Perception of Clinical Debriefing (TALK©) as a Tool to Promote Patient Safety in a Prehospital Emergency Service.

HintergrundDas Sachverständigengutachten zur bedarfsgerechten Steuerung der Gesundheitsversorgung 2018 empfiehlt zur Entlastung der klinischen Notfallversorgung unter anderem, dem Rettungsdienst die Option einzuräumen, geeignete Patienten direkt in eine Praxis zur fachärztlichen Versorgung zu transportieren.FragstellungQuantifizierung von Patienten, die mit dem Rettungswagen (RTW) in der Notaufnahme vorgestellt wurden und sicher und sinnvoll zur Behandlung primär in eine Praxis transportiert hätten werden können.Material und MethodenRetrospektive Auswertung prähospitaler und klinischer Daten von erwachsenen Patienten, die innerhalb von 2 Monaten mit einem RTW in die Notaufnahme eines universitären Maximalversorgers eingeliefert wurden. Anhand einer durch Rettungsassistenten durchgeführten, 5‑stufigen Dringlichkeitseinschätzung erfolgte durch die Autoren zunächst die Kategorisierung in „dringliche“ (Arztkontakt innerhalb von maximal 30 min notwendig) und „weniger dringliche“ Fälle (Arztkontakt nicht in weniger als 30 min notwendig, maximal in 120 min). In der Gruppe der „weniger dringlichen“ Fälle wurden aus den klinischen Behandlungsdaten diejenigen mit ambulanter Weiterbehandlung diskriminiert sowie folgend die Fälle, deren administrative Notaufnahme von Montag bis Freitag (Feiertage ausgeschlossen) jeweils zwischen 08.00 und 19.00 Uhr stattfand (praxistaugliche Fälle). Außerdem erfolgte eine medizinisch-inhaltliche Differenzierung dieser Fälle und ein Vergleich mit der Dringlichkeitseinschätzung in der Notaufnahme (Manchester Triage System, MTS).ErgebnisseEs wurden n = 1260 Patienten mit dem RTW in die Notaufnahme disponiert (Gesamtbehandlungszahl n = 11.506). Bei n = 894 war eine prähospitale Dringlichkeitseinschätzung dokumentiert, auf deren Grundlage n = 477 (53,4 %) als „weniger dringliche“ Fälle kategorisiert und n = 317 (66,5 %) ambulant weiterbehandelt wurden, n = 114 (23,9 %) zu üblichen Praxisöffnungszeiten. Das entspricht 1 % aller im Beobachtungszeitraum behandelten Patienten. 70 Fälle dieser praxistauglichen Gruppe (63,6 % von n = 110 mit dokumentierter MTS) wurden in der Notaufnahme dringlicher eingestuft. Die prähospital dokumentierten Beschwerdebilder und die in der Klinik erhobenen Hauptdiagnosen lassen den Einsatz relevanter diagnostischer Ressourcen bei einer Vielzahl der praxistauglichen Fälle vermuten.DiskussionDie Notaufnahmen könnten im Zeitfenster üblicher Praxisöffnungszeiten bei primärer Disposition der weniger dringlichen, ambulant behandelten Fälle in eine Praxis von ungefähr jedem zehnten mit dem RTW disponierten Patienten und 1 % ihrer Gesamtpatientenzahl entlastet werden. Unter dem Aspekt der Patientensicherheit ist dieses Vorgehen mit > 60 % möglicher Untertriage kritisch zu bewerten. Für die Diagnostik und Behandlung müssten entsprechende Ressourcen in der Praxis vorhanden und dem Rettungsdienst bekannt sein. Die primäre Disposition in eine Praxis erscheint bezogen auf die mögliche Entlastung einer großstädtischen Notaufnahme unbedeutend, ist potenziell patientengefährdend und mit einem enormen logistischen Aufwand verbunden.

