Ambulance Crews Research Articles

What are ambulance crews' experiences of using a mechanical chest compression device for out-of-hospital resuscitation? A constructivist qualitative study utilising online focus groups.

Mechanical chest compression devices (MCCDs) provide chest compressions mechanically to a person in cardiac arrest. Those chest compressions would usually be provided manually. Previous studies into the use of MCCDs have focused on the quantitative outcomes, with little emphasis on the qualitative experiences of those using MCCDs. To collect and report ambulance crews' experiences of using MCCDs for out-of-hospital resuscitation attempts. The philosophical approach was constructivist, the methodology qualitative and the data collection method online focus groups. Convenience sampling was used to recruit participants who met the inclusion criteria, which broadly were to have experience of using MCCDs for out-of-hospital resuscitation. There have been two types of MCCD used locally. Participants were included regardless of which type of device they had experience of. Similarly, participants were included whether they had active or passive experience of the devices. The focus groups were recorded, fully transcribed and then analysed using constant comparison. Four selective codes emerged. These were factors directly affecting ambulance crew members; practicalities of a resuscitation attempt; ambulance crew members' perceptions, experiences and thoughts; negatives of MCCDs. The main perceptions arising from the participants' discussion in this work were that MCCD use could potentially provide psychological protection to ambulance crew members when reflecting on resuscitation attempts, and participants felt there is an overall reduction of cognitive load for ambulance crew members when using MCCDs for resuscitation attempts. There were particularly timely benefits expressed of MCCDs easing the physical fatigue of a resuscitation attempt when responding wearing personal protective equipment, as has been required during the COVID-19 pandemic. MCCDs were felt to be of benefit when transporting a patient in cardiac arrest but differences were expressed as to whether the LUCAS-2 in particular helps or hinders extrication of a patient.

A Prehospital Triage System to Detect Traumatic Intracranial Hemorrhage Using Machine Learning Algorithms

An adequate system for triaging patients with head trauma in prehospital settings and choosing optimal medical institutions is essential for improving the prognosis of these patients. To our knowledge, there has been no established way to stratify these patients based on their head trauma severity that can be used by ambulance crews at an injury site. To develop a prehospital triage system to stratify patients with head trauma according to trauma severity by using several machine learning techniques and to evaluate the predictive accuracy of these techniques. This single-center retrospective cohort study was conducted by reviewing the electronic medical records of consecutive patients who were transported to Tokyo Medical and Dental University Hospital in Japan from April 1, 2018, to March 31, 2021. Patients younger than 16 years with cardiopulmonary arrest on arrival or with a significant amount of missing data were excluded. Machine learning-based prediction models to detect the presence of traumatic intracranial hemorrhage were constructed. The predictive accuracy of the models was evaluated with the area under the receiver operating curve (ROC-AUC), area under the precision recall curve (PR-AUC), sensitivity, specificity, and other representative statistics. A total of 2123 patients (1527 male patients [71.9%]; mean [SD] age, 57.6 [19.8] years) with head trauma were enrolled in this study. Traumatic intracranial hemorrhage was detected in 258 patients (12.2%). Among several machine learning algorithms, extreme gradient boosting (XGBoost) achieved the mean (SD) highest ROC-AUC (0.78 [0.02]) and PR-AUC (0.46 [0.01]) in cross-validation studies. In the testing set, the ROC-AUC was 0.80, the sensitivity was 74.0% (95% CI, 59.7%-85.4%), and the specificity was 74.9% (95% CI, 70.2%-79.3%). The prediction model using the National Institute for Health and Care Excellence (NICE) guidelines, which was calculated after consultation with physicians, had a sensitivity of 72.0% (95% CI, 57.5%-83.8%) and a specificity of 73.3% (95% CI, 68.7%-77.7%). The McNemar test revealed no statistically significant differences between the XGBoost algorithm and the NICE guidelines for sensitivity or specificity (P = .80 and P = .55, respectively). In this cohort study, the prediction model achieved a comparatively accurate performance in detecting traumatic intracranial hemorrhage using only the simple pretransportation information from the patient. Further validation with a prospective multicenter data set is needed.

