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Farhat H, Makhlouf A, Gangaram P, Aifa KE, Khenissi MC, Howland I, Abid C, Jones A, Howard I, Castle N, Al Shaikh L, Khadhraoui M, Gargouri I, Laughton J, Alinier G. Exploring factors influencing time from dispatch to unit availability according to the transport decision in the pre-hospital setting: an exploratory study. BMC Emerg Med 2024; 24:77. [PMID: 38684980 PMCID: PMC11057082 DOI: 10.1186/s12873-024-00992-1] [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: 01/17/2024] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Efficient resource distribution is important. Despite extensive research on response timings within ambulance services, nuances of time from unit dispatch to becoming available still need to be explored. This study aimed to identify the determinants of the duration between ambulance dispatch and readiness to respond to the next case according to the patients' transport decisions. METHODS Time from ambulance dispatch to availability (TDA) analysis according to the patients' transport decision (Transport versus Non-Transport) was conducted using R-Studio™ for a data set of 93,712 emergency calls managed by a Middle Eastern ambulance service from January to May 2023. Log-transformed Hazard Ratios (HR) were examined across diverse parameters. A Cox regression model was utilised to determine the influence of variables on TDA. Kaplan-Meier curves discerned potential variances in the time elapsed for both cohorts based on demographics and clinical indicators. A competing risk analysis assessed the probabilities of distinct outcomes occurring. RESULTS The median duration of elapsed TDA was 173 min for the transported patients and 73 min for those not transported. The HR unveiled Significant associations in various demographic variables. The Kaplan-Meier curves revealed variances in TDA across different nationalities and age categories. In the competing risk analysis, the 'Not Transported' group demonstrated a higher incidence of prolonged TDA than the 'Transported' group at specified time points. CONCLUSIONS Exploring TDA offers a novel perspective on ambulance services' efficiency. Though promising, the findings necessitate further exploration across diverse settings, ensuring broader applicability. Future research should consider a comprehensive range of variables to fully harness the utility of this period as a metric for healthcare excellence.
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Affiliation(s)
- Hassan Farhat
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
- Faculty of Sciences, University of Sfax, 3000, Sfax, Tunisia.
- Faculty of Medicine 'Ibn El Jazzar', University of Sousse, 4000, Sousse, Tunisia.
| | - Ahmed Makhlouf
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- College of Engineering, Qatar University, Doha, Qatar
| | - Padarath Gangaram
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- Faculty of Health Sciences, Durban University of Technology, PO Box 1334, Durban, 4000, South Africa
| | - Kawther El Aifa
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | | | - Ian Howland
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Cyrine Abid
- Laboratory of Screening Cellular and Molecular Process, Centre of Biotechnology of Sfax, University of Sfax, Sfax, Tunisia
| | - Andre Jones
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Ian Howard
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Nicholas Castle
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Loua Al Shaikh
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Moncef Khadhraoui
- Higher Institute of Biotechnology, University of Sfax, Sfax, Tunisia
| | - Imed Gargouri
- Faculty of Medicine, University of Sfax, Sfax, Tunisia
| | - James Laughton
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Guillaume Alinier
- Ambulance Service, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
- University of Hertfordshire, Hatfield, UK
- Weill Cornell Medicine-Qatar, Doha, Qatar
- Northumbria University, Newcastle Upon Tyne, UK
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Bianconi K, Zielinski W, Fischer S, Ferlazzo J, Steenberg M, Ariyaprakai N. Brugada Syndrome as an Underlying Diagnosis for a Prehospital Seizure Dispatch. PREHOSP EMERG CARE 2023; 28:656-659. [PMID: 38059594 DOI: 10.1080/10903127.2023.2285387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/18/2023] [Indexed: 12/08/2023]
Abstract
Brugada syndrome is an inherited genetic disorder known to cause a variety of patient complaints but may ultimately cause ventricular fibrillation and sudden cardiac death. We present a patient with witnessed seizure who was ultimately diagnosed with Brugada syndrome. Multiple ventricular arrhythmias complicated the case, which was managed in- and out-of-hospital.
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Affiliation(s)
| | - Wayne Zielinski
- Robert Wood Johnson Mobile Health, New Brunswick, New Jersey
| | - Scott Fischer
- Robert Wood Johnson Mobile Health, New Brunswick, New Jersey
| | - Jenna Ferlazzo
- Robert Wood Johnson Mobile Health, New Brunswick, New Jersey
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Colgan A, Swanson MB, Ahmed A, Harland K, Mohr NM. Documented Use of Emergency Medical Dispatch Protocols is Associated with Improved Survival in Out of Hospital Cardiac Arrest. PREHOSP EMERG CARE 2023; 28:160-167. [PMID: 37471458 DOI: 10.1080/10903127.2023.2239363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE There are over 300,000 out-of-hospital cardiac arrests (OHCA) annually in the United States (US) and despite many scientific advances in the field, the survival rate remains low. We seek to determine if return of spontaneous circulation (ROSC) is higher when use of emergency medical dispatch (EMD) protocols is documented for OHCA calls compared to when no EMD protocol use is documented. We also seek identify care-related processes that differ in calls that use EMD protocols. METHODS This is a retrospective cohort study of U.S. adults with OHCA prior to emergency medical services (EMS) arrival using 2019 National EMS Information System data. The primary exposure was EMD usage during EMS call. The primary outcome was prehospital ROSC, and secondary outcomes included automated external defibrillator (AED) use before EMS arrival, bystander CPR, and end-of-event EMS survival (survival to the end of the EMS care at transport destination). Multivariable logistic regression adjusted for age, sex, race/ethnicity, primary insurance, rurality, initial rhythm, arrest etiology, and witnessed arrest. RESULTS Of the 96,269 OHCA cases included, EMD use was documented in 73%. Overall, 26% of subjects achieved ROSC in EMS care. EMD subjects were more likely to achieve ROSC (27.2% vs. 23.5%, uOR 1.22, 95%CI 1.18 - 1.26) even after adjusting for subject and arrest characteristics (aOR 1.13, 95%CI 1.08 - 1.17). EMD subjects also had higher end-of-event survival (19.1% vs. 16.4%, aOR 1.20, 95%CI 1.15 - 1.25). AED use before EMS arrival was more common in the EMD group (28.3% vs. 26.3% %diff 2.0, 95%CI 1.4 to 2.6), as was CPR before EMS arrival (63.8% vs. 55.1%, difference 8.6%, 95%CI 7.9 to 9.3%). CONCLUSIONS In this retrospective analysis, the rate of ROSC was higher in adult OHCA patients when EMD protocol use was reported compared to when it was not reported. The group with documented EMD use also experienced higher rates of bystander AED use, bystander CPR, and end-of-event survival.