IntroductionThe provision of efficient and integrated emergency services constitutes a vital cornerstone for reducing mortality rates and improving clinical outcomes for patients and casualties within complex healthcare systems. Effective engagement between hospital-based and pre-hospital emergency services is crucial for the delivery of higher quality and more appropriate patient care. This study was conducted with the aim of analyzing the factors affecting organizational engagement between pre-hospital and hospital emergency departments.MethodsThis was a qualitative study employing a conventional content analysis approach, conducted across pre-hospital emergency services and affiliated educational hospitals of Shahid Sadoughi University of Medical Sciences, Iran, in 2025. Participants included 38 experienced stakeholders in the field, encompassing managers, supervisors, physicians, nurses, and emergency medical technicians. These individuals were selected using purposive sampling until data saturation was achieved. Data were collected through semi-structured interviews and subsequently analyzed using MAXQDA software (Version 22). The credibility and trustworthiness of the findings were assessed according to Lincoln and Guba’s criteria.ResultsData analysis revealed that organizational interaction between pre-hospital and hospital emergency services faced significant barriers, primarily attributable to poor managerial coordination, cognitive and professional limitations, and gaps in clinical practice. Specifically, the lack of effective inter-organizational communication, weak leadership in conflict resolution, and insufficient structural and human resource support were identified as key managerial obstacles. In the domain of cognitive and professional limitations, negative attitudes, knowledge and skills gaps, and decision-making biases—often arising under conditions of high workload or limited information—were found to reduce mutual understanding and collaboration between personnel across the two sectors. Regarding clinical practice gaps, the absence of standardized patient handover protocols, inconsistencies in the implementation of care processes, and deficiencies in initial clinical assessments disrupted care continuity and diminished overall service quality.ConclusionThe findings of this study provide scientific guidance for decision-makers seeking to establish a more integrated, efficient, and safer emergency system. Enhancing organizational engagement within the emergency system necessitates a multifaceted and policy-driven approach, wherein policymakers play a pivotal role in reforming organizational structures, empowering human resources, and standardizing operational processes.

Background: Pre-hospital care plays an important role in managing patients who require emergency services and preserving human life. The aim of this study was to evaluate the cost of completed public pre-hospital emergency missions according to the activity-based costing model and to compare it with the cost of private pre-hospital emergency services in Mashhad in 2016. Methods: In this applied and descriptive cross-sectional study, the data were collected using a researcher-made form 4 major groups of costs were identified to estimate the total costs: 1- Personnel salaries, 2- Current expenses 3- Medical consumables 4- Depreciation. The cost of providing pre-hospital services was calculated based on the activity-based costing. Eventually, the cost of pre-hospital emergency services was compared between the public and private sectors. To investigate the cost-effective factors for missions, multiple regression analysis, Breusch-Pagan, Ramsey RESET, Swilk, and Linktest diagnostic tests were used by Stata 11.0 software. Results: The average cost of each mission was equal to 2114337 ± 217786 thousand Rials in 58 emergency medical centers of Mashhad in 2016. Of this cost, 78.51 %, (1660129 ± 1578445 Rials) was related to employees' salaries, 19.24 % (406842 ± 375083 Rials) was related to the current costs of each center, 0.23 % (4796 ± 4476 Rials) was related to depreciation, and 2/02 % (42761 ± 42822 Rials) was related to medical consumables in each pre-hospital emergency mission. The value of contract with an emergency pre-hospital emergency was 1104000 Rials for each mission in 2016, which is almost half of the cost related to the public pre-hospital. Results of the regression model estimation also showed that among the variables of the model, the fuel cost variable was identified as an effective variable on the cost of each mission (p = 0.0001). Conclusion: The private sector provides pre-hospital emergency services at a lower cost. Moreover, before establishing a pre-hospital pre-service center, the cost-effectiveness of establishing a center in each region should be checked.

