Ambulance Attendants Research Articles

Impact of virtual reality on performance among undergraduate healthcare professionals: A cross-sectional study

ABSTRACT In recent years, Virtual Reality (VR) has been increasingly used to train healthcare professionals. However, certain aspects of its application, such as the relationship between VR environments, training, and Sense of Presence (SoP), have yet to be explored. SoP impacts learners’ performances in certain learning situations, whereas in others, it does not. This study aimed to investigate the impact of VR, including SoP, on immersive mass incident simulation performances. A cross-sectional study was performed by immersing 83 undergraduate students (ambulance attendants, student nurses, and medical students) in a VR simulation. Questionnaires were administered before, during, and after the simulation to assess variables impacting non-technical skills. The results revealed that SoP was not associated with performance (P = 0.66). However, performance was associated with the learners’ perceptions of the VR environment (P = 0.008). Therefore, the impact of environmental perception on performance should be considered, allowing instructors to promote optimal training in VR. Moreover, SoP may impact performance in certain types of learning, like emotional skills training. Thus, VR should be chosen as a simulation modality to encourage reflexivity through rapid feedback and learning skills in the affective domain.

RAPE, LEGALITY AND INDECENCY S v Khumalo, S v Zondi, S v Buthelezi (unreported, NPD) Case No 219/2004

The three accused were found guilty on various charges, including robbery and kidnapping, arising from the hijacking of an ambulance at gunpoint and the holding of the ambulance attendants as prisoners in the back of the vehicle. In respect of each of the accused, the court, per Combrink J, found (3) that their identities were not placed in issue; that they could be placed on the scene of the offences by their own admission; and that all other relevant facts relating to the charges were common cause, apart from the defence of coercion, which each accused raised, unsuccessfully (in the absence of any credible evidence supporting this defence (see 12, 15)). The court relied on the testimony of two accomplice witnesses, and whilst the court noted the need to be cautious in accepting such evidence, it found that there was abundant evidence corroborating the accomplices’ testimony, that a number of safeguards were present in order to be able to readily accept it, and that the doctrine of common purpose provided further probative assistance (13). The focus of this note is, however, only on one portion of the events which took place, namely the additional charges against the third accused, Buthelezi, of rape, attempted rape and indecent assault. After the hijacking of the vehicle, the two ambulance attendants, Gladness Mdlalose and Mdu Zungu, were joined by Buthelezi in the rear of the ambulance, whilst the other two accused, Khumalo and Zondi, sat in front of the ambulance, with the sliding window between the front and the rear of the ambulance, closed (17-18, read with 7). The court held, in respect of these two accused, that it could not be held that they had performed any act of associative conduct in respect of the charges of rape, attempted rape and indecent assault, thus excluding the possibility of common purpose in this regard (15), and thus their liability will not be further discussed below. Whilst the vehicle was in transit, Buthelezi forced the two attendants to undress, by slapping them (particularly Mdlalose) on the face, and by threatening them with a firearm. When they were both naked, Butheleziinstructed Zungu to engage in sexual intercourse with Mdlalose. Their refusals fell on deaf ears, resulting in further threats and assaults. Mdlalose was forced to lie on her back on a bunk and Zungu was instructed to mount her and to have intercourse with her. However, as a result of stress, Zungu was unable to attain an erection and thus intercourse could not follow. Buthelezi then inserted his finger into the complainant’s vagina, ostensibly to ease intercourse between Zungu and herself. He further executed masturbatory movements with Zungu’s penis, endeavouring to arouse Zungu in order to facilitate penetration. Since that was also unsuccessful, Buthelezi used his fingers to push Zungu’s semi-erect penis into the complainant’s vagina, notwithstanding her protests. Zungu, according to the evidence, tried his best not to comply, but was forced to attempt intercourse (8). Buthelezi apparently lost patience and told Zungu to get off and that he, Buthelezi, would show him how it should be done. He instructed Mdlalose to position herself in such a manner that he could have intercourse with her against her will. The complainant delayed as long as possible, but, whenintercourse seemed inevitable, she asked him to use a condom. Not being able to find one in the rear of the ambulance, Buthelezi asked the other two accused in the front of the vehicle for a condom. At that time the first accused told Buthelezi to give the ambulance attendants their clothes back so that they could be released. It then transpired that they were released, and had to walk a considerable distance to summon assistance (8-9).

