Ambulance Call-outs Research Articles

A public health approach to reducing violence: Can data linkage help to reduce demand on blue light services?

Scotland has witnessed a remarkable reduction in violent crime in recent years. In part, the success of this reduction has been attributed to a ‘public health’ approach, which includes improvements in partnership working across multiple agencies – especially law enforcement and public health. Nevertheless, the emergency services continue to deal with a high volume of violent incidents, an increasing number of which involve some aspect of underlying vulnerability. Policy makers are keen to understand more about how aspects of vulnerability impact on violent crime, especially as this is a primary driver for policies like the public health approach to reducing violence.
 In a project that brings together stakeholders from the Scottish Government, Police Scotland and the Scottish Ambulance Service, the Scottish Centre for Administrative Data Research aims to examine patterns of ambulance callouts and/or hospital admissions involving people who experience violence. The study, which will link together a range of health datasets, will bring together data about violence-related incidents with wider information about an individual’s history of drug misuse, alcohol-related conditions and mental health problems. The study will also examine the extent to which violence and vulnerability contribute to increasing risk of premature death.
 This paper will focus on the development of the research proposal and the opportunities and challenges of trying to bring together data from different emergency service organisations. If possible, it will present preliminary findings from the research. It is anticipated that this study will support the development of further violence prevention policies in Scotland, especially in terms of helping to identify opportunities for better partnership working and points of intervention that could reduce demand on blue light services to deal with violent incidents.

Evaluating the impact of individual alcohol licensing decisions on local health and crime: a natural experiment with synthetic controls

BackgroundLocal authorities in England can influence the local alcohol environment by contributing to the licensing process and controlling the enforcement of existing licenses. However, a gap remains in the availability of quantitative evidence of effectiveness and impact of these local interventions, including a shortage of public health evidence around individual premises. Natural experiments offer the opportunity to evaluate these interventions where formal randomisation is not possible. We aimed to assess whether it is possible to quantitatively evaluate three natural experiments of alcohol licensing decisions at small spatial scale. MethodsThree situations presenting a natural experiment were identified in different English Local Authority areas by public health or licensing practitioners: (i) the closure of a nightclub in 2013, (ii) the closure of a restaurant-nightclub following reviews in 2016, and (iii) the implementation of new local licensing guidance (LLG) in 2013/14. We obtained monthly numbers of reported incidents of emergency department admissions for alcohol-related reasons, ambulance call-outs, and various crimes at lower/middle-super-output-area level (from 2010–14 for case i, 2015–17 for case ii, and 2008–14 for case iii). Bayesian structural timeseries were used to compare trends to their counterfactuals, approximated by synthetic controls based on time series of the same outcomes in other, comparable, areas. FindingsClosure of the nightclub was associated with temporary reductions in antisocial behaviour (–18%; 95% Bayesian Credible Interval [BCI] –37 to –4); equivalent to 60 averted incidents in 4 months. Closure of the restaurant-nightclub was not associated with measurable changes in outcomes. There was some evidence that the LLG introduction was associated with a reduction in drunk and disorderly behaviour (–42%, 95% BCI –109 to 23), but this reduction equated to less than one incident per month. The unplanned end of the LLG might have contributed to an increase in domestic violence (11%, 95% BCI –10 to 35), corresponding to two additional incidents per month. InterpretationIt is possible to evaluate the impact of local alcohol policies, even at the level of individual premises, using this methodology. We provide quantitative evidence that local government actions to influence the local alcohol environment can have a positive impact on health and crime in the area but could also have unintended consequences. FundingThis work was funded by the National Institute for Health Research School for Public Health Research (NIHR SPHR), a partnership between the Universities of Sheffield, Bristol, Cambridge, Exeter, and University College London); the London School for Hygiene and Tropical Medicine; the LiLaC collaboration between the Universities of Liverpool and Lancaster and Fuse; and the Centre for Translational Research in Public Health, a collaboration between Newcastle, Durham, Northumbria, Sunderland and Teesside Universities. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health.

