Road accidents on Indian National highways, ambulance reachability and transportation of injured to trauma facility: Survey-based introspection of golden hour

Background

The transportation system plays a crucial role in the context of socioeconomic development, whereas the highway infrastructure acts as a base for the transportation system. In recent years, a rich impetus has been given to the development of road infrastructure by Indian governance. There is a need to introspect how well the prevailing highway infrastructure is equipped with emergency rescue management during road accidents. Lack of ambulance service and trauma facilities along the highways results in a steady loss of lives and injuries and increases people's exposure to risks.

Objective

This study aims to determine the response time of ambulance reachability to the accident spot on Indian national highways associated with heavy commercial transportation. Also, determining the time to transport the injured to the nearest trauma facility is another factor included as an objective in this investigation.

Methods

The study adopted survey-based research, whereby the variables in the questionnaire were designed to record and assess the time for an ambulance to reach the accident spot and, from there, to transport the injured to the trauma management facility on Indian highways. Two hundred twenty-five participants who were either victims/relatives of victims or those involved in the rescue of the injured have participated in the survey. The dates of the accident events were 2017 and 2022.

Results

The survey resulted in the identification of two categories of highway accidents. The first category of accidents happened on the highways near city limits/dense settlements, and the second category occurred on the core highways. The percentage of accidents caused on the highways either adjacent to or passing through the city limits/dense settlements was reported to be higher than the accidents on the core highways. Ninety percent of the participants reported successful contact with the ambulance call/service centre, but only ~75% success rate exists for ambulances to reach the accident scene. On the core highways, the time taken for the ambulance to arrive at the accident scene is 25-35 minutes. The results from the survey ascertained that the patients were prioritised for treatment in the nearest hospitals (irrespective of having a trauma facility) at a distance of ~12-20 km, for which the time taken is ~15-25 minutes. Importantly, from the interviews, it is understood that in many cases, these hospitals have further referred to specialty hospitals located in nearby cities or trauma centres with greater facilities. Occasions exist where the injured were taken directly to hospitals 30-40 km from the accident spot, for which the time was more than 40 minutes.

Conclusions

The results provide evidence that in either of the accident cases on the highways that are adjacent to/passing through the city limits or on the core highways, the total time for emergency care accessibility is nearly 60 minutes or greater; this implies that in the majority of cases, there is very meagre time left to provide emergency medical care to the needy and injured on the Indian highways to abide by the concept of golden hour. Plausible reforms backed by technology for enabling highways into 'emergency rescuable highways' are highly needed to guarantee a safer and more sustainable transportation system in India.

Measuring the Capability of Biological Incident Rescue Teams in China: A Fuzzy Analytic Hierarchy Process Based Model - Tianjin Municipality, China, 2022-2023

Introduction

The swift advancement of biotechnology has presented both opportunities and challenges to our society, thrusting biosafety to the forefront of concern. Consequently, the evaluation of rescue capabilities in the event of a bioterrorism incident becomes of paramount importance. Currently, there is a notable absence of specific measurement criteria and a comprehensive evaluation system. This paper aims to establish a systematic approach towards assessing emergency response capabilities in the context of bioterrorism incidents.

Methods

We employed an enhanced Delphi methodology to establish an index evaluation framework. Subsequently, the weight of the judgment matrix was ascertained via the application of the fuzzy comprehensive evaluation approach. This led to the creation of a fuzzy comprehensive evaluation model for bioterrorism rescue capability.

Results

A modified Delphi study was conducted involving 11 experts across two rounds, achieving a response rate of 100%. The Kendall coordination coefficients recorded in the first and second rounds were 0.303 and 0.632, respectively (P<0.05). Upon comprehensive analysis involving score, coefficient of variation, and full score ratio, we distinguished five primary indicators and 25 secondary indicators. Subsequently, an evaluation model was developed based on the Analytic Hierarchy Process (AHP) tailored to assess the response to a rescue from bioterrorism.

Discussion

The expert panel confirmed consensus on all aspects of the model, validating its comprehensive content. The succeeding course of action involves converting the assessment model to a measurable scale, affirming its functionality, and implementing it in practical evaluation tasks to further enhance the capabilities of the biological incident rescue team.

[Research progress on the occupational health and personal protection of emergency responders]

To meet the requirement from the economy and society, China's emergency rescue has been developing towards specialization and professionalization. The working environment for emergency responders is special accompanying with tremendous challenges and uncertainties. To promote the research on occupational health and personal protection is an important guarantee for the workers in China to realize the goal of "decent work". This paper reviews the hazards that affect the occupational health of emergency rescue workers, the research progress of adverse outcomes caused from exposure to these hazards, and the related development issues of personal protection. In order to ensure the safety and health of emergency rescue workers, the direction of further research on occupational health of emergency rescue workers is put forward.

