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Mellum M, Saei R, Brattebø G, Wisborg T. Do emergency medical dispatchers choose the same response to serious injury in men and women - a qualitative study. BMC Emerg Med 2024; 24:60. [PMID: 38614978 PMCID: PMC11015548 DOI: 10.1186/s12873-024-00985-0] [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: 02/08/2024] [Accepted: 04/09/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Recent research has indicated that sex is an important determinant of emergency medical response in patients with possible serious injuries. Men were found to receive more advanced prehospital treatment and more helicopter transportation and trauma centre destinations and were more often received by an activated trauma team, even when adjusted for injury mechanism. Emergency medical dispatchers choose initial resources when serious injury is suspected after a call to the emergency medical communication centre. This study aimed to assess how dispatchers evaluate primary responses in trauma victims, with a special focus on the sex of the victim. METHODS Emergency medical dispatchers were interviewed using focus groups and a semistructured interview guide developed specifically for this study. Two vignettes describing typical and realistic injury scenarios were discussed. Verbatim transcripts of the conversations were analysed via systematic text condensation. The findings were reported in accordance with the Consolidated Criteria for Reporting Qualitative Studies (COREQ) checklist. RESULTS The analysis resulted in the main category "Tailoring the right response to the patient", supported by three categories "Get an overview of location and scene safety", "Patient condition" and "Injury mechanism and special concerns". The informants consistently maintained that sex was not a relevant variable when deciding emergency medical response during dispatch and claimed that they rarely knew the sex of the patient before a response was implemented. Some of the participants also raised the question of whether the Norwegian trauma criteria reliably detect serious injury in women. CONCLUSIONS The results indicate that the emergency medical response is largely based on the national trauma criteria and that sex is of little or no importance during dispatch. The observed sex differences in the emergency medical response seems to be caused by other factors during the emergency medical response phase.
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Affiliation(s)
- Marlene Mellum
- Faculty of Health Sciences, Interprofessional Rural Research Team-Finnmark, University of Tromsø - the Arctic University of Norway, Hammerfest, Norway
| | - Raika Saei
- Faculty of Health Sciences, Interprofessional Rural Research Team-Finnmark, University of Tromsø - the Arctic University of Norway, Hammerfest, Norway
| | - Guttorm Brattebø
- Norwegian National Advisory Unit On Emergency Medical Communication, Department of Anaesthesia & Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Torben Wisborg
- Faculty of Health Sciences, Interprofessional Rural Research Team-Finnmark, University of Tromsø - the Arctic University of Norway, Hammerfest, Norway.
- Norwegian National Advisory Unit On Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
- Department of Anaesthesiology and Intensive Care, Hammerfest Hospital, Finnmark Health Trust, Hammerfest, Norway.
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Shaw J, Bannister C, Ariyibi A, Fothergill R. Emergency medical dispatchers' experiences of using the Medical Priority Dispatch System telephone triage to identify maternity emergencies: a qualitative focus group study. BMJ Open 2024; 14:e078787. [PMID: 38508612 PMCID: PMC10952860 DOI: 10.1136/bmjopen-2023-078787] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 02/20/2024] [Indexed: 03/22/2024] Open
Abstract
OBJECTIVES The ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an emergency situation to prevent unnecessary delays in treatment. This study aimed to explore emergency medical dispatchers' (EMDs) perceptions of the structured protocol they use. DESIGN Voluntary participation in semistructured phenomenological focus groups. The participants were asked to discuss their experiences of using Medical Priority Dispatch System Protocol 24 (pregnancy, childbirth and miscarriage). Thematic analysis was applied to code and group topics. Discussion between the EMDs is presented for each theme and their experiences, including quotes, are presented to offer an overview of the maternity protocol and its use. SETTING A large urban UK ambulance service. PARTICIPANTS 23 control room staff. RESULTS Perceptions of maternity emergencies, challenges with key questions, the need for sensitivity surrounding miscarriage, using prearrival instructions and postdispatch instructions to help patients and ideas for additional ProQA functionality emerged as the five overarching themes. Protocol 24 was considered to reflect many of the clinical factors EMDs associate with maternity emergencies although further factors, including some non-clinical, were suggested for inclusion. Miscarriage and termination-related calls were thought to be challenging as the language of the protocol is designed for pregnancy. However, instructions were generally considered well written and user-friendly, although some were thought to be unnecessary. EMDs were largely positive regarding the ProQA software, but felt backward navigation was difficult if a situation changed. CONCLUSIONS Maternity calls were considered rewarding but complex by EMDs. We suggest changes including the use of more sensitive language in response to miscarriage and termination and make recommendations for the omission and inclusion of specific instructions, as well as enhancements to key questions and functionality. Further research is needed to ensure focus group findings are generalisable to other services, particularly in other countries.
