Review article: Emergency medical services transfer of severe traumatic brain injured patients to a neuroscience centre: A systematic review

Patients with severe traumatic brain injuries require urgent medical attention at a hospital. We evaluated whether transporting adult patients with a severe traumatic brain injury (TBI) to a Neuroscience Centre is associated with reduced mortality. We reviewed studies published between 2010 and 2023 on severe TBI in adults (>18 years) using Medline, CINAHL, Google Scholar and Cochrane databases. We focused on mortality rates and the impact of transferring patients to a Neuroscience Centre, delays to neurosurgery and EMS triage accuracy. This review analysed seven studies consisting of 53 365 patients. When patients were directly transported to a Neuroscience Centre, no improvement in survivability was demonstrated. Subsequently, transferring patients from a local hospital to a Neuroscience Centre was significantly associated with reduced mortality in one study (adjusted odds ratio: 0.79, 95% confidence interval: 0.64-0.96), and 24-h (relative risk [RR]: 0.31, 0.11-0.83) and 30-day (RR: 0.66, 0.46-0.96) mortality in another. Patients directly transported to a Neuroscience Centre were more unwell than those taken to a local hospital. Subsequent transfers increased time to CT scanning and neurosurgery in several studies, although these were not statistically significant. Additionally, EMS could accurately triage. None of the included studies demonstrated statistically significant findings indicating that direct transportation to a Neuroscience Centre increased survivability for patients with severe traumatic brain injuries. Subsequent transfers from a non-Neuroscience Centre to a Neuroscience Centre reduced mortality rates at 24 h and 30 days. Further research is required to understand the differences between direct transport and subsequent transfers to Neuroscience Centres.

Analysis of skin condition emergency department outcomes via the free Healthline service from Whakarongorau Aotearoa

The aim of this research is to gain a deeper understanding of the ethnic and socio-demographic differences in the utilisation of the national 24/7 Healthline service in relation to skin condition calls and their outcomes. Healthline is one of the 39 free telehealth services that Whakarongorau Aotearoa | New Zealand Telehealth Services provides to New Zealanders. This is a retrospective observational study analysing Healthline data over a 4-year period: January 2019 through to December 2022. A total of 61,876 skin condition calls were analysed including demographics of service users: age group, ethnicity, area of residence and call outcome. Higher acuity skin condition calls resulting in an outcome of a recommendation for emergency department (ED) care accounted for 5.3% (n=3,294) of calls. This research found that Māori were over-represented in this ED recommendation data over four years (942 ED outcomes; 28.6%), and Pasifika were under-represented (203 ED outcomes; 5.9%). Wairarapa and West Coast were found to have the highest number of ED outcomes per capita. Our results support the theory that severe skin conditions positively correlate with smaller district populations and increased deprivation in access to services. This study highlights the potential that telehealth services have to help reduce the inequity of access to care.

A study protocol for a cluster-randomised controlled trial of smartphone-activated first responders with ultraportable defibrillators in out-of-hospital cardiac arrest: The First Responder Shock Trial (FIRST)

Objective

To describe the First Responder Shock Trial (FIRST), which aims to determine whether equipping frequently responding, smartphone-activated (GoodSAM) first responders with an ultraportable AED can increase 30-day survival rates in OHCA.

Methods

The FIRST trial is an investigator-initiated, bi-national (Victoria, Australia and New Zealand), registry-nested cluster-randomised controlled trial where the unit of randomisation is the smartphone-activated (GoodSAM) first responder. High-frequency GoodSAM responders are randomised 1:1 to receive an ultraportable, single-use AED or standard alert procedures using the GoodSAM app.The primary outcome is survival to 30 days. The secondary outcome measures (shockable rhythm, return of spontaneous circulation, event survival, and time to first shock delivery) are routinely collected by OHCA registries in both regions. The trial was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (Registration: ACTRN12622000448741) on 22 March 2022.

Results

The trial started in November 2022 and the last patient is expected to be enrolled in November 2024. We aim to detect a 7% increase in the proportion of 30-day survivors, from 9% in patients attended by control responders to 16% in patients attended by responders randomised to the ultraportable AED intervention arm. With 80% power, an alpha of 0.05, a cluster size of 1.5 and a coefficient of variation for cluster sizes of 1, the sample size required to detect this difference is 714 (357 per arm).

Conclusion

The FIRST study will increase our understanding of the potential role of portable AED use by smartphone-activated community responders and their impact on survival outcomes.

A socio-spatial analysis of pedestrian falls in Aotearoa New Zealand

Falls are a leading cause of injury and accidental death, particularly amongst older people. Evidence of environmental risk factors for pedestrian falls among older adults could support age-friendly urban design and contribute to efforts to reduce the incidence of pedestrian falls and support outdoor mobility among older adults. Yet investigation of the environment in which pedestrian falls occur is often hampered by its reliance on participant recall and self-report information. We identified the point locations of falls occurring on the road or street among adults that were attended by an ambulance in New Zealand over a two-year period (2016-2018) and connected these to a range of social (e.g. deprivation) and environmental (e.g. slope, greenspace) risk factors. Three types of analysis were used: a descriptive analysis of fall rates, logistic regression assessing whether a patient was transported to hospital following a fall, and a negative binomial regression analysis of the pedestrian falls by small area. We found a number of differences in the built environment surrounding fall locations between age groups. Compared with younger age groups, older adults showed high fall rates closer to home, and higher fall rates in areas with many types of destinations nearby. Additionally, our results showed a higher rate of pedestrian falls in more deprived areas. People who live in more deprived areas also fell over more frequently, but the pattern is stronger based on deprivation at the fall location, rather than home location. Residents of more deprived areas were less likely to be transported to hospital following a fall. Thus, our findings have equity implications for both environments and patient experience. These patterns could not have been identified without the novel use of spatially specific fall data.

Interaction between a live avian pneumovirus vaccine and two different Newcastle disease virus vaccines in broiler chickens with maternal antibodies to Newcastle disease virus

Broiler chicks with maternal antibodies to Newcastle disease virus (NDV) but none to avian metapneumovirus (APV) were divided into six groups. One group was kept as an unvaccinated control group. Three of the other groups were vaccinated at 1 day old with live APV vaccine or one of two live NDV vaccines (VG/GA or HB1). The remaining two groups received the APV vaccine in combination with either of the two NDV vaccines at 1 day old. At intervals after vaccination for up to 42 days, distribution of the viruses in the tissues was monitored, together with humoral antibody responses. Few NDV isolations were made from any NDV-vaccinated chicks, probably due to the presence of NDV maternal antibodies. In both dual-vaccinated groups, APV persisted longer (up to 21 days post vaccination (d.p.v.)) than in the single vaccinates (up to 14 d.p.v.). After 14 d.p.v., antibody titres against APV in both dual-vaccinated groups remained higher than the single APV vaccinates. For NDV haemagglutination inhibition antibodies, similar titres were found in the single and dual NDV VG/GA vaccinates. However, for chickens dually vaccinated with NDV HB1 and APV, the haemagglutination inhibition titres were significantly higher at 21 and 28 d.p.v. than the single HB1 vaccinates. These differences reflect the fact that NDV haemagglutination inhibition titres may depend on the NDV vaccine used.