Relationships Between Internal Factors, Social Factors and the Sense of Presence in Virtual Reality-Based Simulations

BackgroundVirtual Reality (VR) has proven to be an interesting and expanding tool for healthcare education, especially with the impact of the Sense of Presence (SoP) on learning. The study was designed to investigate to what extent users’ social and internal factors might influence the SoP and to further identify members of occupations’ characteristics influencing immersive experiences. MethodA cross-sectional study immersing 83 undergraduate students (ambulance attendants, students nurses, and medical students) in a mass casualty incident simulation was performed. Questionnaires were administred to assess personal, environmental, and experiential in pre and post-simulation. ResultsSoP was associated with gender, disaster medicine education, propensity for immersion, and members of occupations.. Immersion characteristics specific to occupational categories have been identified. ConclusionPersonal differences were discovered between ambulance attendants, students nurses, and medical students. Consideration should be given on how best practices could promote the design of VR experiences that cater to professional groups' needs. Identifying in the future what level of experience is needed for a sufficient SoP also seems necessary.

How Blockchain Will Improve Private Ambulance Service Challenge

The ambulance service system for the patient's transport to the hospital is essential for the healthcare system. However, traffic congestion increases the urban population, a centralized management system, and increased demand for prehospital emergency services challenge the health system; there is a risk of lack of information sharing and information reliability, the consequences of which may directly and detrimentally affect patient well-being. This paper has built a blockchain-based ambulance model to solve these problems. The model can solve existing problems by decentralizing centralized ambulance system information and processes. All users in the emergency medical services (EMS) network can participate and use the service in the blockchain, using real-time state information such as patient location, ambulance, and ambulance attendants. To effectively implement blockchain in the medical sector, the ambulance business logic for a smart contract must reflect and confirm the operation of the defined functions suggested in this paper.

Beneficiaries’ Willingness to Pay for Resuscitation Provided by Ambulance Attendants: A Survey Using the Contingent Valuation Approach

Background: Japanese emergency medical services (EMS) can be used by anyone for free. Recently, EMS usage has increased; the increased costs and the prolonged time for ambulance transport have become recent social problems. Objective: We surveyed the willingness to pay (WTP) for resuscitation provided by EMS. Methods: In November 2011, men and women (3160) aged 20 - 59 years were asked to assume that they were experiencing a cardiopulmonary arrest (CPA), and their WTP for EMS services was assessed in the following three situations: Case A, ambulance transport alone; Case B, chest compression in addition to ambulance transport; and Case C, artificial ventilation through chest compression and intratracheal intubation, in addition to ambulance transport. We calculated the mean WTP for each case. Results: The WTP for Case A, B, and C were ￥6,696 ($65.0), ￥16,081 ($156.1), and ￥27,505 ($267.0), respectively. The WTP for Case B was significantly higher in respondents aged 40 - 59 years compared to those aged 20 - 39 years. The WTP for case B and C were significantly higher in males compared to females. WTP was significantly lower in students than it was in private employees. Although women’s intention to pay was higher than that of men, their WTP was lower than that of men. Public employees’ and students’ intention to pay was significantly lower than that of private employees. Conclusions: Our study provides information about the optimal fee for EMS, which will be useful for discussions on the feasibility of introducing a fee for EMS in Japan.

Emergency health care professionals’ experiences of factors that influence care quality and safety

Introduction: More research is required on care quality and patient safety, especially from the care provider perspective. Aims and objectives: The study describes factors that affect the quality of emergency care as experienced by nurses, paramedics, hospital and ambulance attendants and practical nurses in out-of-hospital emergency medical services. Methods: Data were collected in October 2013 by semi-structured interviews ( n = 15) in Finland and analysed using inductive content analysis. Results: High quality emergency care is patient-centred, equal, professional, individualized and holistic. It encompasses the following areas: prompt emergency care on site; prevention of patient deterioration; individualized holistic care; arranging safe follow-up care; supporting the coping of patients and families and; securing the safety of patients and staff on site and in ambulance. The care quality care is affected by professionals’ theoretical and practical competence and personal qualities, by the availability of equipment, co-operation, contextual factors, personnel policy and by the outcome of consultation with a doctor. Conclusions: Emergency care staff will be expected to provide increasingly extensive, holistic care on site. All stages of the care pathway should be evaluated and comparative international studies conducted to detect development needs. Relevance to clinical practice: Consistent practices and instructions are indicated. Management needs to promote staff coping and motivation by means of education, focusing on the care of older patients and clients affected by multiple diseases, and on psychosocial and social problems of people affected by alcoholism or social exclusion.

