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Lupton JR, Johnson E, Prigmore B, Daya MR, Jui J, Thompson K, Nuttall J, Neth MR, Sahni R, Newgard CD. Out-of-hospital cardiac arrest outcomes when law enforcement arrives before emergency medical services. Resuscitation 2024; 194:110044. [PMID: 37952574 PMCID: PMC10842836 DOI: 10.1016/j.resuscitation.2023.110044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/03/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Law enforcement (LE) professionals are often dispatched to out-of-hospital cardiac arrests (OHCA) to provide early cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) application with mixed evidence of a survival benefit. Our objective was to comprehensively evaluate LE care in OHCA. METHODS This is a secondary analysis of adults with non-traumatic OHCA not witnessed by EMS and without bystander AED use from 2018-2021. Our primary outcome was survival with Cerebral Perfusion Category score ≤ 2 (functional survival). Our exposures included: LE On-scene Only (without providing care); LE CPR Only (without applying an AED); LE Ideal Care (ensuring CPR and AED application). Our control group had no LE arrival before EMS. We performed multivariable logistic regression analyses adjusting for confounders and stratified our analyses by patients with and without bystander CPR. RESULTS There were 2569 adult, non-traumatic OHCAs from 2018-2021 meeting inclusion criteria. There were no differences in the odds of functional survival for LE On-scene Only (adjusted odds ratio [95% CI]: 1.28 [0.47-3.45]), LE CPR Only (1.26 [0.80-1.99]), or LE Ideal Care (1.36 [0.79-2.33]). In patients without bystander CPR, LE Ideal Care had significantly higher odds of functional survival (2.01 [1.06-3.81]) compared to no LE on-scene, with no significant associations for LE On-scene Only or LE CPR Only. There were no significant differences by LE care in patients already receiving bystander CPR. CONCLUSIONS LE arrival before EMS and ensuring both CPR and AED application is associated with significantly improved functional survival in OHCA patients not already receiving bystander CPR.
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Affiliation(s)
- Joshua R Lupton
- Department of Emergency Medicine, Oregon Health & Science University, USA.
| | - Erika Johnson
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Brian Prigmore
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Mohamud R Daya
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Jonathan Jui
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Kathryn Thompson
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | | | - Matthew R Neth
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Ritu Sahni
- Department of Emergency Medicine, Oregon Health & Science University, USA
| | - Craig D Newgard
- Department of Emergency Medicine, Oregon Health & Science University, USA
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Binhotan M, Turnbull J, Petley G, Aljerian N, Altuwaijri M. Evaluation of Telephone Cardiopulmonary Resuscitation Performance in Current Practice in Saudi Arabia. J Saudi Heart Assoc 2023; 35:244-253. [PMID: 37881593 PMCID: PMC10597598 DOI: 10.37616/2212-5043.1353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/10/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
Objectives Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. Methods A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. Results A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. Conclusion T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance.
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Affiliation(s)
- Meshary Binhotan
- School of Health Sciences, University of Southampton, Southampton,
United Kingdom
- Department of 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
| | - Joanne Turnbull
- School of Health Sciences, University of Southampton, Southampton,
United Kingdom
| | - Graham Petley
- School of Health Sciences, University of Southampton, Southampton,
United Kingdom
| | - Nawfal Aljerian
- Medical Referrals Center, Ministry of Health, Riyadh,
Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh,
Saudi Arabia
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Messelink DM, van der Ploeg GJ, van der Linden T, Flameling RD, Bierens JJLM. Medical emergencies at sea: an analysis of ambulance-supported and autonomously performed operations by lifeboat crews. BMC Emerg Med 2023; 23:108. [PMID: 37726714 PMCID: PMC10510182 DOI: 10.1186/s12873-023-00879-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/31/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Very little data is available about the involvement of lifeboat crews in medical emergencies at sea. The aim of this study is to analyze the medical operations at sea performed by the Royal Netherlands Sea Rescue Institution (KNRM). METHODS This is a retrospective descriptive analysis of all medical operations at sea performed by the KNRM between January 2017 and January 2020. The operations were divided in three groups: with ambulance crew aboard the lifeboat, ambulance crew on land waiting for the arrival of the lifeboat, and autonomous operations (without ambulance crew involvement). The main outcome measures were circumstances, encountered medical problems, follow-up and crew departure time. RESULTS The KNRM performed 282 medical operations, involving 361 persons. Operations with ambulance crew aboard the lifeboat (n = 39; 42 persons) consisted mainly of persons with serious trauma or injuries; 32 persons (76.2%) were transported to a hospital. Operations with ambulance crew on land (n = 153; 188 persons) mainly consisted of situations where time was essential, such as persons who were still in the water, with risk of drowning (n = 45, 23.9%), on-going resuscitations (n = 9, 4.8%) or suicide attempts (n = 7, 3.7%). 101 persons (53,7%) were transported to a hospital. All persons involved in the autonomous operations (n = 90; 131 persons) had minor injuries. 38 persons (29%) needed additional medical care, mainly for (suspected) fractures or stitches. In 115 (40.8%) of all operations lifeboat crews did not know that there was a medical problem at the time of departure. Crew departure time in operations with ambulance crew aboard the lifeboat (13.7 min, min. 0, max. 25, SD 5.74 min.) was significantly longer than in operations with ambulance crew on land (7.7 min, min. 0, max 21, SD 4.82 min., p < 0.001). CONCLUSION This study provides new information about the large variety of medical emergencies at sea and the way that lifeboat and ambulance crews are involved. Crew departure time in operations with ambulance crew aboard the lifeboat was significantly longer than in operations with ambulance crew on land. This study may provide useful indications for improvement of future medical operations at sea, such as triage, because in 40.8% of operations, it was not known at the time of departure that there was a medical problem.
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Affiliation(s)
- Daphne M Messelink
- Department of Internal Medicine, Ziekenhuis Groep Twente Hospital, Zilvermeeuw 1, 7609 PP, Almelo, The Netherlands.
| | - Gert-Jan van der Ploeg
- Regional Ambulance Service Noord-Holland Noord, Hertog Aalbrechtweg 22, 1823 DL, Alkmaar, The Netherlands
| | - Theo van der Linden
- The Royal Dutch Lifeboat Institution (KNRM), Haringkade 2, 1976 CP, IJmuiden, The Netherlands
| | - Roos D Flameling
- Regional Ambulance Service Ambulance Oost, Demmersweg 55, 7556 BN, Hengelo, The Netherlands
| | - Joost J L M Bierens
- Extreme Environments Laboratory, School of Sport, Health & Exercise Science, University of Portsmouth, Portsmouth, UK
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Morton S, Wareham G, Sherren P. When can an enhanced critical care team add value to equestrian related incidents? A retrospective observational study. Injury 2023; 54:110885. [PMID: 37365090 DOI: 10.1016/j.injury.2023.110885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/04/2023] [Accepted: 06/10/2023] [Indexed: 06/28/2023]
Abstract
BACKGROUND Helicopter Emergency Medical Services (HEMS) may be tasked to equestrian related incidents. Previous studies have suggested that majority of patients do not require HEMS specific interventions. No data has been published since 2015 so this article aims to establish the current incidence of equestrian incidents attended by one UK HEMS and identify trends that would aid the dispatch of HEMS to the patients who most need it. METHODS A retrospective review of the computerised record system for one UK HEMS was performed between 1st January 2015-30th June 2022. Demographic data, timings, suspected injury pattern and HEMS specific intervention details were extracted. The 20 patients with the highest confirmed injury burden were reviewed in detail. RESULTS 257 patients (229 female) were treated by HEMS (0.02% of all HEMS dispatches). Of those 124 dispatches were due to interrogation of the 999 calls by a clinician on the dispatch desk. Only 52% were conveyed to hospital by the HEMS team; 51% had no HEMS specific intervention. Of the 20 most severely injured patients their pathology included splenic, liver, spinal cord and traumatic brain injuries. CONCLUSION Whilst HEMS dispatches to equestrian incidents remain a small percentage, there are four mechanisms that may benefit due to potential injury burden: fall onto head with suggestion of hyper-extension or hyper-flexion injury; kick to the torso; horse fallen or repetitively rolled onto patient and, no movement of patient since incident. In addition, age >50 years should be considered as higher risk.
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Affiliation(s)
- Sarah Morton
- Essex Herts Air Ambulance, Flight House, Earls Colne Business Centre, Earls Colne Business Park, Earls Colne, Colchester, Essex, CO6 2NS, UK; Department of Surgery, Imperial College, London, UK.
| | - Gaynor Wareham
- Essex Herts Air Ambulance, Flight House, Earls Colne Business Centre, Earls Colne Business Park, Earls Colne, Colchester, Essex, CO6 2NS, UK
| | - Peter Sherren
- Essex Herts Air Ambulance, Flight House, Earls Colne Business Centre, Earls Colne Business Park, Earls Colne, Colchester, Essex, CO6 2NS, UK
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Nikolaj Blomberg S, Jensen TW, Porsborg Andersen M, Folke F, Kjær Ersbøll A, Torp-Petersen C, Lippert F, Collatz Christensen H. When the machine is wrong. Characteristics of true and false predictions of Out-of-Hospital Cardiac arrests in emergency calls using a machine-learning model. Resuscitation 2023; 183:109689. [PMID: 36634755 DOI: 10.1016/j.resuscitation.2023.109689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
BACKGROUND A machine-learning model trained to recognize emergency calls regarding Out-of-Hospital Cardiac Arrest (OHCA) was tested in clinical practice at Copenhagen Emergency Medical Services (EMS) from September 2018 to December 2019. We aimed to investigate emergency call characteristics where the machine-learning model failed to recognize OHCA or misinterpreted a call as being OHCA. METHODS All emergency calls were linked to the dispatch database and verified OHCAs were identified by linkage to the Danish Cardiac Arrest Registry. Calls with either false negative or false positive predictions of OHCA were evaluated by trained auditors. Descriptive analyses were performed with absolute numbers and percentages reported. RESULTS The machine-learning model processed 169,236 calls to Copenhagen EMS and suspected 5,811 (3.4%) of the calls as OHCA, resulting in 84.5% sensitivity and 97.1% specificity. Among OHCAs not recognised by machine-learning model, a condition completely different from OHCA was presented by caller in 31% of the cases. In 28% of unrecognised calls, patient was reported breathing normally, and language barriers were identified in 23% of the cases. Among falsely suspected OHCA, the patient was reported unconscious in 28% of the cases, and in 13% of the false positive cases the machine-learning model interpreted calls regarding dead patients with irreversible signs of death as OHCA. CONCLUSION Continuous optimization of the language model is needed to improve the prediction of OHCA and thereby improve sensitivity and specificity of the machine-learning model on recognising OHCA in emergency telephone calls.
