Public awareness of the need to call emergency medical services following the onset of acute myocardial infarction and associated factors in Japan

The awareness of public about the Emergency Medical Services in the Eastern region of Saudi Arabia

Emergency Medical Services (EMS) are crucial for immediate medical assistance during life-threatening situations. However, insufficient public awareness about EMS services can impede their effectiveness. This study aimed to assess EMS knowledge and trust among the population of Eastern Saudi Arabia while identifying factors contributing to low awareness. A cross-sectional study was conducted in Eastern Saudi Arabia from September 2022 to September 2023. The study included participants aged 18 to 60 from diverse backgrounds. Using a convenience sampling approach, data was collected using a validated questionnaire covering demographics, hypothetical scenarios, EMS knowledge, and trust in EMS. We conducted the Chi-square tests and logistic regression using Jamovi software, with significance levels set at p < 0.05. Our study yielded 435 participants; 55% were males. Gender-based analysis showed significant differences in responses regarding first aid provision and EMS services (P < 0.001). Expectations for EMS response times also varied by gender (P = 0.01). Knowledge-based analysis revealed that age and education significantly influenced EMS knowledge (P < 0.001). Respondents with EMS knowledge were more likely to know how to provide first aid, understand the importance of emergency number 112, and trust EMS (P < 0.001). Trust-based analysis showed age and education-related differences in EMS trust (P < 0.001). Respondents with EMS knowledge and awareness of emergency numbers displayed higher trust in EMS (P < 0.001). This study underscores the need for enhanced public awareness of EMS services in Eastern Saudi Arabia. Age, education, and gender emerged as critical factors affecting EMS knowledge and trust. Bridging this awareness gap necessitates tailored educational campaigns and continuous monitoring. Policymakers should prioritise EMS awareness within broader healthcare strategies, contributing to improved public health outcomes and community well-being.

Strengthening care for emergencies: what is the level of awareness and utilization of Emergency Medical Services (EMS) in FCT, Nigeria?

BACKGROUND

As part of the Federal Government of Nigeria's desire to increase medical coverage among the citizenry, the National Emergency Medical Service and Ambulance Scheme (NEMSAS) was set up and piloted in the FCT in 2022. To gauge the progress so far, this study sought to assess the level and determinants of public awareness and utilization of Emergency Medical Services (EMS) among residents of the Federal Capital Territory, Abuja.

METHODS

A cross-sectional study was conducted in June 2023 among 1177 respondents residing in FCT Abuja at the time of the survey. Data was collected by trained research assistants using an interviewer-administered questionnaire and purposive sampling was adopted. The level of awareness and the socio-demographic determinants of the level of awareness in the FCT were assessed. Logistic regression was used to find predictors of EMS awareness and utilization.

RESULTS

57.8% of respondents are aware of EMS, while 42.2% are not. 62.7% are uncertain about the source of information for EMS with only a minority relying on word of mouth (17.7%), traditional media (11.1%), or social media (8.5%). 91.4% have not accessed or utilized EMS via the toll-free emergency line, while only 8.6% reported doing so. There are median EMS awareness and utilization differences across gender, age, location, and employment status of the respondents. Additionally, the multivariate logistic regression showed that age, location, and employment status are significant predictors of EMS awareness and utilization. Males have lower odds of awareness and utilization of EMS compared to females. Furthermore, there was a significant relationship between EMS access and utilization (Chi-square = 80.748, p < 0.001). However, awareness did not necessarily translate to utilization.

CONCLUSION

The relationship between EMS awareness and utilization and the unmasked predictors in this paper should be factored into the design of interventions to increase access and utilization of EMS in Nigeria.

Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries

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.

Factors Associated with Willingness to Call Emergency Medical Services for Worsening Symptoms of COVID-19 in Addis Ababa, Ethiopia

Background

In response to the COVID-19 pandemic, the Ethiopian Ministry of Health has established ambulances and dispatch centers specifically designed to transport COVID-19 patients to city medical centers. Due to a lack of evidence in this area, it is critical to assess the factors that influence the willingness to call for emergency medical services.

