1
|
Zhang C. A Literature Study of Medical Simulations for Non-Technical Skills Training in Emergency Medicine: Twenty Years of Progress, an Integrated Research Framework, and Future Research Avenues. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4487. [PMID: 36901496 PMCID: PMC10002261 DOI: 10.3390/ijerph20054487] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/26/2023] [Accepted: 03/01/2023] [Indexed: 06/18/2023]
Abstract
Medical simulations have led to extensive developments in emergency medicine. Apart from the growing number of applications and research efforts in patient safety, few studies have focused on modalities, research methods, and professions via a synthesis of simulation studies with a focus on non-technical skills training. Intersections between medical simulation, non-technical skills training, and emergency medicine merit a synthesis of progress over the first two decades of the 21st century. Drawing on research from the Web of Science Core Collection's Science Citation Index Expanded and Social Science Citation Index editions, results showed that medical simulations were found to be effective, practical, and highly motivating. More importantly, simulation-based education should be a teaching approach, and many simulations are utilised to substitute high-risk, rare, and complex circumstances in technical or situational simulations. (1) Publications were grouped by specific categories of non-technical skills, teamwork, communication, diagnosis, resuscitation, airway management, anaesthesia, simulation, and medical education. (2) Although mixed-method and quantitative approaches were prominent during the time period, further exploration of qualitative data would greatly contribute to the interpretation of experience. (3) High-fidelity dummy was the most suitable instrument, but the tendency of simulators without explicitly stating the vendor selection calls for a standardised training process. The literature study concludes with a ring model as the integrated framework of presently known best practices and a broad range of underexplored research areas to be investigated in detail.
Collapse
Affiliation(s)
- Cevin Zhang
- School of Media and Design, Beijing Technology and Business University, Sunlight South Road 1, Beijing 102488, China
| |
Collapse
|
2
|
Wibring K, Lingman M, Herlitz J, Bång A. The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study. Scand J Trauma Resusc Emerg Med 2022; 30:34. [PMID: 35527302 PMCID: PMC9080130 DOI: 10.1186/s13049-022-01021-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 04/25/2022] [Indexed: 08/30/2023] Open
Abstract
Abstract
Objectives
To develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain.
Methods
Observational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.
Results
Prediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk.
Conclusions
By introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.
Collapse
|
3
|
Barkhordarzadeh S, Choobineh A, Razeghi M, Cousins R, Mokarami H. Effects of an ergonomic intervention program based on the PRECEDE-PROCEED model for reducing work-related health problems and exposure risks among emergency medical dispatchers. Int Arch Occup Environ Health 2022; 95:1389-1399. [PMID: 35266041 DOI: 10.1007/s00420-022-01846-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an ergonomic intervention program based on the PRECEDE-PROCEED model in terms of improving exposure risks and work-related health problems in emergency medical dispatchers. METHODS This quasi-experimental study used an interrupted time series design. Participants were 55 employees working in an Emergency Medical Communications Center in Iran. The intervention program was based on the PRECEDE-PROCEED model and included five face-to-face training sessions and installing auxiliary equipment according to best ergonomic principles. Direct observations of the emergency medical dispatchers' working postures using the Rapid Office Strain Assessment and a survey which included a modified Nordic Questionnaire, Work Ability Score, Visual Fatigue Questionnaire, and a Behavioral Factors Questionnaire were used at three time points: baseline, 1 month post-intervention, and 3 months post-intervention. RESULTS The modified Nordic Questionnaire showed significant reductions in pain intensity scores for neck, lower back, knee and ankle after the ergonomic intervention program. In addition, there were considerable post-training improvements in behavioral factors (knowledge and enabling factors) and working postures. No significant changes were observed in Work Ability Scores, or visual symptoms. CONCLUSIONS An ergonomic intervention program based on a systematic framework such as the PRECEDE-PROCEED model and on-site interventions can be effective in improving and enhancing the working conditions of emergency medical dispatchers. Therefore, it is suggested that ergonomic interventions be implemented based on standard and valid behavioral change models such as PRECEDE-PROCEED model in other work environments in which musculoskeletal pain and digital eye strain are common.