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Affiliation(s)
- Joanna Shaw
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
| | | | | | - Rachael Fothergill
- Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
- Faculty of Health, Social Care and Education, Kingston University of London and St George's University of London, London, UK
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Richards CT, McCarthy DM, Markul E, Rottman DR, Lindeman P, Prabhakaran S, Klabjan D, Holl JL, Cameron KA. A mixed methods analysis of caller- emergency medical dispatcher communication during 9-1-1 calls for out-of-hospital cardiac arrest. Patient Educ Couns 2022; 105:2130-2136. [PMID: 35304072 DOI: 10.1016/j.pec.2022.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/15/2022] [Accepted: 03/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Recognition of out-of-hospital cardiac arrest (OHCA) during 9-1-1 calls is critically important, but little is known about how laypersons and emergency medical dispatchers (EMDs) communicate. We sought to describe 9-1-1 calls for OHCA. METHODS We performed a mixed-methods, retrospective analysis of 9-1-1 calls for OHCA victims in a large urban emergency medical services (EMS) system using a random sampling of cases containing the term "cardiopulmonary resuscitation" (CPR) in the EMS electronic report. A constant comparison qualitative approach with four independent reviewers continued until thematic saturation was achieved. Quantitative analysis employed computational linguistics. Callers' emotional states were rated using the emotional content and cooperation score (ECCS). RESULTS Thematic saturation was achieved after 46 calls. Three "OHCA recognition" themes emerged [ 1) disparate OHCA terms used, 2) OHCA mimics create challenges, 3) EMD questions influence recognition]. Three "CPR facilitation" themes emerged [ 1) directive language may facilitate CPR, 2) specific instructions assist CPR, 3) caller's emotions affect CPR initiation]. Callers were generally "anxious but cooperative." Callers saying "pulse" was associated with OHCA recognition. CONCLUSION Communication characteristics appear to influence OHCA recognition and CPR facilitation. PRACTICE IMPLICATIONS Dispatch protocols that acknowledge characteristics of callers' communication may improve OHCA recognition and CPR facilitation.
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Affiliation(s)
- Christopher T Richards
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA; Chicago EMS System, Chicago, IL, USA.
| | - Danielle M McCarthy
- Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
| | - Eddie Markul
- Chicago EMS System, Chicago, IL, USA; Department of Emergency Medicine, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.
| | | | - Patricia Lindeman
- Department of Emergency Medicine, Northwestern Feinberg School of Medicine, Chicago, IL, USA; Chicago EMS System, Chicago, IL, USA.
| | - Shyam Prabhakaran
- Department of Neurology, The University of Chicago Biological Sciences, Chicago, IL, USA.
| | - Diego Klabjan
- Department of Industrial Engineering and Management Sciences, Northwestern University McCormick School of Engineering, Evanston, IL, USA.
| | - Jane L Holl
- Department of Neurology, The University of Chicago Biological Sciences, Chicago, IL, USA.
| | - Kenzie A Cameron
- Division of General Internal Medicine & Geriatrics, Northwestern Feinberg School of Medicine, Chicago, IL, USA.
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Torlén Wennlund K, Kurland L, Olanders K, Khoshegir A, Kamil HA, Castrén M, Bohm K. Emergency medical dispatchers' experiences of managing emergency calls: a qualitative interview study. BMJ Open 2022; 12:e059803. [PMID: 35418440 PMCID: PMC9014079 DOI: 10.1136/bmjopen-2021-059803] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls. DESIGN A qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis. SETTING EMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden. PARTICIPANTS To achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years). RESULTS The analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes. CONCLUSIONS Managing emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.