Methods

A community-based cross-sectional study was conducted from June to July 2021 in Addis Ababa. The data were gathered through use of a pretested questionnaire and analyzed using SPSS 25. Logistic regression was used to calculate odds ratios with and without confounding variable controls, and significant associations were declared at (0.05). For the variables that show significant associations in bivariate and multivariate analyses, a 95% confidence interval is provided.

Results

Three-quarters of those surveyed said they would call ambulance if they experienced worsening COVID-19 symptoms. The individual’s language was associated with the willingness to call EMS for worsening COVID-19 symptoms [AOR 0.51(95% CI: 0.28–0.92)].; awareness of the availability of toll-free ambulance services [AOR 3.4(95% CI: 1.92–5.95)]; recalling an EMS number [AOR 4.3(95% CI: 1.71–10.67)]; ambulance crew quality of care perception [AOR 3.6(95% CI: 2.09–6.10)]; ambulance service adequacy and accessibility perception [AOR 0.25(95% CI: 0.11–0.55)].

Conclusion

The study showed significant portion of the Addis Ababa community recognized the need to call EMS due to worsening COVID-19 symptoms. The individual’s language, awareness of toll-free ambulance; ability to recall an ambulance number, perception of the ambulance crew’s quality of care and adequacy and accessibility of service in the city influence the decision to call an ambulance. The finding highlights the significance of addressing problems through various media outlet, for advocacy and public awareness. More research, including qualitative studies, is needed to investigate the factors that encourage people to seek EMS.

Emergency medical services awareness and practices among rural population of District Hapur, Uttar Pradesh

Introduction: The awareness and practices of the general population regarding handling of medical emergency situations is important as many lives can be saved from premature deaths if many people are equipped to handle emergency situation. The aim and objective of this study was to assess awareness about medical emergency and practices pertaining medical emergencies.  Methodology; This cross-sectional study was conducted among 202 residents from 10 randomly selected villages in Hapur district, Uttar Pradesh, recruited using simple random sampling technique. A pretested structured questionnaire was used to collect data through face-to-face interview from July 2020 to Feb 2021. Result: A total of 202 participants were included in the study. We estimated 174(86.1%) are males and 28(13.9%) females in this study.  Education of participants 94(46.5%) completed primary school, 76(37.6%) high school, 22(10.9%) senior secondary school, 8(4%) are illiterates and 2(1%) are university graduates. Regarding family size, 194(96%) are married while 8(4%) are single.

Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States- and Foreign-Born Adults in the National Health Interview Survey

Background

Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality.

Methods and Results

We analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017.

Conclusions

These findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.

Knowledge of Heart Disease, Preventive Behavior and Source of Information in a Multi-ethnic Asian Population: A Population-Based Survey

Several population-based studies have been conducted to better understand the public knowledge of cardiovascular disease (CVD) and behavior. However, most studies have predominantly focused on Western populations. This study aimed to investigate heart disease knowledge, preventive behavior and source of information on heart disease in a multi-ethnic Asian population. We conducted a nation-wide population-based survey of 1000 participants of three ethnic groups (Chinese, Malay, Indian) in Singapore. A structured questionnaire was used to collect sociodemographics, knowledge on CVD risk factors, symptoms, emergency action, preventive health behaviors and sources of information on heart disease. Univariate and multivariate analyses were conducted to identify factors associated with the CVD knowledge and behavior. Knowledge on CVD risk factors was generally high. Knowledge on emergency actions was low particularly in younger people. More than 60% did not meet the recommended levels of physical activity, and this was more evident for individuals of overweight/obese status, lower education and workforce. Chinese were less likely to be obese/overweight compared to the Malays and Indians. Malays were less likely to seek information from internet and social media compared to their ethnic counterparts. This study highlighted heterogeneity in the levels of knowledge and health behavior across population segments, suggesting the need for a tailored approach to heart health interventions and optimal channels for information dissemination. Our findings will form the basis for contextually and culturally appropriate interventions to combat the growing CVD burden and prevent its toll on a rapidly ageing population.

