Ambulance Crews Research Articles

Ideal Workers, Supporting Actors, or Thrill Seekers? How Coworker Demands Influence Ambulance Volunteers’ Experiences of Freedom and Meaningful Work

AbstractFor nonprofit organizations (NPOs) struggling to attract adequate numbers of volunteers, examining what makes nonprofit engagement meaningful is essential because disenchanted volunteers can simply quit. Yet, the assumption that freedom is a core aspect of the volunteer experience and of meaningful work may not hold true in high-stakes environments where volunteers must demonstrate high levels of commitment and expertise. This study aims to analyze how freedom plays out in high-stakes volunteering and its impact on meaningful work. Drawing on interviews with volunteer and paid ambulance crew working in nine stations in Aotearoa New Zealand, the study explores how “super-volunteers” talk about freedom in the context of their on-road work and how coworkers communicatively attempt to influence volunteers’ freedom. Three volunteer profiles emerged from the analysis: ideal workers, supporting actors, and thrill seekers. Most paid staff encouraged ideal workers to strive for self-realization, a form of positive freedom in work, which led to optimal clinical performance. Supporting actors privileged self-determination or positive freedom at work, although coworkers successfully pushed them to contribute to basic emergency work. Because thrill seekers demanded freedom from boring or dirty jobs, appeals to teamwork failed to sway them. The study makes two key contributions. First, the diversity of freedoms volunteers evoked and resisted underscores the importance of nuancing the assertion that volunteering is a “free” act. Second, although the meaningful work literature is drifting in the pro-freedom direction, it shows that the freedoms enacted by volunteers or promoted by coworkers were arguably “mistaken”—for volunteers, patients, and the NPO itself.

A community-based ambulance model: lessons for emergency medical services and everyday health systems resilience from South Africa.

The role of the emergency medical service (EMS) is changing globally as ambulance crews respond to a shifting burden of disease, as well as societal stressors such as violence and inequality. New ways of thinking about how to provide emergency care are required to shift EMS from a role primarily focused on clinical care and transporting patients to hospital. In this paper, we present the experience of the Philippi Project (PP), an innovative community-based model of care developed by front line ambulance crews in a low-income neighbourhood in Cape Town, South Africa. Our insights were developed through observational, interview and document review work, within an overall embedded research approach. Our analysis draws on the everyday health systems resilience (EHSR) framework, which sees resilience as an emergent process that may be stimulated through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies and are underpinned by system capacities (cognitive, behavioural and contextual). We consider the PP as a potentially transformative resilience strategy, defined as a new way of working that offered the promise of long-term health system gains. We found that the PP's initial development was supported by a range of system capacity attributes (such as the intentional development of relationships, a sense of collective purpose and creating spaces for constructive sense-making). However, the PP was hard to sustain over time because emergent ways of working were undermined both by other capacity attributes rooted in pre-existing organizational routines and two contextual shocks (Coronavirus and a violent incident). The paper adds a new empirical contribution to the still-small EHSR literature. In addition, the PP experience offers globally relevant lessons for developing community-based models of EMS care. It demonstrates that front line staff can develop creative solutions to their stressful daily realities, but only if space is created and protected.

The offload study: A prospective observational study of the time to offload a patient from an ambulance or helicopter into an emergency department or percutaneous coronary intervention centre

Introduction Providing an accurate estimated time for patient handover in the emergency department (ED) can be difficult from the scene. The time taken to offload a patient from a conveying ambulance and transfer into the resuscitation room is often not considered within the estimated time of arrival (ETA). The aim of this study was to assess offload times for pre-alerted patients conveyed by a UK Helicopter Emergency Medical Service (HEMS) by air and road ambulance. Methods A prospective observational study was conducted at The Air Ambulance Service (TAAS) from August 2022 to February 2023. Consecutive emergency patients who were pre-alerted to hospital and arrived at an ED or Percutaneous Coronary Intervention (PCI) centre with an escorting air ambulance crew member were included. The offload time (time between hospital arrival and handover of the patient) was measured using a stopwatch. Results Data was available for 228 patients arriving at 18 hospitals and 6 helipads. The median offload time by road ambulance was 2 min 34 s. The range of helicopter offload times was from 4 min 20 s to 21 min 37 s, which mainly depended on the location of the helipad. Conclusion An additional 2–3 min should be added to the ETA by road ambulance. There is large variation in helicopter offload times depending on the helipad location (secondary/offsite helipad taking longer than a primary rooftop helipad or primary same-level helipads). HEMS services should review their own offload times at local sites to be able to provide a more accurate ETA.

