Enhancing tactical emergency care abilities in policing: a study of The Swedish Regional Task Force

Shooting Episodes Prompt Cooperation Between EMS and Police, With an Assist From Emergency Medicine

Frequency of Mass Casualty Incidents (MCIs) Responded to by Helicopter Emergency Medical Services (HEMS)

There have been major changes in pre-hospital emergency care training and education in South African over the past 30 years. This has culminated in the publication of a regulation that brings an end to an era of short courses in emergency care and paves the way for the implementation of the National Emergency Care Education and Training (NECET) policy. The policy envisions a 1-year higher certificate, a 2-year diploma and the 4-year professional degree in emergency medical care. This paper aims to describe the history of emergency care education and training in South Africa that culminated in the NECET policy. The lessons in the professional development of pre-hospital emergency care education and training may have application for emergency medical services in other countries. The migration of existing emergency medical services personnel to the new higher education qualification structure is a major challenge. The transition to the new framework will take time due to the many challenges that must be overcome before the vision of the policy is realised. Ongoing engagement with all stakeholders is necessary for the benefits envisioned in the NECET policy to be realised.

To meet surge capacity and to prevent hospitals from being overwhelmed with COVID-19 patients, a regional crisis task force was established during the first pandemic wave to coordinate the even distribution of COVID-19 patients in the Amsterdam region. Based on a preexisting regional management framework for acute care, this task force was led by physicians experienced in managing mass casualty incidents. A collaborative framework consisting of the regional task force, the national task force, and the region's hospital crisis coordinators facilitated intraregional and interregional patient transfers. After hospital admission rates declined following the first COVID-19 wave, a window of opportunity enabled the task forces to create, standardize, and optimize their patient transfer processes before a potential second wave commenced. Improvement was prioritized according to 3 crucial pillars: process standardization, implementation of new strategies, and continuous evaluation of the decision tree. Implementing the novel "fair share" model as a straightforward patient distribution directive supported the regional task force's decisionmaking. Standardization of the digital patient transfer registration process contributed to a uniform, structured system in which every patient transfer was verifiable on intraregional and interregional levels. Furthermore, the regional task force team was optimized and evaluation meetings were standardized. Lines of communication were enhanced, resulting in increased situational awareness among all stakeholders that indirectly provided a safety net and an improved integral framework for managing COVID-19 care capacities. In this article, we describe enhancements to a patient transfer framework that can serve as an exemplary system to meet surge capacity demands during current and future pandemics.

In Jordan, pre-hospital care is provided by the civil defense department in general but there is a wide underpopulated area in the eastern and southern parts of the coutry plus many remote small villages and communities, which are underserved by clinics, hospitals and civil defense units and the evacuation routes are very long, so emergency care which is needed is provided by general physicians and family practitioners with little if any training in emergency care. Ten years ago we started to train all physicians who would practice in such areas, in providing emergency care. All 220 physicians graduated from the family medicine residency programs in Jordan had to rotate through the emergency departments as basic 3-month rotation in their family medicine training program and were required to master all life saving skills before they finish this rotation. Also all of them were tested to make sure that they are competent to provide emergency care. A questionnaire was designed for both the receiving hospitals and the providers in the field physicians to assess the outcome of this training scheme. Feedback from the hospitals on the quality of care given to patients by those physicians in pre-hospital setting indicated great improvement in evaluating, stabilizing, and providing the necessary care mainly to trauma and cardiac patients. All providers feel more satisfied with their practice and less stressed when they face an emergency, and that pre-hospital care had improved dramatically in those remote areas.

Introduction. Helicopter and ground emergency medical services (EMS) units are frequently called to transport patients from winter resorts to area trauma centers. Objective. The purpose of this study was to examine helicopter EMS (HEMS) utilization for such patients, and to investigate out-of-hospital clinical variables that might help providers determine the most appropriate utilization of HEMS. Methods. The study included patients aged ≥12 years who were transported by ground EMS (GEMS) or HEMS to a regional trauma center with an acute injury sustained at a winter resort. The decision to transport via HEMS was based on field provider judgment. Injury information was prospectively obtained and combined with emergency department (ED) and hospital data abstracted from trauma registry and hospital records. For the purpose of this study, appropriate HEMS utilization was defined according to two different schemes. Limited utilization of HEMS was defined as the need for an emergent ED or out-of-hospital intervention (intubation, chest tube or needle thoracostomy, central line placement, or cardiopulmonary resuscitation). Expanded utilization of HEMS was defined as the need for an emergent intervention and/or an Injury Severity Score (ISS) ≥16 and/or need for emergent nonorthopedic surgery. Provider judgment alone was compared with results of recursive partitioning to predict the need for HEMS. Results. Of 815 patients enrolled between 2006 and 2009, 65 (8.0%) patients met the expanded criteria for appropriate HEMS utilization. Of these, 30 (46.2%) were transported by GEMS and 35 (53.8%) were transported by HEMS. Twenty-seven of the 65 patients (41.5%) required an emergent ED or out-of-hospital intervention. Activation of HEMS by out-of-hospital providers was (at best) 55.6% sensitive and 89.1% specific (85.2% overtriage rate) for predicting the need for an emergent out-of-hospital or ED intervention. Recursive partitioning, using a Glasgow Coma Scale score (GCS) ≤13 or pulse oximetry value <89%, was superior to provider judgment in predicting the need for an emergent procedure (57.9% sensitive, 98.6% specific, 45% overtriage rate). Conclusion. Use of a simple prediction rule was superior to provider judgment in predicting the need for an emergent ED or out-of-hospital procedure in patients injured at winter resorts. If validated, this rule may be a resource to help out-of-hospital providers decide when to activate HEMS in these unique areas.