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Affiliation(s)
- Alexander Colgan
- Department of Emergency Medicine, Banner Wyoming Medical Center, Casper, Wyoming
| | - Morgan B Swanson
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Azeemuddin Ahmed
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Kari Harland
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
| | - Nicholas M Mohr
- Department of Emergency Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa
- Department of Epidemiology, University of Iowa College of Public Health, Iowa City, Iowa
- Divison of Critical Care, Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, Iowa
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Byrsell F, Jonsson M, Claesson A, Ringh M, Svensson L, Riva G, Nordberg P, Forsberg S, Hollenberg J, Nord A. Swedish emergency medical dispatch centres' ability to answer emergency medical calls and dispatch an ambulance in response to out-of-hospital cardiac arrest calls in accordance with the American Heart Association performance goals: An observational study. Resuscitation 2023; 189:109896. [PMID: 37414242 DOI: 10.1016/j.resuscitation.2023.109896] [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: 05/04/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/08/2023]
Abstract
AIM To investigate the ability of Swedish Emergency Medical Dispatch Centres (EMDCs) to answer medical emergency calls and dispatch an ambulance for out-of-hospital cardiac arrest (OHCA) in accordance with the American Heart Association (AHA) performance goals in a 1-step (call connected directly to the EMDC) and a 2-step (call transferred to regional EMDC) procedure over 10 years, and to assess whether delays may be associated with 30-day survival. METHOD Observational data from the Swedish Registry for Cardiopulmonary Resuscitation and EMDC. RESULTS A total of 9,174,940 medical calls were answered (1-step). The median answer delay was 7.3 s (interquartile range [IQR], 3.6-14.5 s). Furthermore, 594,008 calls (6.1%) were transferred in a 2-step procedure, with a median answer delay of 39 s (IQR, 30-53 s). A total of 45,367 cases (0.5%, 1-step) were registered as OHCA, with a median answer delay of 7.2 s (IQR, 3.6-14.1 s) (AHA high-performance goal, 10 s). For 1-step procedure, no difference in 30-day survival was found regarding answer delay. For OHCA (1-step), an ambulance was dispatched after a median of 111.9 s (IQR, 81.7-159.9 s). Thirty-day survival was 10.8% (n = 664) when an ambulance was dispatched within 70 s (AHA high-performance) versus 9.3% (n = 2174) > 100 s (AHA acceptable) (p = 0.0013). Outcome data in the 2-step procedure was unobtainable. CONCLUSION The majority of calls were answered within the AHA performance goals. When an ambulance was dispatched within the AHA high-performance standard in response to OHCA calls, survival was higher compared with calls when dispatch was delayed.
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Affiliation(s)
- Fredrik Byrsell
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden.
| | - Martin Jonsson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Andreas Claesson
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Mattias Ringh
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Leif Svensson
- Department of Medicine, Karolinska Institutet, Solna, Sweden
| | - Gabriel Riva
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Per Nordberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Sune Forsberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Jacob Hollenberg
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anette Nord
- Center for Resuscitation Science, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
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Missel AL, Dowker SR, Chiola M, Platt J, Tsutsui J, Kasten K, Swor R, Neumar RW, Hunt N, Herbert L, Sams W, Nallamothu BK, Shields T, Coulter-Thompson EI, Friedman CP. Barriers to the Initiation of Telecommunicator-CPR during 9-1-1 Out-of-Hospital Cardiac Arrest Calls: A Qualitative Study. PREHOSP EMERG CARE 2023; 28:118-125. [PMID: 36857489 DOI: 10.1080/10903127.2023.2183533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 02/15/2023] [Indexed: 03/03/2023]
Abstract
INTRODUCTION Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. OBJECTIVE We examined the barriers to initiation of T-CPR. METHODS We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). RESULTS We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. CONCLUSIONS We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions.
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Affiliation(s)
- Amanda L Missel
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Stephen R Dowker
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | | | - Jodyn Platt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | | | | | - Robert Swor
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan
| | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Nathaniel Hunt
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Logan Herbert
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Woodrow Sams
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brahmajee K Nallamothu
- Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor, Michigan
- Max Harry Weil Institute for Critical Care Research and Innovation, University of Michigan, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Theresa Shields
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emilee I Coulter-Thompson
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Charles P Friedman
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
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Uejio CK, Joiner AP, Gonsoroski E, Tamerius JD, Jung J, Moran TP, Yancey AH. The association of indoor heat exposure with diabetes and respiratory 9-1-1 calls through emergency medical dispatch and services documentation. Environ Res 2022; 212:113271. [PMID: 35427590 DOI: 10.1016/j.envres.2022.113271] [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] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND People with pre-existing medical conditions, who spend a large proportion of their time indoors, are at risk of emergent morbidities from elevated indoor heat exposures. In this study, indoor heat of structures wherein exposed people received Grady Emergency Services based care in Atlanta, GA, U.S., was measured from May to September 2016. METHOD ology: In this case-control study, analyses were conducted to investigate the effect of indoor heat on the odds of 9-1-1 calls for diabetic (n = 90 cases) and separately, for respiratory (n = 126 cases), conditions versus heat-insensitive emergencies (n = 698 controls). Generalized Additive Models considered both linear and non-linear indoor heat and health outcome associations using thin-plate regression splines. RESULTS Hotter and more humid indoor conditions were non-linearly associated with an increasing likelihood of receiving emergency care for complications of diabetes and severe respiratory distress. Higher heat indices were associated with increased odds of a diabetes (odds ratio for change from 30 to 31 °C: 1.12, 95% CI: 1.08-1.16) or respiratory 9-1-1 medical call versus control (odds ratio for change from 34 to 35 °C: 1.18, 95% CI: 1.09-1.28) call. Both diabetic and respiratory distress patients were more likely to be African-American and/or have comorbidities. CONCLUSIONS In this study, the statistical association of indoor heat exposure with emergency morbidities (diabetic, respiratory) was demonstrated. The study also showcased the value and utility of data gathered by emergency medical dispatch and services from inaccessible private indoor sources (i.e., domiciles) for environmental health.
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Affiliation(s)
- Christopher K Uejio
- Florida State University, Department of Geography, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, USA.
| | - Anjni Patel Joiner
- Duke University, Department of Surgery, Division of Emergency Medicine. 2301 Erwin Road, Duke Hospital North, Box 3096, Durham, NC, 27710, USA.
| | - Elaina Gonsoroski
- Florida State University, Department of Geography, Bellamy Building, Room 323, 113 Collegiate Loop, PO Box 3062190, Tallahassee, FL, 32306, USA.
| | - James D Tamerius
- Center of Sustainable Energy, 3980 Sherman St #170, San Diego, CA, 92110, USA.
| | - Jihoon Jung
- University of North Carolina at Chapel Hill, Department of City and Regional Planning, New East Building, CB3140, Chapel Hill, NC, 27599, USA.
| | - Tim P Moran
- Emory University, Department of Emergency Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
| | - Arthur H Yancey
- Emory University, Department of Emergency Medicine, 100 Woodruff Circle, Atlanta, GA, 30322, USA.