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Affiliation(s)
- Klara Torlén Wennlund
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Lisa Kurland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Medical Sciences, Örebro University, Örebro, Sweden
| | - Knut Olanders
- Department of Intensive and Perioperative Care, Skåne University Hospital Lund, Lund, Sweden
| | - Amanda Khoshegir
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Hussein Al Kamil
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Maaret Castrén
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Department of Emergency Medicine, University of Helsinki, Helsinki, Finland
| | - Katarina Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
- Emergency Department, Södersjukhuset, Stockholm, Sweden
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Barkhordarzadeh S, Choobineh A, Razeghi M, Cousins R, Mokarami H. Effects of an ergonomic intervention program based on the PRECEDE-PROCEED model for reducing work-related health problems and exposure risks among emergency medical dispatchers. Int Arch Occup Environ Health 2022; 95:1389-1399. [PMID: 35266041 DOI: 10.1007/s00420-022-01846-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 02/22/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of an ergonomic intervention program based on the PRECEDE-PROCEED model in terms of improving exposure risks and work-related health problems in emergency medical dispatchers. METHODS This quasi-experimental study used an interrupted time series design. Participants were 55 employees working in an Emergency Medical Communications Center in Iran. The intervention program was based on the PRECEDE-PROCEED model and included five face-to-face training sessions and installing auxiliary equipment according to best ergonomic principles. Direct observations of the emergency medical dispatchers' working postures using the Rapid Office Strain Assessment and a survey which included a modified Nordic Questionnaire, Work Ability Score, Visual Fatigue Questionnaire, and a Behavioral Factors Questionnaire were used at three time points: baseline, 1 month post-intervention, and 3 months post-intervention. RESULTS The modified Nordic Questionnaire showed significant reductions in pain intensity scores for neck, lower back, knee and ankle after the ergonomic intervention program. In addition, there were considerable post-training improvements in behavioral factors (knowledge and enabling factors) and working postures. No significant changes were observed in Work Ability Scores, or visual symptoms. CONCLUSIONS An ergonomic intervention program based on a systematic framework such as the PRECEDE-PROCEED model and on-site interventions can be effective in improving and enhancing the working conditions of emergency medical dispatchers. Therefore, it is suggested that ergonomic interventions be implemented based on standard and valid behavioral change models such as PRECEDE-PROCEED model in other work environments in which musculoskeletal pain and digital eye strain are common.
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Affiliation(s)
- Susan Barkhordarzadeh
- Student Research Committee, Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Choobineh
- Research Center for Health Sciences, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohsen Razeghi
- Department of Physiotherapy, School of Rehabilitation Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Rosanna Cousins
- Department of Psychology, Liverpool Hope University, Liverpool, UK
| | - Hamidreza Mokarami
- Department of Ergonomics, School of Health, Shiraz University of Medical Sciences, PO Box 71645-111, Shiraz, Iran.
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Dubucs X, Balen F, Charpentier S, Lauque D, De Souto Barreto P, Tavassoli N, Houze-Cerfon CH, Rolland Y. Factors associated with Emergency Medical Dispatcher request and residents' inappropriate transfers from Nursing Homes to Emergency Department. Eur Geriatr Med 2021; 13:351-357. [PMID: 34652784 DOI: 10.1007/s41999-021-00574-5] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE In the last decades, the amount of emergency department (ED) transfers of nursing home (NH) residents has disproportionally increased in western countries. The main role of emergency medical dispatcher (EMD) among this population is to refer residents to EDs in the most appropriate way. The aim of this study was to assess risk factors of inappropriate transfers from NH to ED after EMD request. METHODS This research was a secondary analysis of a prospective observational multicenter study carried out in 17 EDs entitled FINE aimed to assess potentially inappropriate transfer prevalence among this population. Inappropriate transfers were determined in the FINE study threw a standardized approach by a unique expert team. RESULTS Overall, 572/1037 (55.2%) of residents were transferred to the ED after an EMD's decision. Among them, 92/572 (16.1%) transfers was defined as inappropriate. The average age was 87.3 years old (SD = 0.3). The main reason for ED transfer were falls (217/572, 37.9%). In multivariate analysis, the presence of a Special Care Unit in NH was significantly associated with a high rate of inappropriate transfer (OR 1.78; 95 CI [1.07-2.93]; p = 0.02) whereas a medical examination by a general practitioner before the transfer (OR 0.55; 95 CI [0.33-0.83]; p = 0.02) and a prompt access to psychiatric advice (OR 0.54; 95 CI [0.33-0.84]; p = 0.007) were associated with a low rate of potentially inappropriate transfer. CONCLUSION Promoting onsite medical assessment and partnership thanks to available geriatrician's advice may help the emergency medical dispatcher to improve the appropriateness of residents' transfer from Nursing Home to the emergency department.
