Application of Automated External Defibrillators in Motorcycle Ambulances in Thailand’s Emergency Medical Services

Flight testing of drone-delivered automated external defibrillators for simulated out-of-hospital cardiac arrest in suburban Thailand

The use of automated external defibrillators (AEDs) in a timely manner is critical for improving survival rates in out-of-hospital cardiac arrest (OHCA) cases. However, in developing countries, logistical and infrastructural challenges often result in delays, particularly in suburban areas. This study evaluates the feasibility and safety of using drones to deliver AEDs in suburban OHCA scenarios. A series of ninety test flights were conducted using a DJI Matrice 600 drone (DJI, China) to deliver a Philips HeartStart AED (Philips, Netherlands) across varying payloads. Bystanders in simulated OHCA situations identified their location via mobile applications, enabling the drone operator to dispatch the drone beyond the pilot's line of sight. The results showed a 97.7% success rate in AED delivery, with a median flight distance of 4042 m and a median response time of 7 min and 39 s. Despite payload variations, the drone maintained adequate speed and landing accuracy, with a mean speed of 9.17 m per second and a median landing error of 122 centimeters. The findings suggest that drones have significant potential for improving emergency medical responses in suburban areas of developing countries. Integration into emergency services could address current delays, though further research is necessary to optimize performance under varying conditions.

Exploring the experiences and challenges of motorcycle ambulance personnel in pre-hospital emergency healthcare services: A qualitative study

BACKROUND

Motorcycle ambulances are particularly useful in navigating narrow and congested areas during premium hours due to their ability to provide rapid access to patients in pre-hospital emergency healthcare services (PHEHS), possessing suitable and necessary advanced life support accessories, and their speed, flexibility, and ease of maneuverability.

OBJECTIVE

This study aims to examine the experiences and challenges encountered by motorcycle ambulance workers in PHEHS.

METHODS

This study adopts a qualitative research methodology, specifically employing a phenomenological approach within the framework of a case study. The research sample consists of 19 paramedics and Emergency Medical Technicians (EMTs) working on motorcycle ambulances. Purposeful sampling method, specifically the snowball sampling technique, was employed in selecting the sample. Research data were collected through in-depth interviews conducted using a semi-structured interview form, from August 2022 to February 2023. The interviews were transcribed, coded, and thematically analyzed using the MAXQDA program.

RESULTS

Participants shared their experiences and the problems they encountered while performing their duties across four themes: purpose of motorcycle ambulances, most frequently assigned cases, challenges encountered, and the importance of teamwork.

CONCLUSIONS

It is crucial to ensure personnel safety by forming the motorcycle ambulance team from selected individuals, subjecting the selected personnel to the same standard and comprehensive advanced driving and technical training, regulating working hours, increasing the number of personnel, and fostering teamwork. Further efforts are needed to improve the working conditions of motorcycle ambulance services.

"Smart Emergency Call Point" Enhancing Emergency Medical Services on University Campuses

INTRODUCTION

The "Smart Emergency Call Point" is a device designed for requesting assistance and facilitating rapid responses to emergencies. The functionality of smart emergency call points has evolved to include features as real-time photo transmission and communication capabilities for both staff and emergency personnel. These devices are being used to request Emergency Medical Services (EMS) on university campuses. Despite these developments, there has been a lack of previous studies demonstrating significant advantages of integrating smart emergency call points into EMS systems.

STUDY OBJECTIVE

The primary goal of this study was to compare the response times of EMS between traditional phone calls and the utilization of smart emergency call points located on university campuses. Additionally, the study aimed to provide insights into the characteristics of smart emergency call points as a secondary objective.

METHODS

This retrospective database analysis made use of information acquired from Thailand's EMS at Srinagarind Hospital. The data were gathered over a period of four years, specifically from January 2019 through January 2022. The study included two groups: the first group used the phone number 1669 to request EMS assistance, while the second group utilized the smart emergency call point. The primary focus was on the response times. Additionally, the study documented the characteristics of the smart emergency call points that were used in the study.

RESULTS

Among the 184 EMS operations included in this study, 60.9% (N = 56) involved females in the smart emergency call point group. Notably, the smart emergency call point group showed a higher frequency of operations between the hours of 6:00am and 6:00pm when compared to the 1669 call group (P = .020). In dispatch triage, the majority of emergency call points were categorized as non-urgent, in contrast to the phone group for 1669 which were primarily cases categorized as urgent (P = .010). The average response time for the smart emergency call point group was significantly shorter, at 6.01 minutes, compared to the phone number 1669 group, which had an average response time of 9.14 minutes (P <.001).

CONCLUSION

In the context of calling for EMS on a university campus, the smart emergency call points demonstrate a significantly faster response time than phone number 1669 in Thailand. Furthermore, the system also offers the capability to request emergency assistance.