Innovations in preoperative control of exsanguination in major trauma

Exsanguination places a considerable strain on trauma systems worldwide, and is estimated to be involved in 20–40% of trauma deaths. This article evaluates innovations in the preoperative care of the injured patient to minimise the impact of bleeding. These include reform of organisations and structure of trauma networks, adoption of objective prehospital triage tools and changes in ambulance crews' approach to on-scene interventions. Developments of methods to mechanically control these bleeds—simple tourniquets, topical haemostatics developed in military settings and endovascular interventions such as resuscitative endovascular balloon occlusion of the aorta—are also analysed. This article has examined advancements in damage control resuscitation, including a possible future shift towards whole-blood transfusion and interventional radiology for primary haemorrhage control. Finally, a potential further development—the uptake of hybrid resuscitation suites—is examined.

Non-technical skills in pre-hospital care in the Czech Republic: a prospective multicentric observational study (NTS study)

BackgroundNon-technical skills (NTS) are important for the proper functioning of emergency medical ambulance crews but have hardly been researched in the conditions of clinical pre-hospital care.The primary objective of this study, therefore, is to describe the use of NTS in practice. The secondary objective is to compare if the performance of NTS varies according to the type of case.MethodsIn this multicentric observational study the modified Team Emergency Assessment Measure (TEAM) score was used to assess the performed NTS of two or more crews on site. The evaluation consisted of leadership, teamwork and task management, rated by a field supervisor.The study observations took place in real clinical pre-hospital emergency medical cases when two or more crews were dispatched between October 2019 and August 2020. The sample size was determined by researchers prior to the study to at least 100 evaluated events per each of the three participating emergency medical services.The results are presented as median and interquartile range. The internal reliability, consistency and validity of test items and results were evaluated. The Kruskal–Wallis test and the post hoc Mann-Whitney U test with Bonferroni correction were used for multiple comparisons of three groups.ResultsA total of 359 events were evaluated. Surprisingly, the median value for all eight items was as high as 3.0 with a similar interquartile range of 1.0. There were no differences observed by case type (CPR vs. TRAUMA vs. MEDICAL) except from item 1. A post hoc analysis revealed that this difference is in favour of a higher rated performance of non-technical skills in CPR.ConclusionsThe overall result of the performance of non-technical skills can be regarded as very good and can serve for further evaluations. The crews achieved better parameters of NTS in leadership in resuscitation situations in comparison with general medical events.Trial RegistrationThe study is registered at Clinical Trials under the ID: NCT04503369.

MRSA Colonization in Workers from Different Occupational Environments—A One Health Approach Perspective

Staphylococcus aureus and particularly methicillin-resistant S. aureus (MRSA) infections are currently associated with extremely high morbidity and mortality rates worldwide. The global escalation in the development of antibiotic-resistant human pathogens and S. aureus ability in developing new clones with the capacity to invade community settings, leads to an urgent need to develop accurate and efficient assessments of S. aureus colonization in occupational settings, particularly those with increased risk of human and animal colonization and food contamination. Here we present cross-sectional studies with the aim to assemble crucial information regarding MRSA prevalence in workers from five different Portuguese occupational environments (bakeries, swineries (humans and animals), ambulance crews, veterinary clinics and healthcare facilities). Our data demonstrated high prevalence of S. aureus asymptomatic carriers among bakery workers (40%; 75% MSSA and 25% MRSA), swinery workers (54%; 8% MSSA and 46% MRSA), firefighters (48.5%; 24% MSSA and 21% MRSA) and healthcare workers (Study 1: 42.2%; 18.4% MSSA and 23.7% MRSA, Study 2: 43.3% MRSA). S. aureus prevalence in veterinary staff was 7.1% (MSSA), lower than the results obtained in control groups (33.3% S. aureus; MRSA 4% to 10%). The present study sustains the urge to develop accurate and efficient assessment of S. aureus human and animal colonization, particularly in high risk occupational settings, with proper guidelines and validated procedures in order to avoid potential hazardous health outcomes associated with bioaerosol exposure and associated infectious diseases.

