance model. Associations of job stress indicators with age, sex, body mass index, and working conditions were measured by logistic regression. Psychosocial work stress was prevalent with effort reward ratio > 1 in 83% of participants and overcommitment scores > 13 in 89% of participants. Age, body mass index, and work hours showed strong associations with ERR and OC scores. The investigation findings suggested that a psychosocial work environment is prevalent among EMS, as revealed by high ERR, OC, and their correlation with sleep apnea in rotating shift employees. Appropriate interventions may be helpful in reducing psychosocial work stress in EMS professionals.
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Mohd Hassan NZA, Bahari MS, Aminuddin F, Mohd Nor Sham Kunusagaran MSJ, Zaimi NA, Mohd Hanafiah AN, Kamarudin F. Data envelopment analysis for ambulance services of different service providers in urban and rural areas in Ministry of Health Malaysia. Front Public Health 2023; 10:959812. [PMID: 36684911 PMCID: PMC9853528 DOI: 10.3389/fpubh.2022.959812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/06/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Ambulance services are pivotal in any country's healthcare system. An efficient ambulance service not only decreases patient mortality rate but also allows resource prioritization for better outputs. This study aims to measure the efficiency of ambulance services provided by health facilities in the Ministry of Health (MOH), Malaysia. Methods This cross-sectional study analyzed the efficiency of 76 Decision-Making Units (DMUs) or health facilities, consisting of 62 health clinics and 14 hospitals. Data Envelopment Analysis (DEA) was used for computing efficiency scores while adopting the Variable Return to Scale (VRS) approach. The analysis was based on input orientation. The input was the cost of ambulance services, while the output for this analysis was the distance coverage (in km), the number of patients transferred, and hours of usage (in hours). Subsequent analysis was conducted to test the Overall Technical Efficiency (OTE), the Pure Technical Efficiency (PTE), the Scale Efficiency (SE), and the Return to Scale with the type of health facilities and geographical areas using a Mann-Whitney U-test and a chi-square test. Results The mean scores of OTE, PTE, and SE were 0.508 (±0.207), 0.721 (±0.185), and 0.700 (±0.200), respectively. Approximately, 14.47% of the total health facilities were PTE. The results showed a significant difference in OTE and SE between ambulance services in hospitals and health clinics (p < 0.05), but no significant difference in PTE between hospitals and clinics (p>0.05). There was no significant difference in efficiency scores between urban and rural health facilities in terms of ambulance services except for OTE (p < 0.05). Discussion The ambulance services provided in healthcare facilities in the MOH Malaysia operate at 72.1% PTE. The difference in OTE between hospitals and health clinics' ambulance services was mainly due to the operating size rather than PTE. This study will be beneficial in providing a guide to the policymakers in improving ambulance services through the readjustment of health resources and improvement in the outputs.
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Affiliation(s)
- Nor Zam Azihan Mohd Hassan
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Mohd Shahri Bahari
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Farhana Aminuddin
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | | | - Nur Amalina Zaimi
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Ainul Nadziha Mohd Hanafiah
- Institute for Health Systems Research, National Institutes of Health, Ministry of Health Malaysia, Shah Alam, Selangor, Malaysia
| | - Fakarudin Kamarudin
- School of Business and Economics, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Dixon M, Appleton JP, Scutt P, Woodhouse LJ, Haywood LJ, Havard D, Williams J, Siriwardena AN, Bath PM. Time intervals and distances travelled for prehospital ambulance stroke care: data from the randomised-controlled ambulance-based Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2). BMJ Open 2022; 12:e060211. [PMID: 36410799 PMCID: PMC9680177 DOI: 10.1136/bmjopen-2021-060211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Ambulances offer the first opportunity to evaluate hyperacute stroke treatments. In this study, we investigated the conduct of a hyperacute stroke study in the ambulance-based setting with a particular focus on timings and logistics of trial delivery. DESIGN Multicentre prospective, single-blind, parallel group randomised controlled trial. SETTING Eight National Health Service ambulance services in England and Wales; 54 acute stroke centres. PARTICIPANTS Paramedics enrolled 1149 patients assessed as likely to have a stroke, with Face, Arm, Speech and Time score (2 or 3), within 4 hours of symptom onset and systolic blood pressure >120 mm Hg. INTERVENTIONS Paramedics administered randomly assigned active transdermal glyceryl trinitrate or sham. PRIMARY AND SECONDARY OUTCOMES Modified Rankin scale at day 90. This paper focuses on response time intervals, distances travelled and baseline characteristics of patients, compared between ambulance services. RESULTS Paramedics enrolled 1149 patients between September 2015 and May 2018. FINAL DIAGNOSIS intracerebral haemorrhage 13%, ischaemic stroke 52%, transient ischaemic attack 9% and mimic 26%. Timings (min) were (median (25-75 centile)): onset to emergency call 19 (5-64); onset to randomisation 71 (45-116); total time at scene 33 (26-46); depart scene to hospital 15 (10-23); randomisation to hospital 24 (16-34) and onset to hospital 97 (71-141). Ambulances travelled (km) 10 (4-19) from scene to hospital. Timings and distances differed between ambulance service, for example, onset to randomisation (fastest 53 min, slowest 77 min; p<0.001), distance from scene to hospital (least 4 km, most 20 km; p<0.001). CONCLUSION We completed a large prehospital stroke trial involving a simple-to-administer intervention across multiple ambulance services. The time from onset to randomisation and modest distances travelled support the applicability of future large-scale paramedic-delivered ambulance-based stroke trials in urban and rural locations. TRIAL REGISTRATION NUMBER ISRCTN26986053.
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Affiliation(s)
- Mark Dixon
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
- Leicester, Leicestershire & Rutland Division, East Midlands Ambulance Service NHS Trust, Nottingham, UK
| | - Jason P Appleton
- Stroke, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Polly Scutt
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Lisa J Woodhouse
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Lee J Haywood
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Diane Havard
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
| | - Julia Williams
- Division of Paramedic Science, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | | | - Philip M Bath
- Division of Mental Health and Clinical Neuroscience, University of Nottingham Faculty of Medicine and Health Sciences, Nottingham, UK
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Lee MHM, Chia MYC, Fook-Chong S, Shahidah N, Tagami T, Ryu HH, Lin CH, Karim SA, Jirapong S, Rao HVR, Cai W, Velasco BP, Khan NU, Son DN, Naroo GY, El Sayed M, Ong MEH. Characteristics and Outcomes of Traumatic Cardiac Arrests in the Pan-Asian Resuscitation Outcomes Study. PREHOSP EMERG CARE 2022; 27:978-986. [PMID: 35994382 DOI: 10.1080/10903127.2022.2113941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/02/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival. METHODS Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC). RESULTS There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39-73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99-4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25-5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71-2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27-7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80-21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39-97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99-5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05-10.53) relative to asystole. CONCLUSIONS In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes.
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Affiliation(s)
| | | | - Stephanie Fook-Chong
- Prehospital Emergency & Research Centre, Duke-NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan
| | - Hyun Ho Ryu
- Department of Emergency Medicine, Chonnam National University Medical School and Hospital, Gwangju, Korea
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Sarah Abdul Karim
- Department of Emergency Medicine, Hospital Sungai Buloh, Selangor, Malaysia
| | | | - H V Rajanarsing Rao
- Emergency Medicine Learning Centre, GVK Emergency Management and Research Institute, Secunderabad, Telangana, India
| | - Wenwei Cai
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Zhejiang, China
| | | | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Do Ngoc Son
- Center for Emergency Medicine, Bach Mai Hospital, Hanoi, Vietnam
| | - G Y Naroo
- ED-Trauma Centre, Rashid Hospital, Dubai, United Arab Emirates
| | - Mazen El Sayed
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, Health Services and Systems Research, Singapore, Singapore
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Long-Term Outcomes after Non-Traumatic Out-of-Hospital Cardiac Arrest in Pediatric Patients: A Systematic Review. J Clin Med 2022; 11:jcm11175003. [PMID: 36078931 PMCID: PMC9457161 DOI: 10.3390/jcm11175003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Long-term outcomes after non-traumatic pediatric out-of-hospital cardiac arrest (OHCA) are not well understood. This systematic review aimed to summarize long-term outcomes (1 year and beyond), including overall survival, survival with favorable neurological outcomes, and health-related quality of life (HRQoL) outcomes) amongst pediatric OHCA patients who survived to discharge. Embase, Medline, and The Cochrane Library were searched from inception to October 6, 2021. Studies were included if they reported outcomes at 1 year or beyond after pediatric OHCA. Data abstraction and quality assessment was conducted by three authors independently. Qualitative outcomes were reported systematically. Seven studies were included, and amongst patients that survived to hospital discharge or to 30 days, longer-term survival was at least 95% at 24 months of follow up. A highly variable proportion (range 10–71%) of patients had favorable neurological outcomes at 24 months of follow up. With regard to health-related quality of life outcomes, at a time point distal to 1 year, at least 60% of pediatric non-traumatic OHCA patients were reported to have good outcomes. Our study found that at least 95% of pediatric OHCA patients, who survived to discharge, survived to a time point distal to 1 year. There is a general paucity of data surrounding the pediatric OHCA population.