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Larribau R, Chappuis VN, Guiche F, Dami F. [Medical dispatch and interprofessionalism : Who, what training, and for what missions ?]. Rev Med Suisse 2022; 18:1512-1516. [PMID: 35975773 DOI: 10.53738/revmed.2022.18.791.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The missions of the emergency medical communication centers (EMCC) are to provide a response to calls related to emergencies (emergency medical dispatch) or to on-call medicine. The medical dispatch process is complex. The dispatch process tends to become fragmented and specialized for the different dispatch tasks, medical and non-medical, involving the collaboration of several health and non-health professionals in the same centre. A real chain of competences inside the EMCC has thus been created, within the pre-hospital emergency chain itself. Cross-disciplinary training based on simulated situations can be used to strengthen inter-professional collaboration within the EMCC.
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Affiliation(s)
- Robert Larribau
- Service des urgences, Département de médecine aiguë, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Victor Nathan Chappuis
- Service des urgences, Département de médecine aiguë, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Florent Guiche
- Service des urgences, Département de médecine aiguë, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Fabrice Dami
- Service des urgences, Centre hospitalier universitaire vaudois, 1011 Lausanne
- Fondation Urgences Santé, rue Dr César-Roux 31, 1005 Lausanne
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Ferri P, Sáez C, Félix-De Castro A, Sánchez-Cuesta P, García-Gómez JM. Discovering Key Topics in Emergency Medical Dispatch from Free Text Dispatcher Observations. Stud Health Technol Inform 2022; 294:859-863. [PMID: 35612226 DOI: 10.3233/shti220607] [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] [Indexed: 06/15/2023]
Abstract
The objective of this work was to discover key topics latent in free text dispatcher observations registered during emergency medical calls. We used a total of 1374931 independent retrospective cases from the Valencian emergency medical dispatch service in Spain, from 2014 to 2019. Text fields were preprocessed to reduce vocabulary size and filter noise, removing accent and punctuation marks, along with uninformative and infrequent words. Key topics were inferred from the multinomial probabilities over words conditioned on each topic from a Latent Dirichlet Allocation model, trained following an online mini-batch variational approach. The optimal number of topics was set analyzing the values of a topic coherence measure, based on the normalized pointwise mutual information, across multiple validation K-folds. Our results support the presence of 15 key topics latent in free text dispatcher observations, related with: ambulance request; chest pain and heart attack; respiratory distress; head falls and blows; fever, chills, vomiting and diarrhea; heart failure; syncope; limb injuries; public service body request; thoracic and abdominal pain; stroke and blood pressure abnormalities; pill intake; diabetes; bleeding; consciousness. The discovery of these topics implies the automatic characterization of a huge volume of complex unstructured data containing relevant information linked to emergency medical call incidents. Hence, results from this work could lead to the update of structured emergency triage algorithms to directly include this latent information in the triage process, resulting in a positive impact in patient wellbeing and health services sustainability.
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Affiliation(s)
- Pablo Ferri
- Biomedical Data Science Laboratory (BDSLab), Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València (UPV), Valencia, Spain
| | - Carlos Sáez
- Biomedical Data Science Laboratory (BDSLab), Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València (UPV), Valencia, Spain
| | - Antonio Félix-De Castro
- Conselleria de Sanitat Universal i Salut Pública, Generalitat Valenciana (GVA), Valencia, Spain
| | | | - Juan M García-Gómez
- Biomedical Data Science Laboratory (BDSLab), Instituto de Aplicaciones de las Tecnologías de la Información y de las Comunicaciones Avanzadas (ITACA), Universitat Politècnica de València (UPV), Valencia, Spain
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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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Dylla L, Rice JD, Poisson SN, Monte AA, Higgins HM, Ginde AA, Herson PS. Analysis of Stroke Care Among 2019-2020 National Emergency Medical Services Information System Encounters. J Stroke Cerebrovasc Dis 2022; 31:106278. [PMID: 34998044 PMCID: PMC8851983 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106278] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/07/2021] [Accepted: 12/17/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Emergency Medicine Service (EMS) providers play a pivotal role in early identification and initiation of treatment for stroke. The objective of this study is to characterize nationwide EMS practices for suspected stroke and assess for gender-based differences in compliance with American Stroke Association (ASA) guidelines. MATERIALS AND METHODS Using the 2019-2020 National Emergency Medical Services Information System (NEMSIS) Datasets, we identified encounters with an EMS designated primary impression of stroke. We characterized patient characteristics and EMS practices and assessed compliance with eight metrics for "guideline-concordant" care. Multivariable logistic regression modeled the association between gender and the primary outcome (guideline-concordant care), adjusted for age, EMS level of service, EMS geographical region, region type (i.e. urban or rural), and year. RESULTS Of 693,177 encounters with a primary impression of stroke, overall compliance with each performance metric ranged from 18% (providing supplemental oxygen when the pulse oximetry is less than 94%) to 76% (less than 90sec from incoming call to EMS dispatch). 2,382 (0.39%) encounters were fully guideline-concordant. Women were significantly less likely than men to receive guideline-concordant care (adjusted OR 0.82, 95% CI 0.75-0.89; 0.36% women, 0.43% men with guideline-concordant care). CONCLUSIONS A minority of patients received prehospital stroke care that was documented to be compliant with ASA guidelines. Women were less likely to receive fully guideline-compliant care compared to men, after controlling for confounders, although the difference was small and of uncertain climical importance. Further studies are needed to evaluate the underlying reasons for this disparity, its impact on patient outcomes, and to identify potential targeted interventions to improve prehospital stroke care.
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Affiliation(s)
- Layne Dylla
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora CO, USA.
| | - John D Rice
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora CO, USA.
| | - Sharon N Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora CO, USA.
| | - Andrew A Monte
- Department of Emergency Medicine and Pharmaceutical Sciences, University of Colorado School of Medicine, Aurora CO, USA.
| | - Hannah M Higgins
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora CO, USA.
| | - Adit A Ginde
- Department of Emergency Medicine, University of Colorado School of Medicine.
| | - Paco S Herson
- (7)Department of Neurological Surgery, The Ohio State University, Columbus OH, USA.
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11
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Rzońca E, Bień A, Bączek G, Rzońca P, Filip M, Gałązkowski R. Suspected Miscarriage in the Experience of Emergency Medical Services Teams-Preliminary Study. Int J Environ Res Public Health 2021; 18:12305. [PMID: 34886025 PMCID: PMC8657126 DOI: 10.3390/ijerph182312305] [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] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/17/2021] [Accepted: 11/20/2021] [Indexed: 11/17/2022]
Abstract
Vaginal bleeding and abdominal pain are symptoms indicative of a threat to pregnancy that prompt women to seek assistance from health care professionals. The purpose of the study was to present the characteristics of Emergency Medical Services (EMS) team interventions in cases of suspected miscarriage. The study involved a retrospective analysis of EMS team interventions in cases of suspected miscarriage carried out between January 2018 and December 2019 in Poland. Data obtained from Poland's National Monitoring Center of Emergency Medical Services included emergency medical procedure records and EMS team dispatch records in electronic format. The mean patient age was 30.53 years. Most were primiparous (48.90%) and up to the 13th gestational week (76.65%). The most commonly reported symptom was vaginal bleeding (80.71%). EMS teams were most commonly dispatched in the winter (27.03%), between 7 A.M. and 6:59 P.M. (51.87%), in urban areas (69.23%), with urgency code 2 (55.60%), and in most cases, they transferred the patient to a hospital (97.53%). The present study addresses very important issues concerning the characteristics of Polish suspected miscarriage cases handled by different EMS team types, in different locations (urban vs. rural areas), and concerning patients in a different obstetric situation (gestational week, gravidity, parity). Our findings suggest a need for further studies in this field and for gestational health promotion activities to be implemented, specifically including actions to reduce the risk of vaginal bleeding during pregnancy.