This systematic review examined the efficacy and safety of intranasal fentanyl (INF) for acute pain treatment in children, adults, and the elderly in prehospital emergency services (PHES) and emergency departments (ED). ClinicalTrials.gov, LILACS, PubMed, SCOPUS, EMBASE, Google Scholar and Cochrane databases were consulted until 31 December 2022. A total of 23 studies were included: 18 in children (1 PHES, 17 ED), 5 in adults (1 PHES, 4 ED) and 1 in older people (1 PHES subgroup analysis). In children, INF was effective in both settings and as effective as the comparator drugs, with no differences in adverse events (AEs); one randomised controlled trial (RCT) showed that INF was more effective than the comparator drugs. In adults, one study demonstrated the efficacy of INF in the PHES setting, one study demonstrated the efficacy of INF in the ED setting, two RCTs showed INF to be less effective than the comparator drugs and one RCT showed INF to be as effective as the comparator, with no difference in AEs reported. In older people, one study showed effective pain relief and no AEs. In summary, INF appears to be effective and safe in children and adults in PHES and ED. More high-quality studies are needed, especially in PHES and older people.

Trauma care systems in China

Pain, as a complex neurophysiological and neuropsychological mechanism, is one of the most common experiences among patients in prehospital emergency service. Although, there is no accurate data regarding the prevalence of pain in prehospital settings like there is for hospital emergency departments, in developed countries, despite the contradictions in the results of the numerous studies, the evidence indicate the high prevalence of acute pain in prehospital emergency service ranging from 20% to 53%. Yet, unfortunately, in Iran there is no statistics available in this regard. The physiological (affecting cardiovascular, respiratory, endocrine and other systems) and psychological (anxiety, anger, aggression, and …) complications due to uncontrolled acute pain have many adverse effects on the clinical outcomes of medical and traumatic patients and impose immense direct and indirect financial burdens on the limited resources of healthcare systems. Therefore, effective pain management using various pharmaceutical and non-pharmaceutical methods both on the scene and during transportation has become a potentially indispensable necessity and considered as a potential key performance indicator according to the National Association of EMS Physicians. An extensive literature review also revealed remarkable improvements in the use of analgesics in prehospital emergency service of many developed countries and opioid analgesics (e.g., morphine sulfate, fentanyl and ketamine); nonsteroidal anti-inflammatory drugs (e.g., Ketorolac and ibuprofen); and Paracetamol and Nitric Oxide (inhalation gas) have been put on the list of prehospital emergency service for relieving patients’ pain, which can be used based on qualification/competencies, roles, responsibilities, and degrees (EMR, EMT, AEMT, paramedic) of the providers of prehospital care with approval of the consultant physician or through use of a combination of off-line and on-line medical protocols in this regard. The majority of recent studies in this field focus on the inadequacy of prehospital pain management as well as the comparison and combination of various analgesic drugs to enhance efficacy, effectiveness and quality of healthcare provision.

Objective To understand the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Methods Taking a survey among the pre-hospital emergency physicians(80 people)and nurses(248 people)by Questionnaire of ethics conflicts during pre-hospital emergeney service,to investigate the ethics conflict situations between the pre-hospital patients and ambulance staff's determinations. Resulls (8.046±6.990)%of the patients who needed treatments refused to be treated completely,and(14.544±10.558)%of them refused partially.(14.451±14.747)% of the patients who needed ambulance transport refused to be delivered.In the patients who refused treatments and transportation.payment problem accounted for(23.52±19.79)%,(22.22±20.84)%of them did not believe they needed.(5.77±4.47)%of them wished to die,(19.44.4±18.65)%of them were hard to be idenfified.Other reasons accounted for(30.08±25.78)%.(20.31.4±16.66)% of the patients refused the ambulance crews' judge for some state.(29.66.4±24.02)%of the patients who got the pre-hospital emergency service were not necessary to call an ambulance.(22.1 l±19.52)%of the patients' demand conflicted with pre-hospital emergency services network management system.Conclusions There exists some conflicts between the pre-hospital patients and ambulance crews' determinations. Key words: Pre-hospital emergency service; Ethics; Conflict