Emergency cricothyroidotomy in difficult airway simulation \u2013 a national observational study of Air Ambulance crew performance

BackgroundAdvanced prehospital airway management includes complex procedures carried out in challenging environments, necessitating a high level of technical and non-technical skills. We aimed to describe Norwegian Air Ambulance-crews’ performance in a difficult airway scenario simulation, ending with a “cannot intubate, cannot oxygenate”-situation.MethodsThe study describes Air Ambulance crews’ management of a simulated difficult airway scenario. We used video-observation to assess time expenditure according to pre-defined time intervals and technical and non-technical performance was evaluated according to a structured evaluation-form.ResultsThirty-six crews successfully completed the emergency cricothyroidotomy with mean procedural time 118 (SD: ±70) seconds. There was variation among the crews in terms of completed procedural steps, including preparation of equipment, patient- monitoring and management. The participants demonstrated uniform and appropriate situational awareness, and effective communication and resource utilization within the crews was evident.ConclusionsWe found that Norwegian Air Ambulance crews managed a prehospital “cannot intubate, cannot oxygenate”-situation with an emergency cricothyroidotomy under stressful conditions with effective communication and resource utilization, and within a reasonable timeframe. Some discrepancies between standard operating procedures and performance are observed. Further studies to assess the impact of check lists on procedural aspects of airway management in the prehospital environment are warranted.

Structured communication during emergency response driving: Safety-critical points identified by Finnish emergency response driving experts

BackgroundEmergency response driving (ERD) is a major occupational risk factor in emergency medical services (EMS). Inadequate communication has been acknowledged as a significant contributing cause for major incidents during ERD. Previous evidence shows that structured communication can promote safety in high-risk procedures, but knowledge in ERD context is lacking. The aim of this study was to examine what are the safety-critical points in ERD that should be secured using structured communication. MethodThe nominal group technique (NGT) was used for gathering interview material from ERD experts’ (n = 11) workshop. In addition, semi-structured thematic interviews were conducted with other ERD experts (n = 15) from five different EMS areas in Finland. The interview material was analyzed using inductive content analysis. ResultsUsing NGT, 13 safety-critical points in ERD requiring the use of structured communication were identified. As a result of the interviews, two main categories were found: 1) Factors affecting the adaptation of the appropriate speed for the current situation and 2) Factors affecting orientation in a driving event. ConclusionERD comprises multiple safety-critical points that should be secured using structured communication between ambulance crew members. Pilot and implementation studies exploring the use of structured communication in ERD are needed in the future.

Training trial of critical care paramedics for non-medical authorisation of blood

The use of pre-hospital blood transfusion by air ambulance crews is increasing. Blood transfusion is traditionally ‘authorised’ by doctors, not prescribed. However, there is an increasing interest in extending the capability of authorisation to other practitioners – that is, non-medical authorisation (NMA). A UK framework for nurses and midwives has existed since 2007, but training for critical care paramedics (CCPs) has been limited.The Resuscitation with Pre-Hospital Blood Products (RePHILL) trial was launched in 2016, requiring pre-hospital administration of red cells and LyoPlas. Authorisation was initially restricted to doctors, leading to missed recruitment by paramedic-only crews. The trial protocol was amended in 2019 to permit NMA following suitable training and stakeholder consultation. We present a targeted training programme designed to support paramedic-led transfusion within the framework of the pre-hospital trial.We considered the knowledge and skills required for NMA and compared this with baseline knowledge from paramedic training to identify the training gap. We examined examples of existing military and civilian NMA training to develop a targeted programme for a single air ambulance. The four elements of our training programme were pre-course online training, previous trial participation, face-to-face training and competency assessment.Training was delivered to three CCPs, who cascaded the training to 14 colleagues. The training time was one morning, including a face-to-face session and assessment. Novel topics included physiological triggers for transfusion and transfusion risks in the pre-hospital environment. Paramedics were encouraged to recognise and report new patterns of adverse events. Reflective feedback suggests the programme provided CCPs the knowledge to autonomously recruit trial patients and authorise transfusion.

Оценка влияния межрегиональной маршрутизации пациентов с острым коронарным синдромом с подъемом сегмента ST на снижение смертности от острого инфаркта миокарда на модели цифрового двойника Курганской области