Anaphylactic Shock Caused by Eating Buckwheat.

Background: Urticaria is a common disease with a marked influence on quality of life. The key cell involved is the mast cell, which can be activated by a vast variety of stimuli, and the major mediator is histamine. Allergic urticaria is a disorder with a large variety of causes: food, drugs, insect venom, skin contact with allergens, and physical exercise. Buckwheat consumption has increased in European countries and the USA because it is gluten-free. It can trigger anaphylactic shock if ingested, inhaled, or handled with the hands. Five common buckwheat allergens named Fag e1 to 5 (Fag e1, 2, and 3 are considered the major allergens) and two tartary buckwheat allergens named Fag t1 and Fag t2 have been described. Method: We present the case of a patient who experienced two anaphylactic shocks and in whom the etiological factor was buckwheat. The patient presented to the Allergology department for the evaluation of two episodes of severe allergic reactions that required emergency therapy, episodes that involved the loss of consciousness and were of major severity. At each anaphylactic shock, an ambulance was requested, and emergency therapy was administered, leading to the patient's recovery within a few hours. Diagnosis: Since each episode occurred a few minutes after eating, the diagnosis was established based on a detailed anamnesis and prick skin tests, followed by specific IgE dosages. Other foods consumed by the patient, assessed by prick skin testing and specific IgE dosages of suspected foods, were excluded as the etiological cause. Increased levels of buckwheat-specific immunoglobulin E were highlighted, thus identifying the etiological agent. The treatment of anaphylactic shock was performed urgently by the ambulance crew with adrenaline, infusion solutions, cortisone preparations, and antihistamines. Result: Following the treatment that was initiated, there was a partial remission of the lesions after a few hours. Conclusions: Buckwheat allergy is rare, but it produces symptoms that affect the skin, gastrointestinal tract, and respiratory tract, as well as anaphylaxis. In a professional environment, it can trigger allergic rhinitis, asthma, and hives. Although buckwheat allergens have been described, their clinical relevance has only been studied in a small number cases. In current practice, the only commercially available allergen is Beech e2 per the ImmunoCAP ISAC microarray. Diagnosis can be difficult in clinical practice. This reported case suggests the need for a thorough anamnesis, since buckwheat is consumed as a hidden allergen, and in Europe, it is not necessary to label foods containing this allergen.

Enhancing the Quality of Ambulance Crew Work by detecting Ambulance Equipment using Computer Vision and Deep Learning

Enhancing the Quality of Ambulance Crew Work by detecting Ambulance Equipment using Computer Vision and Deep Learning

FROM THE CONCEPT OF THE DRAFT POLICE CHARTER OF THE RUSSIAN EMPIRE TO ITS STRUCTURE AND CONTENT: VIEWS OF MEMBERS OF THE COMMISSION OF SENATOR A.A. MAKAROV (1906-1917) PART 7. PREVENTION AND SUPPRESSION BY THE POLICE OF THE RUSSIAN EMPIRE OF FIGHTS, VIOLENCE, ACCIDENTS, FIRES. MEASURES TO ASSIST VICTIMS, REGISTRATION OF THE POPULATION FOR THE PURPOSE OF TIMELY DETECTION OF

The responsibilities of the police to suppress fights between civilians are briefly outlined, the specifics of fights among officers and the peculiarities of the implementation of police measures are noted, and means of preventing accidents in public places and on communications routes are provided. It is noted that the activities of the general police on the tracks belonging to the Ministry of Railways were carried out in the absence of supervisory authorities of the said department or when railway police officials were replaced. Measures are revealed to provide police assistance to victims of criminal acts, accidents, people who become ill in public places, and to transport them to medical institutions. When forming a position in the draft charter, the organizers hoped that city public administrations would create special ambulance crews, which already existed in some medical institutions in large urban settlements. It is indicated that the adoption by police officials of various efforts to resolve situations related to accidents was combined with conducting an inquiry and issuing a copy of the report to the victims, at their request. The article shows the struggle of the police against neglect: the transfer of abandoned babies, orphans, lost children to trustworthy citizens, to educational homes, charitable institutions of city and zemstvo institutions; transport to public hospitals. As an area of police activity, measures to prevent fires are shown, the role of the police in managing their extinguishing, ensuring the protection of personal property, and the work of the police during floods, shipwrecks, and railway accidents. Monitoring the registration of residents in residential premises, daily control over sanitary order in houses, entrances, streets, and squares are independently presented.