[Development and validation of a course concept for Tactical Medical Mining Rescue : Standardized training curriculum for mine rescue teams]

Hintergrund

Die Strukturänderung im modernen Bergbau erhöht das Notfallpotenzial ohne Verfügbarkeit einer dem öffentlichen Rettungsdienst vergleichbaren Notfallrettung unter Tage, bei zusätzlich deutlich verlängerten Rettungszeiten.

Fragestellung

Kann die Grubenwehr zur medizinischen Notfallrettung unter Tage ertüchtigt werden?

Material und Methoden

Ein auf typische Notfälle optimiertes medizinisch-taktisches Rettungsschema nebst Ausrüstung wurde entwickelt und medizindidaktisch optimiert in 16 Unterrichtseinheiten geschult. Objective Structured Practical Examinations (OSPE) von 3 geschulten Grubenwehrtrupps a 4 Wehrleuten wurden mittels identischer Prüfung von zufällig ausgewähltem Rettungsdienstreferenzpersonal (17 Teilnehmer unterschiedlicher Ausbildungsniveaus) verglichen.

Ergebnisse

Das medizinisch-taktische Rettungsschema beinhaltet Vitalfunktions- und Bodycheck, Reanimation mit Defibrillation, nasale und intraossäre Medikamentengabe, Atemwegssicherung, Thoraxpunktion, Blutstillung, Tourniquet, Reposition, Schienung sowie Transportlagerung mit Wärmeerhalt. In der OSPE-Prüfung erzielte die Grubenwehr (Mittelwert [M] = 3,42, 95 %-Konfidenzintervall [KI_95 %] = [3,24; 3,60]) gleiche Ergebnisse wie der Rettungsdienst höheren Ausbildungsniveaus (M = 3,28, KI_95 % = [3,09; 3,46]), jedoch deutlich bessere Ergebnisse als Rettungssanitäter (M = 2,43, KI_95 % = [2,10; 2,77]). Das Kompetenzniveau der Grubenwehr blieb nach einem 6‑monatigen übungsfreien Intervall stabil (M = 3,54, KI_95 % = [3,31; 3,73]).

Diskussion

Das erzielte Kompetenzniveau der ausgebildeten Wehrleute nach taktischem Minenrettungskurs ist mit dem öffentlichen Rettungsdienst innerhalb des eng definierten Behandlungsschemas vergleichbar. Die Grubenwehr kann unter Anwendung medizinischer Notkompetenz ein geeignetes Instrument sein, um die Lücke der professionellen Notfallrettung unter Tage zu schließen.

Zusatzmaterial online

Die Onlineversion dieses Beitrags (10.1007/s00063-021-00861-w) enthält die Tabellen A1–A3.

Multi-objective location-scale optimization model and solution methods for large-scale emergency rescue resources

The location of emergency rescue resources is the basis for the supply of all kinds of materials required for rescue work. Appropriate selection of emergency resource locations can greatly improve the efficiency of emergency supplies. Based on the summary and analysis of the existing research on it, we aim to provide efficient and feasible models and solutions for the location and layout of emergency rescue resources. In optimizing the layout of emergency rescue resources, we have taken into account the dynamic characteristics of emergency demand, the needs of emergency efficiency, cost and fairness, and constructed an optimization model for emergency resource location and construction scale. At the same time, in order to reduce the scale of solving the multi-objective optimization problem under multiple disasters, improve the computational efficiency, and obtain the absolute optimal solution in the feasible region, two types of power function methods are proposed to solve the model: basic efficacy coefficient method and unit cost utility method. Finally, we design a simulation example to verify the feasibility and effectiveness of the proposed emergency resource location model and solution methods. The results show that the model proposed in this paper can maximize the effectiveness of priority emergency rescue resources, while greatly reducing emergency costs. More importantly, it can ensure the fairness of emergency rescue to a certain extent and can optimize resource scale while optimizing location. Our research will provide a practical plan reference for the configuration decision in emergency rescue work.

Airway Assessment for Office Sedation/Anesthesia

Whenever a patient is about to receive sedation or general anesthesia, no matter what the technique, the preoperative assessment of the airway is one of the most important steps in ensuring patient safety and positive outcomes. This article, Part III in the series on airway management, is directed at the ambulatory office practice and focuses on predicting the success of advanced airway rescue techniques.