Collapse
Affiliation(s)
- Susan Barkhordarzadeh
- Student Research Committee, Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Hamidreza Mokarami
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, PO Box 71645-111, Shiraz, Iran.
| |
Collapse
|
4
|
Alotaibi A, Body R, Carley S, Pennington E. Towards enhanced telephone triage for chest pain: a Delphi study to define life-threatening conditions that must be identified. BMC Emerg Med 2021; 21:158. [PMID: 34911466 PMCID: PMC8672334 DOI: 10.1186/s12873-021-00553-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Improving telephone triage for patients with chest pain has been identified as a national research priority. However, there is a lack of strong evidence to define the life-threatening conditions (LTCs) that telephone triage ought to identify. Therefore, we aimed to build consensus for the LTCs associated with chest pain that ought to be identified during telephone triage for emergency calls. METHODS We conducted a Delphi study in three rounds. Twenty experts in pre-hospital care and emergency medicine experience from the UK were invited to participate. In round I, experts were asked to list all LTCs that would require priority 1, 2, and 4 ambulance responses. Round II was a ranking evaluation, and round III was a consensus round. Consensus level was predefined at > = 70%. RESULTS A total of 15 participants responded to round one and 10 to rounds two and three. Of 185 conditions initially identified by the experts, 26 reached consensus in the final round. Ten conditions met consensus for requiring priority 1 response: oesophageal perforation/rupture; ST elevation myocardial infarction; non-ST elevation myocardial infarction with clinical compromise (defined, also by consensus, as oxygen saturation < 90%, heart rate < 40/min or systolic blood pressure < 90 mmHg); acute heart failure; cardiac tamponade; life-threatening asthma; cardiac arrest; tension pneumothorax and massive pulmonary embolism. An additional six conditions met consensus for priority 2 response, and three for priority 4 response. CONCLUSION Using expert consensus, we have defined the LTCs that may present with chest pain, which ought to receive a high-priority ambulance response. This list of conditions can now form a composite primary outcome for future studies to derive and validate clinical prediction models that will optimise telephone triage for patients with a primary complaint of chest pain.
Collapse
Affiliation(s)
- Ahmed Alotaibi
- Division of Cardiovascular Sciences, Core Technology Facility, University of Manchester, 46 Grafton St, Manchester, M13 9WU, UK.
- College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
| | - Richard Body
- Division of Cardiovascular Sciences, Core Technology Facility, University of Manchester, 46 Grafton St, Manchester, M13 9WU, UK
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Simon Carley
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Health, Social Care & Psychology, Manchester Metropolitan University, Manchester, UK
| | | |
Collapse
|
5
|
Alotaibi A, Alghamdi A, Reynard C, Body R. Accuracy of emergency medical services (EMS) telephone triage in identifying acute coronary syndrome (ACS) for patients with chest pain: a systematic literature review. BMJ Open 2021; 11:e045815. [PMID: 34433592 PMCID: PMC8388270 DOI: 10.1136/bmjopen-2020-045815] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To systematically appraise the available evidence to determine the accuracy of decision aids for emergency medical services (EMS) telephone triage of patients with chest pain suspected to be caused by acute coronary syndrome (ACS) or life-threatening conditions. DESIGN Systematic review. DATA SOURCES Electronic searches were performed in Embase 1974, Medline 1946 and CINAHL 1937 databases from 3 March 2020 to 4 March 2020. ELIGIBILITY CRITERIA The review included all types of original studies that included adult patients (>18 years) who called EMS with a primary complaint of chest pain and evaluated dispatch triage priority by telephone. Outcomes of interest were a final diagnosis of ACS, acute myocardial infarction or other life-threatening conditions. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data on study design, population, study period, outcome and all data for assessment of accuracy, including cross-tabulation of triage priority against the outcomes of interest. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 assessment tool. RESULTS Searches identified 553 papers, of which 3 were eligible for inclusion. Those reports described the evaluation of three different prediction models with variation in the variables used to detect ACS. The overall results showed that dispatch triage tools have good sensitivity to detect ACS and life-threatening conditions, even though they are used to triage signs and symptoms rather than diagnosing the patients. On the other hand, prediction models were built to detect ACS and life-threatening conditions, and therefore, prediction models showed better sensitivity and negative predictive value than dispatch triage tools. CONCLUSION We have identified three prediction models for telephone triage of patients with chest pain. While they have been found to have greater accuracy than standard EMS dispatch systems, prospective external validation is essential before clinical use is considered. PROSPERO REGISTRATION NUMBER This systematic review was pre-registered on the International prospective register of systematic reviews (PROSPERO) database (reference CRD42020171184).