Real-world experiences of the diagnosis process in Korean patients with ankylosing spondylitis based on a self-report questionnaire

Objectives

The diagnosis of ankylosing spondylitis (AS) is often delayed, which affects various clinical outcomes. This study examined the real-world situation of patients with AS during diagnosis and treatment.

Methods

Data were obtained from 26 tertiary care hospitals in Korea using a self-report questionnaire. The questionnaire assessed symptoms, pain, extra-articular manifestations, the initial pattern of pain before diagnosis, factors leading to delayed referral to rheumatology, time until receiving an AS diagnosis, comorbid diseases, treatment status, and disease education needs.

Results

Between September and October 2019, 1012 patients with AS completed the survey. Of these, 75.8% were men and 51.8% were in their 30s or 40s. Median disease duration was 76 months. The median time to diagnosis with AS was 12 months. When pain occurred, the medical departments most frequently visited first were orthopedic (61.5%) and rheumatology (18.7%) departments. The likelihood of the first visit being to the orthopedic department and the frequency of biologics use increased with the disease duration. The rates of uveitis, depressed mood, and comorbid diseases were higher in the group with delayed diagnosis.

Conclusions

Physicians should be aware of subtypes of AS that take longer to diagnose and comorbid diseases in the real-world clinical setting.

Health literacy among participants from neighbourhoods with different socio-economic statuses in the southern region of Hungary: a pilot study

Background

Health literacy (HL) has a deep impact on people’s decisions about their health and health care system. Measurement and improvement of HL level is essential to develop an appropriate health care system. The aim of the study was to (1) conduct a pilot study among the population of Baranya County in Hungary with different socio-economic statuses, (2) evaluate the HL level and (3) found the correlations between socio-economic data, emergency departments’ visits, medical history and HL.

Methods

In a cross-sectional study conducted in 2019 with 186 participants, socio-economic status, health status, HL level and knowledge about the triage system were measured. The questionnaire included questions on socio-economic status, previous chronic diseases, and satisfaction with the emergency care system as well as the standardised European Health Literacy Survey Questionnaire (HLS-EU-Q47). Descriptive statistical analysis (mean, SD, mode) and mathematical statistical analysis (ANOVA, chi² test, Pearson Correlations, Two sample t-test) were applied. SPSS 24.0 statistical software was used to analyse the data. Relationships were considered significant at the p < 0.05 level.

Results

One hundred and eighty-six people were involved in the research, but 45 of them were excluded (N = 141). The participation rate was 75.8%. There were significant differences in HL levels by gender and educational level (p = 0.017), health education (p = 0.032) and presence of children in the household (p = 0.049). Educational level (p = 0.002) and type of settlement (p = 0.01) had strong impacts on economic status. We found that 46.1% of the participants had limited comprehensive HL (cHL) level. This proportion was slightly lower for the disease prevention sub-index (33.3%). The average cHL index score was 34.8 ± 8.7 points, the average health care sub-index score was 34.6 ± 9.7 points, the average disease prevention sub-index score was 35.8 ± 9.9 points, and the average health promotion sub-index score was 34.2 ± 9.4 points. 46.1% of the examined population in Hungary had limited HL level.

Conclusions

Socio-economic status has a strong influence on HL level. It is not enough to improve awareness but we need to improve knowledge and cooperation with the doctors and health care system.

Spatial distribution of in- and out-of-hospital mortality one year after acute myocardial infarction in France

OBJECTIVE

To describe the spatial distribution of acute myocardial infarction (AMI) mortality in France in association with the socio-economic characteristics of the patient's place of residence.