Objective To explore the variations in category of internal diseases in order to plan out strategies to deal with during pre-hospital period in Chongqing urban area.Methods The category of internal diseases of pre-hospital emergency service in Chongqing urban area from January 2004 to December 2013 was studied and the data were analyzed retrospectively.Results Firstly,the number of patients in pre-hospital emergency service continued to mount up year by year,from 6031 patients in 2004 to 12 264 patients in 2013.The ration of male to femal was 1.24∶1 to 1.68∶ 1,and the cases of female increased year after year,from 2246 to 5486.Secondly,cardiovascular disease was the leading illness in the wide varieties of internal disease (15.35％-19.36％).The number of cerebrovascular accident (9.72％-13.11％),respiratory diseases (7.48％-10.20％) and digestive diseases (8.36％-10.58％) were escalating.However,the acute poisoning cases (2.36％-6.18％) showed a tendency of decline.The peak time of the pre-hospital emergency service was stable in past ten years.Thirdly,there were seasonal variation in incidence of cardiovascular,cerebrovascular and respiratory disease,more cases occurred in January and December than in other months.Alcoholism commonly peaked before Spring Festival.Fourthly,the peak time of internal disease occurred in the past 10 years was stable,peaked during 20:00-24:00,and the trough time was during 0:00-4:00,the ratio of trough to peak ranged from 30.7％ to 43.5％.Conclusion The variation of the internal disease category was associated more or less with seasonal rotation,the improved living standards,and stress of modern life,and the incidence of emergency illness were escalating year by year,thus the corresponding measures should be instituted to deal with those major changes.Improving pre-hospital emergency response capacity and efficacy of treatment is of great significance.Strengthening the prophylaxis and healthcare,and establishing a professional capability for triage classification of diseases during emergency service are great essential for promoting the swiftness of prehospital emergency response. Key words: Pre-hospital care; Prevention; Spectrum of diseases ; Internal medicine; Retrospective study; Response strategies

First step of health care system is Pre-hospital emergency service to provide treatment facilities to patients. Before admission of patients to hospital, provision of services to patients by pre hospital emergency service causes satisfaction or dissatisfaction for the patients with overall health care system of a society. This study was conducted to measure the satisfaction of patients with Punjab Emergency Service Rescue 1122 in the city of Chiniot, Punjab. There were 340 conscious patients at the time of emergency were included in this study by using systematic sampling technique. Data were analysed by a computer software Statistical Packages for Social Sciences (SPSS). Results of the univariate analysis showed that the majority of the users of the service were male and belong to rural area of the Chiniot 236 and 225 respectively. The majority of the respondents 250 experienced road traffic accidents. The results showed that the satisfaction of the patients from condition of the ambulance, response time, behaviour of the rescue team, efficiency of the service and professionalism of rescue crew was very high. The independent variables including condition of ambulance, behaviour of rescue team and professionalism of team showed a strong positive relationship with patients’ satisfaction. While response time of the ambulance showed a strong negative correlation. The results of the study revealed a very high level of satisfaction of the patients with Punjab Emergency Service Rescue 1122 Chiniot.

Objective: This study aims to analyse the number and characteristics of calls made to the Málaga Prehospital Emergency Service (PES) for suicidal behavior based on sociodemographic, temporal, and health care variables.Method: This is a retrospective, descriptive study that records all calls made to the PES due to suicidal behavior (suicide attempts and completed suicides) in 2014. Sociodemographic variables (age, sex, and health district), variables related to the calls (time-slot, degree of sunlight, type of day, month, season of the year, prioritization, and number of resources mobilized) were extracted from these calls. The number of cases and percentages were presented for the qualitative variables. The rates per 100,000 were calculated by sex and health district and presented with the corresponding 95% confidence interval (CI).Results: Of the total valid calls to PES (n = 181,824), 1,728 calls were made due to suicidal behavior (0.9%). The mean age was 43.21 (±18) years, 57.4% were women, and the rate was 112.1 per 100,000 inhabitants. The calls due to suicidal behavior were in the younger-middle age segment, in the time-slot between 16 and 23 h and during daylight hours, on bank holidays, in spring and summer in comparison with winter, and with a peak of calls in August. The majority of these calls were classified as undelayable emergencies and mobilized one health resource.Conclusions: Prehospital emergency services are the first contact to the sanitary services of persons or families with suicide attempts. This information should be a priority to offer a complete overview of the suicide behavior.