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Affiliation(s)
- Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Agnieszka Bień
- Chair of Obstetrics Development, Faculty of Health Sciences, Medical University of Lublin, 4-6 Staszica St., 20-081 Lublin, Poland;
| | - Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 5 Chałubińskiego St., 02-004 Warsaw, Poland;
| | - Michał Filip
- Department of Obstetrics and Pathology of Pregnancy, Medical University of Lublin, 16 Staszica St., 20-081 Lublin, Poland;
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 14/16 Litewska St., 00-575 Warsaw, Poland;
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12
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Sonne A, Andersen JB, Eskesen V, Lippert F, Waldorff FB, Bang CW, Siersma V, Lohse N, Rasmussen LS. Criteria-based dispatch of emergency medical services in non-traumatic subarachnoid haemorrhage. Dan Med J 2021; 68:A02210152. [PMID: 34477094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Timely admission to a facility capable of providing highly specialised treatment is key in patients with spontaneous subarachnoid haemorrhage. We aimed to determine the time elapsed from the initial emergency telephone call to arrival at a neurosurgical department. Also, we aimed to determine the ambulance dispatch criteria used and the activated prehospital responses. METHODS This was a retrospective study. Patients admitted in the Capital Region of Denmark within a 3.5-year period were identified in the Danish National Patient Register. Data were extracted from medical records and from automated telephone logs at the Emergency Medical Dispatch Centre. RESULTS Time intervals were available in 124 out of 262 patients and ambulance dispatch criteria in 98 patients. The median time from call to neurosurgical admission was 207.5 minutes. The dispatch criterion sudden severe headache had a sensitivity of 17.4%. An ambulance with lights and sirens was dispatched to 77% of patients and 28% were brought directly to a hospital with neurosurgical facilities. CONCLUSIONS The median time from emergency call to neurosurgical admission was 3.5 hours. No single dispatch criterion detected the condition with an acceptable sensitivity. A high proportion of patients received an ambulance with lights and sirens, but more than two out of three were not initially brought to a hospital with neurosurgical facilities. FUNDING the non-profit organisation Trygfonden Trial registration: NCT03786068 - www.clinicaltrials.gov.
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Martín-Rodríguez F, Sanz-García A, Alberdi Iglesias A, Ortega Rabbione G, Del Pozo Vegas C, de la Torre-Díez I, Fernández Bayón G, Delgado Benito JF, Gómez-Escolar Pérez M, García Cortés JJ, López-Izquierdo R. Mortality risk model for patients with suspected COVID-19 based on information available from an emergency dispatch center. Emergencias 2021; 33:265-272. [PMID: 34251139] [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: 06/13/2023]
Abstract
OBJECTIVES To develop and validate a scale to stratify risk of 2-day mortality based on data collected during calls to an emergency dispatch center from patients with suspected coronavirus disease 2019 (COVID-19). MATERIAL AND METHODS Retrospective multicenter study of consecutive patients over the age of 18 years with suspected COVID-19 who were transported from home over the course of 3 months after telephone interviews with dispatchers. We analyzed clinical and epidemiologic variables and comorbidities in relation to death within 2 days of the call. Using data from the development cohort, we built a risk model by means of logistic regression analysis of categorical variables that were independently associated with 2-day mortality. The scale was validated first in a validation cohort in the same province and then in a cohort in a different province. RESULTS A total of 2320 patients were included. The mean age was 79 years, and 49.8% were women. The overall 2-day mortality rate was 22.6% (376 deaths of patients with severe acute respiratory syndrome coronavirus 2 infection). The model included the following factors: age, location (rural location as a protective factor), institutionalization, desaturation, lung sounds (rhonchi), and altered mental status. The area under the receiver operating characteristic curve for death within 2 days was 0.763 (95% CI, 0.725-0.802; P .001). Mortality in patients at high risk (more than 2.4 points on the scale) was 60%. CONCLUSION This risk scale derived from information available to an emergency dispatch center is applicable to patients with suspected COVID-19. It can stratify patients by risk of early death (within 2 days), possibly helping with decision making regarding whether to transport from home or what means of transport to use, and destination.
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Affiliation(s)
- Francisco Martín-Rodríguez
- Gerencia de Emergencias Sanitarias, Gerencia Regional de Salud de Castilla y León (SACYL), España. Facultad de Medicina, Universidad de Valladolid, Valladolid, España
| | | | - Ana Alberdi Iglesias
- Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), España
| | | | - Carlos Del Pozo Vegas
- Hospital Clínico Universitario de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL), España
| | - Isabel de la Torre-Díez
- Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad de Valladolid, Valladolid, España
| | - Germán Fernández Bayón
- Hospital de Medina del Campo, Gerencia Regional de Salud de Castilla y León (SACYL), España
| | | | | | | | - Raúl López-Izquierdo
- Hospital Universitario Río Hortega de Valladolid, Gerencia Regional de Salud de Castilla y León (SACYL)
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14
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Ebinger M, Siegerink B, Kunz A, Wendt M, Weber JE, Schwabauer E, Geisler F, Freitag E, Lange J, Behrens J, Erdur H, Ganeshan R, Liman T, Scheitz JF, Schlemm L, Harmel P, Zieschang K, Lorenz-Meyer I, Napierkowski I, Waldschmidt C, Nolte CH, Grittner U, Wiener E, Bohner G, Nabavi DG, Schmehl I, Ekkernkamp A, Jungehulsing GJ, Mackert BM, Hartmann A, Rohmann JL, Endres M, Audebert HJ. Association Between Dispatch of Mobile Stroke Units and Functional Outcomes Among Patients With Acute Ischemic Stroke in Berlin. JAMA 2021; 325:454-466. [PMID: 33528537 PMCID: PMC7856548 DOI: 10.1001/jama.2020.26345] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
IMPORTANCE Effects of thrombolysis in acute ischemic stroke are time-dependent. Ambulances that can administer thrombolysis (mobile stroke units [MSUs]) before arriving at the hospital have been shown to reduce time to treatment. OBJECTIVE To determine whether dispatch of MSUs is associated with better clinical outcomes for patients with acute ischemic stroke. DESIGN, SETTING, AND PARTICIPANTS This prospective, nonrandomized, controlled intervention study was conducted in Berlin, Germany, from February 1, 2017, to October 30, 2019. If an emergency call prompted suspicion of stroke, both a conventional ambulance and an MSU, when available, were dispatched. Functional outcomes of patients with final diagnosis of acute cerebral ischemia who were eligible for thrombolysis or thrombectomy were compared based on the initial dispatch (both MSU and conventional ambulance or conventional ambulance only). EXPOSURE Simultaneous dispatch of an MSU (computed tomographic scanning with or without angiography, point-of-care laboratory testing, and thrombolysis capabilities on board) and a conventional ambulance (n = 749) vs conventional ambulance alone (n = 794). MAIN OUTCOMES AND MEASURES The primary outcome was the distribution of modified