Caring for a person in mental health crisis (2019)

Journal of Paramedic PracticeVol. 11, No. 10 Art & HistoryCaring for a person in mental health crisis (2019)Sarah Jane PalmerSarah Jane PalmerEmail for Correspondence:E-mail Address: [email protected]Registered Nurse; Disability Analyst, Department for Work and Pensions, Maximus; and Freelance Writer/Artist, London, UKSearch for more papers by this authorSarah Jane PalmerPublished Online:8 Oct 2019https://doi.org/10.12968/jpar.2019.11.10.448AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Care Quality Commission. 2018 community mental health survey statistical release. 2018. https://tinyurl.com/y6kmrudf (accessed 30 September 2019) Google ScholarDepartment of Health and Concordat Signatories. outcomes for people experiencing mental health crisis. 2014. https://tinyurl.com/y2boxtu5 (accessed 30 September 2019) Google ScholarMind. Ambulance: How to manage your mental wellbeing. 2015. https://www.mind.org.uk/media/23702012/managing-mental-wellbeing-ambulance_3_new_update.pdf (accessed 30 September 2019) Google ScholarNHS England. Mental health nurses and paramedics to respond together to reduce avoidable hospital admissions. 2018. https://tinyurl.com/y23uoyub (accessed 30 September 2019) Google ScholarNHS England. NHS Long Term Plan. 2019. https://www.longtermplan.nhs.uk/areas-of-work/mental-health/ (accessed 30 September 2019) Google ScholarMarsh S. Ambulance call-outs for mental health patients in England soar by 23%. 2017. https://tinyurl.com/ybz3dom4 (accessed 30 September 2019) Google ScholarMildenhall J. Occupational stress, paramedic informal coping strategies: a review of the literature. J Para Pract. 2012; 4(6):318–328. https://doi.org/10.12968/jpar.2012.4.6.318 Link, Google Scholar FiguresReferencesRelatedDetails 2 October 2019Volume 11Issue 10ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 8 October 2019 Published in print 2 October 2019 Information© MA Healthcare LimitedPDF download

Effects of heat on ambulance call-outs

PDS 66: Climate change, Exhibition Hall (PDS), Ground floor, August 28, 2019, 1:30 PM - 3:00 PM Background/Aim: Few multi-city studies on heat and emergency health outcomes have been conducted in Asia. This study aimed to examine the associations between high temperature and ambulance call-outs (ACOs) in ten cities in China to identify vulnerable populations and explore the regional differences and possible causes. Methods: Daily air pollution, meteorological data and ACOs were collected from ten cities during 2014-2017. We first applied a semi-parametric generalized additive model with a Poisson distribution to analyze the city-specific associations of daily maximum temperature and number of ACOs during June to August after controlling for covariates including outdoor air pollution. Then pooled these effect estimates using meta-analysis at the national level, and finally further explore the heterogeneity at regional level using subgroup analysis stratified by latitude and per capita disposable income (PCDI). Gender and age-specific associations were estimated to identify vulnerable sub-populations. Results: Strong associations between daily maximum temperature and ACOs were observed in multiple cities, with increases of 0.7% (0.2%, 1.1%) to 2.7% (2.0%, 3.5%) in daily overall ACOs with each 1°C increment in the daily maximum temperature. Slightly stronger pooled temperature-ACOs association was detected in males compared to females. Adults, especially the population aged 18-44 years, reported significant heat-ACOs association (pooled RR=1.017, 95%CI: 1.011–1.022), and the younger adults with the higher risks. Generally, the south and central regions seemed to have higher risks than north region in China and the regional vulnerability appeared to be related to the combination of latitude, climate and PCDI. Conclusions: Population and region-specific significant associations between ACOs and high temperature were observed in multiple cities, suggesting combined impacts of climate and economy on the emergency health situations against high temperature, deserves further larger multi-city studies as evidence for relevant national and regional public health strategies and early warning system.

A cross-sectional study of child injury ambulance call-out characteristics and their utility in surveillance

Background: Injuries are a leading cause of death and ill health in children. Aims: To explore the potential utility of ambulance call-out data in understanding the burden and characteristics of child injury. Methods: A cross-sectional examination was carried out of injury-related ambulance callouts to children aged 0–14 years in the north west of England between April 2016 and March 2017. Findings: The majority of the 16 285 call-outs were for unintentional injuries (91.4%), with falls the most prevalent injury type (38.4%). The incidence of child injury ambulance call-outs peaked at age 1 year (233.4 per 10 000 population). Burns in children aged 5–9 years were significantly higher at weekends (P=0.003) and on celebration days (P=0.001); poisoning in 10–14 year-olds was significantly higher at weekends (P=0.001); and traffic injuries were significantly lower at weekends in 0–4 year-olds (P=0.009) and 10–14 year-olds (P=0.003). Conclusion: Ambulance call-out data can provide epidemiological support in examining the characteristics of child injury and identifying at-risk groups.