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Liu N, Liu M, Chen X, Ning Y, Lee JW, Siddiqui FJ, Saffari SE, Ho AFW, Shin SD, Ma MHM, Tanaka H, Ong MEH. Development and validation of an interpretable prehospital return of spontaneous circulation (P-ROSC) score for patients with out-of-hospital cardiac arrest using machine learning: A retrospective study. EClinicalMedicine 2022; 48:101422. [PMID: 35706500 PMCID: PMC9096672 DOI: 10.1016/j.eclinm.2022.101422] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/09/2022] [Accepted: 04/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Return of spontaneous circulation (ROSC) before arrival at the emergency department is an early indicator of successful resuscitation in out-of-hospital cardiac arrest (OHCA). Several ROSC prediction scores have been developed with European cohorts, with unclear applicability in Asian settings. We aimed to develop an interpretable prehospital ROSC (P-ROSC) score for ROSC prediction based on patients with OHCA in Asia. METHODS This retrospective study examined patients who suffered from OHCA between Jan 1, 2009 and Jun 17, 2018 using data recorded in the Pan-Asian Resuscitation Outcomes Study (PAROS) registry. AutoScore, an interpretable machine learning framework, was used to develop P-ROSC. On the same cohort, the P-ROSC was compared with two clinical scores, the RACA and the UB-ROSC. The predictive power was evaluated using the area under the curve (AUC) in the receiver operating characteristic analysis. FINDINGS 170,678 cases were included, of which 14,104 (8.26%) attained prehospital ROSC. The P-ROSC score identified a new variable, prehospital drug administration, which was not included in the RACA score or the UB-ROSC score. Using only five variables, the P-ROSC score achieved an AUC of 0.806 (95% confidence interval [CI] 0.799-0.814), outperforming both RACA and UB-ROSC with AUCs of 0.773 (95% CI 0.765-0.782) and 0.728 (95% CI 0.718-0.738), respectively. INTERPRETATION The P-ROSC score is a practical and easily interpreted tool for predicting the probability of prehospital ROSC. FUNDING This research received funding from SingHealth Duke-NUS ACP Programme Funding (15/FY2020/P2/06-A79).
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Affiliation(s)
- Nan Liu
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- SingHealth AI Health Program, Singapore Health Services, Singapore, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
- Institute of Data Science, National University of Singapore, Singapore, Singapore
- Corresponding author at: Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore.
| | - Mingxuan Liu
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Xinru Chen
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Yilin Ning
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Jin Wee Lee
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Fahad Javaid Siddiqui
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
| | - Seyed Ehsan Saffari
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
- National Neuroscience Institute, Singapore, Singapore
| | - Andrew Fu Wah Ho
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, School of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Marcus Eng Hock Ong
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore 169857, Singapore
- Health Services Research Centre, Singapore Health Services, Singapore, Singapore
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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11
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Goto Y, Funada A, Maeda T, Goto Y. Termination-of-resuscitation rule in the emergency department for patients with refractory out-of-hospital cardiac arrest: a nationwide, population-based observational study. Crit Care 2022; 26:137. [PMID: 35578295 PMCID: PMC9109290 DOI: 10.1186/s13054-022-03999-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background In Japan, emergency medical service (EMS) providers are prohibited from field termination-of-resuscitation (TOR) in out-of-hospital cardiac arrest (OHCA) patients. In 2013, we developed a TOR rule for emergency department physicians (Goto’s TOR rule) immediately after hospital arrival. However, this rule is subject to flaws, and there is a need for revision owing to its relatively low specificity for predicting mortality compared with other TOR rules in the emergency department. Therefore, this study aimed to develop and validate a modified Goto’s TOR rule by considering prehospital EMS cardiopulmonary resuscitation (CPR) duration. Methods We analysed the records of 465,657 adult patients with OHCA from the All-Japan Utstein registry from 2016 to 2019 and divided them into two groups: development (n = 231,363) and validation (n = 234,294). The primary outcome measures were specificity, false-positive rate (FPR), and positive predictive value (PPV) of the revised TOR rule in the emergency department for predicting 1-month mortality. Results Recursive partitioning analysis for the development group in predicting 1-month mortality revealed that a modified Goto’s TOR rule could be defined if patients with OHCA met the following four criteria: (1) initial asystole, (2) unwitnessed arrest by any laypersons, (3) EMS-CPR duration > 20 min, and (4) no prehospital return of spontaneous circulation (ROSC). The specificity, FPR, and PPV of the rule for predicting 1-month mortality were 99.2% (95% confidence interval [CI], 99.0–99.4%), 0.8% (0.6–1.0%), and 99.8% (99.8–99.9%), respectively. The proportion of patients who fulfilled the rule and the area under the receiver operating curve (AUC) was 27.5% (95% CI 27.3–27.7%) and 0.904 (0.902–0.905), respectively. In the validation group, the specificity, FPR, PPV, proportion of patients who met the rule, and AUC were 99.1% (95% CI 98.9–99.2%), 0.9% (0.8–1.1%), 99.8% (99.8–99.8%), 27.8% (27.6–28.0%), and 0.889 (0.887–0.891), respectively. Conclusion The modified Goto’s TOR rule (which includes the following four criteria: initial asystole, unwitnessed arrest, EMS-CPR duration > 20 min, and no prehospital ROSC) with a > 99% predictor of 1-month mortality is a reliable tool for physicians treating refractory OHCAs immediately after hospital arrival. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03999-x.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa, 920-8640, Japan.
| | - Akira Funada
- Department of Cardiology, Osaka Saiseikai Senri Hospital, Tukumodai 1-1-6, Suita, 565-0862, Japan
| | - Tetsuo Maeda
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Takaramachi 13-1, Kanazawa, 920-8640, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Yawata I 12-7, Komatsu, 923-8551, Japan
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12
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Blewer AL, Joiner AP. Emergency medical services-witnessed out-of-hospital cardiac arrest: global variation and opportunities for future investigation. Resuscitation 2022; 175:64-66. [PMID: 35489521 DOI: 10.1016/j.resuscitation.2022.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Audrey L Blewer
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA; Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA; Department of Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Anjni P Joiner
- Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine, Durham, NC, USA; Duke Global Health Institute, Duke University, Durham, NC, USA
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13
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Peng Tham L, Fook-Chong S, Shahidah N, Fu-Wah Ho A, Tanaka H, Do Shin S, Chow-In Ko P, Darin Wong K, Jirapong S, Ramana Rao GV, Cai W, Al Qahtani S, Eng Hock Ong M. PRE-HOSPITAL AIRWAY MANAGEMENT AND SURVIVAL OUTCOMES AFTER PAEDIATRIC OUT-OF-HOSPITAL CARDIAC ARRESTS. Resuscitation 2022; 176:9-18. [PMID: 35483494 DOI: 10.1016/j.resuscitation.2022.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region. METHODS We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort. RESULTS We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95%CI, 0.25 - 0.69), p = 0.001] and survival with favourable neurological status. CONCLUSION In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.
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Affiliation(s)
- Lai Peng Tham
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Stephanie Fook-Chong
- Prehospital Emergency & Research Centre, Duke- NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - G V Ramana Rao
- GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
| | - Wenwei Cai
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
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14
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Adequacy of care during interfacility transfer in Taiwan: A pilot study. J Formos Med Assoc 2022; 121:1864-1871. [DOI: 10.1016/j.jfma.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 03/13/2022] [Accepted: 03/21/2022] [Indexed: 11/19/2022] Open
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15
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Lin YY, Lai YY, Chang HC, Lu CH, Chiu PW, Kuo YS, Huang SP, Chang YH, Lin CH. Predictive performances of ALS and BLS termination of resuscitation rules in out-of-hospital cardiac arrest for different resuscitation protocols. BMC Emerg Med 2022; 22:53. [PMID: 35346055 PMCID: PMC8958476 DOI: 10.1186/s12873-022-00606-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/13/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Resuscitation guidance has advanced; however, the predictive performance of the termination of resuscitation (TOR) rule has not been validated for different resuscitation protocols published by the American Heart Association (AHA). METHODS A retrospective study validating the basic life support (BLS) and advanced life support (ALS) TOR rules was conducted using an Utstein-style database in Tainan city, Taiwan. Adult patients with nontraumatic out-of-hospital cardiac arrests from January 1, 2015, to December 31, 2015, (using the AHA 2010 resuscitation protocol) and from January 1, 2020, to December 31, 2020, (using the AHA 2015 resuscitation protocol) were included. The characteristics of rule performance were calculated, including sensitivity, specificity, positive predictive value (PPV) and negative predictive value. RESULTS Among 1260 eligible OHCA patients in 2015, 757 met the BLS TOR rule and 124 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 61.1% and 99.0%, respectively, for the BLS TOR rule and 93.8% and 99.2%, respectively, for the ALS TOR rule. A total of 970 OHCA patients were enrolled in 2020, of whom 438 met the BLS TOR rule and 104 met the ALS TOR rule. The specificity and PPV for predicting unfavorable neurological outcomes were 85.7% and 100%, respectively, for the BLS TOR rule and 99.5% and 100%, respectively, for the ALS TOR rule. CONCLUSIONS Both the BLS and ALS TOR rules performed better when using the 2015 AHA resuscitation protocols compared to the 2010 protocols, with increased PPVs and decreased false-positive rates in predicting survival to discharge and good neurological outcomes at discharge. The BLS and ALS TOR rules can perform differently while the resuscitation protocols are updated. As the concepts and practices of resuscitation progress, the BLS and ALS TOR rules should be evaluated and validated accordingly.