Rankin Scale (mRS) scores (a disability score ranging from 0, no neurological deficits, to 6, death) at 3 months. The coprimary outcome was a 3-tier disability scale at 3 months (none to moderate disability; severe disability; death) with tier assignment based on mRS scores if available or place of residence if mRS scores were not available. Common odds ratios (ORs) were used to quantify the association between exposure and outcome; values less than 1.00 indicated a favorable shift in the mRS distribution and lower odds of higher levels of disability. RESULTS Of the 1543 patients (mean age, 74 years; 723 women [47%]) included in the adjusted primary analysis, 1337 (87%) had available mRS scores (primary outcome) and 1506 patients (98%) had available the 3-tier disability scale assessment (coprimary outcome). Patients with an MSU dispatched had lower median mRS scores at month 3 (1; interquartile range [IQR], 0-3) than did patients without an MSU dispatched (2; IQR, 0-3; common OR for worse mRS, 0.71; 95% CI, 0.58-0.86; P < .001). Similarly, patients with an MSU dispatched had lower 3-month coprimary disability scores: 586 patients (80.3%) had none to moderate disability; 92 (12.6%) had severe disability; and 52 (7.1%) had died vs patients without an MSU dispatched: 605 (78.0%) had none to moderate disability; 103 (13.3%) had severe disability; and 68 (8.8%) had died (common OR for worse functional outcome, 0.73, 95% CI, 0.54-0.99; P = .04). CONCLUSIONS AND RELEVANCE In this prospective, nonrandomized, controlled intervention study of patients with acute ischemic stroke in Berlin, Germany, the dispatch of mobile stroke units, compared with conventional ambulances alone, was significantly associated with lower global disability at 3 months. Clinical trials in other regions are warranted.
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Affiliation(s)
- Martin Ebinger
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Bob Siegerink
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
| | - Alexander Kunz
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik für Neurologie, Medical Park Berlin Humboldtmühle, Berlin, Germany
| | - Matthias Wendt
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | - Joachim E. Weber
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
| | - Eugen Schwabauer
- Klinik für Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Frederik Geisler
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Erik Freitag
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Julia Lange
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Janina Behrens
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Hebun Erdur
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Ramanan Ganeshan
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Thomas Liman
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Jan F. Scheitz
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Ludwig Schlemm
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Peter Harmel
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Katja Zieschang
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | - Irina Lorenz-Meyer
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Ira Napierkowski
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
| | - Carolin Waldschmidt
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- Klinik für Neurologie–Stroke Unit–Zentrum für Epilepsie; Vivantes Humboldt-Klinikum, Berlin, Germany
| | - Christian H. Nolte
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
| | - Ulrike Grittner
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Germany
| | - Edzard Wiener
- Institut für Neuroradiologie, Charité–Universitätsmedizin Berlin, Germany
| | - Georg Bohner
- Institut für Neuroradiologie, Charité–Universitätsmedizin Berlin, Germany
| | - Darius G. Nabavi
- Klinik für Neurologie mit Stroke Unit, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Ingo Schmehl
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | - Axel Ekkernkamp
- Klinik für Neurologie mit Stroke Unit und Frührehabilitation, Unfallkrankenhaus Berlin, Germany
| | | | - Bruno-Marcel Mackert
- Klinik für Neurologie mit Stroke Unit, Vivantes Auguste-Viktoria-Klinikum, Berlin, Germany
| | | | - Jessica L. Rohmann
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Institute of Public Health, Charité–Universitätsmedizin Berlin, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), partner site Berlin, Germany
- NeuroCure Cluster of Excellence, Berlin, Germany
- German Center for Neurodegenerative Diseases (DZNE), partner site Berlin, Germany
| | - Heinrich J. Audebert
- Center for Stroke Research Berlin, Charité–Universitätsmedizin Berlin, Germany
- Klinik und Hochschulambulanz für Neurologie, Charité–Universitätsmedizin Berlin, Germany
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15
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Blomberg SN, Christensen HC, Lippert F, Ersbøll AK, Torp-Petersen C, Sayre MR, Kudenchuk PJ, Folke F. Effect of Machine Learning on Dispatcher Recognition of Out-of-Hospital Cardiac Arrest During Calls to Emergency Medical Services: A Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2032320. [PMID: 33404620 PMCID: PMC7788469 DOI: 10.1001/jamanetworkopen.2020.32320] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
IMPORTANCE Emergency medical dispatchers fail to identify approximately 25% of cases of out-of-hospital cardiac arrest (OHCA), resulting in lost opportunities to save lives by initiating cardiopulmonary resuscitation. OBJECTIVE To examine how a machine learning model trained to identify OHCA and alert dispatchers during emergency calls affected OHCA recognition and response. DESIGN, SETTING, AND PARTICIPANTS This double-masked, 2-group, randomized clinical trial analyzed all calls to emergency number 112 (equivalent to 911) in Denmark. Calls were processed by a machine learning model using speech recognition software. The machine learning model assessed ongoing calls, and calls in which the model identified OHCA were randomized. The trial was performed at Copenhagen Emergency Medical Services, Denmark, between September 1, 2018, and December 31, 2019. INTERVENTION Dispatchers in the intervention group were alerted when the machine learning model identified out-of-hospital cardiac arrest, and those in the control group followed normal protocols without alert. MAIN OUTCOMES AND MEASURES The primary end point was the rate of dispatcher recognition of subsequently confirmed OHCA. RESULTS A total of 169 049 emergency calls were examined, of which the machine learning model identified 5242 as suspected OHCA. Calls were randomized to control (2661 [50.8%]) or intervention (2581 [49.2%]) groups. Of these, 336 (12.6%) and 318 (12.3%), respectively, had confirmed OHCA. The mean (SD) age among of these 654 patients was 70 (16.1) years, and 419 of 627 patients (67.8%) with known gender were men. Dispatchers in the intervention group recognized 296 confirmed OHCA cases (93.1%) with machine learning assistance compared with 304 confirmed OHCA cases (90.5%) using standard protocols without machine learning assistance (P = .15). Machine learning alerts alone had a significantly higher sensitivity than dispatchers without alerts for confirmed OHCA (85.0% vs 77.5%; P < .001) but lower specificity (97.4% vs 99.6%; P < .001) and positive predictive value (17.8% vs 55.8%; P < .001). CONCLUSIONS AND RELEVANCE This randomized clinical trial did not find any significant improvement in dispatchers' ability to recognize cardiac arrest when supported by machine learning even though artificial intelligence did surpass human recognition. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04219306.
