Critical care transfers of ventilator-dependent patients from operating theatres to Critical Care Units in a South African Metropole.

A population-based investigation of public access defibrillation: Role of emergency medical services care

Background. As the role of emergency medical services (EMS) continues to expand, EMS physicians andmedical directors require special skills andtraining to keep pace with the rapidly evolving subspecialty of EMS. In Canada, subspecialty training in EMS is still relatively new, anda standard national curriculum for physician EMS training does not exist. Objective. To develop a national EMS curriculum for emergency medicine (EM) residents andfellows andan abbreviated curriculum for non-EM trainees andcommunity physicians. Methods. The authors obtained EMS curricula andopportunities from Canadian EM andEMS training programs anda sample of U.S. programs to determine existing curricula, anddeveloped a framework for a national EMS curriculum using an expert working group of EMS medical directors andEMS leaders in Canada. Results. Canadian EM residency training programs included an EMS rotation, but their content anddepth of training were not uniform. The expert working group proposed a comprehensive set of training objectives, grouped into 16 categories, stratified by level of training. Conclusion. The proposed framework andobjectives are suitable for training medical students, family medicine trainees, community physicians, EM residents, andEMS fellows in Canada. The authors hope this article will serve as a guideline for residency andfellowship directors to develop their EMS training programs in a consistent manner, promote formal training for physicians involved in EMS, andhelp define the specific knowledge andexpertise required of physicians who provide EMS medical direction in Canada.

Impact of Community Socioeconomic Characteristics on Emergency Medical Service Delays in Responding to Fatal Vehicle Crashes

Background: Mass gatherings are worldwide events, and the Hajj season is considered one of the significant mass gathering events that happen annually in Makkah city, Saudi Arabia. Medical preparation such as preparation for transportation, training, and medical staffing for mass gatherings at existing sites has been discussed. Aims: This study aimed to assess the role of emergency medical services (EMS) providers during Hajj Season 2019 and the preparedness of the EMS system through providers' perspectives. Settings and Design: A cross-sectional survey using a questionnaire has been conducted in Makkah during the Hajj season 2019, which took place in Mena valley and Arafat. Methods: Convenience sampling from two major institutions (the Saudi Red Crescent and the National Guards Hospital, EMS Department) was used. The inclusion criteria included emergency medical specialists and emergency medical technicians. Statistical Analysis Used: The data were analyzed using JMP. Data for continuous variables were presented as mean and standard deviation if normally distributed, otherwise median and interquartile range were used. Data for the categorical variables were presented as frequencies and percentages. Results: The majority of EMS providers were male in gender and almost half of them were emergency medical technicians with a diploma qualification. Most of them had specific training before Hajj such as basic life support. However, the majority reported the use of medications during transport and training are areas that require improvement. During Hajj, the majority of the EMS providers do ambulance decontamination. Busy shifts and lack of workforce were the main reasons for working more than 12 h per shift. Conclusions: This study offers important recommendations for improving the EMS system's preparedness during Hajj, which include more workforce coverage as well as improved providers' qualifications and level of training. Furthermore, this study provides a recommendation to change the scope of practice to treat and release in the majority of cases rather than unnecessarily transport to the hospital. This study urges the importance of collaboration between agencies to facilitate the EMS system.

The Role of Emergency Medical Services in Primary Injury Prevention

The role of emergency medical services (EMS) in out-of-hospital cardiac arrest (OHCA) among children and young adults remains understudied. This study evaluated EMS utilization and its association with outcomes in non-traumatic pediatric and young adult OHCA. Patients aged <35 years with non-traumatic OHCA treated at a tertiary center between 1995 and 2019 were analyzed. Exclusion criteria included referrals and newborns <24 hours old. EMS use was defined as public-ambulance transport to the emergency department. The primary outcome was return of spontaneous circulation (ROSC). Of 195 OHCAs, 109 (55.9%) were pediatric. EMS use increased with age, from 38.0% (0-5 years) to 82.6% (18 to <35 years). EMS was associated with higher ROSC and survival to hospital discharge (41.7% vs. 24.6%, p = 0.06, and 25.0% vs. 6.6%, p = 0.007, respectively) in pediatric group but not in the young adult group. However, EMS improved the ROSC rate in young adults from 30.8% during 1995-2002 to 65.7% during 2011-2019. The impact of EMS was not significant after multivariable adjustment. EMS utilization and clinical outcomes in pediatric and young adults OHCA remained suboptimal over the 25-year study period. Targeted advocacy and education are essential to strengthen the chain of survival in these population. Pediatric OHCA patients had significantly lower EMS use than young adults. EMS was associated with higher ROSC and survival to hospital discharge in the pediatric group but not in the young adult group. While EMS-transported young adults showed improved outcomes over time, pediatric outcomes remained unchanged. Pediatric OHCA patients transported by EMS had shorter scene times and received fewer prehospital interventions than young adults. Educating caregivers on the importance of EMS activation is crucial. Emergency departments must be prepared for unannounced pediatric cases. There is an urgent need for protocols specifically tailored to pediatric OHCA care.

This is the official position statement of the National Association of EMS Physicians on the role of emergency medical services (EMS) in disaster response.