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Affiliation(s)
- Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Yin-Yu Lai
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Hung-Chieh Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Po-Wei Chiu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Yuh-Shin Kuo
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Shao-Peng Huang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Ying-Hsin Chang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 70403, Taiwan.
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16
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Do SN, Luong CQ, Pham DT, Nguyen MH, Ton TT, Hoang QTA, Nguyen DT, Pham TTN, Hoang HT, Khuong DQ, Nguyen QH, Nguyen TA, Tran TT, Vu LD, Van Nguyen C, McNally BF, Ong MEH, Nguyen AD. Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study. BMC Emerg Med 2021; 21:148. [PMID: 34814830 PMCID: PMC8609736 DOI: 10.1186/s12873-021-00542-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. METHODS We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. RESULTS Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). CONCLUSION In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.
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Affiliation(s)
- Son Ngoc Do
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam. .,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tra Thanh Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Quoc Trong Ai Hoang
- Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam
| | - Dat Tuan Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Thao Thi Ngoc Pham
- Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.,Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hanh Trong Hoang
- Intensive Care Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Hue City, Thua Thien Hue, Vietnam
| | - Dai Quoc Khuong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Quan Huu Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Long Duc Vu
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Bryan Francis McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
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17
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Designing, Implementing, and Managing a National Emergency Medical Service in Sierra Leone. Prehosp Disaster Med 2020; 36:115-120. [PMID: 33256859 DOI: 10.1017/s1049023x20001442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.
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18
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Do SN, Luong CQ, Pham DT, Nguyen CV, Ton TT, Pham TT, Hoang QT, Hoang HT, Nguyen DT, Khuong DQ, Nguyen QH, Nguyen TA, Pham HT, Nguyen MH, McNally BF, Ong ME, Nguyen AD. Survival after out-of-hospital cardiac arrest, Viet Nam: multicentre prospective cohort study. Bull World Health Organ 2020; 99:50-61. [PMID: 33658734 DOI: 10.2471/blt.20.269837] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/14/2020] [Accepted: 10/06/2020] [Indexed: 11/27/2022] Open
Abstract
Objective To investigate factors associated with survival after out-of-hospital cardiac arrest in Viet Nam. Methods We did a multicentre prospective observational study of people (> 18 years) presenting with out-of-hospital cardiac arrest (not caused by trauma) to three tertiary hospitals in Viet Nam from February 2014 to December 2018. We collected data on characteristics, management and outcomes of patients with out-of-hospital cardiac arrest and compared these data by type of transportation to hospital and survival to hospital admission. We assessed factors associated with survival to admission to and discharge from hospital using logistic regression analysis. Findings Of 590 eligible people with out-of-hospital cardiac arrest, 440 (74.6%) were male and the mean age was 56.1 years (standard deviation: 17.2). Only 24.2% (143/590) of these people survived to hospital admission and 14.1% (83/590) survived to hospital discharge. Most cardiac arrests (67.8%; 400/590) occurred at home, 79.4% (444/559) were witnessed by bystanders and 22.3% (124/555) were given cardiopulmonary resuscitation by a bystander. Only 8.6% (51/590) of the people were taken to hospital by the emergency medical services and 32.2% (49/152) received pre-hospital defibrillation. Pre-hospital defibrillation (odds ratio, OR: 3.90; 95% confidence interval, CI: 1.54-9.90) and return of spontaneous circulation in the emergency department (OR: 2.89; 95% CI: 1.03-8.12) were associated with survival to hospital admission. Hypothermia therapy during post-resuscitation care was associated with survival to discharge (OR: 5.44; 95% CI: 2.33-12.74). Conclusion Improvements are needed in the emergency medical services in Viet Nam such as increasing bystander cardiopulmonary resuscitation and public access defibrillation, and improving ambulance and post-resuscitation care.
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Affiliation(s)
- Son N Do
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Chinh Q Luong
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Dung T Pham
- Department of Nutrition and Food Safety, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Chi V Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Tra T Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Thao Tn Pham
- Intensive Care Unit, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Quoc Ta Hoang
- Emergency Department, Hue Central General Hospital, Hue, Viet Nam
| | - Hanh T Hoang
- Intensive Care Unit, Hue Central General Hospital, Hue, Viet Nam
| | - Dat T Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Dai Q Khuong
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Quan H Nguyen
- Emergency Department, Bach Mai Hospital, 78 Giai Phong Road, Dong Da District, Hanoi, 100000, Viet Nam
| | - Tuan A Nguyen
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
| | - Hanh Tm Pham
- Department of Epidemiology, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - My H Nguyen
- Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Bryan F McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, United States of America
| | - Marcus Eh Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Anh D Nguyen
- Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Viet Nam
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19
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Ho AFW, De Souza NNA, Blewer AL, Wah W, Shahidah N, White AE, Ng YY, Mao DR, Doctor N, Gan HN, Chia MYC, Leong BSH, Cheah SO, Tham LP, Ong MEH. Implementation of a National 5-Year Plan for Prehospital Emergency Care in Singapore and Impact on Out-of-Hospital Cardiac Arrest Outcomes From 2011 to 2016. J Am Heart Assoc 2020; 9:e015368. [PMID: 33103542 PMCID: PMC7763405 DOI: 10.1161/jaha.119.015368] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Outcomes of patients from out‐of‐hospital cardiac arrest (OHCA) vary widely globally because of differences in prehospital systems of emergency care. National efforts had gone into improving OHCA outcomes in Singapore in recent years including community and prehospital initiatives. We aimed to document the impact of implementation of a national 5‐year Plan for prehospital emergency care in Singapore on OHCA outcomes from 2011 to 2016. Methods and Results Prospective, population‐based data of OHCA brought to Emergency Departments were obtained from the Pan‐Asian Resuscitation Outcomes Study cohort. The primary outcome was Utstein (bystander witnessed, shockable rhythm) survival‐to‐discharge or 30‐day postarrest. Mid‐year population estimates were used to calculate age‐standardized incidence. Multivariable logistic regression was performed to identify prehospital characteristics associated with survival‐to‐discharge across time. A total of 11 465 cases qualified for analysis. Age‐standardized incidence increased from 26.1 per 100 000 in 2011 to 39.2 per 100 000 in 2016. From 2011 to 2016, Utstein survival rates nearly doubled from 11.6% to 23.1% (P=0.006). Overall survival rates improved from 3.6% to 6.5% (P<0.001). Bystander cardiopulmonary resuscitation rates more than doubled from 21.9% to 56.3% and bystander automated external defibrillation rates also increased from 1.8% to 4.6%. Age ≤65 years, nonresidential location, witnessed arrest, shockable rhythm, bystander automated external defibrillation, and year 2016 were independently associated with improved survival. Conclusions Implementation of a national prehospital strategy doubled OHCA survival in Singapore from 2011 to 2016, along with corresponding increases in bystander cardiopulmonary resuscitation and bystander automated external defibrillation. This can be an implementation model for other systems trying to improve OHCA outcomes.
