Emergency versus standard response: time efficacy of London’s Air Ambulance rapid response vehicle

Driving Speeds in Urgent and Non-Urgent Ambulance Missions during Normal and Reduced Winter Speed Limit Periods—A Descriptive Study

Objective: Most traffic research on emergency medical services (EMS) focuses on investigating the time saved with emergency response driving. Evidence regarding driving speed during non-urgent ambulance missions is lacking. In contrast, this descriptive study compared registered driving speeds to the road speed limit in urgent A-missions and non-urgent D-missions. Specifically, the study examined driving speeds during normal speed limits, periods of reduced winter speed limits, and speeding during non-urgent D-missions. Methods: Urgent A-missions and non-urgent D-missions were included. Registered ambulance locations and speed data from Pirkanmaa Hospital District, Finland between 1 January 2018 and 31 December 2018 were used. Ambulance locations were linked to OpenStreetMap digital road network data. The registered driving speed distribution was reported as quartiles by the effective road speed limit. Furthermore, the results during the normal speed limit and reduced winter speed limit periods were reported separately. Driving speeds in non-urgent missions were compared with current Finnish traffic violation legislation. Results: As expected, the urgent A-missions exceeded the speed limits during both the normal speed limit and reduced winter speed limit periods. On the smallest streets with speed limits of 30 km/h, the driving speeds in urgent missions were lower than the speed limit. The driving speeds in non-urgent D-missions were broadly similar throughout the whole year on high-speed roads, and mostly on lower speed limit roads. However, within the 30 km/h speed limits, the mean speed in non-urgent missions appeared to increase during the winter. One-fifth of the registered non-urgent D-missions were speeding. Conclusions: Speeding is common in urgent A-missions and non-urgent D-missions throughout the year. Stricter guidelines for EMS are needed to increase driving safety.

Improving the Appropriateness of Advanced Life Support Teams' Dispatch: A Before-After Study

BACKGROUND AND IMPORTANCE

The dispatch of Advanced Life Support (ALS) teams in Emergency Medical Services (EMS) is still a hardly studied aspect of prehospital emergency logistics. In 2015, the dispatch algorithm of Emilia Est Emergency Operation Centre (EE-EOC) was implemented and the dispatch of ALS teams was changed from primary to secondary based on triage of dispatched vehicles for high-priority interventions when teams with Immediate Life Support (ILS) skills were dispatched.

OBJECTIVES

This study aimed to evaluate the effects on the appropriateness of ALS teams' intervention and their employment time, and to compare sensitivity and specificity of the algorithm implementation.

DESIGN

This was a retrospective before-after observational study.

SETTINGS AND PARTICIPANTS

Primary dispatches managed by EE-EOC involving ambulances and/or ALS teams were included. Two groups were created on the basis of the years of intervention (2013-2014 versus 2017-2018).

INTERVENTION

A switch from primary to secondary dispatch of ALS teams in case of high-priority dispatches managed by ILS teams was implemented.

OUTCOMES

Appropriateness of ALS team intervention, total task time of ALS vehicles, and sensitivity and specificity of the algorithm were reviewed.

RESULTS

The study included 242,501 emergency calls that generated 56,567 red code dispatches. The new algorithm significantly increased global sensitivity and specificity of the system in terms of recognition of potential need of ALS intervention and the specificity of primary ALS dispatch. The appropriateness of ALS intervention was significantly increased; total tasking time per day for ALS and the number of critical dispatches without ALS available were reduced.

CONCLUSION

The revision of the dispatch criteria and the extension of the two-tiered dispatch for ALS teams significantly increased the appropriateness of ALS intervention and reduced both the global tasking time and the number of high-priority dispatches without ALS teams available.

Geo-temporal provision of pre-hospital emergency anaesthesia by UK Helicopter Emergency Medical Services: an observational cohort study

BACKGROUND

Pre-hospital emergency anaesthesia (PHEA) is frequently required for injured patients. National Institute for Health and Care Excellence (NICE) quality standards state that PHEA should be delivered within 45 min of an emergency call. We investigated whether there is geo-temporal variation in service provision to the UK population.

METHODS

We retrospectivly audited the time of day when PHEA is provided by UK Helicopter Emergency Medical Services (HEMS), by recording PHEA provision on a randomly selected week and weekend day in 2018. Pre-hospital emergency anaesthesia in the United Kingdom: an observational cohort study retrospectively assessed the time from emergency call to pre-hospital emergency anaesthesia delivery by HEMS during a 1 yr period from April 2017 to March 2018. The population coverage likely to receive pre-hospital emergency anaesthesia in accord with NICE guidelines was estimated by integrating population data with the median time to PHEA, hours of service provision, geographic location, and transport modality.

RESULTS

On a weekday 20 HEMS units (comprising from four to 31 enhanced care teams) were estimated to be able to meet NICE guidelines for delivery of PHEA to a poulation of 6.6-35.2 million individuals (at times of minimum and maximal staffing, respectively). At the weekend, 17 HEMS units (comprising from 5 to 28 enhanced care teams) were estimated to be able to meet NICE guidelines for PHEA deliveryto a population of 6.8-34.1 million individuals (minimum and maximal staffing, respectively).

CONCLUSIONS

There is marked geo-temporal variation in the ability of HEMS organisations to deliver pre-hospital emergency anaesthesia in the UK.

Utilizing Advanced Telecommunication Strategies to Enhance the Response of Emergency Medical Services Volunteers

Emergency medical services (EMS) provides a critical role in the rapid treatment, stabilization, and transfer of patients in the prehospital setting. The national EMS provider for Israel has developed a robust and unique organization of volunteers with advanced telecommunication strategies to activate and direct them in order to improve these processes. The volunteers include local high school students, international college students, emergency medical technicians, on-call volunteers, motorcyclists, and Life Guardian first responders. The telecommunication strategies include pagers, push-to-talk over cellular, and sophisticated smartphone-based software applications. These are monitored and directed via a central command and control station. Such processes, both on an organizational as well as technical level, can be adapted to improve prehospital emergency care.

A new model for standardising and treating thermal injury in the rat

Thermal burn injury methodologies are inconsistently described within the current literature. To permit the advancement of new treatments there is an urgent need for the development and standardisation of an acute rat model. We describe a rat thermal burn model that involves: anaesthesia, chronic catheterisation, skin preparation, baseline hemodynamic and physiological monitoring, and a quantifiable method to reproduce a severe full-thickness burns injury affecting ∼30% percent of the total body surface area (%TBSA). Following a 15 min post-burn period, treatment commences with an acute monitoring phase lasting up to 8 h, which can be modified according to individual protocols. This model reflects the clinical continuum-of-care from point-of-injury, a 15 min ambulance response time, a 60 min prehospital phase and hospital treatment monitoring phase. The model is validated with histological evidence of full-thickness injury, evidence of the hypermetabolic response (K+, Base Excess, lactate) and changes in complete blood counts. •It has been 50 years since Walker and Mason published their widely popular "A Standard Animal Burn Model".•The model, however, lacks quantifiable methodology for the assessment of burn thickness, surface area burnt and physiological status.•We present a new standardised method for evaluation of drug and interventional therapies that mimic the clinical scenario including ambulance response, pre-hospital and hospital phases after burn.