Joint effects of heatwaves and air quality on ambulance services for vulnerable populations in Perth, western Australia

As the frequency, intensity, and duration of heatwaves increases, emergency health serviceutilization, including ambulance service, has correspondingly increased across the world. The negative effects of air pollution on health complicate these adverse health effects. This research work is the first known study to analyze the joint effects of heatwaves and air quality on the ambulance service in Western Australia (WA). The main objective is to investigate the potential joint effects of heatwaves and air quality on the ambulance service for vulnerable populations in the Perth metropolitan area. A time series design was used. Daily data on ambulance callouts, temperature and air pollutants (CO, SO2, NO2, O3, PM10 and PM2.5) were collected for the Perth metropolitan area, WA from 2006 to 2015. Poisson regression modeling was used to assess the association between heatwaves, air quality, and ambulance callouts. Risk assessments on age, gender, socio-economic status (SES), and joint effects between heatwaves and air quality on ambulance callouts were conducted. The ambulance callout rate was higher during heatwave days (14.20/100,000/day) compared to non-heatwave days (13.95/100,000/day) with a rate ratio of 1.017 (95% confidence interval 1.012, 1.023). The ambulance callout rate was higher in males, people over 60 years old, people with low SES, and those living in coastal areas during period of heatwaves. Exposure to CO, SO2, O3 and PM2.5 increased risk on ambulance callouts and exposure to NO2 showed joint effect with heatwave and increased risk of ambulance callouts by 3% after adjustment of all other risk factors. Ambulance callouts are an important indicator for evaluating heatwave-related emergency morbidity in WA. As the median concentrations of air pollutants in WA were lower than the Australian National Standards, the interactive effects of heatwaves and air quality on ambulance service need to be further examined, especially when air pollutants exceed the standards.

"I was worried if I don't have a broken leg they might not take it seriously": Experiences of men accessing ambulance services for mental health and/or alcohol and other drug problems.

BackgroundA large proportion of ambulance callouts are for men with mental health and/or alcohol and other drug (AOD) problems, but little is known about their experiences of care. This study aimed to describe men's experiences of ambulance care for mental health and/or AOD problems, and factors that influence their care.MethodsInterviews were undertaken with 30 men who used an ambulance service for mental health and/or AOD problems in Australia. Interviews were analysed using the Framework approach to thematic analysis.ResultsThree interconnected themes were abstracted from the data: (a) professionalism and compassion, (b) communication and (c) handover to emergency department staff. Positive experiences often involved paramedics communicating effectively and conveying compassion throughout the episode of care. Conversely, negative experiences often involved a perceived lack of professionalism, and poor communication, especially at handover to emergency department staff.ConclusionIncreased training and organizational measures may be needed to enhance paramedics' communication when providing care to men with mental health and/or AOD problems.

What constitutes an emergency ambulance call?

IntroductionAmbulance services are often utilised for low-acuity conditions. This study seeks to understand under what medical circumstances the Australian public perceive it to be appropriate to call triple zero requesting ambulance assistance.Methods A total of 544 participants completed a 15-minute online survey distributed via social media, flyers and email links. Participants viewed 17 medical case study scenarios, developed in consultation with a panel of paramedic experts, and were asked to select which of nine possible medical interventions was most appropriate. A panel of paramedic experts reached consensus for each case study on whether it was or was not appropriate to call for triple zero assistance. Results Inappropriate medical intervention responses were more prevalent in scenarios deemed appropriate for ambulance assistance, compared with scenarios where an ambulance call-out was inappropriate (48% vs. 3% respectively, p<0.001). Many scenarios where ambulance use was appropriate found respondents utilising other healthcare services typically associated with lower-acuity conditions. Individuals without first aid training were more inclined to choose healthcare services incorrectly (65% vs. 69% respectively, p<0.001). ConclusionResponses to our case studies suggested a lack of understanding of situations that warrant an emergency. First aid training and education regarding medical emergencies and paramedic scope-of-practice would be beneficial. This study did not demonstrate substantial inappropriate ambulance usage, however respondents did not recognise the severity of certain emergencies and were inclined to utilise other healthcare services. Further research investigating the rationale behind triple zero use, improving public education and clarifying the role of paramedics is required.