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Affiliation(s)
- Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme Singapore.,Pre-Hospital & Emergency Research Centre Duke-NUS Medical School Singapore
| | | | - Audrey L Blewer
- Department of Family Medicine and Community Health and Department of Population Health Sciences Duke University School of Medicine Durham NC
| | - Win Wah
- Unit for Prehospital Emergency Care Singapore General Hospital Singapore
| | - Nur Shahidah
- Department of Emergency Medicine Singapore General Hospital Singapore
| | | | - Yih Yng Ng
- Medical Department Singapore Civil Defence Force Singapore.,Emergency Department Tan Tock Seng Hospital Singapore
| | - Desmond Renhao Mao
- Department of Acute and Emergency Care Khoo Teck Puat Hospital Singapore
| | - Nausheen Doctor
- Department of Emergency Medicine Sengkang General Hospital Singapore
| | - Han Nee Gan
- Accident & Emergency Changi General Hospital Singapore
| | | | | | - Si Oon Cheah
- Emergency Medicine Department Ng Teng Fong General Hospital Singapore
| | - Lai Peng Tham
- Children's Emergency KK Women's and Children's Hospital Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine Singapore General Hospital Singapore.,Health Services & Systems Research Duke-NUS Medical School Singapore
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20
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Morgan DP, Muscatello D, Travaglia J, Hayen A. Retrospective observational cohort study of out‐of‐hospital cardiac arrest outcomes in Tasmania 2010–2014. Emerg Med Australas 2020; 32:631-637. [DOI: 10.1111/1742-6723.13490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Dominic P Morgan
- Faculty of MedicineThe University of New South Wales Sydney New South Wales Australia
| | - David Muscatello
- Faculty of MedicineThe University of New South Wales Sydney New South Wales Australia
| | - Joanne Travaglia
- Faculty of HealthUniversity of Technology Sydney Sydney New South Wales Australia
| | - Andrew Hayen
- Faculty of HealthUniversity of Technology Sydney Sydney New South Wales Australia
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21
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Coppola A, Black S, Johnston S, Endacott R. UK ambulance service resuscitation management of pulseless electrical activity: a systematic review protocol of text and opinion. Br Paramed J 2020; 5:20-25. [PMID: 33456382 PMCID: PMC7783909 DOI: 10.29045/14784726.2020.06.5.1.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Out-of-hospital cardiac arrest patients with pulseless electrical activity are treated by paramedics using basic and advanced life support resuscitation. When resuscitation fails to achieve return of spontaneous circulation, there are limited evidence and national guidelines on when to continue or stop resuscitation. This has led to ambulance services in the United Kingdom developing local guidelines to support paramedics in the resuscitative management of pulseless electrical activity. The content of each guideline is unknown, as is any association between guideline implementation and patient survival. We aim to identify and synthesise local ambulance service guidelines to help improve the consistency of paramedic-led decision-making for the resuscitation of pulseless electrical activity in out-of-hospital cardiac arrest. Methods: A systematic review of text and opinion will be conducted on ambulance service guidelines for resuscitating adult cardiac arrest patients with pulseless electrical activity. Data will be gathered direct from the ambulance service website. The review will be guided by the methods of the Joanna Briggs Institute (JBI). The search strategy will be conducted in three stages: 1) a website search of the 14 ambulance services; 2) a search of the evidence listed in support of the guideline; and 3) an examination of the reference list of documents found in the first and second stages and reported using the Preferred Reporting Items for Systematic Reviews and Meta-analyses. Each document will be assessed against the inclusion criteria, and quality of evidence will be assessed using the JBI Critical Appraisal Checklist for Text and Opinion. Data will be extracted using the JBI methods of textual data extraction and a three-stage data synthesis process: 1) extraction of opinion statements; 2) categorisation of statements according to similarity of meaning; and 3) meta-synthesis of statements to create a new collection of findings. Confidence of findings will be assessed using the graded ConQual approach.
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Affiliation(s)
- Alison Coppola
- The University of Plymouth; South Western Ambulance Service NHS Foundation Trust
| | - Sarah Black
- South Western Ambulance Service NHS Foundation Trust
| | - Sasha Johnston
- The University of Plymouth; South Western Ambulance Service NHS Foundation Trust
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22
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Tønsager K, Krüger AJ, Ringdal KG, Rehn M. Template for documenting and reporting data in physician-staffed pre-hospital services: a consensus-based update. Scand J Trauma Resusc Emerg Med 2020; 28:25. [PMID: 32245496 PMCID: PMC7119287 DOI: 10.1186/s13049-020-0716-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician-staffed emergency medical services (p-EMS) are resource demanding, and research is needed to evaluate any potential effects of p-EMS. Templates, designed through expert agreement, are valuable and feasible, but they need to be updated on a regular basis due to developments in available equipment and treatment options. In 2011, a consensus-based template documenting and reporting data in p-EMS was published. We aimed to revise and update the template for documenting and reporting in p-EMS. METHODS A Delphi method was applied to achieve a consensus from a panel of selected European experts. The experts were blinded to each other until a consensus was reached, and all responses were anonymized. The experts were asked to propose variables within five predefined sections. There was also an optional sixth section for variables that did not fit into the pre-defined sections. Experts were asked to review and rate all variables from 1 (totally disagree) to 5 (totally agree) based on relevance, and consensus was defined as variables rated ≥4 by more than 70% of the experts. RESULTS Eleven experts participated. The experts generated 194 unique variables in the first round. After five rounds, a consensus was reached. The updated dataset was an expanded version of the original dataset and the template was expanded from 45 to 73 main variables. The experts approved the final version of the template. CONCLUSIONS Using a Delphi method, we have updated the template for documenting and reporting in p-EMS. We recommend implementing the dataset for standard reporting in p-EMS.
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Affiliation(s)
- Kristin Tønsager
- Department of Research, The Norwegian Air Ambulance Foundation, Post box 414, Sentrum, N-0103, Oslo, Norway. .,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. .,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Andreas Jørstad Krüger
- Department of Research, The Norwegian Air Ambulance Foundation, Post box 414, Sentrum, N-0103, Oslo, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
| | - Kjetil Gorseth Ringdal
- Department of Anaesthesiology, Vestfold, Hospital Trust, Tønsberg, Norway.,Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
| | - Marius Rehn
- Department of Research, The Norwegian Air Ambulance Foundation, Post box 414, Sentrum, N-0103, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
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23
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Ting PZY, Ho AFW, Lin X, Shahidah N, Blewer A, Ng YY, Leong BSH, Gan HN, Mao DR, Chia MYC, Cheah SO, Ong MEH. Nationwide trends in residential and non-residential out-of-hospital cardiac arrest and differences in bystander cardiopulmonary resuscitation. Resuscitation 2020; 151:103-110. [PMID: 32217133 DOI: 10.1016/j.resuscitation.2020.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/26/2020] [Accepted: 03/09/2020] [Indexed: 11/25/2022]
Abstract
AIMS Singapore is highly-urbanized, with >90% of the population living in high-rise apartments. She has implemented several city-wide interventions such as dispatcher-assisted CPR, community CPR training and smartphone activation of volunteers to increase bystander CPR (BCPR) rates for out-of-hospital cardiac arrest (OHCA). These may have different impact on residential and non-residential OHCA. We aimed to evaluate the characteristics, processes-of-care and outcome differences between residential and non-residential OHCA and study the differences in temporal trends of BCPR rates. METHODS This was a national, observational study in Singapore from 2010 to 2016, using data from the prospective Pan-Asian Resuscitation Outcomes Study. The primary outcome was survival (to-discharge or to-30-days). Multivariate logistic regression was performed to determine the effect of location-type on survival and a test of statistical interaction was performed to assess the difference in the temporal relationship of BCPR rates between location-type. RESULTS 8397 cases qualified for analysis, of which 5990 (71.3%) were residential. BCPR and bystander automated external defibrillator (AED) rates were significantly lower in residential as compared to non-residential arrests (41.0% vs 53.6%, p < 0.01; 0.4% vs 10.8%, p < 0.01 respectively). Residential BCPR increased from 15.8% (2010) to 57.1% (2016). Residential cardiac arrests had lower survival-to-discharge (2.9% vs 10.1%, p < 0.01). Multivariate logistic regression analysis showed that location-type had an independent effect on survival, with residential arrests having poorer survival compared to non-residential cardiac arrests (adjusted OR 0.547 [0.435-0.688]). A test of statistical interaction showed a significant interaction effect between year and location-type for bystander CPR, with a narrowing of differences in bystander CPR between residential and non-residential cardiac arrests over the years. CONCLUSION Residential cardiac arrests had poorer bystander intervention and survival from 2010 to 2016 in Singapore. BCPR had improved more in residential arrests compared to non-residential arrests over a period of city-wide interventions to improve BCPR.