Reduction of the time required for medical evacuation to the regional vascular center in order to carry out percutaneous coronary intervention in case of ST-segment elevation acute coronary syndrome is an essential factor directly affecting the mortality rate of this condition. The concept of territorial attribution in rendering emergency medical services militates against the effective use of such emergency medical services aimed to promptly deliver patients to the hospital. Research objective. The research objective is to study the efficiency of trans-regional communication in reducing the time required to deliver patients with ST-segment elevation acute coronary syndrome to hospitals in order to carry out percutaneous coronary intervention and its impact on acute myocardial infarction mortality rate basing on the digital twin of Kurgan region. Materials and methods. the digital twin of the Kurgan region represents the time required to evacuate patients with ST-segment elevation acute coronary syndrome to regional vascular centers by ambulance crews in pursuance with an applicable order, compared with patient routing in case of trans-regional cooperation with vascular centers of neighboring regions. Results: due to the implementation of trans-regional cooperation, mean patient evacuation time within the region had been reduced by 21,3 ± 9,84 minutes, and mean time on routes from the localities wherefrom it was faster to deliver patients to vascular centers in neighboring regions had been reduced by 55±25,73 minutes. The estimated myocardial infarction mortality rate on average for the Kurgan region caused by medical evacuation time reduction in case of implementing trans-regional cooperation had been reduced by 5,32%. Conclusions: the use of resources of neighboring regions when working out regional orders on routing the patients with acute coronary syndrome in a number of instances contributes to the provision of two-hour availability of percutaneous coronary intervention and serves as a significant reserve for acute myocardial infarction mortality reduction.

Problems and Prospects in Development of Emergency Medical Help Center in OSH, Kyrgyzstan

This article is presenting an analysis of emergency medical center work in Osh city, Kyrgyzstan for a five-year period. Ambulance crew visits indicators from 2016 to 2020 were studied in the Kyrgyz Republic, and in Bishkek and Osh cities, visit numbers monitoring in Emergency Medical Help Center in Osh carried out with a delay of more than 20 minutes, was carried out using statistical test forms from 2016 to 2020 years and proposed measures to improve emergency quality in medical help providing to a population in Osh city. Statistical and analytical methods were used including dynamic analysis of time series, correlation and regression analysis, data processing carried out using application programs. Comparison of average Republican indicator of load on ambulance crews revealed teams load in Osh city 46443 calls, with 68100 calls exceeding the average Republican indicator by 35%, and shows the overload of EMH service mobile teams in Osh. Keywords: emergency medicine, paramedic, mobile teams, trips, optimization, lateness.

ОБЕСПЕЧЕННОСТЬ И УКОМПЛЕКТОВАННОСТЬ ВРАЧАМИ, РАБОТАЮЩИМИ НА СКОРОЙ МЕДИЦИНСКОЙ ПОМОЩИ, В РОССИЙСКОЙ ФЕДЕРАЦИИ И ЕЕ СУБЪЕКТАХ, 2016-2020 Г.Г.

Significance. One of the most actual problems in medical care organization is personnel-related problem due to insufficient number and staffing levels of medical organizations against the background of a high incidence of diseases requiring emergency medical care. Purpose of the study. To evaluate the number of ambulance crew doctors and their staffing levels in the Russian Federation. Material and methods. The study used data from the form N30 of the Federal statistical observation «Information about medical organization» for calculating indicators on the number of ambulance crew doctors, staffing and ratio of ambulance crew doctors holding a second job in the Russian Federation, federal districts and constituent entities of the Russian Federation in 2016 - 2020. Analytical, statistical, descriptive methods were used. Results. The study shows that in the Russian Federation, ambulance crew doctors have high rates of holding second job under the study period (2016-2020), their number decreased by 10.0% (from 15107 to 13602) resulting in a decline from 1.03 to 0.93 per 10,000 population and reduced staffing level (from 73.4 to 69.3%). However, in some constituent entities of the Russian Federation, the situation in terms of number and staffing levels of ambulance crew doctors is far from being unambiguous: in some constituent entities the indicators increased under the study period while in others – decreased. However, the trend towards a lower rate of ambulance crew doctors holding a second job is typical for all federal districts. Conclusion. Analysis of the number and staffing levels of ambulance crew doctors showed an unequal situation in constituent entities of the Russian Federation, with a general decrease in the average statistical indicators in the country. Scope of application. The study results can be of interest to health care organizers and practitioners.

Covid-19-თან დაკავშირებული შეტყობინებების ანალიზი და ვიზუალიზაცია 112-ში

The coronavirus pandemic has significantly changed a person's life and almost all areas of his activity. One of the organizations whose activities are directly related to the management of the pandemic is the Emergency Management Center 112. It is actively involved in the process of managing the coronavirus and has been working in a special mode for more than a year to provide timely and highly qualified services to every citizen. Сovid-19 monitoring system developed at the 112 Emergency Management Center is described, whose real-time stability has been compromised by the increasing number of incoming calls during the pandemic. Consequently, a new functionality has been created, the purpose of which is the optimal geographical distribution of ambulance crews. The article discusses the front-end part of this functionality. It also describes the process of integrating maps into the application, which results in the transformation of the desired data into map layers and visual representation. The application shows the number of Covid-19 cases along with an additional text. An example of Covid-19 cases map is shown. The illustrations are provided showing the statistical data of both current days and past period.