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Affiliation(s)
- Stig Nikolaj Blomberg
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Danish Clinical Quality Program, National Clinical Registries, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Michael R. Sayre
- Department of Emergency Medicine, University of Washington, Seattle
| | | | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Copenhagen, Denmark
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Hamim OF, Hoque MS, McIlroy RC, Plant KL, Stanton NA. Representing two road traffic collisions in one Accimap: highlighting the importance of emergency response and enforcement in a low-income country. Ergonomics 2020; 63:1512-1524. [PMID: 32757883 DOI: 10.1080/00140139.2020.1807064] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 07/13/2020] [Indexed: 05/21/2023]
Abstract
Seemingly erratic pedestrian crossing has become a major source of vehicle-pedestrian collisions on highways in Bangladesh, and across other low- and middle-income countries (LMICs). In this article, we approach the challenge from a sociotechnical systems perspective by using the Accimap method to analyse a pair of time-separated yet interconnected road traffic collisions. The first event involved a truck colliding with a road divider; in the second, fatal incident, a bus hit a university student. The traditional-style investigation conducted immediately after the collision apportioned blame to end users, that is, drivers and pedestrian; however, application of sociotechnical systems thinking revealed the contribution from lack of emergency response and enforcement among many other important factors. Results and recommendations are discussed in terms of reducing the chance and severity of such collisions across LMICs, and in terms of the need to look beyond the end-user, a focus that remains dominant in such settings. Practitioner summary: This paper applies sociotechnical systems thinking to pedestrian safety in Bangladesh by analysing two inter-connected road traffic collisions using a single Accimap. The findings emphasise the importance of implementing road safety interventions that target all system levels, and draw attention to the importance of post-collision response in low-income settings. Abbreviation: BUET: Bangladesh University of Engineering and Technology.
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Affiliation(s)
- Omar Faruqe Hamim
- Department of Civil Engineering, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | - Md Shamsul Hoque
- Department of Civil Engineering, Bangladesh University of Engineering and Technology, Dhaka, Bangladesh
| | - Rich C McIlroy
- Human Factors Engineering, Transportation Research Group, University of Southampton, Southampton, UK
| | - Katherine L Plant
- Human Factors Engineering, Transportation Research Group, University of Southampton, Southampton, UK
| | - Neville A Stanton
- Human Factors Engineering, Transportation Research Group, University of Southampton, Southampton, UK
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17
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Salhi RA, Fouche S, Mendel P, Nelson C, Fetters MD, Guetterman T, Forman J, Nham W, Goldstick JE, Lehrich J, Forbush B, Iovan S, Hsu A, Shields TA, Domeier R, Setodji CM, Neumar RW, Nallamothu BK, Abir M. Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study: sequential mixed-methods study protocol in Michigan, USA. BMJ Open 2020; 10:e041277. [PMID: 33247025 PMCID: PMC7703417 DOI: 10.1136/bmjopen-2020-041277] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Out-of-hospital cardiac arrest (OHCA) is a common, life-threatening event encountered routinely by first responders, including police, fire and emergency medical services (EMS). Current literature suggests that there is significant regional variation in outcomes, some of which may be related to modifiable factors. Yet, there is a persistent knowledge gap regarding strategies to guide quality improvement efforts in OHCA care and, by extension, survival. The Enhancing Prehospital Outcomes for Cardiac Arrest (EPOC) study aims to fill these gaps and to improve outcomes. METHODS AND ANALYSIS This mixed-methods study includes three aims. In aim I, we will define variation in OHCA survival to the emergency department (ED) among EMS agencies that participate in the Michigan Cardiac Arrest Registry to Enhance Survival (CARES) in order to sample EMS agencies with high-survival and low-survival outcomes. In aim II, we will conduct site visits to emergency medical systems-including 911/dispatch, police, non-transport fire, and EMS agencies-in approximately eight high-survival and low-survival communities identified in aim I. At each site, key informant interviews and a multidisciplinary focus group will identify themes associated with high OHCA survival. Transcripts will be coded using a structured codebook and analysed through thematic analysis. Results from aims I and II will inform the development of a survey instrument in aim III that will be administered to all EMS agencies in Michigan. This survey will test the generalisability of factors associated with increased OHCA survival in the qualitative work to ultimately build an EPOC Toolkit which will be distributed to a broad range of stakeholders as a practical 'how-to' guide to improve outcomes. ETHICS AND DISSEMINATION The EPOC study was deemed exempt by the University of Michigan Institutional Review Board. Findings will be compiled in an 'EPOC Toolkit' and disseminated in the USA through partnerships including, but not limited to, policymakers, EMS leadership and health departments.
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Affiliation(s)
- Rama A Salhi
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Sydney Fouche
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | | | | | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy Guetterman
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Jane Forman
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Center for Clinical Management Research, Veterans Affairs Health System, Ann Arbor, Michigan, USA
| | - Wilson Nham
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jason E Goldstick
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jessica Lehrich
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Bill Forbush
- City of Alpena Fire Department, Alpena County EMS, City of Alpena, Alpena, Michigan, USA
| | - Samantha Iovan
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
| | - Antony Hsu
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Theresa A Shields
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Robert Domeier
- Department of Emergency Medicine, Saint Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | | | - Robert W Neumar
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Brahmajee K Nallamothu
- Division of Cardiovascular Diseases and the Department of Internal Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Mahshid Abir
- Acute Care Research Unit, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Emergency Medicine, University of Michigan Health System, Ann Arbor, Michigan, USA
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Jackson SL, Legvold B, Vahratian A, Blackwell DL, Fang J, Gillespie C, Hayes D, Loustalot F. Sociodemographic and Geographic Variation in Awareness of Stroke Signs and Symptoms Among Adults - United States, 2017. MMWR Morb Mortal Wkly Rep 2020; 69:1617-1621. [PMID: 33151923 PMCID: PMC7643899 DOI: 10.15585/mmwr.mm6944a1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Affiliation(s)
- Wendi P Rank
- Wendi Rank is employed as a substitute nurse for the Centennial School District in Pennsylvania
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Abstract
BACKGROUND It is a challenge to dispatch Emergency medical Services (EMS) appropriately with limited resources and maintaining patient safety; this requires accurate dispatching systems. The objective of the current systematic review was to examine the evidence, according to GRADE, for medical dispatching systems to accurately dispatch EMS according to level of acuity and in recognition of specific conditions. A systematic search was performed trough PubMed, Web of Science, Embase (free text in all fields), Centre for Reviews and Dissemination (CRD), and Cochrane Central Register of Controlled Trials up to 16th of May, 2017. A combination of keywords and Medical Subject Heading (MeSH) terms relevant to "emergency medical dispatch criteria" were used, to search for articles published between 2012 and 2017. Publications were included according to the inclusion/exclusion criteria using the Systematic Reviews and Meta-Analyses (PRISMA) protocol. Level of evidence was evaluated in accordance with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Articles included were those that provided evidence for at least one of the measures of dispatch system accuracy; i.e. sensitivity, specificity, positive and negative predictive and/or over- and under-triage. The search identified 1445 articles. After the removal of duplicates, 382 titles were reviewed for relevance and an additional 359 articles were excluded based on manuscript title and abstract. An additional five articles were excluded after review of the full text versions of the remaining articles. The current review included 18 publications which all were based on primary research. CONCLUSIONS The 18 articles addressed the identification of cardiac arrest, stroke, medical priority and major trauma using different dispatching systems. The results of the current review show that there is a very low to low overall level of evidence for the accuracy of medical dispatching systems. We suggest that it is necessary to create a consensus on common standards for reporting before consensus can be reached for the level of accuracy in medical dispatching systems.