Workers' Clinical Skills at Out-of-Hospital Emergency Care

Background: Workers’ clinical skills at out-of-hospital emergency care greatly affect patient safety and care quality. The objectives of the study was to examine emergency care workers’ self-perception of their clinical skills in out-of-hospital emergency care to produce new knowledge that can be used to develop basic and continuing education programmes. Methods: A quantitative approach was selected. Participants consisted of nurses (86), practical nurses (48) and medical emergency technicians/ hospital and ambulance attendants (8) in out-of-hospital emergency service units in one hospital district in Finland (N=1, response rate 53%). Self-administered questionnaire with 8 background questions and 70 multi-choice questions analysed using SPSS for Windows 22. Results: Respondents rated their skills in fluid care, circulation maintenance and care of lifeless patients highest, whereas the results were poorest for skills in intubation and care of gynaecological patients. Emergency care workers’ age, sex work experience, type of employment and educational background were associated with variation in their self-rated clinical skills. Conclusions: Regular updates by means of simulation-based learning or group supervision are required, especially for novices and non-permanent workers to create safe routines in airway maintenance and caring for less common groups of patients.

The relationship between hepatitis serology of ambulance attendants and duration of education.

Healthcare workers (HCWs) run the risk of hepatitis B virus (HBV) infection. Studies investigating the HBV and hepatitis C virus (HCV) serology of HCWs have been generally conducted in secondary or tertiary hospitals. In this study we aimed to determine the relationships between education level and HBV and HCV serology and HBV vaccination status of ambulance attendants. The data of this study were obtained by retrospective review of ambulance personnel files in Sakarya Province, Turkey. Out of 314 ambulance attendants, 216 (68.7%; 78 males, 138 females) were enrolled in this study. The mean length of employment in the province's ambulance service was 5.22 years. While hepatitis B surface antigen positivity was found in 3 (1.4%) workers, 147 (68%) of them were positive for hepatitis B surface antibodies (anti-HBs). The lowest HBV vaccination rate was 12.5%, in drivers. Naturally acquired immunity against HBV was again the highest in drivers (17.5%; P < 0.05). All personnel were anti-HCV-negative. Anti-HBs positivity is rather low in the province's ambulance service attendants, and positive anti-HBs status related to vaccination is associated with vocational training. Training should be performed to increase HBV awareness of ambulance attendants. Nonvaccinated personnel should be determined on the first day of employment, and regulations should be put in place to ensure their vaccination.

Job Strain and Shift Work Influences on Biomarkers and Subclinical Heart Disease Indicators: A Pilot Study

This pilot study is one of the first to examine the impact of job strain and shift work on both the autonomic nervous system (ANS) and the hypothalamic-pituitary-adrenal (HPA) axis using two salivary stress biomarkers and two subclinical heart disease indicators. This study also tested the feasibility of a rigorous biological sampling protocol in a busy workplace setting. Paramedics (n = 21) self-collected five salivary samples over 1 rest and 2 workdays. Samples were analyzed for α-amylase and cortisol diurnal slopes and daily production. Heart rate variability (HRV) was logged over 2 workdays with the Polar RS800 Heart Rate monitors. Endothelial functioning was measured using fingertip peripheral arterial tonometry. Job strain was ascertained using a paramedic-specific survey. The effects of job strain and shift work were examined by comparing paramedic types (dispatchers vs. ambulance attendants) and shift types (daytime vs. rotating day/night). Over 90% of all expected samples were collected and fell within expected normal ranges. Workday samples were significantly different from rest day samples. Dispatchers reported higher job strain than ambulance paramedics and exhibited reduced daily alpha-amylase production, elevated daily cortisol production, and reduced endothelial function. In comparison with daytime-only workers, rotating shift workers reported higher job strain, exhibited flatter α-amylase and cortisol diurnal slopes, reduced daily α-amylase production, elevated daily cortisol production, and reduced HRV and endothelial functioning. Despite non-statistically significant differences between group comparisons, the consistency of the overall trend in subjective and objective measures suggests that exposure to work stressors may lead to dysregulation in neuroendocrine activity and, over the long-term, to early signs of heart disease. Results suggest that further study is warranted in this population. Power calculations based on effect sizes in the shift type comparison suggest a study size of n = 250 may result in significant differences at p = 0.05. High compliance among paramedics to complete the intensive protocol suggests this study will be feasible in a larger population.