Оказание скорой медицинской помощи пациентам в коматозном состоянии в г.Рязани в 2016–2020 гг.

The study objectives were to investigate the prevalence and to determine the most frequent causes of coma in patients in Ryazan; to determine the frequency of fatal outcomes at the stage of medical evacuation and the frequency of hospitalizations; to identify the features of emergency medical care in the prehospital period. Materials and methods. We analyzed statistical data on the number of witnesses who applied for emergency medical aid in cases of disturbance of consciousness in patients who were subsequently diagnosed as comatose patients; we revealed main causes and types of comatose states, number of fatal outcomes and frequency of hospitalizations in Ryazan. Materials of the study – cards of calls of ambulance crews in Ryazan in 2016-2020. Results of the study and their analysis. Analysis of statistical data for Ryazan in 2016-2020 showed a steady increase in the number of ambulance calls to patients in coma. In Ryazan, as in Russia as a whole, cerebral coma prevailed, with diabetic coma in second place and toxic coma – in third. In 2016-2020, the proportion of coma-related deaths was 2.7% in the prehospital period and had no upward trend. In 84% of cases patients were hospitalized in medical treatment organisations, patients with hypoglycemic coma sometimes refused hospitalization, there was no tendency in increase of the number of refusals. In the prehospital period, ambulance care for patients with coma was provided in accordance with the algorithms, average time to reach the call was 12.4 min, which corresponds to the respective norms for emergency calls for Ryazan.

New development: A ‘journey of personal and professional emotions’—emergency ambulance professionals during Covid-19

IMPACT This article explores the consequences of emotional labour on UK NHS ambulance staff and their response to the Covid-19 pandemic. It highlights the challenges faced by ambulance crews while dealing with their emotional labour within the context of organizational settings. Research findings also explain the importance of emergency responders’ psychosocial wellbeing. The article has clear relevance as to how frontline staff manage their emotional labour in other emergency service settings, such as the police and fire and rescue services.

The Safety INdEx of Prehospital On Scene Triage (SINEPOST) study: the development and validation of a risk prediction model to support ambulance clinical transport decisions on-scene\u2014a protocol

BackgroundDemand for both the ambulance service and the emergency department (ED) is rising every year and when this demand is excessive in both systems, ambulance crews queue at the ED waiting to hand patients over. Some transported ambulance patients are ‘low-acuity’ and do not require the treatment of the ED. However, paramedics can find it challenging to identify these patients accurately. Decision support tools have been developed using expert opinion to help identify these low acuity patients but have failed to show a benefit beyond regular decision-making. Predictive algorithms may be able to build accurate models, which can be used in the field to support the decision not to take a low-acuity patient to an ED.Methods and analysisAll patients in Yorkshire who were transported to the ED by ambulance between July 2019 and February 2020 will be included. Ambulance electronic patient care record (ePCR) clinical data will be used as candidate predictors for the model. These will then be linked to the corresponding ED record, which holds the outcome of a ‘non-urgent attendance’. The estimated sample size is 52,958, with 4767 events and an EPP of 7.48. An XGBoost algorithm will be used for model development. Initially, a model will be derived using all the data and the apparent performance will be assessed. Then internal-external validation will use non-random nested cross-validation (CV) with test sets held out for each ED (spatial validation). After all models are created, a random-effects meta-analysis will be undertaken. This will pool performance measures such as goodness of fit, discrimination and calibration. It will also generate a prediction interval and measure heterogeneity between clusters. The performance of the full model will be updated with the pooled results.DiscussionCreating a risk prediction model in this area will lead to further development of a clinical decision support tool that ensures every ambulance patient can get to the right place of care, first time. If this study is successful, it could help paramedics evaluate the benefit of transporting a patient to the ED before they leave the scene. It could also reduce congestion in the urgent and emergency care system.Trial RegistrationThis study was retrospectively registered with the ISRCTN: 12121281