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Affiliation(s)
| | - Andrew Fu Wah Ho
- SingHealth Duke-NUS Emergency Medicine Academic Clinical Programme, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore; Cardiovascular & Metabolic Disorders Programme, Duke-National University of Singapore Medical School, Singapore
| | - Xinyi Lin
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore; Singapore Clinical Research Institute, Singapore; Singapore Institute for Clinical Sciences, A*STAR, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Audrey Blewer
- Duke University, Durham, NC, USA; Health Services and Systems Research, Duke- National University of Singapore Medical School, Singapore, Singapore
| | - Yih Yng Ng
- Emergency Department, Tan Tock Seng Hospital, Singapore
| | | | - Han Nee Gan
- Accident & Emergency Department, Changi General Hospital, Singapore
| | - Desmond Renhao Mao
- Department of Acute and Emergency Care, Khoo Teck Puat Hospital, Singapore
| | | | - Si Oon Cheah
- Emergency Medicine Department, Ng Teng Fong General Hospital, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore
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24
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Shao F, Fan KL, Robertson C, Ong M, Liu N, Leung LP, Leung R, Li CS. Comparison of two emergency medical services in Beijing and Hong Kong, China. Chin Med J (Engl) 2019; 132:1372-1374. [PMID: 31157676 PMCID: PMC6629346 DOI: 10.1097/cm9.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Indexed: 11/26/2022] Open
Affiliation(s)
- Fei Shao
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
| | - Kit-Ling Fan
- Accident and Emergency Department, The Hong Kong University-Shenzhen Hospital, Shenzhen, Guangdong 518053, China
| | - Colin Robertson
- Accident and Emergency Medicine and Surgery, University of Edinburgh, Scotland, UK
| | - Marcus Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nan Liu
- Health Services Research Centre, Singapore Health Services, Singapore
| | - Ling-Pong Leung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Reynold Leung
- Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Chun-Sheng Li
- Department of Emergency Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China
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25
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Tønsager K, Rehn M, Ringdal KG, Lossius HM, Virkkunen I, Østerås Ø, Røislien J, Krüger AJ. Collecting core data in physician-staffed pre-hospital helicopter emergency medical services using a consensus-based template: international multicentre feasibility study in Finland and Norway. BMC Health Serv Res 2019; 19:151. [PMID: 30849977 PMCID: PMC6408770 DOI: 10.1186/s12913-019-3976-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 02/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Comparison of services and identification of factors important for favourable patient outcomes in emergency medical services (EMS) is challenging due to different organization and quality of data. The purpose of the present study was to evaluate the feasibility of physician-staffed EMS (p-EMS) to collect patient and system level data by using a consensus-based template. METHODS The study was an international multicentre observational study. Data were collected according to a template for uniform reporting of data from p-EMS using two different data collection methods; a standard and a focused data collection method. For the standard data collection, data were extracted retrospectively for one year from all FinnHEMS bases and for the focused data collection, data were collected prospectively for six weeks from four selected Norwegian p-EMS bases. Completeness rates for the two data collection methods were then compared and factors affecting completeness rates and template feasibility were evaluated. Standard Chi-Square, Fisher's Exact Test and Mann-Whitney U Test were used for group comparison of categorical and continuous data, respectively, and Kolomogorov-Smirnov test for comparison of distributional properties. RESULTS All missions with patient encounters were included, leaving 4437 Finnish and 128 Norwegian missions eligible for analysis. Variable completeness rates indicated that physiological variables were least documented. Information on pain and respiratory rate were the most frequently missing variables with a standard data collection method and systolic blood pressure was the most missing variable with a focused data collection method. Completeness rates were similar or higher when patients were considered severely ill or injured but were lower for missions with short patient encounter. When a focused data collection method was used, completeness rates were higher compared to a standard data collection method. CONCLUSIONS We found that a focused data collection method increased data capture compared to a standard data collection method. The concept of using a template for documentation of p-EMS data is feasible in physician-staffed services in Finland and Norway. The greatest deficiencies in completeness rates were evident for physiological parameters. Short missions were associated with lower completeness rates whereas severe illness or injury did not result in reduced data capture.
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Affiliation(s)
- Kristin Tønsager
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Marius Rehn
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
- Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Kjetil G. Ringdal
- Department of Anesthesiology, Vestfold Hospital Trust, Tønsberg, Norway
- Division of Emergencies and Critical Care, Department of Anesthesiology, Oslo University Hospital, Oslo, Norway
- Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
| | - Hans Morten Lossius
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | | | - Øyvind Østerås
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Jo Røislien
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Health Studies, University of Stavanger, Stavanger, Norway
| | - Andreas J. Krüger
- The Norwegian Air Ambulance Foundation, Oslo, Norway
- Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
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Ho AFW, Hao Y, Pek PP, Shahidah N, Yap S, Ng YY, Wong KD, Lee EJ, Khruekarnchana P, Wah W, Liu N, Tanaka H, Shin SD, Ma MHM, Ong MEH. Outcomes and modifiable resuscitative characteristics amongst pan-Asian out-of-hospital cardiac arrest occurring at night. Medicine (Baltimore) 2019; 98:e14611. [PMID: 30855446 PMCID: PMC6417559 DOI: 10.1097/md.0000000000014611] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Studies are divided on the effect of day-night temporal differences on clinical outcomes in out-of-hospital cardiac arrest (OHCA). This study aimed to elucidate any differences in OHCA survival between day and night occurrence, and the factors associated with differences in survival.This was a prospective, observational study of OHCA cases across multinational Pan-Asian sites. Cases were divided according to time call received by dispatch centers into day (0700H-1900H) and night (1900H-0659H). Primary outcome was 30-day survival. Secondary outcomes were prehospital and hospital modifiable resuscitative characteristics.About 22,501 out of 55,881 cases occurred at night. Night cases were less likely to be witnessed (40.2% vs. 43.1%, P < .001), more likely to occur at home (32.5% vs. 29%, P < .001), had non-shockable initial rhythms (90.8% vs. 89.4%, P < .001), lower bystander CPR rates (36.2 vs. 37.6%, P = .001), lower bystander AED application rate (0.3% vs. 0.7%, P < .001), lower rates of prehospital defibrillation (13% vs. 14.4%, P < .001), and were less likely to receive prehospital adrenaline (9.8% vs. 11%, P < .001). 30-day survival at night was lower with an adjusted odds ratio of 0.79 (95% CI 0.73-0.86, P < .001). On multivariate logistic regression, occurrence at night was associated with decreased provision of bystander CPR, bystander AED application, and prehospital adrenaline.30-day survival was worse in OHCA occurring at night. There were circadian patterns in incidence. Bystander CPR and bystander AED application were significantly lower at night in multivariate analysis. This would at least partially explain the decreased survival at night.
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Affiliation(s)
- Andrew Fu Wah Ho
- SingHealth Emergency Medicine Residency Programme, Singapore Health Services, Singapore
| | - Ying Hao
- Division of Medicine, Singapore General Hospital
| | - Pin Pin Pek
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore
| | | | - Eui Jung Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | | | - Win Wah
- Unit for Prehospital Emergency Care, Singapore General Hospital, Singapore
| | - Nan Liu
- Health Services Research Centre, Singapore Health Services, Singapore
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Hideharu Tanaka
- Department of Emergency System, Graduate School of Sport System, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore
- Health Services & Systems Research, Duke-NUS Medical School, Singapore
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27
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Morgan DP, Muscatello D, Hayen A, Travaglia J. Human factors influencing out-of-hospital cardiac arrest survival. Emerg Med Australas 2019; 31:600-604. [PMID: 30759497 DOI: 10.1111/1742-6723.13222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 09/04/2018] [Accepted: 11/26/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Programmes that reduce the time to defibrillation are likely to improve overall survival rates from out-of-hospital cardiac arrests (OHCAs). This research sought to identify human factors common among community responders taking an automated external defibrillator (AED) to a victim of an OHCA that are either barriers or enablers of desired behaviour. METHODS A qualitative methodology was used. Community members who had access to an AED and who had been notified of an incident of OHCA near them were approached to participate in the research. Participants completed a written survey and undertook a semi-structured interview. A thematic analysis was undertaken using NVivo software and triangulated against findings from an automated data-mining package, Leximancer. RESULTS The study found that 100% of people who were notified of the need for an AED responded. Twelve participants subsequently identified during interviews that they held some form of leadership role in their community. First aid training and previous experience of, and competency in managing emergencies were the strongest motivations for their response. Personal risk was not a concern when responding to victims in immediately life-threatening situations. CONCLUSION Prospective programmes may be able to be designed to increase the likelihood that community members with AEDs will respond in advance of emergency medical services by targeting common human factors, such as leadership behaviour, training, competency and experience in managing emergencies, leading to better overall survival rates from OHCA.