Global Hemispheric CT Hypoperfusion May Differentiate Headache With Associated Neurological Deficits and Lymphocytosis From Acute Stroke

Headache with associated neurological deficits and lymphocytosis (HaNDL) is characterized by temporary recurrent neurological deficits, moderate–severe headache, cerebrospinal fluid lymphocytosis, elevated protein, and increased opening pressure.1 Although CT and MRI should be normal, single photon emission CT may indicate focal hypoperfusion and electroencephalogram may reveal slowing or even epileptiform activity2 resolving once the patient is symptom-free (3 months). Catheter angiography also yields normal results but may trigger an acute neurological episode.3,4 Because HaNDL is a benign, self-limited syndrome, it is important to differentiate it from cerebrovascular disease to avoid unnecessary interventions such as catheter angiography and thrombolysis. We present a case initially thought to be acute stroke in which the patient was considered for thrombolysis. CT perfusion changes atypical for stroke made stroke diagnosis questionable and thrombolysis was withheld. A 31-year-old man with hypertension, dyslipidemia, and sleep apnea (treated with continuous positive airway pressure), but no history of prior migraine, was brought into our emergency department by ambulance with suspected acute ischemic stroke. He had become aphasic at work so his coworkers called 911. On examination, he was globally aphasic without focal weakness or obvious sensory changes aside from questionable mild right facial paresis (National Institutes of Health Stroke Scale score 6). A noncontrast CT and CT angiogram (CTA) were normal, but CT perfusion revealed a striking pattern of …

Canada's “Toxic Bus”: The New Challenge for Law Enforcement in the Post-9/11 World/Mass Psychogenic Illness

Talk of devil, and is bound to appear. --Proverb Episodes of psychogenic illness are challenging under best of circumstances. Typically incubated an atmosphere of fear and uncertainty, initial diagnoses are often contentious, and ir takes time for environmental tests to be processed. Even when results come back negative and a psychogenic cause is obvious assessment, there is often a backlash from victims and community members, who resent mass hysteria label, which is typically viewed as something that happens to others. For this reason, cases are often officially left unresolved under guise of mystery illnesses or possible terrorist attacks, as occurred following Canadian which documents caveats faced by law enforcement and emergency medical personnel, resulting an inefficient use of rime and resources, and unnecessary public anxiety. The Episode On Tuesday 25 May 2004, at approximately 1 p.m., a passenger walked to front of public TransLink bus #98 downtown Vancouver, British Columbia. As the Richmond Express came to a halt at intersection of 49th Street and Granville Avenue, disembarking man made a cryptic remark. As one passenger recalled, said how's your day going ... and bus driver said good. Then man said it won't be for long ('Passenger 2004). As driver continued his route, began to feel nauseated, and later vomited after travelling 10 kilometres from where man had stepped off. He then asked if any passengers felt ill. When one replied affirmatively, steered bus to roadside and radioed for medics, fearing a chemical or biological As two responding paramedics began to treat driver and hear his version of events, they too fell ill. Others arriving on scene also felt sick. The incident made headlines around world as a possible terrorist attack and became focus of a major investigation that would become known as the toxic bus case, or police file #04-128479. Immediately after incident, 19 people, including driver, passengers, emergency personnel, and journalists, were briefly quarantined. Air quality tests and a forensic examination of bus were unremarkable. Vancouver Police searched for suspect: an olive-skinned male his mid-20s, with an average build, pencil-thin moustache, and a 5 o'clock shadow. This description, suggesting that may have been Middle Eastern, likely heightened suspicion and fear of terrorism (Vancouver Police Department 26 May 2004, 28 May 2004). In early June, incident became subject of a public dispute between Vancouver's Chief Medical Health Officer, John Blatherwick, who maintained that cause was mass anxiety, and both police and ambulance agencies, who disagreed. At a police press conference, a spokeswoman rejected Blatherwick's position, noting that he is not involved investigation and is misinformed. The investigation remains active, as toxicology results are still not complete (Vancouver Police Department 11 June 2004). On June 25, Vancouver Police made a startling announcement: When tests of bus by Royal Canadian Mounted Police were unrevealing, they hired a private firm to conduct further tests, which identified methyl chloride as chemical attack. Reporters were told that in high concentrations [methyl chloride] is capable of killing someone. While it is impossible to say how much of gas victims were exposed to or how it came to be delivered into air on bus, it would have taken a fairly high concentration to force gas into some of materials on bus, such as seat fabric and air filters (Vancouver Police Department 25 June 2004). One of lead police investigators publicly defended his department's interpretation of methyl chloride findings, but on emotional, not scientific grounds, implying that elite medical professionals are immune from hysteria: You're talking about two very senior ambulance attendants and they're not going to have psychosomatic symptoms, they've seen everything (Crawford 2004). …