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Affiliation(s)
- Xavier Dubucs
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France.
| | - Frederic Balen
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
- INSERM, U1295, F-31073, Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
- INSERM, U1295, F-31073, Toulouse, France
| | - Dominique Lauque
- Emergency Department, Toulouse University Hospital, 31059, Toulouse, France
| | | | - Neda Tavassoli
- Gérontopôle, Toulouse University Hospital, 31059, Toulouse, France
| | | | - Yves Rolland
- INSERM, U1295, F-31073, Toulouse, France
- Gérontopôle, Toulouse University Hospital, 31059, Toulouse, France
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Abstract
BACKGROUND Implementation of dispatcher-assisted cardiopulmonary resuscitation (DACPR) has increased the likelihood of bystander CPR upon cardiac arrest. However, the quality of CPR has been found to be very low. In this study, we aimed to compare CPR quality between the current DACPR practices and the interventional instruction of adding verbal encouragement from the dispatcher. METHODS In this randomized controlled trial, we recruited adult (age ≥18) laypersons who were non-health care providers and had never received any previous verified CPR training. They were randomly selected to perform DACPR using metronome sounds (mDACPR) as per the standard protocol, or DACPR with metronome sounds along with human encouragement (mheDACPR). The ratio of accurate compression rate, depth, and complete release for each CPR phase was examined. RESULTS Sixty nine records (34, mDACPR; 35, mheDACPR) were taken. The median proportion of accurate chest compression rate was initially 29.5% with mDACPR, and significantly increased to 71% after 2 minutes of CPR administration (P = .046). However, the median ratio of accurate chest compression depth was 61.5% in the first phase, and significantly decreased to 0% in the last phase (P < .001). In contrast, for the mheDACPR group, a high accurate compression rate was maintained throughout the 2 minutes of CPR administration (91%, 100%, 100%, 100%). CONCLUSION To maintain the quality of CPR administered by bystanders, continuous feedback and repeated human encouragement should be provided during DACPR. Active dispatcher intervention reduces the time required to reach an appropriate CPR rate and allows for the maintenance of accurate compression rates.
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Affiliation(s)
- Bo Na Hwang
- Emergency Medicine Research Foundation, Seoul
| | - Eun Hae Lee
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea
| | - Hang A. Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea
| | - Ju Ok Park
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea
| | - Choung Ah Lee
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Gyeonggi-do, Korea
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Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2020; 145:peds.2019-1358. [PMID: 31727861 DOI: 10.1542/peds.2019-1358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.
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Balen F, Lhermusier T, Grolleau S, Pélissier F, Dehours E, Charpentier S, Azema O, Lamy S. Identifying key factors leading to the optimal care pathway for patients with ST-segment elevation myocardial infarction: Results from the RESCAMIP registry. Arch Cardiovasc Dis 2019; 112:374-380. [PMID: 31160206 DOI: 10.1016/j.acvd.2019.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/12/2018] [Revised: 09/27/2018] [Accepted: 01/24/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND In France, when someone presents with chest pain, it is recommended to call a health emergency number. The patient talks with an emergency doctor at a medical dispatch centre, who decides whether (or not) to send a Mobile Intensive Care Unit (MICU). Patients with an ST-segment elevation myocardial infarction (STEMI) should have an MICU as their first medical contact, to speed up confirmation of diagnosis and enable them to benefit from reperfusion therapy as quickly as possible. AIM To evaluate the proportion of patients with STEMI benefiting from an optimal care pathway, and to identify the key factors leading to this pathway. METHODS RESCAMIP was a multicentre registry conducted between May 2015 and May 2017 in Midi-Pyrénées. All patients treated for STEMI within 12hours of symptoms onset, without initially going into cardiac arrest, were included. RESULTS Data from 1371 patients with STEMI were analysed; 60% had an MICU as their first medical contact. In-hospital mortality was 4%. Factors associated with calling the medical dispatch centre when presenting chest pain were: age>65 years (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.02-1.83), personal history of cardiovascular disease (OR 1.9, 95% CI 1.22-2.96) and having cardiovascular risk factors (OR 1.84, 95% CI 1.35-2.5). Factors associated with sending an MICU as first medical contact were: male sex (OR 2.11, 955 CI 1.49-2.99) and personal history of cardiovascular disease (OR 1.69, 95% CI 1.07-2.65). CONCLUSIONS The proportion of patients with STEMI going through non-optimal pathways was 40% in our area. We note that there are sex-based inequalities in accessing MICUs.