A Motorcycle Paramedic Increases the Survival Rate of Patients after OHCA

Background and Objectives: Despite advancements in modern medicine, the survival rate of patients after out-of-hospital cardiac arrest (OHCA) remains low. The proportion of OHCA patients who could be saved under ideal circumstances is unknown. A significant portion of patients experience cardiac arrest due to irreversible conditions. The survival of patients with reversible causes depends on the prompt initiation of basic life support (BLS) and early defibrillation. In order to increase the chances of survival, the motorcycle paramedic (MP) project was implemented in Ljubljana in 2003. The MP is equipped with an AED. In the case of OHCA with a shockable rhythm, he performs defibrillation before the arrival of the emergency medical team (EMT). The aim of this study was to evaluate whether the MP, by reducing response times to OHCA patients, increases the survival and outcome of these patients compared to the EMT. Materials and Methods: A retrospective analysis of OHCA cases within the area covered by Ljubljana Emergency Medical Service (EMS) was conducted for the period from January 2003 to December 2022. Instances where the MP arrived at the scene before the EMT were considered MP interventions and classified as the MP group; all other interventions were classified as the EMT group. Results: Between January 2003 and December 2022, the EMT performed resuscitation on 3352 patients. In 316 cases, the MP was simultaneously activated and arrived at the scene before the EMT. The response time in the MP group was shorter compared to the EMT group (7.7 ± 4.1 min vs. 9.9 ± 6.5 min, p < 0.001). In 16 patients, return of spontaneous circulation (ROSC) was achieved before the arrival of the EMT. The MP group had a higher ROSC rate, a larger proportion of patients were discharged from the hospital and there were more patients with a good neurological outcome compared to the EMT group (44.3% vs. 36.9%, p = 0.009; 18.7% vs. 13.0%, p = 0.005; 15.9% vs. 10.6%, p = 0.004, respectively). Conclusion: This study has demonstrated that the implementation of the MP into the EMS in Ljubljana has resulted in shorter response times, an increased survival rate and improved neurological outcome for OHCA patients.

Prehospital Emergency Care in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND

An under-developed and fragmented prehospital Emergency Medical Services (EMS) system is a major obstacle to the timely care of emergency patients. Insufficient emphasis on prehospital emergency systems in low- and middle-income countries (LMICs) currently causes a substantial number of avoidable deaths from time-sensitive illnesses, highlighting a critical need for improved prehospital emergency care systems. Therefore, this systematic review aimed to assess the prehospital emergency care services across LMICs.

METHODS

This systematic review used four electronic databases, namely: PubMed/MEDLINE, CINAHL, EMBASE, and SCOPUS, to search for published reports on prehospital emergency medical care in LMICs. Only peer-reviewed studies published in English language from January 1, 2010 through November 1, 2022 were included in the review. The Newcastle-Ottawa Scale (NOS) and Critical Appraisal Skills Programme (CASP) checklist were used to assess the methodological quality of the included studies. Further, the protocol of this systematic review has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Ref: CRD42022371936) and has been conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

RESULTS

Of the 4,909 identified studies, a total of 87 studies met the inclusion criteria and were therefore included in the review. Prehospital emergency care structure, transport care, prehospital times, health outcomes, quality of information exchange, and patient satisfaction were the most reported outcomes in the considered studies.

CONCLUSIONS

The prehospital care system in LMICs is fragmented and uncoordinated, lacking trained medical personnel and first responders, inadequate basic materials, and substandard infrastructure.

Optimizing Operation Time and Travel Distance for Motorcycle Ambulances in Emergency Medical Services

INTRODUCTION

The motorcycle ambulance is used for quick access to patients. The response time to reach the patient takes less time than with a van ambulance. Moreover, accidents involving ambulances tend to be higher. However, at present, there is no study regarding the appropriate situation used of motorcycle ambulances in Emergency Medical Services (EMS) in Thailand.

STUDY OBJECTIVE

This study aims to optimize the travel distance and the operation time of motorcycle ambulances used.

METHODS

This study was a prospective, randomized controlled study at the EMS unit of Srinagarind Hospital, Thailand. The data collection period was from November 2021 through May 2022. All data involving dispatch of both ambulances in need were collected.

RESULTS

A total of 2,398 cases of EMS operation were examined. The mean age of the patients in the motorcycle ambulance group was 42.5 (SD = 6.5) years, and 51.3% (n = 616) were male. The response time for motorcycle ambulances and van ambulances during the operation time between 6:00am-9:00am was 6.2 minutes and 9.1 minutes, respectively. The response times for motorcycle ambulances and van ambulances regarding distance traveled from 0-5km were 4.2 minutes and 7.5 minutes, respectively (P <.001); distance traveled from 5-10km were 6.3 minutes and 8.2 minutes, respectively (P = .010).

CONCLUSION

The motorcycle ambulance can reach patients faster than the ambulance at the operation time from 6:00am-9:00am and 3:00pm-6:00pm. This study focused on the distance less than 10 kilometers.