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Affiliation(s)
- Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
| | - Theo W Jensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- Copenhagen Emergency Medical Services, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Christian Torp-Petersen
- Department of Cardiology, Nordsjællands Hospital, Denmark; Department of Public Health, University of Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Falck, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
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Yap J, Helmer J, Gessaroli M, Hutton J, Khan L, Scheuermeyer F, Wall N, Bolster J, Van Diepen S, Puyat J, Asamoah-Boaheng M, Straight R, Christenson J, Grunau B. Performance of the medical priority dispatch system in correctly classifying out-of-hospital cardiac arrests as appropriate for resuscitation. Resuscitation 2022; 181:123-31. [PMID: 36375652 DOI: 10.1016/j.resuscitation.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/30/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Emergency dispatch centres receive emergency calls and assign resources. Out-of-hospital cardiac arrests (OHCA) can be classified as appropriate (requiring emergent response) or inappropriate (requiring non-emergent response) for resuscitation. We sought to determine system accuracy in emergency medical services (EMS) OHCA response allocation. METHODS We analyzed EMS-assessed non-traumatic OHCA records from the British Columbia (BC) Cardiac Arrest registry (January 1, 2019-June 1, 2021), excluding EMS-witnessed cases. In BC the "Medical Priority Dispatch System" is used. We classified EMS dispatch as "emergent" or "non-emergent" and compared to the gold standard of whether EMS personnel decided treatment was appropriate upon scene arrival. We calculated sensitivity, specificity, and positive and negative predictive values (PPV, NPV), with 95% CI's. RESULTS Of 15,371 non-traumatic OHCAs, the median age was 65 (inter quartile range 51-78), and 4834 (31%) were women; 7152 (47%) were EMS-treated, of whom 651 (9.1%) survived). Among EMS-treated cases 6923/7152 had an emergent response (sensitivity = 97%, 95% CI 96-97) and among EMS-untreated cases 3951/8219 had a non-emergent response (specificity = 48%, 95% CI, 47 to 49). Among cases with emergent dispatch, 6923/11191 were EMS-treated (PPV = 62%, 95% CI 61-62), and among those with non-emergent dispatch, 3951/4180 were EMS-untreated (NPV = 95%, 95% CI 94-95); 229/4180 (5.5%) with a non-emergent dispatch were treated by EMS. CONCLUSION The dispatch system in BC has a high sensitivity and moderate specificity in sending the appropriate responses for OHCAs deemed appropriate for treatment by paramedics. Future research may address strategies to increase system specificity, and decrease the incidence of non-emergent dispatch to EMS-treated cases.
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Miller M, Bootland D, Jorm L, Gallego B. Improving ambulance dispatch triage to trauma: A scoping review using the framework of development and evaluation of clinical prediction rules. Injury 2022; 53:1746-1755. [PMID: 35321793 DOI: 10.1016/j.injury.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Ambulance dispatch algorithms should function as clinical prediction rules, identifying high acuity patients for advanced life support, and low acuity patients for non-urgent transport. Systematic reviews of dispatch algorithms are rare and focus on study types specific to the final phases of rule development, such as impact studies, and may miss the complete value-added evidence chain. We sought to summarise the literature for studies seeking to improve dispatch in trauma by performing a scoping review according to standard frameworks for developing and evaluating clinical prediction rules. METHODS We performed a scoping review searching MEDLINE, EMBASE, CINAHL, the CENTRAL trials registry, and grey literature from January 2005 to October 2021. We included all study types investigating dispatch triage to injured patients in the English language. We reported the clinical prediction rule phase (derivation, validation, impact analysis, or user acceptance) and the performance and outcomes measured for high and low acuity trauma patients. RESULTS Of 2067 papers screened, we identified 12 low and 30 high acuity studies. Derivation studies were most common (52%) and rule-based computer-aided dispatch was the most frequently investigated (23 studies). Impact studies rarely reported a prior validation phase, and few validation studies had their impact investigated. Common outcome measures in each phase were infrequent (0 to 27%), making a comparison between protocols difficult. A series of papers for low acuity patients and another for pediatric trauma followed clinical prediction rule development. Some low acuity Medical Priority Dispatch System codes are associated with the infrequent requirement for advanced life support and clinician review of computer-aided dispatch may enhance dispatch triage accuracy in studies of helicopter emergency medical services. CONCLUSIONS Few derivation and validation studies were followed by an impact study, indicating important gaps in the value-added evidence chain. While impact studies suggest clinician oversight may enhance dispatch, the opportunity exists to standardize outcomes, identify trauma-specific low acuity codes, and develop intelligent dispatch systems.
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Affiliation(s)
- Matthew Miller
- Department of Anesthesia, St George Hospital, Kogarah, Sydney, Australia; Aeromedical Operations, New South Wales Ambulance, Rozelle, Sydney, Australia; PhD Candidate, Centre for Big Data Research in Health at UNSW Sydney, Australia.
| | - Duncan Bootland
- Medical Director, Air Ambulance Kent Surrey Sussex; Department of emergency medicine, University Hospitals Sussex, Brighton, UK
| | - Louisa Jorm
- Professor, Foundation Director of the Centre for Big Data Research in Health at UNSW Sydney
| | - Blanca Gallego
- Associate Professor, Clinical analytics and machine learning unit, Centre for Big Data Research in Health, UNSW, Sydney
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Ceklic E, Tohira H, Ball S, Brown E, Brink D, Bailey P, Brits R, Finn J. A predictive ambulance dispatch algorithm to the scene of a motor vehicle crash: the search for optimal over and under triage rates. BMC Emerg Med 2022; 22:74. [PMID: 35524169 PMCID: PMC9074212 DOI: 10.1186/s12873-022-00609-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 03/17/2022] [Indexed: 11/18/2022] Open
Abstract
Background Calls for emergency medical assistance at the scene of a motor vehicle crash (MVC) substantially contribute to the demand on ambulance services. Triage by emergency medical dispatch systems is therefore important, to ensure the right care is provided to the right patient, in the right amount of time. A lights and sirens (L&S) response is the highest priority ambulance response, also known as a priority one or hot response. In this context, over triage is defined as dispatching an ambulance with lights and sirens (L&S) to a low acuity MVC and under triage is not dispatching an ambulance with L&S to those who require urgent medical care. We explored the potential for crash characteristics to be used during emergency ambulance calls to identify those MVCs that required a L&S response. Methods We conducted a retrospective cohort study using ambulance and police data from 2014 to 2016. The predictor variables were crash characteristics (e.g. road surface), and Medical Priority Dispatch System (MPDS) dispatch codes. The outcome variable was the need for a L&S ambulance response. A Chi-square Automatic Interaction Detector technique was used to develop decision trees, with over/under triage rates determined for each tree. The model with an under/over triage rate closest to that prescribed by the American College of Surgeons Committee on Trauma (ACS COT) will be deemed to be the best model (under triage rate of ≤ 5% and over triage rate of between 25–35%. Results The decision tree with a 2.7% under triage rate was closest to that specified by the ACS COT, had as predictors—MPDS codes, trapped, vulnerable road user, anyone aged 75 + , day of the week, single versus multiple vehicles, airbag deployment, atmosphere, surface, lighting and accident type. This model had an over triage rate of 84.8%. Conclusions We were able to derive a model with a reasonable under triage rate, however this model also had a high over triage rate. Individual EMS may apply the findings here to their own jurisdictions when dispatching to the scene of a MVC. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00609-5.
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Affiliation(s)
- Ellen Ceklic
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
| | - Hideo Tohira
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,St John Western Australia, Belmont, WA, Australia
| | | | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,St John Western Australia, Belmont, WA, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,St John Western Australia, Belmont, WA, Australia
| | | | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.,Emergency Medicine, Medical School, The University of Western Australia, Perth, Australia.,St John Western Australia, Belmont, WA, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Sakurai A, Ohta S, Oda J, Muguruma T, Abe T, Morimura N. ABCD approach at the #7119 center, telephone triage system in Tokyo, Japan; a retrospective cohort study. BMC Emerg Med 2022; 22:66. [PMID: 35439949 PMCID: PMC9020061 DOI: 10.1186/s12873-022-00625-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background The algorithm and protocol of the #7119 telephone triage in Tokyo, Japan, had been originally established and consists of three steps. In this study, we investigated the outcome of patients treated with physiological abnormality (ABCD approach: A, airway; B, breathing; C, circulation, and D, dysfunction of central nervous system) in step 2 during the #7119 telephone triage and clarified the meaning of evaluation of this approach. Methods We retrospectively reviewed data from the Tokyo Fire Department from January 2016 to December 2017. Almost all the patients triaged using the ABCD approach were transferred to the hospital by ambulance and assigned severity by a physician. We divided patients into groups with combinations of 15 patterns including A, B, C, D, AB, AC, AD, BC, BD, CD, ABC, ABD, ACD, BCD, and ABCD. We compared the proportion of severe cases in each group using a Fisher's exact test, followed by residual analysis. Results We analyzed 13,793 cases triaged using the ABCD approach. In this analysis, 31% of total cases were assessed as severe cases. Groupwise analysis showed that the proportion of severe cases was significantly higher in the AD, BC, CD, ABD, and ABCD groups, while it was significantly less in the C and AB groups than in the total cases. Conclusion At the #7119 telephone triage, we can pick up the severe cases by the ABCD approach. This may contribute to the prompt transportation of severe patients to hospitals by dispatching ambulance cars using the #7119 telephone triage methods.
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Affiliation(s)
- Atsushi Sakurai
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan. .,Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Oyaguchikamichou 30-1, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Sachiko Ohta
- Department of Pharmaceutical and Medical Business Sciences, Nihon Pharmaceutical University, 3-15-9 Yushima, Bunkyo-ku, Tokyo, 113-0034, Japan.,Research and Analysis, Center for Health Service Outcome Research and Development, 23-17-408 Sakuragaokashou, Shibuya-ku, Tokyo, 150-0031, Japan
| | - Jun Oda
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Traumatology and Acute Critical Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, 565-0871, Japan
| | - Takashi Muguruma
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Emergency Medicine, Yokohama City University Graduate School of Medicine, 3-9 Kanazawa-ku Fukuura, Yokoyama-city, Kanagawa, 236-0004, Japan
| | - Takeru Abe
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Advanced Critical Care and Emergency Center, Yokohama City University Medical Center, 4-57 Minami-ku Urafunemachi, Yokoyama city, Kanagawa, 232-0024, Japan
| | - Naoto Morimura
- Emergency Telephone Consultation Centre, Tokyo Medical Association, 2-5 Kandasurugadai, Chiyoda-ku, Tokyo, 101-8328, Japan.,Department of Emeregency Medicine, Teikyo Univeristy School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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11
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Samdal M, Thorsen K, Græsli O, Sandberg M, Rehn M. Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study. Scand J Trauma Resusc Emerg Med 2021; 29:169. [PMID: 34876197 PMCID: PMC8650530 DOI: 10.1186/s13049-021-00982-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/24/2021] [Indexed: 11/20/2022] Open
Abstract
Background Selection of incidents and accurate identification of patients that require assistance from physician-staffed emergency medical services (P-EMS) remain essential. We aimed to evaluate P-EMS availability, the underlying criteria for dispatch, and the corresponding dispatch accuracy of trauma care in south-east Norway in 2015, to identify areas for improvement.