Endotracheal intubation and esophageal tracheal combitube insertion by regular ambulance attendants:: A comparative trial

Objective Recent cardiac arrest resuscitation guidelines have recommended the esophageal tracheal Combitube (ETC) as an advanced airway management alternative for individuals who infrequently perform endotracheal intubation (ETI). This study attempted to analyze basic (nonparamedic) ambulance attendant success rates at ETI and ETC insertion as well as their continuing skill competency over time and whether ongoing practice on mannequins improved skill performance. Methods Three hundred fifty-seven adult patients in cardiorespiratory arrest were treated by 81 basic ambulance attendants. Original study design called for the analysis of two treatment options in three patient groups: ETC insertion, ETI insertion with mannequin practice (ETI-MP), and ETI insertion without mannequin practice (ETI-NMP). The main outcome measures were: (1) successful insertion and ventilation with ETC or ETI, assessed by receiving physicians; and (2) differences in successful insertion/ventilation between the MP and NMP groups. Results Successful insertion (intent-to-treat) for the ETI-NMP group was 70 of 111 (63%; 95% confidence interval [CI], 54–73%); ETI-MP success was 105 of 139 (76%; 95% CI, 67–84%); ETC-NMP success was 26 of 42 (62%; 95% CI, 49–75%); and ETC-MP success was 36 of 53 (68%; 95% CI, 54–82%). Continuing mannequin practice appeared to improve ETI success (as-treated): MP 75% versus NMP 61% (odds ratio, 2.1; 95% CI, 1.11–3.94). Conclusions There were similar rates of successful insertion/ventilation with the ETC and ETI. ETI insertion success was lower without mannequin practice. ETI skill erosion was partially mitigated by additional field experience.