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Affiliation(s)
- Frederic Balen
- Emergency Department, Toulouse University Hospital, 31059 Toulouse, France; Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 INSERM, 31000 Toulouse, France; Toulouse III-Paul Sabatier University, 31330 Toulouse, France.
| | | | - Sabrina Grolleau
- Regional Observatory of Emergency Medicine in Midi-Pyrénées, Toulouse University Hospital, 31059 Toulouse, France
| | - Fanny Pélissier
- Poison Control Centre, Toulouse University Hospital, 31059 Toulouse, France
| | - Emilie Dehours
- Emergency Department, Toulouse University Hospital, 31059 Toulouse, France
| | - Sandrine Charpentier
- Emergency Department, Toulouse University Hospital, 31059 Toulouse, France; Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 INSERM, 31000 Toulouse, France; Toulouse III-Paul Sabatier University, 31330 Toulouse, France
| | - Olivier Azema
- Regional Observatory of Emergency Medicine in Midi-Pyrénées, Toulouse University Hospital, 31059 Toulouse, France
| | - Sebastien Lamy
- Laboratory of Epidemiology and Analyses in Public Health, UMR 1027 INSERM, 31000 Toulouse, France
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10
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Rybasack-Smith H, Lauro J. A History and Overview of Telecommunicator Cardiopulmonary Resuscitation (T-CPR). R I Med J (2013) 2019; 102:20-22. [PMID: 31042339] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Few events in pre-hospital medicine inspire as much attention and resources as out-of-hospital cardiac arrest (OHCA), yet the survival rate for such events has remained stagnant and unacceptably low. The first links in the chain of survival are early recognition and early CPR; yet EMS services do not arrive to the scene of a medical call for on average 7 minutes. Emergency dispatchers are generally the first trained individuals involved in medical emergencies; they can provide pre-arrival instructions, specifically telecommunicator CPR (T-CPR), and represent the potential to double the bystander CPR rate and increase return of spontaneous circulation. Yet, according to survey data, fewer than half of all public safety answering points (PSAPs) provide any T-CPR and even fewer provide hands-only CPR instruction.1 This article will provide a brief overview, history and introduction to the evidence supporting the use of T-CPR to improve outcomes in OHCA.
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Affiliation(s)
- Heather Rybasack-Smith
- Division of EMS, Department of Emergency Medicine, Assistant Professor of Emergency Medicine, Clinician Educator, Alpert Medical School of Brown University
| | - Joseph Lauro
- Division of EMS, Department of Emergency Medicine, EMS Medical Director, Miriam and Newport Hospitals, Clinical Associate Professor of Emergency Medicine, Alpert Medical School of Brown University; Associate Medical Director: Cumberland Paramedics
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11
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Borowicz A, Nadolny K, Kucap M, Gąsior M, Hudzik B. [The role of medical dispatchers in the prehospital management of patients with ST-segment elevation myocardial infarction]. Wiad Lek 2018; 71:1347-1353. [PMID: 30448809] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Introduction: Cardiovascular diseases are the leading cause of mortality worldwide. Acute coronary syndromes are diagnosed in 1.5 million patients, in Poland about 140,000 patients per year. A medical dispatcher who has first contact with the patient or a witness of the accident plays a very important role. The aim: To analyze the quality indicators of the State Emergency Medical System, including the role of the medical dispatcher diling with patients with STEMI. PATIENTS AND METHODS Material and methods: The medical documentation of the Voivodeship Emergency Medical Service in Katowice for the years 2013-2016 (n =915345)was analized a retrospective analysis. The study included those causes that ended with the diagnosed STEMI (870 cases). The final diagnosis was based on the data of the Polish Registry of Acute Coronary Syndromes PL-ACS and AMI-PL. RESULTS Results: STEMI was diagnosed in 870 visits (0.095%) causes. More often in men than in women (63.8% vs. 36.2%, p <0.001). The average age of the patients was 65 years ± 11.3. Most frequent STEMI occurred during the day (p <0.001). Patients either smoke or smoked in the past, a small proportion never smoked (78.3% vs 31.7%, p <0.001). The most frequent place occurrence of STEMI was the victim's home (p <0.001). The average time in the emergency code (K-1) was 6 min 29 seconds. It is worth noting that changing the code causes a dramatic increase in the time of a team reaching the place of an accident (p <0.001). The time of giving help is related to the time of day and the light of a conversation (p <0.001). CONCLUSION Conclusions: Medical dispatcher and Emergency Medical Teams play a key role diling with patients with STEMI. Conducting activities in accordance with the current medical knowledge leads to much lower mortality and results in a better quality of life for the patient and his family.