Adaptive Ambulance Management System

The ability to quickly and accurately retrieve information is essential for emergency medical response. This project integrates biometric technology and web applications to offer a comprehensive solution for improving emergency medical services. Our approach starts with the use of a fingerprint scanner, which records information on patients and guardians and links it to distinctive fingerprints. A Node MCU processes and stores this data, making it possible to quickly and securely identify patients in urgent situations. The Node MCU displays patient information on an LCD panel as soon as they provide their fingerprint. Both ambulance drivers and hospital administration have access to a user-friendly web application simultaneously. The software gives users access to a database of nearby hospitals that is divided into public and private facilities. Soon, the selected hospital will be informed about the patient condition and able to make the treatment arrangements earlier. The patient's preferences and the resources at their disposal can help ambulance crew make wise selections. Ambulance crew have two selection buttons, one is government hospital selection button and another is private hospital selection button. By reducing response times, this function improves patient care. In order to safeguard sensitive patient data, the project places a strong emphasis on data security and privacy. Our goal is to maximize emergency medical response through this integrated system, ensuring that patients receive prompt and efficient care when it counts.

A case of pulmonary visceral subpleural hematoma treated by hematoma evacuation during care of post-cardiopulmonary resuscitation

BackgroundThe occurrence of pulmonary visceral subpleural hematoma during care of post-cardiopulmonary resuscitation including chest compressions and anticoagulant and antiplatelet therapies is extremely rare. Also, there are few reports of treatment of visceral subpleural hematoma, most of which are treated by lung resection. Here we describe a rare case that pulmonary visceral subpleural hematoma arose during post-cardiopulmonary resuscitation care and was treated by hematoma evacuation.Case presentationA 58-year-old male with no smoking history and, past medical histories of rheumatoid arthritis, chronic atrial fibrillation, hypertension, diabetes, and dyslipidemia developed ventricular fibrillation due to myocardial infarction and fainted. He received bystander cardiopulmonary resuscitation and defibrillation by the ambulance crew and had return of spontaneous circulation. After transfer to our hospital, the patient underwent percutaneous catheter intervention and stenting with a diagnosis of myocardial infarction, followed by anticoagulant and antiplatelet therapies. On the 8th hospital day, chest radiography suggested right lower lobe pneumonia, and subsequent chest computed tomography revealed pulmonary hematoma in the visceral subpleural area from S6 to S10. Since no improvement was observed in hypoxemia, treatment was considered necessary. First, an attempt at computed tomography-guided drainage of hematoma was made, but insertion of the Pig-tail catheter was difficult due to hardness of the hematoma. Next, evacuation of hematoma was performed on the 13th hospital day. The hematoma was located in the visceral subpleural area and was removed by incising the pleura. TachoSil Tissue Sealing sheet and Polyglycoal acid sheet were applied to the sites of air leakage and oozing after hematoma evacuation. No re-bleeding or air leakage was observed after the treatment, and the patient was discharged on the 26th hospital day after an uneventful course.ConclusionsPulmonary visceral subpleural hematoma may occur during post-cardiopulmonary resuscitation care, including chest compressions and anticoagulant and antiplatelet therapies. In our case, CT-guided puncture and drainage was difficult and surgical treatment by incision of the visceral pleura and hematoma evacuation alone was done successfully.