Method for predicting meteopathies in patients with arterial hypertension

Abstract Background Climatotherapy, as part of the spa stage of treatment, with arterial hypertension can give both positive and negative effects in the event of meteopathic reactions. The risk of meteopathies is especially high in patients coming from northern and eastern regions. Purpose Was to predict periods of increased risk of meteopathy development. Methods The study lasted 22 months, from January 01, 2019 to October 31, 2020 in the city of Gelendzhik (44 ° 36 'north latitude 38 ° 08' east longitude). The source of meteorological data: the site Gismeteo.ru, the Gelendzhik weather station and the ambulance data of the cities of Gelendzhik (12,268 requests) and Novorossiysk (12,226) in total (24,494 requests), the ambulance crews of which serve the area. Nonlinear logit regression using the maximum likelihood method was used to calculate the model. Results A prognostic model was built to increase the risk of developing a hypertensive crisis in the studied population; the main indicators of climatic and geomagnetic conditions were used as the studied variables. The sensitivity of the used logistic regression method was 56.0%, and the specificity was 77.3%. The overall accuracy of the model under study was 76.0%. In the winter period, according to the compiled prognostic model, no more than 75.0% of days are accompanied by a low risk of developing hypertension, in the spring period their share decreases to 59.0%, in the summer it is 89.0%, and in the autumn period - 77. 0%. Conclusion The developed logistic regression models make it possible to more accurately calculate the individual risks of developing a hypertensive crisis in patients with arterial hypertension and develop an individual treatment strategy. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): state assignment of the Ministry of the Russian Federation

Do methods of hospital pre-alerts influence the on-scene times for acute pre-hospital stroke patients? A retrospective observational study.

Introduction:Stroke is one of the leading causes of death and disability worldwide. The ambulance service is often the first medical service to reach an acute stroke patient, and due to the time-critical nature of stroke, a time-critical assessment and rapid transport to a hyper acute stroke unit are essential. As stroke services have been centralised, different hospitals have implemented different pre-alert admission policies that may affect the on-scene time of the attending ambulance crew. The aim of this study is to investigate if the different pre-alert admission policies affect time on scene.Method:The current study is a retrospective quantitative observational study using data routinely collected by North East Ambulance Service NHS Foundation Trust. The time on scene was divided into two variables; group one was a telephone pre-alert in which a telephone discussion with the receiving hospital is required before they accept admission of the patient. Group two was a radio-style pre-alert in which the attending clinician makes an autonomous decision on the receiving hospital and alerts them via a short radio message of the incoming patient. These times were then compared to identify if there was any difference between them.Results:Data on 927 patients over a three-month period, from October to December 2019, who had received the full stroke bundle of care, were within the thrombolysis window and recorded as a stroke by the attending clinician, were split into the variable groups and reported on. The mean time on scene for a telephone call pre-alert was 33 minutes and 19 seconds, with a standard deviation of 13 minutes and 8 seconds. The mean on-scene time for a radio pre-alert was 28 minutes and 24 seconds, with a standard deviation of 11 minutes and 51 seconds.Conclusion:A pre-alert given via radio instead of via telephone is shown to have a mean time saving of 4 minutes and 55 seconds, representing an important decrease in time which could be beneficial to patients.

Ambulance waiting and associated work flow improvement strategies: a pilot study to improve door-in-door-out time for thrombectomy patients in a primary stroke center

BackgroundRapid access to thrombectomy for patients with large vessel occlusion (LVO) acute ischemic stroke (AIS) is critical for improving outcome. A major challenge for the ‘drip and ship’ model is...

Treatment of Complicated Coronary Heart Disease after Successful Prehospital Resuscitation in a Public Place