Heatwave and work-related injuries and illnesses in Adelaide, Australia: a case-crossover analysis using the Excess Heat Factor (EHF) as a universal heatwave index

Heatwaves, or extended periods of extreme heat, are predicted to increase in frequency, intensity and duration with climate change, but their impact on occupational injury has not been extensively studied. We examined the relationship between heatwaves of varying severity and work-related injuries and illnesses. We used a newly proposed metric of heatwave severity, the Excess Heat Factor (EHF), which accounts for local climate characteristics and acclimatization and compared it with heatwaves defined by daily maximum temperature. Work-related injuries and illnesses were identified from two administrative data sources: workers' compensation claims and work-related ambulance call-outs for the years 2003-2013 in Adelaide, Australia. The EHF metrics were obtained from the Australian Bureau of Meteorology. A time-stratified case-crossover regression model was used to examine associations between heatwaves of three levels of severity, workers' compensation claims, and work-related ambulance call-outs. There was an increase in work-related ambulance call-outs and compensation claims during low and moderately severe heatwaves as defined using the EHF, and a non-significant decline during high-severity heatwaves. Positive associations were observed during moderate heatwaves in compensation claims made by new workers (RR 1.31, 95% CI 1.10-1.55), workers in medium-sized enterprises (RR 1.15, 95% CI 1.01-1.30), indoor industries (RR 1.09, 95% CI 1.01-1.17), males (RR 1.13, 95% CI 1.03-1.23) and laborers (RR 1.21, 95% CI 1.04-1.39). Workers should adopt appropriate precautions during moderately severe heatwaves, when the risks of work-related injuries and illnesses are increased. Workplace policies and guidelines need to consider the health and safety of workers during heatwaves with relevant prevention and adaptation measures.

Increasing powers to reject licences to sell alcohol: Impacts on availability, sales and behavioural outcomes from a novel natural experiment evaluation

Excessive alcohol consumption leads to negative health and social impacts at individual and population levels. Interventions that aim to limit the density of alcohol retail premises (including cumulative impact policies (CIPs)) have been associated with decreases in alcohol-related crime and alcohol-related hospital admissions. We evaluated the quantitative impact of introducing a new alcohol licensing policy that included a comprehensive Cumulative Impact Policy (CIP) enforced in seven Cumulative Impact Zones (CIZs) in one English Local Authority in 2013. We used time series analysis to assess immediate and longer term impacts on licensing decisions and intermediate outcomes, including spatial and temporal alcohol availability, crime, alcohol-related ambulance call-outs and on-licence alcohol retail sales across the Local Authority and in CIZs and non-CIZs during the period 2008 to 2016. We found no impact on licence application rates but post-intervention applications involved fewer trading hours. Application approvals declined initially but not over the longer term. Longer term, small reductions in units of alcohol sold in bars (−2060, 95% confidence interval (CI) = −3033, −1087) were observed in areas with more intensive licensing policies (‘Cumulative Impact Zones’ (CIZs)). Significant initial declines in overall crime rates (CIZs = −12.2%, 95% CI = −18.0%, −6.1%; non-CIZs = −8.0%, 95% CI = −14.0%, −1.6%) were only partially reversed by small, longer term increases. Ambulance callout rates did not change significantly. The intervention was partially successful but a more intensive and sustained implementation may be necessary for longer term benefits.

Regional morbidity and mortality during heatwaves in South Australia.

Heatwaves can be a common occurrence in Australia, and the public health impacts can be severe. Heat warnings and interventions are being adopted widely to reduce the preventable health impacts. This study examines the effects of heatwaves on morbidity and mortality in different climatic regions in the state of South Australia, to inform the targeting of heat warnings according to regional needs. Heatwaves were defined using the excess heat factor (EHF), an index based on mean daily temperature indices that quantifies heatwave severity relative to the local climate. In all regions, there were increases in morbidity (daily rates of ambulance call-outs and heat-related emergency presentations and hospital admissions) on heatwave days compared to non-heatwave days, which increased with heatwave severity. This study demonstrates that a consistent measure for heatwave severity, based on EHF, can be used to underpin public health warnings for climatically diverse areas.