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Affiliation(s)
- K. Bohm
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, SE 118 83 Stockholm, Sweden
- Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden
| | - L. Kurland
- Department of Medical Sciences, Örebro University, Örebro, Sweden
- Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden
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Ford J. You Call, They Come, and You Say "Help Us". Air Med J 2018; 37:345. [PMID: 30424847 DOI: 10.1016/j.amj.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 06/09/2023]
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Prentice C, Jeyanathan J, De Coverly R, Williams J, Lyon R. Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma: an observational study. BMJ Open 2018; 8:e022464. [PMID: 30185576 PMCID: PMC6129099 DOI: 10.1136/bmjopen-2018-022464] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVES The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate. SETTING Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people. PARTICIPANTS Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust's geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected. OUTCOME MEASURES Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates. RESULTS 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the 'not in TCA cohort', 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital. CONCLUSION A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.
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Affiliation(s)
- Craig Prentice
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
| | - Jeyasankar Jeyanathan
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
- Academic Department of Military Anaesthesia and Critical Care, Defence Medical Services, Birmingham, UK
| | | | - Julia Williams
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
- University of Hertfordshire, Hertfordshire, UK
- South East Coast Ambulance Service, Crawley, UK
| | - Richard Lyon
- Kent, Surrey and Sussex Air Ambulance Trust, Redhill, UK
- University of Surrey, Guildford, UK
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Abstract
Why is neighborhood racial composition linked so strongly to police-reported crime? Common explanations include over-policing and negative interactions with police, but police reports of crime are heavily dependent on resident 911 calls. Using Sampson's concept of legal cynicism and Vaisey's dual-process theory, we theorize that racial concentration and isolation consciously and nonconsciously influence neighborhood variation in 911 calls for protection and prevention. The data we analyze are consistent with this thesis. Independent of police reports of crime, we find that neighborhood racial segregation in 1990 and the legal cynicism about crime prevention and protection it engenders have lasting effects on 911 calls more than a decade later, in 2006-2008. Our theory explains this persistent predictive influence through continuity and change in intervening factors. A source of cumulative continuity, the intensification of neighborhood racial concentration and isolation between 1990 and 2000, predicts 911 calls. Likewise, sources of change-heightened neighborhood incarceration and home foreclosures during the financial crisis in 2006-2008-also predict these calls. Our findings are consistent with legal cynicism theory's focus on neighborhood disadvantage, racial isolation, and concerns about police protection and crime prevention; they correspond less with the emphasis of procedural justice theory on police legitimacy.
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Affiliation(s)
- John Hagan
- Department of Sociology, Northwestern University, Evanston, IL 60611;
- American Bar Foundation, Chicago, IL 60611
| | - Bill McCarthy
- Department of Sociology, University of California, Davis, CA 95616
| | - Daniel Herda
- Department of Sociology, Merrimack College, North Andover, MA 01845
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Joseph D, Vogel JA, Smith CS, Barrett W, Bryskiewicz G, Eberhardt A, Edwards D, Rappaport L, Colwell CB, McVaney KE. Alcohol as a Factor in 911 Calls in Denver. PREHOSP EMERG CARE 2018; 22:427-435. [PMID: 29419332 PMCID: PMC6360267 DOI: 10.1080/10903127.2017.1413467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 11/19/2017] [Accepted: 11/28/2017] [Indexed: 01/12/2023]
Abstract
BACKGROUND Excessive alcohol consumption is associated with a substantial number of emergency department visits annually and is responsible for a significant number of lives lost each year in the United States. However, a minimal amount is known about the impact of alcohol on the EMS system. OBJECTIVES The primary objective was to determine the proportion of 9-1-1 calls in Denver, Colorado in which (1) alcohol was a contributing factor or (2) the individual receiving EMS services had recently ingested alcohol. The secondary objectives were to compare the characteristics of EMS calls and to estimate the associated costs. METHODS This was a prospective observational cohort study of EMS calls for adults from July 1, 2012, to June 30, 2014. Primary outcomes for the study were alcohol as a contributing factor to the EMS call and recent alcohol consumption by the patient receiving EMS services. Logistic regression was utilized to determine the associations between EMS call characteristics and the outcomes. Cost was estimated using historic data. RESULTS During the study period, 169,642 EMS calls were completed by the Denver Health Paramedic Division. Of these 71% were medical and 29% were trauma-related. The median age was 45 (interquartile range [IQR] 29-59) years, and 55% were male. 50,383 calls (30%) had alcohol consumption, and 49,165 (29%) had alcohol as a contributing factor. Alcohol related calls were associated with male sex, traumatic injuries including head trauma, emergent response, use of airway adjuncts, cardiac monitoring, glucose measurement, use of restraints, use of spinal precautions, and administration of medications for sedation. Estimated costs to the EMS system due to alcohol intoxication exceeded $14 million dollars over the study period and required in excess of 37 thousand hours of paramedic time. CONCLUSIONS Compared to 9-1-1 calls that do not involve alcohol, alcohol-related calls are more likely to involve male patients, emergent response, traumatic injuries, advanced monitoring, airway adjuncts, and medications for sedation. This represents a significant burden on the emergency system and society. Further studies are needed to evaluate whether additional interventions such as social services could be used to lessen this burden.
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Bui DP, Balland S, Giblin C, Jung AM, Kramer S, Peng A, Aquino MCP, Griffin S, French DD, Pollack Porter K, Crothers S, Burgess JL. Interventions and controls to prevent emergency service vehicle incidents: A mixed methods review. Accid Anal Prev 2018; 115:189-201. [PMID: 29621721 DOI: 10.1016/j.aap.2018.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 12/14/2017] [Accepted: 01/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Emergency service vehicle incidents (ESVI), including crashes, rollovers, and roadside struck-by-incidents, are a leading cause of occupational fatality and injury among firefighters and other emergency responders. Though there are numerous strategies and interventions to prevent ESVIs, the evidence base for these strategies is limited and dispersed. The goal of this study was to gather and present a review of evidence-based ESVI interventions. METHODS We searched five academic databases for articles published within the last decade featuring interventions to reduce or prevent ESVIs. We interviewed key informants from fire departments serving major metropolitan areas for additional interventions. Interventions from both sources were summarized and data on intervention effectiveness were reported when available. RESULTS Sixty-five articles were included in the final review and 17 key informant interviews were completed. Most articles focused on vehicle engineering interventions (38%), followed by policy and administration interventions (26%), environmental engineering interventions (19%) and education or training (17%). Most key informants reported policy (49%) and training interventions (29%). Enhanced drivers' training and risk management programs were associated with 19-50% and 19-58% reductions in ESVIs, respectively. CONCLUSIONS Only a limited number of interventions to address ESVIs had adequate outcome data. Based on the available data, training and risk management approaches may be particularly effective approaches to reducing ESVIs.