Methods Pre-hospital data from emergency medical coordination centres and P-EMS medical databases were linked with data from the Norwegian Trauma Registry (NTR). Based on a set of conditions (injury severity, interventions performed, level of consciousness, incident category), trauma incidents were defined as complex, warranting P-EMS assistance, or non-complex. Incident complexity and P-EMS involvement were the main determinants when assessing the triage accuracy. Undertriage was adjusted for P-EMS availability and response and transport times. Results Among 19,028 trauma incidents, P-EMS were involved in 2506 (13.2%). The range of overtriage was 74–80% and the range of undertriage was 20–32%. P-EMS readiness in the event of complex incidents ranged from 58 to 70%. The most frequent dispatch criterion was “Police/fire brigade request immediate response” recorded in 4321 (22.7%) of the incidents. Criteria from the groups “Accidents” and “Road traffic accidents” were recorded in 10,875 (57.2%) incidents, and criteria from the groups “Transport reservations” and “Unidentified problem” in 6025 (31,7%) incidents. Among 4916 patient pathways in the NTR, 681 (13.9%) could not be matched with pre-hospital data records. Conclusions Both P-EMS availability and dispatch accuracy remain suboptimal in trauma care in south-east Norway. Dispatch criteria are too vague to facilitate accurate P-EMS dispatch, and pre-hospital data is inconsistent and insufficient to provide basic data for scientific research. Future dispatch criteria should focus on the care aspect of P-EMS. Better tools for both dispatch and incident handling for the emergency medical coordination centres are essential. In general, coordination, standardisation, and integration of existing data systems should enhance the quality of trauma care and increase patient safety. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00982-3.
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Affiliation(s)
- Martin Samdal
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway. .,Department of Anaesthesiology and Intensive Care/Air Ambulance Department, Drammen Hospital, Drammen, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Kjetil Thorsen
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Ola Græsli
- Pre-hospital Division, Emergency Medical Coordination Centre, Oslo University Hospital, Oslo, Norway
| | - Mårten Sandberg
- Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
| | - Marius Rehn
- Department of Research, Norwegian Air Ambulance Foundation, Oslo, Norway.,Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway
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12
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Tijssen JGP, Zwinderman AH, Blom MT, Koster RW. Alert system-supported lay defibrillation and basic life-support for cardiac arrest at home. Eur Heart J 2021; 43:1465-1474. [PMID: 34791171 PMCID: PMC9009403 DOI: 10.1093/eurheartj/ehab802] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 09/17/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022] Open
Abstract
Aims Automated external defibrillators (AEDs) are placed in public, but the majority of out-of-hospital cardiac arrests (OHCA) occur at home. Methods and results In residential areas, 785 AEDs were placed and 5735 volunteer responders were recruited. For suspected OHCA, dispatchers activated nearby volunteer responders with text messages, directing two-thirds to an AED first and one-third directly to the patient. We analysed survival (primary outcome) and neurologically favourable survival to discharge, time to first defibrillation shock, and cardiopulmonary resuscitation (CPR) before Emergency Medical Service (EMS) arrival of patients in residences found with ventricular fibrillation (VF), before and after introduction of this text-message alert system. Survival from OHCAs in residences increased from 26% to 39% {adjusted relative risk (RR) 1.5 [95% confidence interval (CI): 1.03–2.0]}. RR for neurologically favourable survival was 1.4 (95% CI: 0.99–2.0). No CPR before ambulance arrival decreased from 22% to 9% (RR: 0.5, 95% CI: 0.3–0.7). Text-message-responders with AED administered shocks to 16% of all patients in VF in residences, while defibrillation by EMS decreased from 73% to 39% in residences (P < 0.001). Defibrillation by first responders in residences increased from 22 to 40% (P < 0.001). Use of public AEDs in residences remained unchanged (6% and 5%) (P = 0.81). Time from emergency call to defibrillation decreased from median 11.7 to 9.3 min; mean difference –2.6 (95% CI: –3.5 to –1.6). Conclusion Introducing volunteer responders directed to AEDs, dispatched by text-message was associated with significantly reduced time to first defibrillation, increased bystander CPR and increased overall survival for OHCA patients in residences found with VF.
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Affiliation(s)
- Remy Stieglis
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Jolande A Zijlstra
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | | | | | - Jan G P Tijssen
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | | | - Marieke T Blom
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
| | - Rudolph W Koster
- Department of Cardiology, Amsterdam University Medical Center, Location AMC
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13
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Jellestad ASL, Folke F, Molin R, Lyngby RM, Hansen CM, Andelius L. Collaboration between emergency physicians and citizen responders in out-of-hospital cardiac arrest resuscitation. Scand J Trauma Resusc Emerg Med 2021; 29:110. [PMID: 34344415 PMCID: PMC8330065 DOI: 10.1186/s13049-021-00927-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Citizen responder programmes dispatch volunteer citizens to initiate resuscitation in nearby out-of-hospital cardiac arrests (OHCA) before the Emergency Medical Services (EMS) arrival. Little is known about the interaction between citizen responders and EMS personnel during the resuscitation attempt. In the Capital Region of Denmark, emergency physicians are dispatched to all suspected OHCAs. The aim of this study was to evaluate how emergency physicians perceived the collaboration with citizen responders during resuscitation attempts. METHOD This cross-sectional study was conducted through an online questionnaire. It included all 65 emergency physicians at Copenhagen EMS between June 9 and December 13, 2019 (catchment area 1.8 million). The questionnaire examined how emergency physicians perceived the interaction with citizen responders at the scene of OHCA (use of citizen responders before and after EMS arrival, citizen responders' skills in cardiopulmonary resuscitation (CPR), and challenges in this setting). RESULTS The response rate was 87.7% (57/65). Nearly all emergency physicians (93.0%) had interacted with a citizen responder at least once. Of those 92.5%(n = 49) considered it relevant to activate citizen responders to OHCA resuscitation, and 67.9%(n = 36) reported the collaboration as helpful. When citizen responders arrived before EMS, 75.5%(n = 40) of the physicians continued to use citizen responders to assist with CPR or to carry equipment. Most (84.9%, n = 45) stated that citizen responders had the necessary skills to perform CPR. Challenges in the collaboration were described by 20.7%(n = 11) of the emergency physicians and included citizen responders being mistaken for relatives, time-consuming communication, or crowding problems during resuscitation. CONCLUSION Emergency physicians perceived the collaboration with citizen responders as valuable, not only for delivery of CPR, but were also considered an extra helpful resource providing non-CPR related tasks such as directing the EMS to the arrest location, carrying equipment and taking care of relatives.
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Affiliation(s)
- Anne-Sofie Linde Jellestad
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Rune Molin
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark
| | - Rasmus Meyer Lyngby
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Kingston University and St. Georges, University of London, London, UK
| | - Carolina Malta Hansen
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Linn Andelius
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, opgang 2, 3. sal, 2750, Ballerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Berkeveld E, Sierkstra TCN, Schober P, Schwarte LA, Terra M, de Leeuw MA, Bloemers FW, Giannakopoulos GF. Characteristics of helicopter emergency medical services (HEMS) dispatch cancellations during a six-year period in a Dutch HEMS region. BMC Emerg Med 2021; 21:50. [PMID: 33863280 PMCID: PMC8052688 DOI: 10.1186/s12873-021-00439-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background For decades, Helicopter Emergency Medical Services (HEMS) contribute greatly to prehospital patient care by performing advanced medical interventions on-scene. Unnecessary dispatches, resulting in cancellations, cause these vital resources to be temporarily unavailable and generate additional costs. A previous study showed a cancellation rate of 43.5% in our trauma region. However, little recent data about cancellation rates and reasons exist, despite revision of dispatch protocols. This study examines the current cancellation rate in our trauma region over a six-year period. Additionally, cancellation reasons are evaluated per type of dispatch and initial incident report, upon which HEMS is dispatched. Methods This retrospective study analyzed the data of the Dutch HEMS Lifeliner 1 (North-West region of the Netherlands, covering a population of 5 million inhabitants), analyzing all subsequent cases between April 1st 2013 and April 1st 2019. Patient characteristics, type of dispatch (primary; based on dispatcher criteria versus secondary, as judged by the first ambulance team on site), initial incident report received by the EMS dispatch center, and information regarding day- or nighttime dispatches were collected. In case of cancellation, cancel rate and reason per type of dispatch and initial incident report were assessed. Results In total, 18,638 dispatches were included. HEMS was canceled in 54.5% (95% CI 53.8–55.3%) of cases. The majority of canceled dispatches (76.1%) were canceled because respiratory, hemodynamic, and neurologic parameters were stable. Dispatches simultaneously activated with EMS (primary dispatch) were canceled in 58.3%, compared to 15.1% when HEMS assistance was requested by EMS based on their findings on-scene (secondary dispatch). A cancellation rate of 54.6% was found in trauma related dispatches (n = 12,148), compared to 52.2% in non-trauma related dispatches (n = 5378). Higher cancellation rates exceeding 60% were observed in the less common dispatch categories, e.g., anaphylaxis (66.3%), unknown incident report (66.0%), assault with a blunt object (64.1%), obstetrics (62.8%), and submersion (61.9%). Conclusion HEMS cancellations are increased, compared to previous research in our region. Yet, the cancellations are acceptable as the effect on HEMS’ unavailbility remains minimized. Focus should be on identifying the patient in need of HEMS care while maintaining overtriage rates low. Continuous evaluation of HEMS triage is important, and dispatch criteria should be adjusted if necessary.
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Affiliation(s)
- E Berkeveld
- Department of Trauma Surgery, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.
| | - T C N Sierkstra
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - P Schober
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Helicopter Emergency Medical Service (HEMS) Life Liner One, Amsterdam, The Netherlands
| | - L A Schwarte
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Helicopter Emergency Medical Service (HEMS) Life Liner One, Amsterdam, The Netherlands
| | - M Terra
- Department of Trauma Surgery, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Helicopter Emergency Medical Service (HEMS) Life Liner One, Amsterdam, The Netherlands
| | - M A de Leeuw
- Department of Anesthesiology, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands.,Helicopter Emergency Medical Service (HEMS) Life Liner One, Amsterdam, The Netherlands
| | - F W Bloemers
- Department of Trauma Surgery, Amsterdam UMC location VUmc, De Boelelaan 1117, 1081, HV, Amsterdam, The Netherlands
| | - G F Giannakopoulos
- Helicopter Emergency Medical Service (HEMS) Life Liner One, Amsterdam, The Netherlands.,Department of Trauma Surgery, Amsterdam UMC location AMC, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
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15
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Mohindru J, Griggs JE, de Coverly R, Lyon RM, Ter Avest E. Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin. BMC Emerg Med 2020; 20:92. [PMID: 33238877 PMCID: PMC7690130 DOI: 10.1186/s12873-020-00388-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Sudden loss of consciousness (LOC) in the prehospital setting in the absence of cardiac arrest and seizure activity may be a challenge from a dispatcher’s perspective: The aetiology is varied, with many causes being transient and mostly self-limiting, whereas other causes are potentially life threatening. In this study we aim to evaluate the dispatch of HEMS to patients with LOC of medical origin, by exploring to which patients with a LOC HEMS is dispatched, which interventions HEMS teams perform in these patients, and whether HEMS interventions can be predicted by patient characteristics. Methods We performed retrospective cohort study of all patients with a reported unexplained LOC (e.g. not attributable to a circulatory arrest or seizures) attended by the Air Ambulance Kent, Surrey & Sussex (AAKSS), over a 4-year period (July 2013–December 2017). Primary outcome was defined as the number of HEMS-specific interventions performed in patients with unexplained LOC. Secondary outcome was the relation of clinical- and dispatch criteria with HEMS interventions being performed. Results During the study period, 127 patients with unexplained LOC were attended by HEMS. HEMS was dispatched directly to 25.2% of the patients, but mostly (74.8%) on request of the ground ambulance crews. HEMS interventions were performed in 65% of the patients (Prehospital Emergency Anaesthesia 56%, hyperosmolar therapy 21%, antibiotic/antiviral therapy 8%, vasopressor therapy 6%) and HEMS conveyed most patients (77%) to hospital. Acute neurological pathology was a prevalent underlying cause of unexplained LOC: 38% had gross pathology on their CT-scan upon arrival in hospital. Both GCS (r = − 0.60, p < .001) and SBP (r = 0.31, p < .001) were related to HEMS interventions being performed on scene. A GCS < 13 predicted the need for HEMS interventions in our population with a sensitivity of 94.9% and a specificity 75% (AUC 0.85). Conclusion HEMS dispatchers and ambulance personnel are able to identify a cohort of patients with unexplained LOC of medical origin who suffer from potentially life threatening (mainly neurological) pathology, in whom HEMS specific intervention are frequently required. Presenting GCS can be used to inform the triage process of patients with LOC at an early stage. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-020-00388-x.