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Affiliation(s)
- Dominic P Morgan
- Faculty of Medicine, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - David Muscatello
- Faculty of Medicine, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia
| | - Andrew Hayen
- Faculty of Medicine, School of Public Health and Community Medicine, The University of New South Wales, Sydney, New South Wales, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Joanne Travaglia
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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28
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Nadarajan G, Tiah L, Ho A, Azazh A, Castren M, Chong S, El Sayed M, Hara T, Leong B, Lippert F, Ma M, Ng Y, Ohn H, Overton J, Pek P, Perret S, Wallis L, Wong K, Ong M. Global resuscitation alliance utstein recommendations for developing emergency care systems to improve cardiac arrest survival. Resuscitation 2018; 132:85-89. [DOI: 10.1016/j.resuscitation.2018.08.022] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 08/16/2018] [Accepted: 08/22/2018] [Indexed: 11/26/2022]
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29
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Kim TH, Lee K, Shin SD, Ro YS, Tanaka H, Yap S, Wong KD, Ng YY, Piyasuwankul T, Leong B. Association of the Emergency Medical Services-Related Time Interval with Survival Outcomes of Out-of-Hospital Cardiac Arrest Cases in Four Asian Metropolitan Cities Using the Scoop-and-Run Emergency Medical Services Model. J Emerg Med 2018; 53:688-696.e1. [PMID: 29128033 DOI: 10.1016/j.jemermed.2017.08.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Response time interval (RTI) and scene time interval (STI) are key time variables in the out-of-hospital cardiac arrest (OHCA) cases treated and transported via emergency medical services (EMS). OBJECTIVE We evaluated distribution and interactive association of RTI and STI with survival outcomes of OHCA in four Asian metropolitan cities. METHODS An OHCA cohort from Pan-Asian Resuscitation Outcome Study (PAROS) conducted between January 2009 and December 2011 was analyzed. Adult EMS-treated cardiac arrests with presumed cardiac origin were included. A multivariable logistic regression model with an interaction term was used to evaluate the effect of STI according to different RTI categories on survival outcomes. Risk-adjusted predicted rates of survival outcomes were calculated and compared with observed rate. RESULTS A total of 16,974 OHCA cases were analyzed after serial exclusion. Median RTI was 6.0 min (interquartile range [IQR] 5.0-8.0 min) and median STI was 12.0 min (IQR 8.0-16.1). The prolonged STI in the longest RTI group was associated with a lower rate of survival to discharge or of survival 30 days after arrest (adjusted odds ratio [aOR] 0.59; 95% confidence interval [CI] 0.42-0.81), as well as a poorer neurologic outcome (aOR 0.63; 95% CI 0.41-0.97) without an increasing chance of prehospital return of spontaneous circulation (aOR 1.12; 95% CI 0.88-1.45). CONCLUSIONS Prolonged STI in OHCA with a delayed response time had a negative association with survival outcomes in four Asian metropolitan cities using the scoop-and-run EMS model. Establishing an optimal STI based on the response time could be considered.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyungwon Lee
- Department of Emergency Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Biomedical Research Institute Seoul National University Hospital, Seoul, Republic of Korea
| | - Hideharu Tanaka
- Department of Emergency Medical System, Graduate School of Kokushikan University, Tokyo, Japan
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Benjamin Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
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30
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Chiu PW, Lin CH, Wu CL, Fang PH, Lu CH, Hsu HC, Chi CH. Ambulance traffic accidents in Taiwan. J Formos Med Assoc 2018; 117:283-291. [PMID: 29428195 DOI: 10.1016/j.jfma.2018.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/13/2017] [Accepted: 01/17/2018] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND/PURPOSE Ambulance traffic accidents (ATAs) are the leading cause of occupation-related fatalities among emergency medical service (EMS) personnel. We aim to use the Taiwan national surveillance system to analyze the characteristics of ATAs and to assist EMS directors in developing policies governing ambulance operations. METHODS A retrospective, cross-sectional and largely descriptive study was conducted using Taiwan national traffic accidents surveillance data from January 1, 2011 to October 31, 2016. RESULTS Among the 1,627,217 traffic accidents during the study period, 715 ATAs caused 8 deaths within 24 h and 1844 injured patients. On average, there was one ATA for every 8598 ambulance runs. Compared to overall traffic accidents, ATAs were 1.7 times more likely to result in death and 1.9 times more likely to have injured patients. Among the 715 ATAs, 8 (1.1%) ATAs were fatal and 707 (98.9%) were nonfatal. All 8 fatalities were associated with motorcycles. The urban areas were significantly higher than the rural areas in the annual number of ATAs (14.2 ± 7.3 [7.0-26.7] versus 3.1 ± 1.9 [0.5-8.4], p = 0.013), the number of ATA-associated fatalities per year (0.2 ± 0.2 [0.0-0.7] versus 0.1 ± 0.1 [0.0-0.2], p = 0.022), and the annual number of injured patients (who needed urgent hospital visits) in ATAs (19.4 ± 7.3 [10.5-30.9] versus 5.2 ± 3.8 [0.9-15.3], p < 0.001). CONCLUSION The ATA-associated fatality rate in Taiwan was high, and all fatalities were associated with motorcycles. ATAs in a highly motorcycle-populated area may require further investigation. An ambulance traffic accident reporting system should be built to provide EMS policy guidance for ATA reduction and outcome improvements.
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Affiliation(s)
- Po-Wei Chiu
- College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Chen-Long Wu
- Department of Environmental and Occupational Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pin-Hui Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiang-Chin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Hsien Chi
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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31
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Cho DH, Lee JG. Characteristics and Outcomes of Trauma Patients via Emergency Medical Services. JOURNAL OF TRAUMA AND INJURY 2017. [DOI: 10.20408/jti.2017.30.4.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Dae Hyun Cho
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Tanaka H, Ong MEH, Siddiqui FJ, Ma MHM, Kaneko H, Lee KW, Kajino K, Lin CH, Gan HN, Khruekarnchana P, Alsakaf O, Rahman NH, Doctor NE, Assam P, Shin SD. Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study. Ann Emerg Med 2017; 71:608-617.e15. [PMID: 28985969 DOI: 10.1016/j.annemergmed.2017.07.484] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/13/2017] [Accepted: 07/24/2017] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai). METHODS This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community. RESULTS Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival. CONCLUSION In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.
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Affiliation(s)
- Hideharu Tanaka
- Department of Emergency Systems, Graduate School of Sport Systems, Kokushikan University, Tokyo, Japan
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital, and the Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.
| | - Fahad J Siddiqui
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore
| | - Matthew H M Ma
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | | | - Kyung Won Lee
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Kentaro Kajino
- Department of Acute Medicine and Critical Care Medical Center, Osaka National Hospital, Osaka, Japan
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Han Nee Gan
- Accident and Emergency Department, Changi General Hospital, Singapore
| | | | - Omer Alsakaf
- Dubai Corporation for Ambulance Services, Dubai, United Arab Emirates
| | - Nik H Rahman
- School of Medical Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | | | - Pryseley Assam
- Department of Epidemiology, Singapore Clinical Research Institute, Singapore, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
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Kong SY, Shin SD, Tanaka H, Kimura A, Song KJ, Shaun GE, Chiang WC, Kajino K, Jamaluddin SF, Wi DH, Park JO, Moon SW, Ro YS, Cone DC, Holmes JF. Pan-Asian Trauma Outcomes Study (PATOS): Rationale and Methodology of an International and Multicenter Trauma Registry. PREHOSP EMERG CARE 2017; 22:58-83. [PMID: 28792281 DOI: 10.1080/10903127.2017.1347224] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Trauma is a major health burden and a time-dependent critical emergency condition among developing and developed countries. In Asia, trauma has become a rapidly expanding epidemic and has spread out to many underdeveloped and developing countries through rapid urbanization and industrialization. Most casualties of severe trauma, which results in significant mortality and disability are assessed and transported by prehospital providers including physicians, professional providers, and volunteer providers. Trauma registries have been developed in mostly developed countries and measure care quality, process, and outcomes. In general, existing registries tend to focus on inhospital care rather than prehospital care. METHODS The Pan-Asia Trauma Outcomes Study (PATOS) was proposed in 2013 and initiated in November, 2015 in order to establish a collaborative standardized study to measure the capabilities, processes and outcomes of trauma care throughout Asia. The PATOS is an international, multicenter, and observational research network to collect trauma cases transported by emergency medical services (EMS) providers. Data are collected from the participating hospital emergency departments in various countries in Asia which receive trauma patients from EMS. Data variables collected include 1) injury epidemiologic factors, 2) EMS factors, 3) emergency department care factors, 4) hospital care factors, and 5) trauma system factors. The authors expect to achieve a sample size of 67,230 cases over the next 2 years of data collection to analyze the association between potential risks and outcomes of trauma. CONCLUSION The PATOS network is expected to provide comparison of the trauma EMS systems and to benchmark best practice with participating communities.
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Choi SJ, Oh MY, Kim NR, Jung YJ, Ro YS, Shin SD. Comparison of trauma care systems in Asian countries: A systematic literature review. Emerg Med Australas 2017; 29:697-711. [PMID: 28782875 DOI: 10.1111/1742-6723.12840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/03/2017] [Accepted: 06/03/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The study aims to compare the trauma care systems in Asian countries. METHODS Asian countries were categorised into three groups; 'lower middle-income country', 'upper middle-income country' and 'high-income country'. The Medline/PubMed database was searched for articles published from January 2005 to December 2014 using relevant key words. Articles were excluded if they examined a specific injury mechanism, referred to a specific age group, and/or did not have full text available. We extracted information and variables on pre-hospital and hospital care factors, and regionalised system factors and compared them across countries. RESULTS A total of 46 articles were identified from 13 countries, including Pakistan, India, Vietnam and Indonesia from lower middle-income countries; the Islamic Republic of Iran, Thailand, China, Malaysia from upper middle-income countries; and Saudi Arabia, the Republic of Korea, Japan, Hong Kong and Singapore from high-income countries. Trauma patients were transported via various methods. In six of the 13 countries, less than 20% of trauma patients were transported by ambulance. Pre-hospital trauma teams primarily comprised emergency medical technicians and paramedics, except in Thailand and China, where they included mainly physicians. In Iran, Pakistan and Vietnam, the proportion of patients who died before reaching hospital exceeded 50%. In only three of the 13 countries was it reported that trauma surgeons were available. In only five of the 13 countries was there a nationwide trauma registry. CONCLUSION Trauma care systems were poorly developed and unorganised in most of the selected 13 Asian countries, with the exception of a few highly developed countries.