A pre-hospital focus on rhabdomyolysis in elderly falls

More than a quarter of ambulance call-outs relate to elderly falls. Immobility following a fall can cause muscle to break down which can lead to rhabdomyolysis—a life-threatening condition that can be easily overlooked in pre-hospital care. Samantha Murdoch argues the need for training and education around this lesser-known condition

The Melbourne epidemic thunderstorm asthma event 2016: an investigation of environmental triggers, effect on health services, and patient risk factors

A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies. Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emergency department presentations, and data on hospital admissions for Nov 21, 2016, as well as leading up to and following the event were collected between Nov 21, 2016, and March 31, 2017, and analysed. We contacted patients who presented during the epidemic thunderstorm asthma event at eight metropolitan health services (each including up to three hospitals) via telephone questionnaire to determine patient characteristics, and investigated outcomes of intensive care unit (ICU) admissions. Grass pollen concentrations on Nov 21, 2016, were extremely high (>100 grains/m3). At 1800 AEDT, a gust front crossed Melbourne, plunging temperatures 10°C, raising humidity above 70%, and concentrating particulate matter. Within 30 h, there were 3365 (672%) excess respiratory-related presentations to emergency departments, and 476 (992%) excess asthma-related admissions to hospital, especially individuals of Indian or Sri Lankan birth (10% vs 1%, p<0·0001) and south-east Asian birth (8% vs 1%, p<0·0001) compared with previous 3 years. Questionnaire data from 1435 (64%) of 2248 emergency department presentations showed a mean age of 32·0 years (SD 18·6), 56% of whom were male. Only 28% had current doctor-diagnosed asthma. 39% of the presentations were of Asian or Indian ethnicity (25% of the Melbourne population were of this ethnicity according to the 2016 census, relative risk [RR] 1·93, 95% CI 1·74-2·15, p <0·0001). Of ten individuals who died, six were Asian or Indian (RR 4·54, 95% CI 1·28-16·09; p=0·01). 35 individuals were admitted to an intensive care unit, all had asthma, 12 took inhaled preventers, and five died. Convergent environmental factors triggered a thunderstorm asthma epidemic of unprecedented magnitude, tempo, and geographical range and severity on Nov 21, 2016, creating a new benchmark for emergency and health service escalation. Asian or Indian ethnicity and current doctor-diagnosed asthma portended life-threatening exacerbations such as those requiring admission to an ICU. Overall, the findings provide important public health lessons applicable to future event forecasting, health care response coordination, protection of at-risk populations, and medical management of epidemic thunderstorm asthma. None.

Self reported involvement in emergency medicine among GPs in Norway

Objective: To examine general practitioners’ (GPs’) perception of their role in emergency medicine and participation in emergency services including ambulance call outs, and the characteristics of the GPs and casualty clinics associated with the GPs’ involvement in emergency medicine.Design: Cross-sectional online survey.Setting: General practice.Subjects: General practitioners in Norway (n = 1002).Main outcome measures: Proportion of GPs perceiving that they have a large role in emergency medicine, regularly being on call, and the proportion of ambulance callouts with GP participation.Results: Forty six percent of the GPs indicated that they play a large role in emergency medicine, 63 percent of the GPs were regularly on call, and 28 percent responded that they usually took part in ambulance call outs. Multivariable logistic regression analyses indicated that these outcomes were strongly associated with participation in multidisciplinary training. Furthermore, the main outcomes were associated with traits commonly seen at smaller casualty clinics such as those with an absence of nursing personnel and extra physicians, and based on the distance to the hospital.Conclusion: Our findings suggest that GPs play an important role in emergency medicine. Multidisciplinary team training may be important for their continued involvement in prehospital emergencies.Key Points Health authorities and other stakeholders have raised concerns about general practitioner’s (GPs) participation in emergency medicine, but few have studied opinions and perceptions among the GPs themselves. • Norwegian GPs report playing a large role in emergency medicine, regularly being on call, and taking part in selected ambulance call outs. • A higher proportion of GPs who took part in team training perceived themselves as playing a large role in emergency medicine, regularly being on call, and taking part in ambulance call outs. • These outcomes were also associated with attributes commonly seen at smaller casualty clinics.