ENDOTRACHEAL INTUBATION AND ESOPHAGEAL TRACHEAL COMBITUBE INSERTION BY REGULAR AMBULANCE ATTENDANTS: A COMPARATIVE TRIAL

Objective. Recent cardiac arrest resuscitation guidelines have recommended the esophageal tracheal Combitube (ETC) as an advanced airway management alternative for individuals who infrequently perform endotracheal intubation (ETI). This study attempted to analyze basic (nonparamedic) ambulance attendant success rates at ETI and ETC insertion as well as their continuing skill competency over time and whether ongoing practice on mannequins improved skill performance. Methods. Three hundred fifty-seven adult patients in cardiorespiratory arrest were treated by 81 basic ambulance attendants. Original study design called for the analysis of two treatment options in three patient groups: ETC insertion, ETI insertion with mannequin practice (ETI-MP), and ETI insertion without mannequin practice (ETI-NMP). The main outcome measures were: (1) successful insertion and ventilation with ETC or ETI, assessed by receiving physicians; and (2) differences in successful insertion/ventilation between the MP and NMP groups. Results. Successful insertion (intent-to-treat) for the ETI-NMP group was 70 of 111 (63%; 95% confidence interval [CI], 54–73%); ETI-MP success was 105 of 139 (76%; 95% CI, 67–84%); ETC-NMP success was 26 of 42 (62%; 95% CI, 49–75%); and ETC-MP success was 36 of 53 (68%; 95% CI, 54–82%). Continuing mannequin practice appeared to improve ETI success (as-treated): MP 75% versus NMP 61% (odds ratio, 2.1; 95% CI, 1.11–3.94). Conclusions. There were similar rates of successful insertion/ventilation with the ETC and ETI. ETI insertion success was lower without mannequin practice. ETI skill erosion was partially mitigated by additional field experience.

Medical practice-related fatalities in forensic autopsy during the past 6 years in the southern half of Osaka city and surrounding areas

To investigate the features of recent unnatural deaths from mishaps and possible negligence related to medical practice, forensic autopsy cases ( n=856) during the past 6 years (1996–2001) at our institute were reviewed. Among them, there were 28 cases of medical practice-related fatalities (male/female, n=16/12; range 32–87 years of age). Half of the cases ( n=14) were related to possible negligence in nursing and care. These unnatural deaths were reported to the police by physicians in charge ( n=14), second physicians and ambulance attendants ( n=6), patients’ relatives ( n=6) and others ( n=2). In most cases, there was an event, which was sudden, unexpected and clearly noticeable not only by the medical personnel but also by bystanders. The cases where the deaths were reported to the police by patients’ relatives included unexpected deaths during medical treatments following accidental traumas ( n=2) and an anesthetic accident. Clinically unexpected deaths should be more critically assessed by the physicians themselves on the basis of the rights, benefit and welfare of the patients.

The civil war’s medical cadets: medical students serving the Union

Among the medical personnel serving the United States during the Civil War was an obscure group of young men called medical cadets. Composed of medical students, the US Army medical cadet corps was created to dress wounds and act as ambulance attendants. As mounting war casualties overwhelmed Army surgeons, medical cadets found themselves taking on much more responsibility for patient care. Although all but ignored in histories of Civil War medicine, the story of the medical cadets provides valuable insight about medical training and military medicine during that conflict.

Physical Abuse With Severe Hypothermia

Accidental hypothermia is a well-studied entity. Cerebral hypoperfusion is somewhat less damaging at temperatures under 25°C to 28°C.1No studies of nonaccidental hypothermia have been discovered after an extensive literature search. We herein report four cases of child abuse–related hypothermia resulting from cold water immersion or exposure to low ambient temperature in inadequate clothing from our experience in two hospitals in a cold-temperature area. Report of Patients.Patient 1. A 4-year-old girl was found naked on the bathroom floor, pulseless, with a rectal temperature less than 29°C, when police and paramedics were called to the family home. She was noted to have many bruises on her body that appeared both old and new. When called for near drowning, ambulance attendants noted that the patient was dry, as was the bathroom floor, with 4.4 cm of water in the bathtub. In the emergency department, the patient was maintained on full

Emergency ambulance assistance in The Netherlands: is the Dutch situation optimal?

The system of prehospital trauma care in the Netherlands is the subject of great concern. Although many improvements have been achieved in the last decade, there are still some deficits. Legislation concerning the minimal level of education for ambulance attendants was recently upgraded to 'registered nurse', a standard which must be achieved by 1997. Standardization with regard to extrication techniques, equipment and methods of treatment in prehospital trauma care does not yet exist. Although aware of the fact that large regional differences exist throughout the USA, a system of care in accordance with the advanced trauma life support (ATLS) standard of the American College of Surgeons (ACS) and by means of prehospital and advanced trauma life support (PHTLS) given according to the standards of the National Association of Emergency Medical Technicians (NAEMS) was considered to be the 'golden standard'. Nineteen ground ambulance and two helicopter services in different states of the USA, working according to ACS/NAEMS standard, were visited to analyse the system of care, with special reference to (para)medical education, communication, logistics, and immobilization materials and techniques. In the Netherlands all 41 central post ambulance services (CPAs) were asked to return a questionnaire. This resulted in a 90% (37 out of 41) response. The deficits of the Dutch system of care related to the PHTLS/ATLS standard are pointed out, resulting in recommendations to improve the Dutch system. The requirements of the dispatcher are far inferior to the optimal situation, which, together with the lack of technical equipment, results in serious communication problems. The Dutch ambulance attendant education, in which in the present system the education level reaches 'registered nurse' in only 91% and specialized courses are not mandatory, should be upgraded to the PHTLS level of care.