METHODS

In this population-based study, we included patients hospitalized for AMI identified according to ICD-10 codes, using data from the national health insurance database from January 1, 2013 to December 31, 2014. In- and out-of-hospital deaths were identified over a period of 1 year following the first hospital stay for AMI.An exploratory analysis was performed to classify area profiles. The spatial analysis of AMI mortality was performed using a principal component analysis followed by an ascending hierarchical classification taking into account socio-economic data, access-time by road to coronary angiography, standardized in-hospital prevalence, and 1 year mortality.

RESULTS

Over the 2 years, 115,418 patients were hospitalized with a diagnosis of AMI. Patients were a mean of 68 ​± ​15 years and most were men (68.5%). The overall mortality rate was 12.2% after 1 year. More than half of patients (65.5%) underwent an early revascularization procedure. The map of standardized 1 year mortality showed a geographic area of high mortality extending diagonally from north-east to south-west France. We identified 6 different area profiles with standardized mortality varying from 15.9 to 54.4 per 100,000 inhabitants. The spatial distribution of higher mortality was associated with lower socioeconomic levels. These findings were not associated with a lower access to coronary angiography.

CONCLUSION

There are considerable geographical differences in the prevalence of AMI and 1 year mortality. The spatial distribution of lower healthcare indicators follows the distribution of social inequalities. This study highlights the importance of focusing national policies on universally accessible prevention programs such as the promotion cardiac rehabilitation and healthy lifestyles.

Public Awareness of the Emergency Medical Services in Maharashtra, India: A Questionnaire-based Survey

Background and objectives

The most widely used emergency medical services (EMS) model in India is the ‘108’ emergency service which primarily functions as an emergency response system to attend patients in need of critical care, trauma and accident victims. This is an observational cross-sectional study which was conducted using a questionnaire that asks the participants about their awareness and opinion of the current EMS system. The results of this study will enable us to ascertain the level of awareness of EMS among the population and address any misconceptions if they exist.

Materials and methods

All participants had to complete a 24-item self-administered questionnaire consisting of eight socio-demographic questions and 16 questions based on the EMS system. Questions regarding the development of the ‘112’ unified emergency service were also included. The convenient sampling method was used for data collection. The distribution of responses was examined using frequencies and percentages. Further analysis was done using the Chi-square test to compare responses between various subgroups based on the age, gender, profession, and level of education.

Results

A total of 1220 people from the state of Maharashtra responded to the survey and the maximum responses were from Mumbai. Majority of the respondents (59.2%) were from the age group of 15 to 30 years and, most of our responders had received education at the graduate level or above (78.2%). Only 17.5% of the respondents said that they will try to check for responsiveness if they saw a person lying unconscious by the side of the road with the scene being free of any danger. Interestingly, 78.9% of the healthcare professionals who participated in this survey would not check for responsiveness. Only 76.2% of the respondents knew that '108' is the number to dial in case of a medical emergency and about a quarter of them was not aware of it. It may seem that a good number of people are aware of the number. However, with the high number of fatalities occurring every day due to lack of medical facilities and a high current annual death toll on the roads, 100% of the population should know the emergency number. Only 20.2% of the respondents had called the EMS and asked for an ambulance. 68.5% of the respondents would immediately move out of the way and 27.5% of them would move out of their way if the ambulance’s lights and sirens were on. About two-thirds of the respondents were unaware of the development of a unified emergency number (112). However, a large majority (82.9%) were in favor of having a unified emergency number instead of a different number for each emergency. Only 43.8% of the respondents were of the opinion that the current EMS coverage was inadequate. 24.9% of the participants rated the current EMS as good, whereas 53.5% rated the EMS average and 16.9% rated it poor.

Conclusions

An effort should be made to make 100% of the population aware of this service. The first step for increasing awareness would be starting various advertisement campaigns. The next step would be to implement the unified emergency number (112) to address all kinds of distress calls such as police, fire, and ambulance. A very small proportion of the population is trained in first-aid or basic trauma life support. Awareness campaigns and training sessions for the general public should be conducted for the same. It is also necessary to spread awareness and help the populace know about the Good Samaritan law.