Emergency medical services (EMS) play an important role in acute stroke therapy. The goal of this study was to investigate the roles and determinants of EMS in stroke in Southern Taiwan, Kaohsiung. We enrolled stroke patients who arrived at emergent department (ED) of the study hospital within 48 hours after the onset of symptoms. Patients were categorized into arriving by EMS or not EMS. Potential determinants of EMS use for stroke were examined by multivariable analyses and the role of EMS in stroke was discussed. Among 197 stroke patients enrolled, only 44 (22%) patients arrived by EMS at ED. Multivariable logistic regression analysis revealed that the determinants of EMS use were stroke severity measured by NIHSS and non-family member who decided to seek help. Using EMS or not was not associated with the earlier presentation after stroke within 2 hours after attack. EMS use was far from sufficient. The transportation time was not the major component of prehospital delay. Both EMS and other vehicles provided prompt delivery. The public should rush to ED either by EMS or other transportation modes when stroke occurred unless use of EMS is proved to provide better outcome in stroke patient in the future study.

The National Association of EMS Physicians (NAEMSP) advocates for a strong emergency medical services (EMS) role in all phases of disaster management—preparedness, response, and recovery. Emergency medical services administrators and medical directors should play a leadership role in preparedness activities such as training and education, development of performance metrics, establishment of memoranda of understanding (MOUs), and planning for licensure and liability issues. During both the planning and response phases, EMS leadership should advocate for participation in unified command, modified scope of practice appropriate for providers and the event, and expanded roles in community and federal response efforts. To enhance recovery, EMS leadership should strongly advocate for national recognition for EMS efforts and further research into strategies that foster healthy coping techniques and resiliency in the EMS workforce. This resource document will outline the basis for the corresponding NAEMSP position statement on the role of EMS in disaster management.

Emergency department course of patients with asthma receiving initial emergency medical services care—Perspectives From the National Hospital Ambulatory Medical Care Survey

Injury is a leading cause of death and disability. Preventing injuries from ever occurring is primary injury prevention (PIP). The objective of this statement is to present the consensus of a 16-member panel of leaders from the out-of-hospital emergency medical services (EMS) community on essential and desirable EMS PIP activities. Essential PIP activities for leaders and decision makers of every EMS system include: protecting individual EMS providers from injury; providing education to EMS providers in PIP fundamentals; supporting and promoting the collection and utilization of injury data; obtaining support for PIP activities; networking with other injury prevention organizations; empowering individual EMS providers to conduct PIP activities; interacting with the media to promote injury prevention; and participating in community injury prevention interventions. Essential PIP knowledge areas for EMS providers include: PIP principles; personal injury prevention and role modeling; safe emergency vehicle operation; injury risk identification; documentation of injury data; and one-on-one safety education.

Death from acute drug poisoning, also termed drug overdose, is a substantial public health problem. Little is known regarding the role of emergency medical services (EMS) in critical drug poisonings. This study investigates the involvement and potential mortality benefit of EMS for critical drug poisonings, characterized by cardiovascular collapse requiring cardiopulmonary resuscitation (CPR). The study population was composed of death events caused by acute drug poisoning, defined as poisoning deaths and deaths averted (persons successfully resuscitated from out-of-hospital cardiac arrest by EMS) in King County, Washington, during the year 2000. Eleven persons were successfully resuscitated and 234 persons died from cardiac arrest caused by acute drug poisoning, for a total of 245 cardiac events. The EMS responded to 79.6% (195/245), attempted resuscitation in 34.7% (85/245), and successfully resuscitated 4.5% (11/245) of all events. Among the 85 persons for whom EMS attempted resuscitation, opioids, cocaine, and alcohol were the predominant drugs involved, although over half involved multiple drug classes. Among the 11 persons successfully resuscitated, return of circulation was achieved in six following EMS cardiopulmonary resuscitation alone, in one following CPR and defibrillation, and in the remaining four after additional advanced life support. In this community, EMS was involved in the majority of acute drug poisonings characterized by cardiovascular collapse and may potentially lower total mortality by approximately 4.5%. The results show that, in some survivors, return of spontaneous circulation may be achieved with CPR alone, suggesting a different pathophysiology in drug poisoning compared with cardiac arrest due to heart disease.

BackgroundMedical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls. MethodsDescriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed. ResultsIn total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required. ConclusionsHospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs.

The impact of emergency medical services in acute heart failure

IntroductionTimely actions can facilitate the efficacy of Emergency Medical Services (EMS) response in disaster by understanding the scale of event and shifting of traditional tasks. A simple scaling system of earthquakes/disasters by ABC is proposed: Level A treated by the local EMS. One or more Multi Casualty Incident's (MCI) in a defined geographical area that can easily be Level B hours, by reinforcement of regional and national aid coordinated by automatic autonomic response. An earthquake/disaster where the EMS and medical community can complete their task within 48 Level C - An earthquake/disaster that even joint national forces cannot eliminate within 48 hours.MethodsInformation from medical systems around the world was gathered to help develop strategies to minimize the weaknesses whilst achieving the objectives of the EMS via adapting to shifting conditions.ResultsEMS goal is to provide treatment to those in need of urgent medical care and arrange for timely transfer of the patient to definitive care. EMS are not qualified or equipped to delay victims in the field for hours or days. However, many patients in earthquakes do not require definitive treatment or have an immediate lifethreatening.ConclusionBy scaling the event by the ABC - a timely coordinated autonomic regional / national response can begin immediately. An area defined as level A will automatically back-up a level B/C area, in an event that the standard communication and activation systems collapse. Moreover, a clear shift in EMS roles will take place in a level B or C events. Available-Hours Busy-48-Hours Catastrophe-weeks Types of Levels area for delaying evacuation. Prioritizing, sorting and sending patients that require immediate attention to definitive care whilst considering availability of destination facilities and transportation resources. Patients that do not require immediate attention or cannot be saved shall await evacuation.