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Affiliation(s)
- J Mohindru
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J E Griggs
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R de Coverly
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R M Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,University of Surrey, Duke of Kent Building, Guildford, School of Health Sciences, Guildford, GU2 7XH, UK
| | - E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Airfield Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. .,Department of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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16
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Tjelmeland IBM, Masterson S, Herlitz J, Wnent J, Bossaert L, Rosell-Ortiz F, Alm-Kruse K, Bein B, Lilja G, Gräsner JT. Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe. Scand J Trauma Resusc Emerg Med 2020; 28:103. [PMID: 33076942 PMCID: PMC7569761 DOI: 10.1186/s13049-020-00798-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe European Emergency Medical Systems, particularly from the perspective of country and ambulance service characteristics, cardiac arrest identification, dispatch, treatment, and monitoring. Methods An online questionnaire with 51 questions about ambulance and dispatch characteristics, on-scene management of cardiac arrest and the availability and dataset in cardiac arrest registries, was sent to all national coordinators who participated in the European Registry of Cardiac Arrest studies. In addition, individual invitations were sent to the remaining European countries. Results Participants from 28 European countries responded to the questionnaire. Results were combined with official information on population density. Overall, the number of Emergency Medical Service missions, level of training of personnel, availability of Helicopter Emergency Medical Services and the involvement of first responders varied across and within countries. There were similarities in team training, availability of key resuscitation equipment and permission for ongoing performance of cardiopulmonary resuscitation during transported. The quality of reporting to cardiac arrest registries varied, as well as the data availability in the registries. Conclusions Throughout Europe there are important differences in Emergency Medical Service systems and the response to out-of-hospital cardiac arrest. Explaining these differences is complicated due to significant variation in how variables are reported to and used in registries.
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Affiliation(s)
- Ingvild B M Tjelmeland
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany. .,Division of Prehospital Services, Oslo University Hospital, Oslo, Norway. .,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Siobhan Masterson
- The National Ambulance Service Ireland and the National University of Ireland Galway (on behalf of the Out-of-Hospital Cardiac Arrest Register (OHCAR)), Galway, Ireland
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden.,European Resuscitation Council, Niel, Belgium
| | - Jan Wnent
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,Department of Anesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany.,School of Medicine, University of Namibia, Windhoek, Namibia
| | - Leo Bossaert
- European Resuscitation Council, Niel, Belgium.,University of Antwerp, Antwerp, Belgium
| | - Fernando Rosell-Ortiz
- European Resuscitation Council, Niel, Belgium.,Servicio de Urgencias y Emergencias 061 de La Rioja, Logroño, Spain
| | - Kristin Alm-Kruse
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research & Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Berthold Bein
- Anaesthesiology and Intensive Care Medicine, Asklepios Hospital St. Georg, Hamburg, Germany.,Faculty of Medicine, Semmelweis University, Hamburg, Germany
| | - Gisela Lilja
- Department of Clinical Sciences Lund, Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Str. 3, 24105, Kiel, Germany.,European Resuscitation Council, Niel, Belgium.,Department of Anesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Kiel, Germany
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17
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Galbraith N, Boyda D, McFeeters D, Galbraith V. Patterns of occupational stress in police contact and dispatch personnel: implications for physical and psychological health. Int Arch Occup Environ Health 2020; 94:231-241. [PMID: 33044570 DOI: 10.1007/s00420-020-01562-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Occupational stress in police call handlers is researched less frequently than in operational or frontline police, despite the role's unique challenges. Occupational stress is potentially manageable, thus improved understanding of its contributors and consequences is important for effective intervention. We aimed to compare levels and sources of organisational stress in police contact and dispatch personnel with UK benchmarks. Second, to test whether different typologies of stress were associated with physical health, mental health and substance use. Finally, to examine whether non-organisational factors (socio-demographic factors and family interference with work (FIW)) predicted organisational stress typologies. METHODS A sample (n = 720) of police and civilian staff in a UK police call and dispatch centre were surveyed. RESULTS The strongest sources of stress were competing and high demands, low control, insufficient managerial support and ambiguity surrounding workplace change-all of which indicated need for 'urgent action' according to UK benchmarks. Substance use and particularly mental health difficulties were higher than published norms. A latent profile analysis grouped respondents into a low-stress group and two high-stress profiles. As stress increased across profiles, this corresponded with worse physical and mental health and higher substance use. FIW predicted membership of both high-stress profiles. CONCLUSION Despite non-operational roles, police contact and despatch personnel can experience high occupational stress which is associated with physical and mental health difficulties and substance use. Organisational-level interventions which address lack of control, conflicting role demands as well as enhance management support and communication around change might be most effective in this group.
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Affiliation(s)
- Niall Galbraith
- Department of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, MC Building (room MC317), Wolverhampton, WV1 1LY, UK.
| | - David Boyda
- Department of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, MC Building (room MC317), Wolverhampton, WV1 1LY, UK
| | - Danielle McFeeters
- Department of Psychology, Faculty of Education, Health and Wellbeing, University of Wolverhampton, MC Building (room MC317), Wolverhampton, WV1 1LY, UK
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18
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O'Shaughnessy E, Cruce JR, Xu K. Too much of a good thing? Global trends in the curtailment of solar PV. Sol Energy 2020; 208:1068-1077. [PMID: 32908323 PMCID: PMC7470769 DOI: 10.1016/j.solener.2020.08.075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 07/28/2020] [Accepted: 08/24/2020] [Indexed: 06/11/2023]
Abstract
Solar photovoltaic (PV) systems generate electricity with no marginal costs or emissions. As a result, PV output is almost always prioritized over other fuel sources and delivered to the electric grid. However, PV curtailment is increasing as PV composes greater shares of grid capacity. In this paper, we present a novel synthesis of curtailment in four key countries: Chile, China, Germany, and the United States. We find that about 6.5 million MWh of PV output was curtailed in these countries in 2018. We find that: Policy and grid planning practices influence where, when, and how much PV is curtailed; Some PV curtailment is attributable to limited transmission capacity connecting remote solar resources to load centers; PV curtailment peaks in the spring and fall, when PV output is relatively high but electricity demand is relatively low. We discuss available measures to reduce PV curtailment as well as increasing PV curtailment in the contexts of evolving grids and energy technologies.
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Affiliation(s)
- Eric O'Shaughnessy
- National Renewable Energy Laboratory, 15013 Denver West Parkway, Golden, CO 80401, USA
- Clean Kilowatts, LLC, USA
| | - Jesse R Cruce
- National Renewable Energy Laboratory, 15013 Denver West Parkway, Golden, CO 80401, USA
| | - Kaifeng Xu
- National Renewable Energy Laboratory, 15013 Denver West Parkway, Golden, CO 80401, USA
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Parker SA, Kus T, Bowry R, Gutierrez N, Cai C, Yamal JM, Rajan S, Wang M, Jacob AP, Souders C, Persse D, Grotta JC. Enhanced dispatch and rendezvous doubles the catchment area and number of patients treated on a mobile stroke unit. J Stroke Cerebrovasc Dis 2020; 29:104894. [PMID: 32689599 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104894] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/11/2020] [Accepted: 04/14/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mobile Stroke Units (MSUs) deliver acute stroke treatment on-scene in coordination with Emergency Medical Services (EMS). One criticism of the MSU approach is the limited range of a single MSU. The Houston MSU is evaluating MSU implementation, and we developed a rendezvous approach as an innovative solution to expand the range and number of patients treated. METHODS In addition to direct 911 dispatch of our MSU to the scene within our 7-mile catchment area, we empowered more distant EMS units to activate the MSU. We also monitored EMS radio communications to identify possible patients. For these distant patients, the MSU met the EMS unit en route to the stroke center and treated the patient at that intermediate location. The distribution of the distance from MSU base station to site of stroke and time from 911 alert to tissue plasminogen activator (tPA) bolus were compared between patients treated on-scene and by rendezvous using Wilcoxon rank sum test. RESULTS Over 4 years, 338 acute ischemic stroke patients were treated with tPA on our MSU. Of these, 169 (50%) were treated on-scene after MSU dispatch at a median of 6.4 miles (IQR 6.4 miles) from MSU base station. 169 (50%) were treated by 'rendezvous' pathway with assessment and treatment of stroke a median of 12.4 miles from base (IQR 5.5 miles) (p< 0.0001). Time (min) from MSU alert to tPA bolus did not differ: 36.0 ± 10.0 for on-scene vs 37.0 ± 10.0 with rendezvous (p=0.65). 13% of patients alerted via direct 911 dispatch were treated vs 44% of rendezvous patients. CONCLUSION Adding a rendezvous approach to an MSU dispatch pathway doubles the range of operations and the number of patients treated by an MSU in an urban area, without incurring delay.
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Affiliation(s)
- Stephanie A Parker
- McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
| | - Tessa Kus
- McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
| | - Ritvij Bowry
- McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
| | - Nicole Gutierrez
- McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States.
| | - Chunyan Cai
- McGovern Medical School at the University of Texas Health Science Center, 6410 Fannin St, Suite 1423, Houston, TX 77030, United States
| | - Jose-Miguel Yamal
- School of Public Health at the University of Texas Health Science Center, Houston, TX, United States.
| | - Suja Rajan
- School of Public Health at the University of Texas Health Science Center, Houston, TX, United States.
| | - Mengxi Wang
- School of Public Health at the University of Texas Health Science Center, Houston, TX, United States.
| | - Asha P Jacob
- School of Public Health at the University of Texas Health Science Center, Houston, TX, United States.
| | | | - David Persse
- Baylor College of Medicine, Houston, TX, United States.
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Abstract
The COVID-19 crisis is an unprecedented event. It is therefore essential for dispatch centres to share their experiences while the crisis is underway, similar to hospitals, so that we will all benefit from feedback. This letter to the editor describes the Lausanne dispatch centre response to COVID-19 and the lessons learned so far.