Objective. To take a deep look at the challenges of cooperation between the pre-hospital and in-hospital emergency services in the handover of victims of road traffic accidents. Methods. This is a qualitative study and the method used is of content analysis type. Semi-structured interviews were used to collect the data. Through purposive sampling, fifteen employees from ambulance personnel and hospital emergency staff were selected and interviewed. They expressed their experiences of cooperation between these two teams in the handover of traffic accident casualties. The interviews were transcribed verbatim and content analysis method was used to explain and interpret the content of the interviews. Results. Three major categories were derived from the analysis of interviews: Shortage of infrastructure resources (Shortage of equipment, Shortage of physical space, and Shortage of manpower); Inefficient and unscientific management (Shaky accountability, Out-of-date information based activities, Poor motivation, and Manpower low productivity); and Non-common language (Difference in understanding and empathy, and Difference in training and experience). Conclusion. The obtained results of this study suggest that the careful planning of resources, the promotion of managerial practices as well as empowerment program of the staff, healthcare managers and policymakers can take a pace forward in order to enter into a hearty coordination between these two services for the attention of victims of road traffic accidents.

The "Sama Code" is a protocol implemented in Iranian pre-hospital emergency services to manage time and treat patients with suspected stroke symptoms based on the FAST criteria. This study aims to analyze the workflow of patients with stroke symptoms transferred under the Sama Code. All patients with neurological symptoms who were brought to Imam Reza Hospital by pre-hospital emergency services after activating the Sama Code during the years 2021 and 2022 were included in the study. Data were collected from pre-hospital emergency records and registries, including patient age and gender, time of emergency contact, code activation, arrival of personnel at the patient’s side, clinical findings recorded in pre-hospital files, time to emergency department arrival, CT scan (Computed tomography scan), thrombolytic therapy initiation, reasons for treatment cancellation, and patient outcomes. A total of 880 patients were included in the study, with a mean age of 69.24 years (CI 95%: 68.30-70.17). The median age was 71 years, with most patients aged 61-80 years. Among the patients, 505 (57.4%) were male, and 375 (42.6%) were female. The number of patients transferred by pre-hospital emergency services under the Sama Code was roughly equal over the two years studied. The median time from emergency notification to mission start was 1 minute, while the median time from care plan initiation to patient arrival was 10 minutes. The median time from the patient’s side to transfer was 18 minutes, and from transfer initiation to hospital arrival was 10 minutes. The median time from hospital arrival to CT scan was 17 minutes. Of 880 patients, 750 were admitted to the hospital, and 13 Sama Codes were canceled during triage due to other diagnoses. Of the remaining 737 patients, only 20 received thrombolytic treatment, with a median time from CT scan to treatment of 20 minutes. According to this study’s findings, a small percentage of patients receive thrombolytic treatment; however, patient transfers in accordance with the Sama Code guidelines are well implemented, ensuring rapid CT scanning and timely decision-making.

There is a sustained increase in demand for emergency and urgent care services in England. The NHS Long Term Plan aims to reduce the burden on emergency hospital services through changing how pre-hospital care operates, including increased delivery of urgent care. Given the recognised potential of social prescribing to address wider determinants of health and reduce costs in other settings, this study aimed to understand the role that social prescribing can play in pre-hospital emergency and urgent care from the perspectives of staff. Semi-structured interviews (n=15) and a focus group (n=3) were conducted with clinical staff (n=14) and non-clinical health advisors (n=4) from an English Ambulance Service covering emergency (999) and non-emergency (111) calls. Data were analysed using a pre-defined framework: awareness of social prescribing; potential cohorts suitable for social prescribing; and determinants of social prescribing. Awareness and knowledge of social prescribing was limited, though when social prescribing was explained to participants they almost universally recognised its benefits for their role. Social prescribing was considered to be most beneficial to those calling for reasons relating to mental health, loneliness or social isolation, in particular older people and frequent users of 999 and 111 services. Determinants of social prescribing were identified across the micro (patient and staff acceptability of social prescribing), meso (triage and referral pathways) and macro (commissioning and funding) levels of analysis. This is the first empirical study to explore social prescribing in pre-hospital emergency and urgent care services, which suggests that it has potential to improve quality of care at the point of people accessing these services. There is a pressing need to address the micro, macro and meso level determinants identified within this study, in order to support staff within pre-hospital emergency and urgent care services to socially prescribe.