Objective. We sought to characterize and estimate the frequency of mass casualty incidents (MCIs) occurring in the United States during the year 2010, as reported by emergency medical services (EMS) personnel. Methods. Using the 2010 National EMS Database of the National Emergency Medical Services Information System (NEMSIS), containing data from 32 states and territories, we estimated and weighted the frequency of MCIs documented by EMS personnel based on their perception of the event to produce incidence rates of MCIs per 100,000 population and MCIs per 1,000 9-1-1 calls requesting EMS service. We conducted descriptive analyses to characterize the MCIs by geographic location, incident type, and time of day as well as the MCI patients by demographic and health information. We used chi-squared tests to compare response delays and two-tailed t-tests to compare system response times between EMS responses documented as MCIs and those not. Results. Among the 9,776,094 EMS responses in the 2010 National EMS Database, 14,504 entries were documented as MCI. These entries represented an estimated 9,913 unique MCIs from the National EMS Database: 39.1% occurred in the South Atlantic region of the United States where only 19.1% of the population resides, 60.9% occurred in an urban setting, and 58.4% occurred on a street or highway. There were an estimated 13,677 MCI patients. The prehospital EMS personnel's primary impressions of the patients ranged from electrocution (0.01%) to traumatic injury (40.7%). Of the patients with a primary impression of injury (N = 7,960), motor vehicle traffic crash was the cause of injury for 62.7%. Among the MCI EMS responses, 47.6% documented experiencing a response delay compared to only 12.3% of non-MCI EMS responses. Conclusions. This study demonstrates the range of health conditions and characteristics of EMS responses that EMS personnel perceive as MCIs, suggests that response delays are common during MCIs, and indicates there may be underreporting of all persons involved in an MCI. The National EMS Database is useful for describing MCIs and may help guide national leadership in strengthening EMS system preparedness for MCIs.

This study attempted to determine the extent of training and emergency care knowledge of public school teachers in midwestern states. A secondary purpose was to assess the frequency of injury and illness in the school setting requiring the teacher to first-respond. A questionnaire and 14-item, scenario-based, emergency medical care test was developed and pretested. A discrimination index was used for validation of the instrument and a reliability coefficient of .82 was computed using the Kuder-Richardson Formula 20. A randomly recruited group of public school nurses from Arkansas, Kansas, and Missouri administered the instrument to 334 teachers who had no prior knowledge of the test. A random telephone survey of local school patrons also was completed to determine parental assumptions and expectations for emergency care and cardiopulmonary resuscitation (CPR) training in teachers. One-third (112 teachers) had no specific training in first-aid and 40% never had been trained in CPR. However, most (87%) of the respondents strongly agreed that emergency care training should be required in teacher preparation programs. Eighteen percent of the teachers responded to more than 20 injured or ill students annually, and 17% reported that they had encountered at least one life-threatening emergency in a student during their career. The average score for all respondents on the emergency care test was 58% (chi 2 = 8.12 +/- 2.42). Those with prior first-aid training averaged 60.5% (chi 2 = 8.47 +/- 2.32). Significant deficiencies were noted for recognition and appropriate treatment of student emergencies involving basic life support (BLS) and airway interventions, diabetic emergencies, and treatment of profuse bleeding. Forty of the 50 (80%) parents surveyed assumed that all teachers were adequately trained in first-aid and CPR. Public school teachers represent a potentially effective first-response component during disasters and isolated emergencies in the school environment. Overall, most of public school teachers in this study were deficient in both training and knowledge of emergency care and BLS modalities. Lack of effective, formal emergency care training in teacher preparation programs coupled with no continuing education requirement is a possible explanation of these results. Emergency medical services providers should seek opportunities to help with first-responder training and continuing education in their schools.

Rising Helicopter Crash Deaths Spur Debate Over Proper Use of Air Transport

Reimagining health preparedness in the aftermath of COVID-19

Roles of a helicopter emergency medical service in mass casualty incidents

Mid-year report

Introduction. Mass casualty incidents (MCIs) are infrequent but potentially overwhelming events that can stress the capabilities of even the most organized emergency medical services (EMS) system. The Maryland EMS system has been identified as a pioneer and leader in the field of prehospital emergency care and, as with many states, Maryland's regional preparation for MCIs has been integrated into its overall EMS systems planning. Objective. To determine how successful this integration has been by examining a three-year history of response to MCIs in Maryland. Methods. A three-year case series of MCIs in Maryland was obtained from a Nexis national news publications search. These MCIs were cross-referenced with U.S. postal ZIP codes and the U.S. Census Bureau's ZIP code files. They were then mapped and summary statistics were prepared for analysis. Data obtained through the Maryland Health Services Cost Review Commission for all severely injured patients discharged from Maryland hospitals were obtained over the same three-year period for comparison. Results. Eight MCIs occurred over a three-year period, resulting in a total of 203 injuries. An average of 25.4 ± 10.7 injuries occurred per MCI. A total of 158 (77.8%) of injuries necessitated ambulance transportation. An average of 3.1 ± 1.1 hospitals were involved per MCI. Conclusions. The Maryland EMS system was effective in responding to MCIs ranging in size from 10 to nearly 40 injuries. Analyzing MCIs that reoccur on a year-to-year basis should figure into the planning process for EMS systems.

Summary of Suggestions From the Task Force for Mass Critical Care Summit, January 26–27, 2007

BackgroundThe utilization of helicopter emergency medical services (HEMS) in modern trauma systems has been a source of debate for many years. This study set to establish the true impact of...