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Affiliation(s)
- David P Bui
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA.
| | - Samantha Balland
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Casey Giblin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Alesia M Jung
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Sandy Kramer
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Abigail Peng
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Marie Corazon Ponce Aquino
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Stephanie Griffin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
| | - Dustin D French
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, Suite 440, Chicago, IL 60611, USA; Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 633 N. Saint Clair, 20th Floor, Chicago, IL 60611, USA; Veterans Affairs Health Services Research and Development Service, Chicago, 5000 5th Ave, Hines, IL 60141, USA
| | - Keshia Pollack Porter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, 615 N Wolfe St, Baltimore, MS 21205, USA
| | - Steve Crothers
- Seattle Fire Department, 301 2nd Ave S, Seattle, WA 98104, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N Martin Ave, Tucson, AZ 85724, USA
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Weinlich M, Kurz P, Blau MB, Walcher F, Piatek S. Significant acceleration of emergency response using smartphone geolocation data and a worldwide emergency call support system. PLoS One 2018; 13:e0196336. [PMID: 29791450 PMCID: PMC5965832 DOI: 10.1371/journal.pone.0196336] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 04/11/2018] [Indexed: 11/18/2022] Open
Abstract
Importance When patients are disorientated or experience language barriers, it is impossible to activate the emergency response system. In these cases, the delay for receiving appropriate help can extend to several hours. Objectives A worldwide emergency call support system (ECSS), including geolocation of modern smartphones (GPS, WLAN and LBS), was established referring to E911 and eCall systems. The system was tested for relevance in quickly forwarding abroad emergency calls to emergency medical services (EMS). Design To verify that geolocation data from smartphones are exact enough to be used for emergency cases, the accuracy of GPS (global positioning system), Wi-Fi (wireless LAN network) and LBS (location based system) was tested in eleven different countries and compared to actual location. The main objective was analyzed by simulation of emergencies in different countries. The time delay in receiving help in unsuccessful emergency call cases by using the worldwide emergency call support system (ECSS) was measured. Results GPS is the gold standard to locate patients with an average accuracy of 2.0 ± 3.3 m. Wi-Fi can be used within buildings with an accuracy of 7.0 ± 24.1 m. Using ECSS, the emergency call leads to a successful activation of EMS in 22.8 ± 10.8 min (Median 21 min). The use of a simple app with one button to touch did never cause any delay. Conclusions and relevance The worldwide emergency call support system (ECSS) significantly improves the emergency response in cases of disorientated patients or language barriers. Under circumstances without ECSS, help can be delayed by 2 or more hours and might have relevant lifesaving effects. This is the first time that Wi-Fi geolocation could prove to be a useful improvement in emergencies to enhance GPS, especially within or close to buildings.
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Affiliation(s)
- Michael Weinlich
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
- * E-mail:
| | - Peter Kurz
- Hospital am Steinenberg Reutlingen, teaching facility affiliated with the University of Tübingen, Department of Trauma Surgery, Reutlingen, Germany
| | | | - Felix Walcher
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
| | - Stefan Piatek
- University of Magdeburg, Department of Trauma Surgery, Magdeburg, Germany
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Bui DP, Porter KP, Griffin S, French DD, Jung AM, Crothers S, Burgess JL. Risk management of emergency service vehicle crashes in the United States fire service: process, outputs, and recommendations. BMC Public Health 2017; 17:885. [PMID: 29149879 PMCID: PMC5693554 DOI: 10.1186/s12889-017-4894-3] [Citation(s) in RCA: 7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergency service vehicle crashes (ESVCs) are a leading cause of death in the United States fire service. Risk management (RM) is a proactive process for identifying occupational risks and reducing hazards and unwanted events through an iterative process of scoping hazards, risk assessment, and implementing controls. We describe the process, outputs, and lessons learned from the application of a proactive RM process to reduce ESVCs in US fire departments. METHODS Three fire departments representative of urban, suburban, and rural geographies, participated in a facilitated RM process delivered through focus groups and stakeholder discussion. Crash reports from department databases were reviewed to characterize the context, circumstances, hazards and risks of ESVCs. Identified risks were ranked using a risk matrix that considered risk likelihood and severity. Department-specific control measures were selected based on group consensus. Interviews, and focus groups were used to assess acceptability and utility of the RM process and perceived facilitators and barriers of implementation. RESULTS Three to six RM meetings were conducted at each fire department. There were 7.4 crashes per 100 personnel in the urban department and 10.5 per 100 personnel in the suburban department; the rural department experienced zero crashes. All departments identified emergency response, backing, on scene struck by, driver distraction, vehicle/road visibility, and driver training as high or medium concerns. Additional high priority risks varied by department; the urban department prioritized turning and rear ending crashes; the suburban firefighters prioritized inclement weather/road environment and low visibility related crashes; and the rural volunteer fire department prioritized exiting station, vehicle failure, and inclement weather/road environment related incidents. Selected controls included new policies and standard operating procedures to reduce emergency response, cameras to enhance driver visibility while backing, and increased training frequency and enhanced training. The RM process was generally acceptable to department participants and considered useful. All departments reported that the focused and systematic analysis of crashes was particularly helpful. Implementation of controls was a commonly cited challenge. CONCLUSIONS Proactive RM of ESVCs in three US fire departments was positively received and supported the establishment of interventions tailored to each department's needs and priorities.
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Affiliation(s)
- David P. Bui
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
| | - Keshia P. Porter
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Center for Injury Research and Policy, Baltimore, MD USA
| | - Stephanie Griffin
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
| | - Dustin D. French
- Center for Healthcare Studies, Department of Ophthalmology, Northwestern University Feinberg School of Medicine, Chicago, IL USA
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL USA
| | - Alesia M. Jung
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
| | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Drachman Hall, 1295 N Martin Ave, Campus PO Box: 245210, Tucson, AZ 85724 USA
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Issacs SM, Cash C, Antar O, Fowler RL. No Need for Speed: Response and transport with red lights and siren. JEMS 2017; 42:41-43. [PMID: 29215827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Goodloe JM, Knoles CL, McAnallen D, Cox ML, Howerton DS. When is the Need for Speed? JEMS 2017; 42:31-38. [PMID: 29215826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Rubin M. Medical Control: Colleagues in Patient Care. Its mission should be not only consultative but collaborative. EMS World 2016; 45:45-51. [PMID: 29953757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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