Background/Objectives: Patients with multimorbidity frequently rely on emergency services when continuity of care is weak. Strengthening communication between emergency and primary care can prevent unnecessary hospitalizations, yet this relationship remains underexplored. The aim of this study was to analyze the relationship between primary health care utilization in patients with multimorbidity and their demand for prehospital emergency services. Methods: An observational, longitudinal, analytical, and retrospective study was conducted in Málaga (Spain) between 2013 and 2017. Adults (>18 years) with multimorbidity who requested prehospital emergency care services at home were included; those with cancer, rare diseases, severe mental disorders, or incomplete electronic records were excluded. Variables encompassed sociodemographic, clinical, and behavioral characteristics, comorbidities, functional status, polypharmacy, resource type, and outcomes (on-site resolution or hospital referral). Primary health care visits before and after prehospital emergency use were extracted from electronic records. Descriptive, bivariate, and multivariate analyses were performed. Results: Among 532 patients, prior primary health care attendance predicted subsequent utilization (β = 0.57; p < 0.001), along with caregiver availability (β = 0.12; p = 0.001) and prehospital emergency services hyper-demand (β = 0.08; p = 0.022). Super-utilizers were younger, had ≥4 comorbidities, polypharmacy, prior family medicine visits, home oxygen therapy, and lower substance or alcohol use. Conclusions: In multimorbid adults, prehospital emergencies demand is influenced by factors beyond severity, including comorbidities, polypharmacy, the use of home medical devices, caregiver availability, and primary health care utilization patterns. Strengthening coordination between prehospital emergencies and primary health care, promoting patient–caregiver education, and implementing early notification pathways may improve care continuity and reduce avoidable emergencies.

PurposeTo investigate prehospital preparedness work for Mass Casualty Incidents (MCI) and Major Incidents (MI) in Norway.MethodA national cross-sectional descriptive study of Norway’s prehospital MI preparedness through a web-based survey. A representative selection of Rescue and Emergency Services were included, excluding Non-Governmental Organisations and military. The survey consisted of 59 questions focused on organisation, planning, education/training, exercises and evaluation.ResultsTotally, 151/157 (96%) respondents answered the survey. The results showed variance regarding contingency planning for MCI/MI, revisions of the plans, use of national triage guidelines, knowledge requirements, as well as haemostatic and tactical first aid skills training. Participation in interdisciplinary on-going life-threatening violence (PLIVO) exercises was high among Ambulance, Police and Fire/Rescue Emergency Services. Simulations of terrorist attacks or disasters with multiple injured the last five years were reported by 21/151 (14%) on a regional level and 74/151 (48%) on a local level. Evaluation routines after MCI/MI events were reported by half of the respondents (75/151) and 70/149 (47%) described a dedicated function to perform such evaluation.ConclusionThe study indicates considerable variance and gaps among Prehospital Rescue and Emergency Services in Norway regarding MCI/MI preparedness work, calling for national benchmarks, minimum requirements, follow-up routines of the organisations and future reassessments. Implementation of mandatory PLIVO exercises seems to have contributed to interdisciplinary exercises between Fire/Rescue, Police and Ambulance Emergency Service. Repeated standardised surveys can be a useful tool to assess and follow-up the MI preparedness work among Prehospital Rescue and Emergency Services at a national, regional and local level.