Evaluating a dementia learning community: exploratory study and research implications

BackgroundAccess times for, the costs and overload of hospital services are an increasingly salient issue for healthcare managers in many countries. Rising demand for hospital care has been attributed partly to unplanned admissions for older people, and among these partly to the increasing prevalence of dementia. The paper makes a preliminary evaluation of the logic model of a Dementia Learning Community (DLC) intended to reduce unplanned hospital admissions from care homes of people with dementia. A dementia champion in each DLC care home trained other staff in dementia awareness and change management with the aims of changing work routines, improving quality of life, and reducing demands on external services.MethodsControlled mixed methods realistic evaluation comparing 13 intervention homes with 10 controls in England during 2013–15. Each link in the assumed logic model was tested to find whether that link appeared to exist in the DLC sites, and if so whether its effects appeared greater there than in control sites, in terms of selected indicators of quality of life (DCM Well/Ill-Being, QUALID, end-of-life planning); and impacts on ambulance call-outs and hospital admissions.ResultsThe training was implemented as planned, and triggered cycles of Plan-Do-Study-Act activity in all the intervention care homes. Residents’ well-being scores, measured by dementia care mapping, improved markedly in half of the intervention homes but not in the other half, where indeed some scores deteriorated markedly. Most other care quality indicators studied did not significantly improve during the study period. Neither did ambulance call-out or emergency hospital admission rates.ConclusionsPDSA cycles appeared to be the more ‘active ingredient’ in this intervention. The reasons why they impacted on well-being in half of the intervention sites, and not the others, require further research. A larger, longer study would be necessary to measure definitively any impacts on unplanned hospital admissions. Our evidence suggested revising the DLC logic model to include care planning and staff familiarisation with residents’ personal histories and needs as steps towards improving residents’ quality of life.

Cost Calculation for a Flash Glucose Monitoring System for Adults With Type 2 Diabetes Mellitus Using Intensive Insulin – a UK Perspective

Aims: Estimate the costs associated with flash glucose monitoring as a replacement for routine self-monitoring of blood glucose (SMBG) in patients with type 2 diabetes mellitus (T2DM) using intensive insulin, from a UK National Health Service (NHS) perspective. Methods: The base-case cost calculation used the frequency of SMBG and healthcare resource use observed in the REPLACE trial. Scenario analyses considered SMBG at the flash monitoring frequencies observed in the REPLACE trial (8.3 tests per day) and a real-world analysis (16 tests per day). Results: Compared with 3 SMBG tests per day, flash monitoring would cost an additional £585 per patient per year, offset by a £776 reduction in healthcare resource use, based on reductions in emergency room visits (41%), ambulance call-outs (66%) and hospital admissions (77%) observed in the REPLACE trial. Per patient, the estimated total annual cost for flash monitoring was £191 (13.4%) lower than for SMBG. In the scenarios based on acquisition cost alone, flash monitoring was cost-neutral versus 8.3 SMBG tests per day (5% decrease) and cost-saving at higher testing frequencies. Conclusion: From a UK NHS perspective, for patients with T2DM using intensive insulin, flash monitoring is potentially cost-saving compared with routine SMBG irrespective of testing frequency.

Intoxication and violence during ambulance call-outs

Journal of Paramedic PracticeVol. 9, No. 11 CommentsIntoxication and violence during ambulance call-outsSarah Jane PalmerSarah Jane PalmerSearch for more papers by this authorSarah Jane PalmerPublished Online:7 Nov 2017https://doi.org/10.12968/jpar.2017.9.11.483AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Beatson J. Drunk Scots call for ambulance every 21 minutes [Internet]. The Scotsman, 10 April. 2015; Available from http://tinyurl.com/y9ly4ebj Google ScholarHouse of Commons Health Committee, Alcohol (HC 2009-10, 151-I). Institute of Alcohol Studies. Alcohol's impact on emergency services [Internet]. 2015; Available from http://tinyurl.com/ycb9bulh Google ScholarMartin N, Newbury-Birch D, Duckett J et al.. A Retrospective Analysis of the Nature, Extent and Cost of Alcohol-Related Emergency Calls to the Ambulance Service in an English Region. Alcohol Alcohol. 2012;47(2):191-7. https://doi.org/https://doi.org/10.1093/alcalc/agr158 Crossref, Google ScholarNHS. The cost of alcohol harm to the NHS in England (2009/2010). 2012; Available from http://tinyurl.com/pobd4bh Google Scholar FiguresReferencesRelatedDetails 2 November 2017Volume 9Issue 11ISSN (print): 1759-1376ISSN (online): 2041-9457 Metrics History Published online 7 November 2017 Published in print 2 November 2017 Information© MA Healthcare LimitedPDF download