The current problem of modern medicine is the lack of public awareness about personal health, late diagnosis of diseases, untimely prehospital care and treatment of existing complications. This applies to all branches of medicine, especially cardiology and cardiac surgery. Coronary heart disease occupies one of the leading places in the structure of mortality due to cardiovascular diseases. This is mainly due to the fact that patients seek medical care with complicated forms of coronary heart disease like sudden cardiac death, cardiac arrhythmia (ventricular fibrillation, AV blockade, sinus bradycardia and tachycardia), formation of left ventricular (LV) aneurysm, LV free wall rupture and LV false aneurysm, mitral regurgitation. In such cases, all actions must be early, staged, well established, and concordant with clear algorithm.
 The aim. To demonstrate our clinical case as an example of proper logistics, rapid response and timely surgical treatment of complicated forms of coronary heart disease.
 Clinical case. Patient F., born in 1964, was admitted to the clinic on March 24, 2021 with a diagnosis of coronary heart disease: acute non-Q-wave myocardial infarction of the posterolateral LV since March 22, 2021. Clinical death with successful resuscitation at the prehospital stage (03/22/2021). Ventricular fibrillation (03/22/2021). Multivessel coronary artery disease. Mitral valve regurgitation grade II-III. Tricuspid valve regurgitation grade I-II. Pulmonary hypertension grade I. Hypertensive disease grade III, degree 3, risk 4 (very high). Heart failure II A with a moderately reduced LV ejection fraction (47%). NYHA3. Closed chest injury (03/22/2021): fracture of the ribs without displacement: ribs 4-8 on the left, ribs 4-8 on the right. He considers himself ill since March 22, 2021, when he suddenly felt severe pain in his chest and fell unconscious. According to witnesses, the man got out of the subway and fell unconscious, without breathing and pulse. Due to the presence of defibrillators at the subway station, successful resuscitation was conducted by police officers before the ambulance crew arrival. Clinical and instrumental studies were performed after hospitalization. The patient was taken to the operating room on 03/24/2021 at 5:30 PM, 50 minutes after admission to the National Amosov Institute, Kyiv. Urgent off-pump coronary artery bypass grafting of 3 coronary arteries was performed. A cardioverter-defibrillator was implanted due to the history of clinical death and the conclusion of daily ECG monitoring. The intra- and postoperative period was uneventful, the patient was discharged in satisfactory condition for rehabilitation.
 Conclusions. Our clinical experience shows that timely prehospital care, proper logistics and surgical correction of coronary heart disease not only saves but also significantly improves the quality of life of the patient in the future.

An online emergency medical management information system using mobile computing

Purpose The purpose of this paper is to investigate the way technology affects the provision of prehospital emergency care, upgrading the quality of services offered and significantly reducing the risk of premature termination of the patients. Design/methodology/approach The paper presents the development of the eEKAB, a pilot emergency medical information system that simulates the main services offered by the Greek National Instant Aid Centre (EKAB). The eEKAB was developed on an agile system methodology. From a technical perspective, the features and the technology were mainly chosen to provide reliable and user-friendly interfaces that will attract many users. eEKAB is based on three important pillars for offering health care to the patients: the “On-time Incident Reporting”, the “On-time Arrival at the Incident” and “Transfer to the Health Center”. According to the literature review, the emergency medical services (EMS) systems that combine all the features are very few. Findings It reduces the total time of the EMS procedures and it allows for an easier management of EMS, by providing a better allocation of human resources and a better geographical distribution of ambulances. The evaluation displayed that it is a very helpful application for the ambulance drivers as it reduces the ambulance response time to arrive in the patient's location and contributes significantly to the general performance of the prehospital medical care system. Also, the survey verified the importance of implementing eEKAB on a larger scale beyond the pilot usage. It is worth mentioning that the younger ambulance drivers had a more positive view for the purpose of the application. Research limitations/implications The paper clearly identifies implications for further research. Regarding interoperability, the mobile app cooperates with the Operational Center of EKAB, while further collaboration could be achieved with other operational ambulance handling center, mainly, of the private sector. The system can evolve to include better communications among the EKAB departments. Particularly, the ambulance crew as well as the doctors should be informed with more incident features such as the emergency signal so that they know whether to open the siren, the patient's name, etc. The authors are currently working on implementing some features to provide effective medical health services to the patient in the ambulance. Practical implications eEKAB will have very significant implications in case of its enforcement, such as the reduction of the total time of EMS procedures with a corresponding reduction of the operating costs of an accident management system and an ambulance fleet handling system while in parallel informing in time the doctors/clinics. It will provide better distribution of ambulances as well as of total human resources. It will greatly assist ambulance drivers, while reducing ambulance response time to reach the patient's location. In other words, the authors will have a better performance of the whole prehospital care system. Social implications Providing emergency care before the hospital is of great importance for upgrading the quality of health services provided at the accident site, thus significantly reducing the risk of premature death of patients. This in itself has a significant social implication. Originality/value The paper demonstrates a solid understanding in the field of the EMS systems and the corresponding medical services offered. It proposes the development of an effective, feasible and innovative EMS information system that will improve the existing emergency health care system in Greece (EKAB). An in depth literature review and presentation of the adopted new technologies and the respective architecture take place. An evaluation and statistical validation were conducted for proving the high applicability of eEKAB in case of real-life running.