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Affiliation(s)
- Fabrice Dami
- Emergency Department, Lausanne University Hospital, University of Lausanne, CH-1011, Lausanne, Switzerland. .,Fondation Urgences-Santé, Lausanne medical dispatch, Lausanne, Switzerland.
| | - Vincent Berthoz
- Fondation Urgences-Santé, Lausanne medical dispatch, Lausanne, Switzerland
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21
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Stieglis R, Zijlstra JA, Riedijk F, Smeekes M, van der Worp WE, Koster RW. AED and text message responders density in residential areas for rapid response in out-of-hospital cardiac arrest. Resuscitation 2020; 150:170-177. [PMID: 32045663 DOI: 10.1016/j.resuscitation.2020.01.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND For out-of-hospital cardiac arrest (OHCA) in residential areas, a dispatcher driven alert-system using text messages (TM-system) directing local rescuers (TM-responders) to OHCA patients was implemented and the desired density of automated external defibrillators (AEDs) or TM-responders investigated. METHODS We included OHCA cases with the TM-system activated in residential areas between 2010-2017. For each case, densities/km2 of activated AEDs and TM-responders within a 1000 m circle were calculated. Time intervals between 112-call and first defibrillation were calculated. RESULTS In total, 813 patients (45%) had a shockable initial rhythm. In 17% a TM-system AED delivered the first shock. With increasing AED density, the median time to shock decreased from 10:59 to 08:17 min. (p < 0.001) and shocks <6 min increased from 6% to 12% (p = 0.024). Increasing density of TM-responders was associated with a decrease in median time to shock from 10:59 to 08:20 min. (p < 0.001) and increase of shocks <6 min from 6% to 13% (p = 0.005). Increasing density of AEDs and TM-responders resulted in a decline of ambulance first defibrillation by 19% (p = 0.016) and 22% (p = 0.001), respectively. First responder AED defibrillation did not change significantly. Densities of >2 AEDs/km2 did not result in further decrease of time to first shock but >10 TM-responders/km2 resulted in more defibrillations <6 min. CONCLUSION With increasing AED and TM-responder density within a TM-system, time to defibrillation in residential areas decreased. AED and TM-responders only competed with ambulances, not with first responders. The recommended density of AEDs and TM-responders for earliest defibrillation is 2 AEDs/km2 and >10 TM-responders/km2.
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Affiliation(s)
- Remy Stieglis
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands.
| | - Jolande A Zijlstra
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
| | - Frank Riedijk
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | - Martin Smeekes
- Veiligheidsregio Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Rudolph W Koster
- Amsterdam UMC, University of Amsterdam, Department of Cardiology, Amsterdam, The Netherlands
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22
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Tamminen J, Lydén E, Kurki J, Huhtala H, Kämäräinen A, Hoppu S. Spontaneous trigger words associated with confirmed out-of-hospital cardiac arrest: a descriptive pilot study of emergency calls. Scand J Trauma Resusc Emerg Med 2020; 28:1. [PMID: 31900203 PMCID: PMC6942298 DOI: 10.1186/s13049-019-0696-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/23/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND According to the International Liaison Committee on Resuscitation (ILCOR), the trigger words used by callers that are associated with cardiac arrest constitute a scientific knowledge gap. This study was designed to find hypothetical trigger words in emergency calls in order to improve the specificity of out-of-hospital cardiac arrest recognition. METHODS In this descriptive pilot study conducted in a Finnish hospital district, linguistic contents of 80 emergency calls of dispatcher-suspected or EMS-encountered out-of-hospital cardiac arrests between January 1, 2017 and May 31, 2017 were analysed. Spontaneous trigger words used by callers were transcribed and grouped into 36 categories. The association between the spontaneous trigger words and confirmed true cardiac arrests was tested with logistic regression. RESULTS Of the suspected cardiac arrests, 51 (64%) were confirmed as true cardiac arrests when ambulance personnel met the patient. A total of 291 spontaneous trigger words were analysed. 'Is not breathing' (n = 9 [18%] in the true cardiac arrest group vs n = 1 [3%] in the non-cardiac arrest group, odds ratio [OR] 6.00, 95% confidence interval [CI] 0.72-50.0), 'the patient is blue' (n = 9 [18%] vs n = 1 [3%], OR 6.00, 95% CI 0.72-50.0), 'collapsed or fallen down' (n = 12 [24%] vs n = 2 [7%], OR 4.15, 95% CI 0.86-20.1) and 'is wheezing' (n = 17 [33%] vs n = 5 [17%], OR 2.40, 95% CI 0.78-7.40) were frequently used to describe true cardiac arrest. 'Is snoring' was associated with a false suspicion of cardiac arrest (n = 1 [2%] vs n = 6 [21%], OR 0.08, 95% CI 0.009-0.67). CONCLUSIONS In our pilot study, no trigger word was associated with confirmed cardiac arrest. 'Is wheezing' was a frequently used spontaneous trigger word among later confirmed cardiac arrest victims.
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Affiliation(s)
- Joonas Tamminen
- Faculty of Medicine and Health Technology, Tampere University, PO Box 2000, FI-33520, Tampere, Finland. .,Emergency Medical Services, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland.
| | - Erik Lydén
- Emergency Medical Services, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
| | - Jan Kurki
- Emergency Medical Services, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
| | - Heini Huhtala
- Biostatistics, Faculty of Social Sciences, Tampere University, FI-33014, Tampere, Finland
| | - Antti Kämäräinen
- Emergency Medical Services, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Tampere University Hospital, PO Box 2000, FI-33521, Tampere, Finland
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23
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Lerner EB, Farrell BM, Colella MR, Sternig KJ, Westrich C, Cady CE, Liu JM. A centralized system for providing dispatcher assisted CPR instructions to 9-1-1 callers at multiple municipal public safety answering points. Resuscitation 2019; 142:46-49. [PMID: 31323187 DOI: 10.1016/j.resuscitation.2019.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Dispatcher CPR instruction increases the odds of survival. However, many communities do not provide this lifesaving intervention, often citing the barriers of limited personnel, funding, and liability. OBJECTIVE Describe the implementation of a novel centralized dispatcher CPR instruction program that serves seven public safety answering points (PSAPs). METHODS Seven municipal PSAPs that did not previously provide dispatcher instructions implemented our program. Using a 30-min self-directed video, 84 PSAP dispatchers were trained to utilize a two-question protocol to identify and transfer suspected out-of-hospital cardiac arrest (OHCA) cases to a central communication center. At this central communication center, a trained communicator delivered CPR instructions to the caller. The 26 central communicators were trained with a 2-h in-person didactic session followed by a 2-h practice session. We collected and analyzed data from recordings of communicator-to-caller interactions. RESULTS 169 calls were transferred to the central communication center. Of those, 106 needed CPR instructions and 56 of those callers performed chest compressions (53%). The county-wide EMS documented bystander CPR rate was 20% the prior year. The 63 remaining transferred calls were non-OHCA calls. Of the calls where CPR was needed and performed, 11 victims survived to hospital discharge (20%); the countywide survival rate was 12%. CONCLUSIONS Using a central communication center for instructions allowed us to train and maintain a smaller group of communicators, leading to less cost and more experience for those communicators, while limiting the burden on PSAP dispatchers.
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Affiliation(s)
- E Brooke Lerner
- Department of Emergency Medicine, University at Buffalo, Buffalo, NY, United States; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
| | - Brittany M Farrell
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | - M Riccardo Colella
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
| | | | | | - Charles E Cady
- ProHealth Care, Waukesha Memorial Hospital, Waukesha, WI, United States
| | - J Marc Liu
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States
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24
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Ter Avest E, Lambert E, de Coverly R, Tucker H, Griggs J, Wilson MH, Ghorbangholi A, Williams J, Lyon RM. Live video footage from scene to aid helicopter emergency medical service dispatch: a feasibility study. Scand J Trauma Resusc Emerg Med 2019; 27:55. [PMID: 31068199 PMCID: PMC6505217 DOI: 10.1186/s13049-019-0632-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/26/2019] [Indexed: 11/20/2022] Open
Abstract
Background Obtaining accurate information from a 112 caller is key to correct tasking of Helicopter Emergency Medical Services (HEMS). Being able to view the incident scene via video from a mobile phone may assist HEMS dispatch by providing more accurate information such as mechanism of injury and/or injuries sustained. The objective of this study is to describe the acceptability and feasibility of using live video footage from the mobile phone of a 112 caller as an HEMS dispatch aid. Methods Live footage is obtained via the 112 caller’s mobile phone camera through the secure GoodSAM app’s Instant-on-scene™ platform. Video footage is streamed directly to the dispatcher, and not stored. During the feasibility trial period, dispatchers noted the purpose for which they used the footage and rated ease of use and any technical- and operational issues they encountered. A subjective assessment of caller acceptance to use video was conducted. Results Video footage from scene was attempted for 21 emergency calls. The leading reasons listed by the dispatchers to use live footage were to directly assess the patient (18/21) and to obtain information about the mechanism of injury and the scene (11/21). HEMS dispatchers rated the ease of use with a 4.95 on a 5-point scale (range 4–5). All callers gave permission to stream from their telephone camera. Video footage from scene was successfully obtained in 19 calls, and was used by the dispatcher as an aid to send (5) or stand down (14) a Helicopter Emergency Medical Services team. Conclusion Live video footage from a 112 caller can be used to provide dispatchers with more information from the scene of an incident and the clinical condition of the patient(s). The use of mobile phone video was readily accepted by the 112 caller and the technology robust. Further research is warranted to assess the impact video from scene could have on HEMS dispatching.
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Affiliation(s)
- E Ter Avest
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK. .,Department of Emergency Medicine, University Hospital Groningen, Groningen, the Netherlands.
| | - E Lambert
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - R de Coverly
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - H Tucker
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - J Griggs
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK
| | - M H Wilson
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,Neurotrauma Centre, Imperial College, London, UK
| | | | - J Williams
- School of Health Sciences, University of Surrey, Guildford, UK.,South East Coast Ambulance Service NHS Foundation Trust, Crawley, UK
| | - R M Lyon
- Air Ambulance Kent, Surrey and Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.,School of Health Sciences, University of Surrey, Guildford, UK
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25
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Lunde A, Tellefsen C. Patient and rescuer safety: recommendations for dispatch and prioritization of rescue resources based on a retrospective study of Norwegian avalanche incidents 1996-2017. Scand J Trauma Resusc Emerg Med 2019; 27:5. [PMID: 30642369 PMCID: PMC6332597 DOI: 10.1186/s13049-019-0585-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 01/03/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Avalanche emergency response should address current accident scenarios to optimize survival chances of victims and to keep rescuers safe. The purpose of this article is to present a basis for evaluation and necessary adjustments in dispatch, prioritization, and management of Norwegian avalanche rescue operations. METHODS This is the first peer-reviewed retrospective study of all Norwegian avalanche incidents registered by the two Joint Rescue Co-ordination Centers (JRCCs) in the period 1996-2017 that describes the characteristics and trends of rescue missions and victims. RESULTS The Norwegian JRCCs have registered 720 snow avalanche events, with a total of 568 avalanche victims, of which 120 (21%) died. Including those fatally injured, a total of 313 avalanche victims in 209 accidents were treated as patients (55%), and we saw > 1 patient in 24% of these operations. Norwegian avalanche victims were partially or completely recovered prior to the arrival of rescuers in 75% (n = 117) of all rescue operations. In the remaining 25% of cases, the rescue service located 62% (n = 55) of the avalanche victims visually or electronically. In 50% of the 720 incidents, rescuers spent time searching in avalanches with no victims. CONCLUSIONS This survey indicates that we have experienced a shift in Norwegian avalanche rescue: from search for missing persons in the avalanche debris to immediate medical care of already-located patients. The findings suggest that a stronger focus on both patient and rescuer safety is necessary. The patients must be ensured the right treatment at the right place at the right time and the allocation of rescue resources must reflect a need to reduce exposure in avalanche terrain, especially in cases with no affirmed victims. We present a flowchart with a recommended rescue response to avalanche accidents in Norway.