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Affiliation(s)
- Se Jin Choi
- Seoul National University College of Medicine, Seoul, Korea
| | - Moon Young Oh
- Seoul National University College of Medicine, Seoul, Korea
| | - Na Rae Kim
- Seoul National University College of Medicine, Seoul, Korea
| | - Yoo Joong Jung
- Seoul National University College of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
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Van Dillen C, Kim SH. Unnecessary emergency medical services transport associated with alcohol intoxication. J Int Med Res 2017; 46:33-43. [PMID: 28653859 PMCID: PMC6011284 DOI: 10.1177/0300060517718116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective This study investigated medically unnecessary emergency medical services (EMS) transportation by comparing non-intoxicated versus intoxicated patients who did not receive emergency department (ED) treatment but utilized EMS transport. Methods Patients who used EMS but did not receive ED treatment were classified into non-intoxicated and intoxicated groups. Reasons for not receiving ED treatment were categorized according to whether the decision was made by the patient against medical advice or if the decision was based on a physician’s evaluation and their recommendations. Results There were 212 patients reviewed; 120 in the non-intoxicated group and 92 in the intoxicated group. The intoxicated group had a higher proportion of males than the non-intoxicated group. The most common cause of non-disease symptoms in the intoxicated group was assault. In the non-intoxicated group, the most common reason for the lack of ED treatment was that treatment could take place on an outpatient basis, while in the intoxicated group, the reason was lack of patient cooperation. Conclusions The intoxicated group was older, male and more likely to present with symptoms not related to a disease process than those in the non-intoxicated group when using unnecessary EMS transport.
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Affiliation(s)
| | - Sun Hyu Kim
- 2 Department of Emergency Medicine, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
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Kim YJ, Ryoo HW, Shin SD, Song KJ, Ro YS, Lee KW, Ma MHM, Ko PCI, Gan HN, Shahidah N. Diurnal variation in outcomes after out-of-hospital cardiac arrest in Asian communities: The Pan-Asian Resuscitation Outcomes Study. Emerg Med Australas 2017; 29:551-562. [DOI: 10.1111/1742-6723.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 03/30/2017] [Accepted: 05/10/2017] [Indexed: 12/01/2022]
Affiliation(s)
- Yun Jeong Kim
- Laboratory of Emergency Medical Services; Seoul National University Hospital Biomedical Research Institute; Seoul South Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine; Kyungpook National University Hospital; Daegu South Korea
| | - Sang Do Shin
- Laboratory of Emergency Medical Services; Seoul National University Hospital Biomedical Research Institute; Seoul South Korea
- Department of Emergency Medicine; Seoul National University Hospital; Seoul South Korea
| | - Kyoung Jun Song
- Laboratory of Emergency Medical Services; Seoul National University Hospital Biomedical Research Institute; Seoul South Korea
- Department of Emergency Medicine; Seoul National University Hospital; Seoul South Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services; Seoul National University Hospital Biomedical Research Institute; Seoul South Korea
- Department of Emergency Medicine; Seoul National University Hospital; Seoul South Korea
| | - Kyung Won Lee
- Department of Emergency Medicine; Inje University Seoul Paik Hospital; Seoul South Korea
| | | | - Patrick Chow-In Ko
- Department of Emergency Medicine; National Taiwan University; Taipei Taiwan
| | - Han Nee Gan
- Accident and Emergency; Changi General Hospital; Singapore
| | - Nur Shahidah
- Department of Emergency Medicine; Singapore General Hospital; Singapore
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Lee MHM, Fook-Chong S, Wah W, Shin SD, Nishiuchi T, Ko PCI, Naroo GY, Wong KD, Tiah L, Monsomboon A, Siddiqui FJ, Ong MEH. Effect of known history of heart disease on survival outcomes after out-of-hospital cardiac arrests. Emerg Med Australas 2017; 30:67-76. [DOI: 10.1111/1742-6723.12809] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/28/2017] [Accepted: 04/08/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Stephanie Fook-Chong
- Division of Research; Singapore General Hospital; Singapore
- Centre for Quantitative Medicine; Duke-NUS Medical School; Singapore
| | - Win Wah
- Saw Swee Hock School of Public Health; National University of Singapore; Singapore
| | - Sang Do Shin
- Department of Emergency Medicine; Seoul National University Hospital; Seoul Republic of Korea
| | - Tatsuya Nishiuchi
- Department of Acute Medicine; Kinki University Faculty of Medicine; Osaka Japan
| | - Patrick Chow-In Ko
- Department of Emergency Medicine; National Taiwan University Hospital; Taipei Taiwan
| | - Ghulam Yasin Naroo
- Department of Health and Medical Services; Rashid Hospital; Dubai United Arab Emirates
| | | | - Ling Tiah
- Accident and Emergency Department; Changi General Hospital; Singapore
| | | | - Fahad J Siddiqui
- Department of Epidemiology; Singapore Clinical Research Institute; Singapore
| | - Marcus EH Ong
- Department of Emergency Medicine; Singapore General Hospital; Singapore
- Health Services and Systems Research; Duke-NUS Medical School; Singapore
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Kim TH, Shin SD, Song KJ, Hong KJ, Ro YS, Song SW, Kim CH. Chest Compression Fraction between Mechanical Compressions on a Reducible Stretcher and Manual Compressions on a Standard Stretcher during Transport in Out-of-Hospital Cardiac Arrests: The Ambulance Stretcher Innovation of Asian Cardiopulmonary Resuscitation (ASIA-CPR) Pilot Trial. PREHOSP EMERG CARE 2017; 21:636-644. [DOI: 10.1080/10903127.2017.1317892] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sun KM, Song KJ, Shin SD, Tanaka H, Shaun GE, Chiang WC, Kajino K, Jamaluddin SF, Kimura A, Ro YS, Wi DH, Park JO, Moon SW, Jung YH, Kim MJ, Holmes JF. Comparison of Emergency Medical Services and Trauma Care Systems Among Pan-Asian Countries: An International, Multicenter, Population-Based Survey. PREHOSP EMERG CARE 2016; 21:242-251. [DOI: 10.1080/10903127.2016.1241325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ho AFW, Ong MEH. Antiarrhythmic drugs in out-of-hospital cardiac arrest-what does the Amiodarone, Lidocaine, or Placebo Study tell us? J Thorac Dis 2016; 8:E604-6. [PMID: 27501134 DOI: 10.21037/jtd.2016.05.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Andrew Fu Wah Ho
- Singhealth Emergency Medicine Residency, Singapore Health Services, Singapore, Singapore
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore;; Health Services and Systems Research, Duke-National University of Singapore Medical School, Singapore, Singapore
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Ho AFW, Sim ZJ, Shahidah N, Hao Y, Ng YY, Leong BSH, Zarinah S, Teo WKL, Goh GSY, Jaafar H, Ong MEH. Barriers to dispatcher-assisted cardiopulmonary resuscitation in Singapore. Resuscitation 2016; 105:149-55. [PMID: 27288652 DOI: 10.1016/j.resuscitation.2016.05.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/31/2016] [Accepted: 05/09/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is effective in increasing bystander CPR in out-of-hospital cardiac arrests (OHCA). Singapore has recently implemented a DA-CPR program. We aimed to characterize barriers to commencement of chest compressions by callers in Singapore. METHODS We analyzed dispatch recordings of OHCA cases received by the ambulance call center between July 2012 and March 2015. Audio recordings of poor quality were excluded. Trained reviewers noted the sequential stages of the dispatcher's recognition of CPR, delivering CPR instructions and caller performing CPR. Time taken to reach these milestones was noted. Barriers to chest compressions were identified. RESULTS A total of 4897 OHCA occurred during the study period, overall bystander CPR rate was 45.7%. 1885 dispatch recordings were reviewed with 1157 cases qualified for dispatcher CPR. In 1128 (97.5%) cases, the dispatcher correctly recognized the need for CPR. CPR instructions were delivered in 1056 (91.3%) cases. Of these, 1007 (87.0%) callers performed CPR to instruction. One or more barriers to chest compressions were identified in 430 (37.2%) cases. The commonest barrier identified was "could not move patient" (27%). Cases where barriers were identified were less likely to have the need for CPR recognized by the dispatcher (94.9% vs. 99.0%, p<0.001), CPR instructions given (79.3% vs. 98.3%, p<0.001) and CPR started (67.9% vs. 98.3%, p<0.001), while the time taken to reach each of these stages were significantly longer (p<0.001). CONCLUSION Barriers were present in 37% of cases. They were associated with lower proportion of CPR started and longer delay to CPR.