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Affiliation(s)
- Artur Borowicz
- Wojewódzkie Pogotowie Ratunkowe W Katowicach, Katowice, Polska
| | - Klaudiusz Nadolny
- Wojewódzkie Pogotowie Ratunkowe W Katowicach, Katowice, Polska, Klinika Medycyny Ratunkowej, Uniwersytet Medyczny W Białymstoku, Białystok, Polska, Wyższa Szkoła Planowania Strategicznego W Dąbrowie Górniczej, Dąbrowa Górnicz, Polska
| | - Michal Kucap
- Wojewódzkie Pogotowie Ratunkowe W Katowicach, Katowice, Polska, Wyższa Szkoła Planowania Strategicznego W Dąbrowie Górniczej, Dąbrowa Górnicz, Polska
| | - Mariusz Gąsior
- Wyższa Szkoła Planowania Strategicznego W Dąbrowie Górniczej, Dąbrowa Górnicz, Polska
| | - Bartosz Hudzik
- III Klinika Kardiologi, Śląskie Centrum Chorób Serca, Śląski Uniwersytet Medyczny, Katowice, Polska, Zakład Profilaktyki Chorób Żywieniowozależnych, Wydział Zdrowia Publicznego W Bytomiu, Śląski Uniwersytet Medyczny W Katowicach, Bytom, Polska
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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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Nishi T, Kamikura T, Funada A, Myojo Y, Ishida T, Inaba H. Are regional variations in activity of dispatcher-assisted cardiopulmonary resuscitation associated with out-of-hospital cardiac arrests outcomes? A nation-wide population-based cohort study. Resuscitation 2015; 98:27-34. [PMID: 26525273 DOI: 10.1016/j.resuscitation.2015.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [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: 03/10/2015] [Revised: 08/06/2015] [Accepted: 10/11/2015] [Indexed: 11/19/2022]
Abstract
AIM Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) impacts the rates of bystander CPR (BCPR) and survival after out-of-hospital cardiac arrests (OHCAs). This study aimed to elucidate whether regional variations in indexes for BCPR and emergency medical service (EMS) may be associated with OHCA outcomes. METHODS We conducted a population-based observational study involving 157,093 bystander-witnessed, resuscitation-attempted OHCAs without physician involvement between 2007 and 2011. For each index of BCPR and EMS, we classified the 47 prefectures into the following three groups: advanced, intermediate, and developing regions. Nominal logit analysis followed by multivariable logistic regression including OHCA backgrounds was employed to examine the association between neurologically favourable 1-month survival, and regional classifications based on BCPR- and EMS-related indexes. RESULTS Logit analysis including all regional classifications revealed that the number of BLS training course participants per population or bystander's own performance of BCPR without DA-CPR was not associated with the survival. Multivariable logistic regression including the OHCA backgrounds known to be associated with survival (BCPR provision, arrest aetiology, initial rhythm, patient age, time intervals of witness-to-call and call-to-arrival at patient), the following regional classifications based on DA-CPR but not on EMS were associated with survival: sensitivity of DA-CPR [adjusted odds ratio (95% confidence intervals) for advanced region; those for intermediate region, with developing region as reference, 1.277 (1.131-1.441); 1.162 (1.058-1.277)]; the proportion of bystanders to follow DA-CPR [1.749 (1.554-1.967); 1.280 (1.188-1.380)]. CONCLUSIONS Good outcomes of bystander-witnessed OHCAs correlate with regions having higher sensitivity of DA-CPR and larger proportion of bystanders to follow DA-CPR.
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Affiliation(s)
- Taiki Nishi
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Takahisa Kamikura
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Akira Funada
- Emergency Medical Centre, Kanazawa University Hospital, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
| | - Yasuhiro Myojo
- Emergency Medical Centre, Ishikawa Prefectural Central Hospital, 2-1 Kuratsuki-Higashi, Kanazawa, Ishikawa 920-8201, Japan.
| | - Tetsuya Ishida
- Emergency Department, Kaga Citizen's Hospital, 65 Hachikenmichi, Daishoji, Kaga 922-0057, Japan.
| | - Hideo Inaba
- Department of Emergency Medical Science, Kanazawa University Graduate School of Medicine, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8641, Japan.
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