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Affiliation(s)
- Albert Lunde
- University of Stavanger, 4036, Stavanger, Norway.
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26
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Abstract
There are 240 million 9-1-1 calls in the United States every year. The burden of managing these emergencies until first responders can arrive is on the dispatchers working in the 5806 public safety answering points, more commonly known as dispatch centers. They are the first link in the chain of survival between the public and the remainder of the health care system. Dispatchers play a critical role in the early identification of emergencies, assignment of appropriate emergency resources, and provision of life-sustaining interventions like dispatcher-assisted cardiopulmonary resuscitation and disaster management.
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Affiliation(s)
- Saman Kashani
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA.
| | - Stephen Sanko
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
| | - Marc Eckstein
- Los Angeles Fire Department, EMS Bureau, 200 North Main Street, Suite 1860, Los Angeles, CA 90012, USA; Division of Emergency Medical Services, Department of Emergency Medicine, Keck School of Medicine of USC, 1200 North State Street, Room 1011, Los Angeles, CA 90033, USA
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27
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Riou M, Ball S, Whiteside A, Bray J, Perkins GD, Smith K, O'Halloran KL, Fatovich DM, Inoue M, Bailey P, Cameron P, Brink D, Finn J. 'We're going to do CPR': A linguistic study of the words used to initiate dispatcher-assisted CPR and their association with caller agreement. Resuscitation 2018; 133:95-100. [PMID: 30316951 DOI: 10.1016/j.resuscitation.2018.10.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 09/27/2018] [Accepted: 10/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In emergency ambulance calls for out-of-hospital cardiac arrest (OHCA), dispatcher-assisted cardiopulmonary resuscitation (CPR) plays a crucial role in patient survival. We examined whether the language used by dispatchers to initiate CPR had an impact on callers' agreement to perform CPR. METHODS We analysed 424 emergency calls relating to cases of paramedic-confirmed OHCA where OHCA was recognised by the dispatcher, the caller was with the patient, and resuscitation was attempted by paramedics. We investigated the linguistic choices used by dispatchers to initiate CPR, and the impact of those choices on caller agreement to perform CPR. RESULTS Overall, CPR occurred in 85% of calls. Caller agreement was low (43%) when dispatchers used terms of willingness ("do you want to do CPR?"). Caller agreement was high (97% and 84% respectively) when dispatchers talked about CPR in terms of futurity ("we are going to do CPR") or obligation ("we need to do CPR"). In 38% (25/66) of calls where the caller initially declined CPR, the dispatcher eventually secured their agreement by making several attempts at initiating CPR. CONCLUSION There is potential for increased agreement to perform CPR if dispatchers are trained to initiate CPR with words of futurity and/or obligation.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia
| | | | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, 3004, Australia; Ambulance Victoria, Blackburn North, Victoria, 3130, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Bentley, WA, 6102, Australia
| | - Daniel M Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, WA, 6847, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA, 6102, Australia; St John Ambulance (WA), Belmont, WA, 6104, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria, 3004, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA, 6009, Australia
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28
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Munro S, Joy M, de Coverly R, Salmon M, Williams J, Lyon RM. A novel method of non-clinical dispatch is associated with a higher rate of critical Helicopter Emergency Medical Service intervention. Scand J Trauma Resusc Emerg Med 2018; 26:84. [PMID: 30253795 PMCID: PMC6156918 DOI: 10.1186/s13049-018-0551-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 09/19/2018] [Indexed: 11/10/2022] Open
Abstract
Background Helicopter Emergency Medical Services (HEMS) are a scarce resource that can provide advanced emergency medical care to unwell or injured patients. Accurate tasking of HEMS is required to incidents where advanced pre-hospital clinical care is needed. We sought to evaluate any association between non-clinically trained dispatchers, following a bespoke algorithm, compared with HEMS paramedic dispatchers with respect to incidents requiring a critical HEMS intervention. Methods Retrospective analysis of prospectively collected data from two 12-month periods was performed (Period one: 1st April 2014 – 1st April 2015; Period two: 1st April 2016 – 1st April 2017). Period 1 was a Paramedic-led dispatch process. Period 2 was a non-clinical HEMS dispatcher assisted by a bespoke algorithm. Kent, Surrey & Sussex HEMS (KSS HEMS) is tasked to approximately 2500 cases annually and operates 24/7 across south-east England. The primary outcome measure was incidence of a HEMS intervention. Results A total of 4703 incidents were included; 2510 in period one and 2184 in period two. Variation in tasking was reduced by introducing non-clinical dispatchers. There was no difference in median time from 999 call to HEMS activation between period one and two (period one; median 7 min (IQR 4–17) vs period two; median 7 min (IQR 4–18). Non-clinical dispatch improved accuracy of HEMS tasking to a mission where a critical care intervention was required (OR 1.25, 95% CI 1.04–1.51, p = 0.02). Conclusion The introduction of non-clinical, HEMS-specific dispatch, aided by a bespoke algorithm improved accuracy of HEMS tasking. Further research is warranted to explore where this model could be effective in other HEMS services.
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Affiliation(s)
- Scott Munro
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.,Kent, Surrey & Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.,South East Coast Ambulance Service NHS Foundation Trust, Banstead, Surrey, SM7 2AS, UK
| | - Mark Joy
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Richard de Coverly
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK
| | - Mark Salmon
- Kent, Surrey & Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK
| | - Julia Williams
- South East Coast Ambulance Service NHS Foundation Trust, Banstead, Surrey, SM7 2AS, UK.,School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, England
| | - Richard M Lyon
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK. .,Kent, Surrey & Sussex Air Ambulance Trust, Redhill Airfield, Redhill, Surrey, RH1 5YP, UK.
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Pförringer D, Breu M, Crönlein M, Kolisch R, Kanz KG. Closure simulation for reduction of emergency patient diversion: a discrete agent-based simulation approach to minimizing ambulance diversion. Eur J Med Res 2018; 23:32. [PMID: 29884227 PMCID: PMC5994037 DOI: 10.1186/s40001-018-0330-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 05/29/2018] [Indexed: 12/02/2022] Open
Abstract
Background The city of Munich uses web-based information system IVENA to promote exchange of information regarding hospital offerings and closures between the integrated dispatch center and hospitals to support coordination of the emergency medical services. Hospital crowding resulting in closures and thus prolonged transportation time poses a major problem. An innovative discrete agent model simulates the effects of novel policies to reduce closure times and avoid crowding. Methods For this analysis, between 2013 and 2017, IVENA data consisting of injury/disease, condition, age, estimated arrival time and assigned hospital or hospital-closure statistics as well as underlying reasons were examined. Two simulation experiments with three policy variations are performed to gain insights on the influence of diversion policies onto the outcome variables. Results A total of 530,000+ patients were assigned via the IVENA system and 200,000+ closures were requested during this time period. Some hospital units request a closure on more than 50% of days. The majority of hospital closures are not triggered by the absolute number of patient arrivals, but by a sudden increase within a short time period. Four of the simulations yielded a specific potential for shortening of overall closure time in comparison to the current status quo. Conclusion Effective solutions against crowding require common policies to limit closure status periods based on quantitative thresholds. A new policy in combination with a quantitative arrival sensor system may reduce closing hours and optimize patient flow.
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Affiliation(s)
- D Pförringer
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.
| | - M Breu
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany.,TUM School of Management, Technische Universität München, Arcisstr. 21, 80333, Munich, Germany
| | - M Crönlein
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
| | - R Kolisch
- TUM School of Management, Technische Universität München, Arcisstr. 21, 80333, Munich, Germany
| | - K-G Kanz
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, Technische Universität München, Ismaninger Str. 22, 81675, Munich, Germany
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Sinclair N, Swinton PA, Donald M, Curatolo L, Lindle P, Jones S, Corfield AR. Clinician tasking in ambulance control improves the identification of major trauma patients and pre-hospital critical care team tasking. Injury 2018; 49:897-902. [PMID: 29622470 DOI: 10.1016/j.injury.2018.03.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 03/09/2018] [Accepted: 03/29/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Trauma remains the fourth leading cause of death in western countries and is the leading cause of death in the first four decades of life. NICE guidance in 2016 advocated the attendance of pre-hospital critical care trauma team (PHCCT) in the pre-hospital stage of the care of patients with major trauma. Previous publications support dispatch by clinicians who are also actively involved in the delivery of the PHCCT service; however there is a lack of objective outcome measures across the current reviewed evidence base. In this study, we aimed to assess the accuracy of PHCCT clinician led dispatch, when measured by Injury Severity Score (ISS). METHODS A retrospective cohort study over a 2 year period pre and post implementation of a PHCCT clinician led dispatch of PHCCT for potential major trauma patients, using national ambulance data combined with national trauma registry data. RESULTS A total of 99,702 trauma related calls were made to SAS including 495 major trauma patients with an ISS >15, and a total of 454 dispatches of a PHCCT. Following the introduction of a PHCCT clinician staffed trauma desk, the sensitivity for major trauma was increased from 11.3% to 25.9%. The difference in sensitivity between the pre and post trauma desk group was significant at 14.6% (95% CI 7.4%-21.4%, p < .001). DISCUSSION The results from the study support the results from other studies recommending that a PHCCT clinician should be located in ambulance control to identify major trauma patients as early as possible and co-ordinate the response.
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Affiliation(s)
- Neil Sinclair
- ScotSTAR, Scottish Ambulance Service, United Kingdom
| | | | - Michael Donald
- ScotSTAR, Scottish Ambulance Service, United Kingdom; Emergency Department, Ninewells Hospital, United Kingdom
| | - Lisa Curatolo
- ScotSTAR, Scottish Ambulance Service, United Kingdom
| | - Peter Lindle
- ScotSTAR, Scottish Ambulance Service, United Kingdom
| | - Steph Jones
- ScotSTAR, Scottish Ambulance Service, United Kingdom
| | - Alasdair R Corfield
- ScotSTAR, Scottish Ambulance Service, United Kingdom; Emergency Department, Royal Alexandra Hospital, United Kingdom.