Continuous monitoring of oxygen saturation in prehospital patients with severe illness: The problem of unrecognized hypoxemia

The continuous measurement of arterial oxygen saturation using pulse oximetry (SpO2) has become popular for critically ill hospitalized patients. Its use in the ambulance transfer of similarly ill patients has been infrequently documented. This study examines the use of prehospital pulse oximetry, with special reference to the ability of ambulance attendants to recognize hypoxemia. Using a prospective single-blind case series method, a convenience sample of adult patients transferred by ambulance designated Code 3 (serious but not life threatening) or Code 4 (serious and life threatening) to a regional base hospital were examined for the presence of hypoxemia. An Ohmeda finger pulse oximeter probe was attached to all patients. Prior to the study, oxygen treatment was reviewed and ambulance personnel were instructed on the use of the instrument. The continuous oxygen saturation record was not revealed to the attendant(s) during the call. Administration of oxygen was monitored, and a study form was completed by the attendant at the completion of the call. Overall, 50 patients were included in the study. The most common complaints were chest pain 21 (37%) and shortness of breath 15 (27%). The average age was 64 years, with a range of 32–82. Hypoxemia, defined as SpO2 of less than 90% for more than 1 minute, was detected in 14 patients. Attendants recognized hypoxemia on clinical grounds in only 4 patients (sensitivity = 28%). Forty-one (82%) patients received various amounts of supplemental oxygen; many patients remained hypoxemic despite therapy. To supplement hypoxemia detection, the addition of vital sign criteria to patient assessment would have improved the sensitivity (93%), however, many patients would receive oxygen without need (specificity = 39%). We conclude that clinical recognition of hypoxemia by ambulance attendants is difficult. The use of a pulse oximeter can assist ambulance attendants to identify hypoxemia in the prehospital setting.

Effect of fire department first-responder automated defibrillation

To examine the effect of fire department first-responder defibrillation on time to defibrillation in a mid-sized community with two tiers of emergency medical services (EMS) ambulance response. Retrospective cohort. The study area was the region of Hamilton-Wentworth, which has more than 445,000 inhabitants and covers 1,136 km2 (438 square miles). We studied 297 victims of out-of-hospital cardiac arrest presenting to the EMS system between May 1, 1990, and April 30, 1991. The mean defibrillation interval was decreased from 11.96 minutes to 8.50 minutes (P < .001) by the introduction of fire first-responder defibrillation. Survival was significantly greater with bystander-witnessed arrest, initial rhythm of ventricular fibrillation, and presence of a pulse on arrival in the emergency department. In our EMS system, fire first-responders were able to provide defibrillation in significantly shorter times than ambulance attendants. Other EMS systems should review their response times and consider instituting first-responder defibrillation as one means of reducing defibrillation intervals.

Automated external defibrillators: Implications for training qualified ambulance staff

To investigate the performance of basic trained ambulance personnel using an automated external defibrillator (AED) after a short training program. One hundred ninety ambulance attendants working in London received six and one-half hours training in the use of an AED, with written feedback and continuing education regarding performance after training. Performance was assessed over a period of 15 months by analysis of report forms and ECG/audible cassette tapes from the patients who were treated. Staff were able to operate the defibrillator correctly in 96% of cases and followed the protocol sequence taught in 34% of cases. The median time taken to activate the defibrillator following arrival of the ambulance at the scene of cardiac arrest was four minutes (range, one to 13 minutes). In 32% of cases, patients were intubated erroneously or moved to the ambulance before the AED was attached. The short course with continuing education was sufficient to train staff in AED operation, but errors in protocol compliance occurred throughout the trial.