Collapse
Affiliation(s)
- Ahmed Alotaibi
- Division of Cardiovascular sciences, University of Manchester, Manchester, UK
- Emergency Medical Services, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulrhman Alghamdi
- Division of Cardiovascular sciences, University of Manchester, Manchester, UK
- Emergency Medical Services, College of Applied Medical Sciences, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Charles Reynard
- Division of Cardiovascular sciences, University of Manchester, Manchester, UK
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
| | - Richard Body
- Division of Cardiovascular sciences, University of Manchester, Manchester, UK
- Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
| |
Collapse
|
6
|
Westman A, Saveman BI, Björnstig U, Hylander J, Gyllencreutz L. Mobilisation of emergency services for chemical incidents in Sweden - a multi-agency focus group study. Scand J Trauma Resusc Emerg Med 2021; 29:99. [PMID: 34289881 PMCID: PMC8293566 DOI: 10.1186/s13049-021-00910-5] [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] [Received: 02/25/2021] [Accepted: 07/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emergency medical services, police services, and emergency dispatch services personnel. METHODS Eight emergency service organizations in two distinct and dissimilar regions in Sweden participated in one organization-specific focus group interview each. The total number of respondents was 25 (7 females and 18 males). A qualitative inductive content analysis was performed. RESULTS Three types of information processing were derived as emerging during acute-phase chemical incident mobilization: Unspecified (a caller communicating with an emergency medical dispatcher), specified (each emergency service obtaining organization-specific expert information), and aligned (continually updated information from the scene condensed and disseminated back to all parties at the scene). Improvable shortcomings were identified, e.g. randomness (unspecified information processing), inter-organizational reticence (specified information processing), and downprioritizing central information transmission while saving lives (aligned information processing). CONCLUSIONS The flow of information may be improved by automation, public education, revised dispatcher education, and use of technical resources in the field. Future studies should independently assess these mechanism's degree of impact on mobilisation of emergency services in chemical incidents.
Collapse
Affiliation(s)
- Anton Westman
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87, Umeå, Sweden. .,Department of Anesthesia and Intensive Care Medicine, Karolinska University Hospital, Huddinge, Sweden.
| | - Britt-Inger Saveman
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87, Umeå, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Ulf Björnstig
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Johan Hylander
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87, Umeå, Sweden
| | - Lina Gyllencreutz
- Department of Surgical and Perioperative Sciences, Surgery, Centre for Disaster Medicine, Umeå University, 901 87, Umeå, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| |
Collapse
|
7
|
Waalwijk JF, Lokerman RD, van der Sluijs R, Fiddelers AAA, Leenen LPH, van Heijl M, Poeze M. Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study. Eur J Trauma Emerg Surg 2021; 48:1111-1120. [PMID: 34019106 PMCID: PMC9001562 DOI: 10.1007/s00068-021-01685-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/28/2021] [Indexed: 12/04/2022]
Abstract
Purpose Priority-setting by dispatch centers and Emergency Medical Services professionals has a major impact on pre-hospital triage and times of trauma patients. Patients requiring specialized care benefit from expedited transport to higher-level trauma centers, while transportation of these patients to lower-level trauma centers is associated with higher mortality rates. This study aims to evaluate the accuracy of priority-setting by dispatch centers and Emergency Medical Services professionals. Methods This observational study included trauma patients transported from the scene of injury to a trauma center. Priority-setting was evaluated in terms of the proportion of patients requiring specialized trauma care assigned with the highest priority (i.e., sensitivity), undertriage, and overtriage. Patients in need of specialized care were defined by a composite resource-based endpoint. An Injury Severity Score ≥ 16 served as a secondary reference standard. Results Between January 2015 and December 2017, records of 114,459 trauma patients were collected, of which 3327 (2.9%) patients were in need of specialized care according to the primary reference standard. Dispatch centers and Emergency Medical Services professionals assigned 83.8% and 74.5% of these patients with the highest priority, respectively. Undertriage rates ranged between 22.7 and 65.5% in the different prioritization subgroups. There were differences between dispatch and transport priorities in 17.7% of the patients. Conclusion The majority of patients that required specialized care were assigned with the highest priority by the dispatch centers and Emergency Medical Services professionals. Highly accurate priority criteria could improve the quality of pre-hospital triage. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01685-1.
Collapse
Affiliation(s)
- Job F Waalwijk
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands.
| | - Robin D Lokerman
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Audrey A A Fiddelers
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mark van Heijl
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Surgery, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Network Acute Care Limburg, Maastricht University Medical Center, Maastricht, The Netherlands
| |
Collapse
|
8
|
Schehadat MS, Scherer G, Groneberg DA, Kaps M, Bendels MHK. Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE). BMC Emerg Med 2021; 21:29. [PMID: 33750317 PMCID: PMC7941891 DOI: 10.1186/s12873-021-00424-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. METHODS This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). RESULTS 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21-3.30; OROFF 3.18, 95% CI 3.04-3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9-47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6-79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. CONCLUSIONS This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
Collapse
Affiliation(s)
- Marc S Schehadat
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany.