Analysis on on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou

Objective: To investigate the situations of on-site rescue and traumatic features of victims involved in gas explosion accident in Hangzhou, so as to provide more data support for emergency medical rescues of the similar incidents of massive casualty. Methods: Two medical workers with a certain clinical experience were sent to Hangzhou 120 emergency medical centers to collect data of the on-site rescue on 21st July, 2017, including ambulance call-outs, on-site command and traffic conditions, and on-site triage and evacuation of the victims. They were then sent to the hospitals receiving the victims to investigate the situations of these victims including the general information (such as gender, age, admitted hospitals, and number of admission, discharge, and transferring in the first two weeks after the accident) and injury assessment [such as injury position and type, injury severity evaluation by New Injury Severity Scoring (NISS), and burn severity evaluation for victims with burns]. Results: (1) A total of 15 ambulances reached the accident site for rescue. The traffic and transportation were jammed and interrupted after this accident. On-site triage and distribution were disorderly conducted. (2) Clinical data of 53 victims were collected, including 24 males and 29 females, with the age of 8 to 70 (34±14) years old. They were sent into 6 hospitals in Hangzhou. Two victims died on the day of accident. Up to two weeks after this accident, 28 (52.8%) victims were discharged from the hospitals and received follow-up in outpatient department. Five victims with severe injuries were transferred to the other hospitals. (3) Based on the results of NISS, the injury severities were mild in 29 (54.7%) cases, moderate in 9 (17.0%) cases, serious in 3 (5.7%) cases, and severe in 12 (22.6%) cases. Those 2 dead victims were classified into the severe category due to the highest NISS score of 75. For all of the victims, skin and soft tissue defects were most common. Six (11.3%) victims were combined with burns. According to the classification of burn severity, there were one case of mild, one case of serious, and 4 cases of severe. Conclusions: The gas explosion accident in Hangzhou caused massive casualties with complex injuries. The local emergency medical rescue responded quickly, but during the rescue process, lots of aspects should be further improved.

Impact of Air Temperature on London Ambulance Call-Out Incidents and Response Times

Ambulance services are in operation around the world and yet, until recently, ambulance data has only been used for operational purposes rather than for assessing public health. Ambulance call-out data offers new and valuable (near) real-time information that can be used to assess the impact of environmental conditions, such as temperature, upon human health. A detailed analysis of London ambulance data at a selection of dates between 2003 and 2015 is presented and compared to London temperature data. In London, the speed of ambulance response begins to suffer when the mean daily air temperature drops below 2 °C or rises above 20 °C. This is explained largely by the increased number of calls past these threshold temperatures. The baseline relationships established in this work will inform the prediction of likely changes in ambulance demand (and illness types) that may be caused by seasonal temperature changes and the increased frequency and intensity of extreme/severe weather events, exacerbated by climate change, in the future.

Extreme climatic conditions and health service utilisation across rural and metropolitan New South Wales.

Periods of successive extreme heat and cold temperature have major effects on human health and increase rates of health service utilisation. The severity of these events varies between geographic locations and populations. This study aimed to estimate the effects of heat waves and cold waves on health service utilisation across urban, regional and remote areas in New South Wales (NSW), Australia, during the 10-year study period 2005-2015. We divided the state into three regions and used 24 over-dispersed or zero-inflated Poisson time-series regression models to estimate the effect of heat waves and cold waves, of three levels of severity, on the rates of ambulance call-outs, emergency department (ED) presentations and mortality. We defined heat waves and cold waves using excess heat factor (EHF) and excess cold factor (ECF) metrics, respectively. Heat waves generally resulted in increased rates of ambulance call-outs, ED presentations and mortality across the three regions and the entire state. For all of NSW, very intense heat waves resulted in an increase of 10.8% (95% confidence interval (CI) 4.5, 17.4%) in mortality, 3.4% (95% CI 0.8, 7.8%) in ED presentations and 10.9% (95% CI 7.7, 14.2%) in ambulance call-outs. Cold waves were shown to have significant effects on ED presentations (9.3% increase for intense events, 95% CI 8.0-10.6%) and mortality (8.8% increase for intense events, 95% CI 2.1-15.9%) in outer regional and remote areas. There was little evidence for an effect from cold waves on health service utilisation in major cities and inner regional areas. Heat waves have a large impact on health service utilisation in NSW in both urban and rural settings. Cold waves also have significant effects in outer regional and remote areas. EHF is a good predictor of health service utilisation for heat waves, although service needs may differ between urban and rural areas.