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Affiliation(s)
- Andrew Fu Wah Ho
- Emergency Medicine Residency, Singapore Health Services, Singapore, Singapore.
| | - Zariel Jiaying Sim
- Barts and the London School of Medicine and Dentistry, Greater London, United Kingdom
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Ying Hao
- Division of Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Benjamin S H Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
| | - Siti Zarinah
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Winston K L Teo
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Hamizah Jaafar
- Operations Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Marcus E H Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
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Ng YY, Wah W, Liu N, Zhou SA, Ho AFW, Pek PP, Shin SD, Tanaka H, Khunkhlai N, Lin CH, Wong KD, Cai WW, Ong MEH. Associations between gender and cardiac arrest outcomes in Pan-Asian out-of-hospital cardiac arrest patients. Resuscitation 2016; 102:116-21. [DOI: 10.1016/j.resuscitation.2016.03.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 02/06/2016] [Accepted: 03/04/2016] [Indexed: 10/22/2022]
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Cheong RWL, Li H, Doctor NE, Ng YY, Goh ES, Leong BSH, Gan HN, Foo D, Tham LP, Charles R, Ong MEH. Termination of Resuscitation Rules to Predict Neurological Outcomes in Out-of-Hospital Cardiac Arrest for an Intermediate Life Support Prehospital System. PREHOSP EMERG CARE 2016; 20:623-9. [DOI: 10.3109/10903127.2016.1162886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The duration of cardiopulmonary resuscitation in emergency departments after out-of-hospital cardiac arrest is associated with the outcome: A nationwide observational study. Resuscitation 2015; 96:323-7. [DOI: 10.1016/j.resuscitation.2015.05.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 05/02/2015] [Accepted: 05/08/2015] [Indexed: 01/31/2023]
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Lam SSW, Nguyen FNHL, Ng YY, Lee VPX, Wong TH, Fook-Chong SMC, Ong MEH. Factors affecting the ambulance response times of trauma incidents in Singapore. ACCIDENT; ANALYSIS AND PREVENTION 2015; 82:27-35. [PMID: 26026970 DOI: 10.1016/j.aap.2015.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 05/07/2015] [Accepted: 05/07/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Time to definitive care is important for trauma outcomes, thus many emergency medical services (EMS) systems in the world adopt response times of ambulances as a key performance indicator. The objective of this study is to examine the underlying risk factors that can affect ambulance response times (ART) for trauma incidents, so as to derive interventional measures that can improve the ART. MATERIAL AND METHODS This was a retrospective study based on two years of trauma data obtained from the national EMS operations centre of Singapore. Trauma patients served by the national EMS provider over the period from 1 January 2011 till 31 December 2012 were included. ART was categorized into "Short" (<4min), "Intermediate" (4-8min) and "Long" (>8min) response times. A modelling framework which leveraged on both multinomial logistic (MNL) regression models and Bayesian networks was proposed for the identification of main and interaction effects. RESULTS Amongst the process-related risk factors, weather, traffic and place of incident were found to be significant. The traffic conditions on the roads were found to have the largest effect-the odds ratio (OR) of "Long" ART in heavy traffic condition was 12.98 (95% CI: 10.66-15.79) times higher than that under light traffic conditions. In addition, the ORs of "Long ART" under "Heavy Rain" condition were significantly higher (OR 1.58, 95% CI: 1.26-1.97) than calls responded under "Fine" weather. After accounting for confounders, the ORs of "Long" ART for trauma incidents at "Home" or "Commercial" locations were also significantly higher than that for "Road" incidents. CONCLUSION Traffic, weather and the place of incident were found to be significant in affecting the ART. The evaluation of factors affecting the ART enables the development of effective interventions for reducing the ART.
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Affiliation(s)
- Sean Shao Wei Lam
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Francis Ngoc Hoang Long Nguyen
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, 91 Ubi Ave 4, Singapore 408827, Singapore.
| | - Vanessa Pei-Xuan Lee
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Ting Hway Wong
- Department of General Surgery, Singapore General Hospital; Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Stephanie Man Chung Fook-Chong
- Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital, 226 Outram Road, Singapore 169039, Singapore.
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital; Health Services Research and Biostatistics Unit, Division of Research, Singapore General Hospital; Health Services and Systems Research, Duke-NUS Graduate Medical School, 226 Outram Road, Singapore 169039, Singapore.
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Pek JH, Lim SH, Ho HF, Ramakrishnan TV, Jamaluddin SF, Mesa-Gaerlan FJC, Tiru M, Hwang SO, Choi WM, Kanchanasut S, Khruekarnchana P, Avsarogullari L, Shimazu T, Hori S. Emergency medicine as a specialty in Asia. Acute Med Surg 2015; 3:65-73. [PMID: 29123755 DOI: 10.1002/ams2.154] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 07/02/2015] [Indexed: 11/07/2022] Open
Abstract
Aim We aim to examine the similarities and differences in areas of EM development, workload, workforce, and capabilities and support in the Asia region. Emerging challenges faced by our EM community are also discussed. Methods The National Societies for Emergency Medicine of Hong Kong, India, Japan, Malaysia, Philippines, Singapore, South Korea, Taiwan, Thailand and Turkey participated in the joint Japanese Association of Acute Medicine (JAAM) and Asian Conference of Emergency Medicine (ACEM) Special Symposium held in October 2013 at Tokyo, Japan. The findings are reviewed in this paper. Results Emergency medicine (EM) has over the years evolved into a distinct and recognized medical discipline requiring a unique set of cognitive, administrative and technical skills for managing all types of patients with acute illness or injury. EM has contributed to healthcare by providing effective, safe, efficient and cost-effective patient care. Integrated systems have developed to allow continuity of emergency care from the community into emergency departments. Structured training curriculum for undergraduates, and specialty training programs for postgraduates are in place to equip trainees with the knowledge and skills required for the unique practice of EM. Conclusion The practice of EM still varies among the Asian countries. However, as a region, we strive to continue in our efforts to develop the specialty and improve the delivery of EM.
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Affiliation(s)
- Jen Heng Pek
- Department of Emergency Medicine Singapore General Hospital Singapore
| | - Swee Han Lim
- Department of Emergency Medicine Singapore General Hospital Singapore
| | - Hiu Fai Ho
- Accident and Emergency Department Queen Elizabeth Hospital Hong Kong
| | - T V Ramakrishnan
- Department of Accident and Emergency Medicine Sri Ramachandra Medical College and Research Institute Chennai India
| | | | | | - Mohan Tiru
- Department of Emergency Medicine Changi General Hospital Singapore
| | - Sung Oh Hwang
- Department of Emergency Medicine Wonju College of Medicine Yonsei University Seoul Korea
| | - Wai-Mau Choi
- Department of Emergency Medicine Mackay Memorial Hospital Hsinchu Taiwan
| | | | | | - Levent Avsarogullari
- Department of Emergency Medicine Erciyes University Medical School Kayseri Turkey
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Faculty of Medicine Osaka University Osaka Japan
| | - Shingo Hori
- Emergency and Critical Care Medicine School of Medicine Keio University Tokyo Japan
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Rahman NH, Tanaka H, Shin SD, Ng YY, Piyasuwankul T, Lin CH, Ong MEH. Emergency medical services key performance measurement in Asian cities. Int J Emerg Med 2015; 8:12. [PMID: 25932052 PMCID: PMC4412872 DOI: 10.1186/s12245-015-0062-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. Findings The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. Conclusions There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.
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Affiliation(s)
- Nik Hisamuddin Rahman
- Department of Emergency Medicine, School of Medical Sciences, University Sains Malaysia, Kota Bharu, 16150 Malaysia
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Chih-Hao Lin
- Department of Emergency Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Ong MEH, Shin SD, Tanaka H, Ma MHM, Nishiuchi T, Lee EJ, Ko PCI, Edwin Doctor N, Khruekarnchana P, Naroo GY, Wong KD, Nakagawa T, Ryoo HW, Lin CH, Goh ES, Khunkhlai N, Alsakaf OA, Hisamuddin NABRN, Bobrow BJ, McNally B, Assam PN, Chan ESY. Rationale, Methodology, and Implementation of a Dispatcher-assisted Cardiopulmonary Resuscitation Trial in the Asia-Pacific (Pan-Asian Resuscitation Outcomes Study Phase 2). PREHOSP EMERG CARE 2014; 19:87-95. [PMID: 25152997 DOI: 10.3109/10903127.2014.942482] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Background. Survival outcomes from out-of-hospital cardiac arrest (OHCA) in Asia are poor (2-11%). Bystander cardiopulmonary resuscitation (CPR) rates are relatively low in Asia. Dispatcher-assisted CPR (DA-CPR) has recently emerged as a potentially cost-effective intervention to increase bystander CPR and survival from OHCA. The Pan-Asian Resuscitation Outcomes Study (PAROS), an Asia-Pacific cardiac arrest registry, was set up in 2009, with the aim of understanding OHCA as a disease in Asia and improving OHCA survival. The network has adopted DA-CPR as part of its strategy to improve OHCA survival. Objective. This article aims to describe the conceptualization, study design, potential benefits, and difficulties for implementation of DA-CPR trial in the Asia-Pacific. Methods. Two levels of intervention, basic and comprehensive, will be offered to PAROS participating sites. The basic level consists of implementation of a DA-CPR protocol and training program, while the comprehensive level consists of implementation of the basic level, with the addition of a dispatch quality measurement tool, quality improvement program, and community education program. Sites that are not able to implement the package will contribute control data. The primary outcome of the study is survival to hospital discharge or survival to 30 days post cardiac arrest. DA-CPR and bystander CPR are secondary outcomes. Conclusion. Implementation of DA-CPR requires concerted efforts by EMS leaders and supervisors, dispatchers, hospital stakeholders, policy makers, and the general public. The DA-CPR trial implemented by the PAROS sites, if successful, can serve as a model for other countries considering such an intervention in their EMS systems.
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