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
| | - Guido Scherer
- District Administration Mainz-Bingen, Department of Civil Protection, Ingelheim/Rhein, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael H K Bendels
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| |
Collapse
|
9
|
Ecker H, Lindacher F, Dressen J, Wingen S, Hamacher S, Böttiger BW, Wetsch WA. Accuracy of automatic geolocalization of smartphone location during emergency calls - A pilot study. Resuscitation 2020; 146:5-12. [PMID: 31706968 DOI: 10.1016/j.resuscitation.2019.10.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/29/2019] [Accepted: 10/29/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Widespread use of smartphones allows automatic geolocalization (i.e., transmission of location data) in countless apps. Until now, this technology has not been routinely used in connection with an emergency call in which location data play a decisive role This study evaluated a new software automatically providing emergency medical service (EMS) dispatchers with a caller's geolocation. We hypothesized that this technology will provide higher accuracy, faster dispatching of EMS and a faster beginning of thoracic compressions in a cardiac arrest scenario. MATERIAL AND METHODS Approval from the local Ethics Committee was obtained. 108 simulated emergency calls reporting a patient in cardiac arrest were conducted at 54 metropolitan locations, which were chosen according to a realistic pattern. At each location, a conventional emergency call, with an oral description of the location, was given first; subsequently, another call using an app with automatic geolocation was placed. Accuracy of localization, time to location, time to EMS dispatch and time to first thoracic compression were compared between both groups. RESULTS The conventional emergency call was always successful (n = 54). Emergency call via app worked successfully in n = 46 cases (85.2%). Automatic geolocation was provided to EMS in all these n = 46 cases (100%). Deviation from estimated position to actual position was 1173.5 ± 4343.1 m for conventional and 65.6 ± 320.5 m for automatic geolocalization (p < 0.001). In addition, time to localization was significantly shorter using automatic geolocalization (34.7 vs. 71.7 s, p < 0.001). Time to first thoracic compression was significantly faster in the geolocalization group (83.0 vs. 122.6 s; p < 0.001). CONCLUSIONS This pilot study showed that automatic geolocalization leads to a significantly shorter duration of the emergency call, significantly shorter times until the beginning of thoracic compressions, and a higher precision in determining the location of an emergency.
Collapse
Affiliation(s)
- Hannes Ecker
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Falko Lindacher
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Jan Dressen
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Sabine Wingen
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Stefanie Hamacher
- University of Cologne, Medical Faculty and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, Kerpener Str. 62, 50937 Cologne, Germany
| | - Bernd W Böttiger
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany
| | - Wolfgang A Wetsch
- University of Cologne, Medical Faculty and University Hospital Cologne, Department of Anaesthesiology and Intensive Care Medicine, Kerpener Str. 62, 50937 Cologne, Germany.
| |
Collapse
|
10
|
Wibring K, Herlitz J, Lingman M, Bång A. Symptom description in patients with chest pain-A qualitative analysis of emergency medical calls involving high-risk conditions. J Clin Nurs 2019; 28:2844-2857. [PMID: 30938902 DOI: 10.1111/jocn.14867] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/14/2019] [Accepted: 03/23/2019] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the symptoms descriptions and situational information provided by patients during ongoing chest pain events caused by a high-risk condition. BACKGROUND Chest pain is a common symptom in patients contacting emergency dispatch centres. Only 15% of these patients are later classified as suffering from a high-risk condition. Prehospital personnel are largely dependent on symptom characteristics when trying to identify these patients. DESIGN Qualitative descriptive. METHODS Manifest content analysis of 56 emergency medical calls involving patients with chest pain was carried out. A stratified purposive sampling was used to obtain calls concerning patients with high-risk conditions. These calls were then listened to and transcribed. Thereafter, meaning units were identified and coded and finally categorised. Consolidated criteria for reporting qualitative studies guidelines have been applied. RESULTS A wide range of situational information and symptoms descriptions was found. Pain and affected breathing were dominating aspects, but other situational information and several other symptoms were also reported. The situational information and these symptoms were classified into seven categories: Pain narrative, Affected breathing, Bodily reactions, Time, Bodily whereabouts, Fear and concern and Situation management. The seven categories consisted of 17 subcategories. CONCLUSIONS Patients with chest pain caused by a high-risk condition present a wide range of symptoms which are described in a variety of ways. They describe different kinds of chest pain accompanied by pain from other parts of the body. Breathing difficulties and bodily reactions such as muscle weakness are also reported. The variety of symptoms and the absence of a typical symptomatology make risk stratification on the basis of symptoms alone difficult. RELEVANCE TO CLINICAL PRACTICE This study highlights the importance of an open mind when assessing patients with chest pain and the requirement of a decision support tool in order to improve risk stratification in these patients.
Collapse
Affiliation(s)
- Kristoffer Wibring
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden.,Department of Ambulance and Prehospital Care, Region Halland, Sweden
| | - Johan Herlitz
- The Prehospital Research Center Western Sweden, University of Borås, Borås, Sweden
| | - Markus Lingman
- Halland Hospital, Region Halland, Sweden.,Department of Molecular and Clinical Medicine/Cardiology, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Angela Bång
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| |
Collapse
|