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Riou M, Ball S, Williams TA, Whiteside A, Cameron P, Fatovich DM, Perkins GD, Smith K, Bray J, Inoue M, O'Halloran KL, Bailey P, Brink D, Finn J. 'She's sort of breathing': What linguistic factors determine call-taker recognition of agonal breathing in emergency calls for cardiac arrest? Resuscitation 2017; 122:92-98. [PMID: 29183831 DOI: 10.1016/j.resuscitation.2017.11.058] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 10/27/2017] [Accepted: 11/24/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND In emergency ambulance calls, agonal breathing remains a barrier to the recognition of out-of-hospital cardiac arrest (OHCA), initiation of cardiopulmonary resuscitation, and rapid dispatch. We aimed to explore whether the language used by callers to describe breathing had an impact on call-taker recognition of agonal breathing and hence cardiac arrest. METHODS We analysed 176 calls of paramedic-confirmed OHCA, stratified by recognition of OHCA (89 cases recognised, 87 cases not recognised). We investigated the linguistic features of callers' response to the question "is s/he breathing?" and examined the impact on subsequent coding by call-takers. RESULTS Among all cases (recognised and non-recognised), 64% (113/176) of callers said that the patients were breathing (yes-answers). We identified two categories of yes-answers: 56% (63/113) were plain answers, confirming that the patient was breathing ("he's breathing"); and 44% (50/113) were qualified answers, containing additional information ("yes but gasping"). Qualified yes-answers were suggestive of agonal breathing. Yet these answers were often not pursued and most (32/50) of these calls were not recognised as OHCA at dispatch. CONCLUSION There is potential for improved recognition of agonal breathing if call-takers are trained to be alert to any qualification following a confirmation that the patient is breathing.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA 6001, Australia
| | | | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Daniel M Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Royal Perth Hospital, WA 6847, Australia
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria 3004, Australia; Ambulance Victoria, Blackburn North, Victoria 3130, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Kay L O'Halloran
- School of Education, Curtin University, Bentley, WA 6102, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
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Hsieh MJ, Chien KL, Sun JT, Tang SC, Tsai LK, Chiang WC, Chien YC, Jeng JS, Huei-Ming Ma M. The effect and associated factors of dispatcher recognition of stroke: A retrospective observational study. J Formos Med Assoc 2017; 117:902-908. [PMID: 29158105 DOI: 10.1016/j.jfma.2017.10.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/PURPOSE Details of the communication between the caller and dispatcher have not been reported previously in Taiwan. This study aimed to: (1) understand the details of the communication between the caller and dispatcher among the calls for stroke patients, (2) identify factors associated with stroke recognition by dispatchers, and (3) evaluate the association between stroke recognition by dispatchers and stroke management. METHODS We conducted a retrospective observational study involving patients with stroke or transient ischemic stroke transported by the emergency medical service, and arriving at 9 hospitals in Taipei within 3 h of symptom onset from January 1, 2013 to February 28, 2014. Patients were excluded if tape-recording data or prehospital information were not available. Data of the enrolled patients were reviewed. We used stroke dispatch determination as the surrogate for stroke recognition by dispatchers. Multivariable logistic regression was used to identify the factors associated with stroke dispatch determination. RESULTS A total of 507 patients were included. In approximately 50% of cases, callers were close family members. Ninety-one patients (17.9%) had stroke dispatch determination. After adjustment, stroke reported spontaneously, any symptom included in the Cincinnati Prehospital Stroke Scale reported spontaneously, and dispatcher adherence to the protocol, were associated with stroke dispatch determination significantly. Stroke dispatch determination was associated with receiving pre-arrival notification, shorter door-to-computed tomography time, and thrombolytic therapy. CONCLUSION The dispatchers should spend more time identifying stroke patients by following the dispatch protocol. Recognition of stroke by dispatchers was associated with improved stroke care.
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Affiliation(s)
- Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kuo-Liong Chien
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Tang Sun
- Department of Emergency Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Sung-Chun Tang
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Kai Tsai
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | | | - Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan.
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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Riou M, Ball S, Williams TA, Whiteside A, O'Halloran KL, Bray J, Perkins GD, Smith K, Cameron P, Fatovich DM, Inoue M, Bailey P, Brink D, Finn J. 'Tell me exactly what's happened': When linguistic choices affect the efficiency of emergency calls for cardiac arrest. Resuscitation 2017; 117:58-65. [PMID: 28599999 DOI: 10.1016/j.resuscitation.2017.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 05/18/2017] [Accepted: 06/05/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clear and efficient communication between emergency caller and call-taker is crucial to timely ambulance dispatch. We aimed to explore the impact of linguistic variation in the delivery of the prompt "okay, tell me exactly what happened" on the way callers describe the emergency in the Medical Priority Dispatch System®. METHODS We analysed 188 emergency calls for cases of paramedic-confirmed out-of-hospital cardiac arrest. We investigated the linguistic features of the prompt "okay, tell me exactly what happened" in relation to the format (report vs. narrative) of the caller's response. In addition, we compared calls with report vs. narrative responses in the length of response and time to dispatch. RESULTS Callers were more likely to respond with a report format when call-takers used the present perfect ("what's happened") rather than the simple past ("what happened") (Adjusted Odds Ratio [AOR] 4.07; 95% Confidence Interval [95%CI] 2.05-8.28, p<0.001). Reports were significantly shorter than narrative responses (9s vs. 18s, p<0.001), and were associated with less time to dispatch (50s vs. 58s, p=0.002). CONCLUSION These results suggest that linguistic variations in the way the scripted sentences of a protocol are delivered can have an impact on the efficiency with which call-takers process emergency calls. A better understanding of interactional dynamics between caller and call-taker may translate into improvements of dispatch performance.
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Affiliation(s)
- Marine Riou
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia.
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Teresa A Williams
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Royal Perth Hospital, Perth, WA 6001, Australia
| | | | - Kay L O'Halloran
- School of Education, Curtin University, Bentley, WA 6102, Australia
| | - Janet Bray
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Gavin D Perkins
- Warwick Clinical Trials Unit and Heart of England NHS Foundation Trust, University of Warwick, Coventry, CV4 7AL, United Kingdom
| | - Karen Smith
- Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria 3004, Australia; Ambulance Victoria, Blackburn North, Victoria 3130, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
| | - Daniel M Fatovich
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Royal Perth Hospital, Perth, WA 6001, Australia; Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Nedlands, WA 6009, Australia
| | - Madoka Inoue
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia
| | - Paul Bailey
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia
| | - Deon Brink
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, WA 6102, Australia; St John Ambulance (WA), Belmont, WA 6104, Australia; Emergency Medicine, The University of Western Australia, Crawley, WA 6009, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Victoria 3004, Australia
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Pedersen PB, Henriksen DP, Mikkelsen S, Lassen AT. Dispatch and prehospital transport for acute septic patients: an observational study. Scand J Trauma Resusc Emerg Med 2017; 25:51. [PMID: 28499459 PMCID: PMC5429534 DOI: 10.1186/s13049-017-0393-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 05/04/2017] [Indexed: 12/21/2022] Open
Abstract
Background In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not clear in all clinical situations, some high urgency patients may end up with a suboptimal mode of transport. Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system. The aim of the study is to investigate the modes of prehospital transport among acute admitted patients with sepsis, severe sepsis and septic shock. Methods We included all adult patients (≥15 years) presenting to an acute medical unit at Odense University Hospital with a first-time admission of community-acquired sepsis between September 2010-August 2011. Cases and prehospital ambulance transport were identified by structured manual chart review. In all cases it was registered, whether the ordinary ambulance was assisted by the mobile emergency care unit (MECU), manned by anesthesiologists. Results We included 1,713 patients median age 72 years (IQR 57–81), 793 (46.3%) male, 621 (36.3%) had sepsis, 1,071 (62.5%) severe sepsis, and 21 (1.2%) septic shock. In the group of sepsis patients, 390 (62.8%) arrived without public prehospital transport, 197 (31.7%) were transported by ambulance, and 34 (5.5%) were assisted by MECU. In the group of severe sepsis patients, the same percentage 62.8% arrived without public pre-hospital transport, a lower percentage 28.2% were transported by ambulance, and a larger percentage 9.0% were transported by MECU. Among 21 patients with septic shock, 10 arrived without public pre-hospital transport (47.7%), 7 (33.3%) were transported by ambulance, and 4 (19.0%) by MECU. The 30-day mortality hazard ratio was associated with mode of transport, with the adjusted highest hazard ratio found in the group of MECU transported patients 1.76 (95%Cl 1.16–2.66). Conclusions A substantial proportion of patients with severe sepsis and septic shock arrive to hospital without public prehospital transport or by unspecialized ambulances.
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Affiliation(s)
- Peter Bank Pedersen
- Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark & Odense University Hospital, Odense, C DK-5000, Denmark.
| | - Daniel Pilsgaard Henriksen
- Department of Emergency Medicine & Department of Respiratory Medicine, Odense University Hospital, Odense, C DK-5000, Denmark
| | - Søren Mikkelsen
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, C DK-5000, Denmark
| | - Annmarie Touborg Lassen
- Department of Emergency Medicine, Institute of Clinical Research, University of Southern Denmark & Odense University Hospital, Odense, C DK-5000, Denmark
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Bakke HK, Steinvik T, Ruud H, Wisborg T. Effect and accuracy of emergency dispatch telephone guidance to bystanders in trauma: post-hoc analysis of a prospective observational study. Scand J Trauma Resusc Emerg Med 2017; 25:27. [PMID: 28270170 PMCID: PMC5341403 DOI: 10.1186/s13049-016-0343-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency medical communication centres (EMCCs) dispatch and allocate ambulance resources, and provide first-aid guidance to on-scene bystanders. We aimed to 1) evaluate whether dispatcher guidance improved bystander first aid in trauma, and 2) to evaluate whether dispatchers and on-scene emergency medical services (EMS) crews identified the same first aid measures as indicated. METHODS For 18 months, the crew on the first EMS crew responding to trauma calls used a standard form to assess bystander first aid. Audio recordings of the corresponding telephone calls from bystanders to the EMCC were reviewed. RESULTS A total of 311 trauma calls were included. The on-scene EMS crew identified needs for the following first-aid measures: free airway in 26 patients, CPR in 6 patients, and hypothermia prevention in 179 patients. EMCC dispatchers advised these measures, respectively, in 16 (62%), 5 (83%), and 54 (30%) of these cases. Dispatcher guidance was not correlated with correctly performed bystander first aid. For potentially life saving first aid measures, all (20/20) callers who received dispatcher guidance attempted first aid, while only some few (4/22) of the callers who did not receive dispatcher guidance did not attempt first aid. DISCUSSION Overall, the EMCC dispatchers had low sensitivity and specificity for correctly identifying trauma patients requiring first-aid measures. Dispatcher guidance did not significantly influence whether on-scene bystander first aid was performed correctly or attempted in this study setting, with a remarkably high willingness to perform first-aid. However, the findings for potentially lifesaving measures suggests that there may be differences that this study was unable to detect. CONCLUSION This study found a high rate of first-aid willingness and performance, even without dispatcher prompting, and a low precision in dispatcher advice. This underlines the need for further knowledge about how to increase EMCC dispatchers' possibility to identify trauma patients in need of first aid. The correlation between EMCC-guidance and bystander first aid should be investigated in study settings with lower spontaneous first-aid rates.
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Affiliation(s)
- Håkon Kvåle Bakke
- Mo i Rana Hospital, Helgeland Hospital Trust, Mo i Rana, Norway. .,Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway.
| | - Tine Steinvik
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway
| | - Håkon Ruud
- University Hospital of Northern Norway, Department of Emergency and Acute Care, Harstad, Norway
| | - Torben Wisborg
- Anaesthesia and Critical Care Research Group, Faculty of Health Sciences, IKM, University of Tromsø, Tromsø, Norway.,Hammerfest Hospital, Department of Anaesthesiology and Intensive Care, Finnmark Health Trust, Hammerfest, Norway.,Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
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Ellensen EN, Wisborg T, Hunskaar S, Zakariassen E. Dispatch guideline adherence and response interval-a study of emergency medical calls in Norway. BMC Emerg Med 2016; 16:40. [PMID: 27737641 DOI: 10.1186/s12873-016-0105-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 09/24/2016] [Indexed: 11/21/2022] Open
Abstract
Background The Emergency Medical Communication Centre (EMCC) operators in Norway report using the Norwegian Index for Medical Emergency Assistance (Index), a criteria-based dispatch guideline, in about 75 % of medical emergency calls. The main purpose of a dispatch guideline is to assist the operator in securing a correct response as quickly as possible. The effect of using the guideline on EMCC response interval is as yet unknown. We wanted to ascertain an objective measure of guideline adherence, and explore a possible effect on emergency medical dispatch (EMD) response interval. Methods Observational cross-sectional study based on digital telephone recordings and EMCC records; 299 random calls ending in acute and urgent responses from seven strategically selected EMCCs were included. Ability to confirm location and patient consciousness within an acceptable time interval and structural use of criteria cards were indicators used to create an overall guideline adherence variable. We then explored the relationship between different levels of guideline adherence and EMD response interval. Results The overall guideline adherence was 80 %. Location and patient consciousness were confirmed within 1 min in 83 % of the calls. The criteria cards were used systematically as intended in 64 % of the cases. Total median response interval was 2:28, with 2:01 for acute calls and 4:10 for urgent calls (p < 0.0005). Lower guideline adherence was associated with higher EMD response interval (p < 0.0005). Conclusion The measured guideline adherence was higher than previously reported by the operators themselves. Patient consciousness was rapidly confirmed in the majority of cases. Failure to use Index criteria as intended result in delayed ambulance dispatch and a potential risk of undertriage. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0105-2) contains supplementary material, which is available to authorized users.
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Garner AA, Lee A, Weatherall A, Langcake M, Balogh ZJ. Physician staffed helicopter emergency medical service case identification - a before and after study in children. Scand J Trauma Resusc Emerg Med 2016; 24:92. [PMID: 27405354 PMCID: PMC4941013 DOI: 10.1186/s13049-016-0284-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severely injured children may have better outcomes when transported directly to a Paediatric Trauma Centre (PTC). A case identification system using the crew of a physician staffed helicopter emergency medical service (P-HEMS) that identified severely injured children for P-HEMS dispatch was previously associated with high rates of direct transfer. It was theorised that discontinuation of this system may have resulted in deterioration of system performance. METHODS Severe paediatric trauma cases were identified from a state based trauma registry over two time periods. In Period A the P-HEMS case identification system operated in parallel with a paramedic dispatcher (Rapid Launch Trauma Co-ordinator-RLTC) operating from a central control room (n = 71). In Period B the paramedic dispatcher operated in isolation (n = 126). Case identification and direct transfer rates were compared as was time to arrival at the PTC. RESULTS After cessation of the P-HEMS system the rate of case identification fell from 62 to 31 % (P < 0.001), identification of fatal cases fell from 100 to 47 % (P < 0.001), the rate of direct transfer to a PTC fell from 66 to 53 % (P = 0.076) and the time to arrival in a PTC increased from a median 69 (interquartile range 52 - 104) mins to 97 (interquartile range 56 - 305) mins (P = 0.003). When analysing the rate of direct transfer to a PTC as a function of team composition, after adjusting for age and injury severity scores, there was no change in the rate between the physician and paramedic groups across the two time periods (relative risk 0.92, 95 % CI: 0.44 to 1.41). DISCUSSION The parallel identification system improves case identification rates and decreases time to arrival at the PTC, whilst requiring RLTC authorisation preserves the safety and efficiency benefits of centralised dispatch. The model could be extended to adult patients with similar benefits. CONCLUSIONS A case identification system relying solely on RLTC paramedics resulted in a significantly lower case identification rate and increased prehospital time with a non-significant fall in direct transfer rate to the PTC. The elimination of the P-HEMS input from the tasking system resulted in worse performance indicators and has the potential for poorer outcomes.
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Affiliation(s)
| | - Anna Lee
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong
| | | | | | - Zsolt J Balogh
- John Hunter Hospital, University of Newcastle, Newcastle, NSW, Australia
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Dami F, Heymann E, Pasquier M, Fuchs V, Carron PN, Hugli O. Time to identify cardiac arrest and provide dispatch-assisted cardio-pulmonary resuscitation in a criteria-based dispatch system. Resuscitation 2015; 97:27-33. [PMID: 26433118 DOI: 10.1016/j.resuscitation.2015.09.390] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/21/2015] [Accepted: 09/16/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Dispatch-assisted cardiopulmonary resuscitation (DA-CPR) plays a key role in out-of-hospital cardiac arrests. We sought to measure dispatchers' performances in a criteria-based system in recognizing cardiac arrest and delivering DA-CPR. Our secondary purpose was to identify the factors that hampered dispatchers' identification of cardiac arrests, the factors that prevented them from proposing DA-CPR, and the factors that prevented bystanders from performing CPR. METHODS AND RESULTS We reviewed dispatch recordings for 1254 out-of-hospital cardiac arrests occurring between January 1, 2011 and December 31, 2013. Dispatchers correctly identified cardiac arrests in 71% of the reviewed cases and 84% of the cases in which they were able to assess for patient consciousness and breathing. The median time to recognition of the arrest was 60s. The median time to start chest compression was 220s. CONCLUSIONS This study demonstrates that performances from a criteria-based dispatch system can be similar to those from a medical-priority dispatch system regarding out-of-hospital cardiac arrest (OHCA) time recognition and DA-CPR delivery. Agonal breathing recognition remains the weakest link in this sensitive task in both systems. It is of prime importance that all dispatch centers tend not only to implement DA-CPR but also to have tools to help them reach this objective, as today it should be mandatory to offer this service to the community. In order to improve benchmarking opportunities, we completed previously proposed performance standards as propositions.
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Affiliation(s)
- Fabrice Dami
- Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland; Emergency Medical Services, Dispatch Center, State of Vaud (Fondation Urgences-Santé), Lausanne, Switzerland.
| | - Eric Heymann
- Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland; Department of Anesthesiology, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Mathieu Pasquier
- Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Vincent Fuchs
- Emergency Medical Services, Dispatch Center, State of Vaud (Fondation Urgences-Santé), Lausanne, Switzerland
| | - Pierre-Nicolas Carron
- Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland
| | - Olivier Hugli
- Department of Emergency Medicine, University Hospital Center (CHUV), Lausanne, Switzerland
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McQueen C, Smyth M, Fisher J, Perkins G. Does the use of dedicated dispatch criteria by Emergency Medical Services optimise appropriate allocation of advanced care resources in cases of high severity trauma? A systematic review. Injury 2015; 46:1197-206. [PMID: 25863418 DOI: 10.1016/j.injury.2015.03.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/23/2015] [Accepted: 03/24/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND OBJECTIVES The deployment of Enhanced Care Teams (ECTs) capable of delivering advanced clinical interventions for patients at the scene of incidents is commonplace by Emergency Medical Services in most developed countries. It is unclear whether primary dispatch models for ECT resources are more efficient at targeting deployment to patients with severe trauma than secondary dispatch, following requests from EMS personnel at scene. The objective of this study was to review the evidence for primary and secondary models in the targeted dispatch of ECT resources to patients with severe traumatic injury. METHODS This review was completed in accordance with a protocol developed using the PRISMA guidelines. We conducted a search of the MEDLINE, EmBase, Web of Knowledge/Science databases and the Cochrane library, focussed on subject headings and keywords involving the dispatch of ECT resources by Emergency Medical Services. Design and results of each study were described. Heterogeneity in the design of the included studies precluded the completion of a meta-analysis. A narrative synthesis of the results therefore was performed. RESULTS Five hundred and forty-eight articles were screened, and 16 were included. Only one study compared the performance of the different models of dispatch. A non-statistically significant reduction in the length of time for HEMS resources to reach incident scenes of 4min was found when primary dispatch protocols were utilised compared to requests from EMS personnel at scene. No effect on mortality; severity of injury or proportion of patients admitted to intensive care was observed. The remaining studies examined the processes utilised within current primary dispatch models but did not perform any comparative analysis with existing secondary dispatch models. CONCLUSIONS This review identifies a lack of evidence supporting the role of primary dispatch models in targeting the deployment of Enhanced Care Teams to patients with severe injuries. It is therefore not possible to identify a model for ECT dispatch within pre-hospital systems that optimises resource utilisation. Further studies are required to assess the efficiency of systems utilised at each stage of the process used to dispatch Enhanced Care Team resources to incidents within regionalised pre-hospital trauma systems.
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Affiliation(s)
- Carl McQueen
- Clinical Trials Unit, University of Warwick Gibbet Hill, CV4 7AL Coventry, UK.
| | - Mike Smyth
- Clinical Trials Unit, University of Warwick Gibbet Hill, CV4 7AL Coventry, UK.
| | - Joanne Fisher
- University of Warwick, Gibbet Hill, CV4 7AL Coventry, UK.
| | - Gavin Perkins
- Clinical Trials Unit, University of Warwick Gibbet Hill, CV4 7AL Coventry, UK.
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Clegg GR, Lyon RM, James S, Branigan HP, Bard EG, Egan GJ. Dispatch-assisted CPR: where are the hold-ups during calls to emergency dispatchers? A preliminary analysis of caller-dispatcher interactions during out-of-hospital cardiac arrest using a novel call transcription technique. Resuscitation 2013; 85:49-52. [PMID: 24005008 DOI: 10.1016/j.resuscitation.2013.08.018] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/05/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Survival from out-of-hospital cardiac arrest (OHCA) is dependent on the chain of survival. Early recognition of cardiac arrest and provision of bystander cardiopulmonary resuscitation (CPR) are key determinants of OHCA survival. Emergency medical dispatchers play a key role in cardiac arrest recognition and giving telephone CPR advice. The interaction between caller and dispatcher can influence the time to bystander CPR and quality of resuscitation. We sought to pilot the use of emergency call transcription to audit and evaluate the holdups in performing dispatch-assisted CPR. METHODS A retrospective case selection of 50 consecutive suspected OHCA was performed. Audio recordings of calls were downloaded from the emergency medical dispatch centre computer database. All calls were transcribed using proprietary software and voice dialogue was compared with the corresponding stage on the Medical Priority Dispatch System (MPDS). Time to progress through each stage and number of caller-dispatcher interactions were calculated. RESULTS Of the 50 downloaded calls, 47 were confirmed cases of OHCA. Call transcription was successfully completed for all OHCA calls. Bystander CPR was performed in 39 (83%) of these. In the remaining cases, the caller decided the patient was beyond help (n = 7) or the caller said that they were physically unable to perform CPR (n = 1). MPDS stages varied substantially in time to completion. Stage 9 (determining if the patient is breathing through airway instructions) took the longest time to complete (median = 59 s, IQR 22-82 s). Stage 11 (giving CPR instructions) also took a relatively longer time to complete compared to the other stages (median = 46 s, IQR 37-75 s). Stage 5 (establishing the patient's age) took the shortest time to complete (median = 5.5s, IQR 3-9s). CONCLUSION Transcription of OHCA emergency calls and caller-dispatcher interaction compared to MPDS stage is feasible. Confirming whether a patient is breathing and completing CPR instructions required the longest time and most interactions between caller and dispatcher. Use of call transcription has the potential to identify key factors in caller-dispatcher interaction that could improve time to CPR and further research is warranted in this area.
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Affiliation(s)
- Gareth R Clegg
- Emergency Medicine Research Group, Edinburgh, United Kingdom; Queen's Medical Research Institute, The University of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom
| | - Richard M Lyon
- Emergency Medicine Research Group, Edinburgh, United Kingdom; Emergency Department, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SA, United Kingdom.
| | - Scott James
- Emergency Medicine Research Group, Edinburgh, United Kingdom
| | - Holly P Branigan
- Department of Psychology, University of Edinburgh, United Kingdom
| | - Ellen G Bard
- Department of Linguistics and English Language, University of Edinburgh, United Kingdom
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