A national multi centre pre-hospital ECPR stepped wedge study; design and rationale of the ON-SCENE study

BackgroundThe likelihood of return of spontaneous circulation with conventional advanced life support is known to have an exponential decline and therefore neurological outcome after 20 min in patients with a cardiac arrest is poor. Initiation of venoarterial ExtraCorporeal Membrane Oxygenation (ECMO) during resuscitation might improve outcomes if used in time and in a selected patient category. However, previous studies have failed to significantly reduce the time from cardiac arrest to ECMO flow to less than 60 min. We hypothesize that the initiation of Extracorporeal Cardiopulmonary Resuscitation (ECPR) by a Helicopter Emergency Medical Services System (HEMS) will reduce the low flow time and improve outcomes in refractory Out of Hospital Cardiac Arrest (OHCA) patients.MethodsThe ON-SCENE study will use a non-randomised stepped wedge design to implement ECPR in patients with witnessed OHCA between the ages of 18–50 years old, with an initial presentation of shockable rhythm or pulseless electrical activity with a high suspicion of pulmonary embolism, lasting more than 20, but less than 45 min. Patients will be treated by the ambulance crew and HEMS with prehospital ECPR capabilities and will be compared with treatment by ambulance crew and HEMS without prehospital ECPR capabilities. The primary outcome measure will be survival at hospital discharge. The secondary outcome measure will be good neurological outcome defined as a cerebral performance categories scale score of 1 or 2 at 6 and 12 months.DiscussionThe ON-SCENE study focuses on initiating ECPR at the scene of OHCA using HEMS. The current in-hospital ECPR for OHCA obstacles encompassing low survival rates in refractory arrests, extended low-flow durations during transportation, and the critical time sensitivity of initiating ECPR, which could potentially be addressed through the implementation of the HEMS system. When successful, implementing on-scene ECPR could significantly enhance survival rates and minimize neurological impairment.Trial registrationClinicaltyrials.gov under NCT04620070, registration date 3 November 2020.

Prehospital Care of Severely Intoxicated Patients by a Dutch Physician-Staffed Helicopter Emergency Medical Services: A Retrospective Study

ObjectiveIntoxicated patients are often encountered by emergency medical services (eg, in cases of recreational drug use, accidental ingestion, or inhalation of toxic substances or [attempted] suicide). Earlier research showed that a physician-staffed helicopter emergency medical service (P-HEMS) is regularly dispatched for intoxicated patients. However, it is still unclear if there is added value of P-HEMS compared with standard care provided by an ambulance crew. The aim of this study was to analyze the contribution of additional expertise and equipment that P-HEMS brings to the prehospital scene. MethodsIn this retrospective study, we searched the database of the helicopter emergency medical service Lifeliner 1 serving the northwestern quadrant of the Netherlands for cases that involved intoxications from January 2013 to July 2020. Patients were included in this study if the primary reason for P-HEMS dispatch was intoxication. The types of intoxication were categorized as (illicit/recreational) drug related, suicide attempt, or accidental. The agents were categorized as stimulants, depressants, hallucinogenic, cannabinoids, and other substances such as bleach or insulin. Patient characteristics, vital signs, and the therapeutic interventions performed were recorded for analysis. ResultsIn our study period, P-HEMS was dispatched 23,878 times. Of these dispatches, a total of 259 cases were included for further analysis. The majority of patients were male (64.5%). Sixty-six patients (25.5%) had an intoxication of depressant agents alone, whereas 60 patients (23.2%) had an intoxication with a combination of agents. With 159 (61.4%) patients, the majority of cases involved recreational drug intoxications. Unintentional intoxications were treated in 27 (10.4%) patients, whereas 73 (28.2%) cases involved suicide attempts. In 159 patients (61.4%), prehospital endotracheal intubation was required; the vast majority was performed by the helicopter emergency medical service physician. Specific antidotes were administered in 56 (21.6%) of the cases. ConclusionIn this study, we found that P-HEMS crews might complement usual prehospital care by ambulance crews for patients with severe intoxications by bringing advanced skills (eg, airway management and specific antidotes) to the scene.

Peningkatan Kualitas Layanan Ambulans Muhammadiyah Yogyakarta

This article is a report on the activities of the Independent Learning Independent Campus (MBKM) Humanitarian Project for Social Welfare Science students. Considering the urgency to create standard standards in providing services to the community, Muhammadiyah Ambulance together with MBKM students realized the formation of Standard Operating Procedures (SOP). This SOP will be a standard and structured guide for Muhammadiyah Ambulance drivers, crew, and volunteers in carrying out their duties. Creating, finalizing, and implementing good SOPs is an important step to improve the quality and effectiveness of Muhammadiyah Ambulance services, as well as minimizing the risks associated with the absence of SOPs or inconsistent implementation. Service operational standards as a requirement in service mobility will contain five important things, including first, service management standards, second, driver and crew rules, third, ethics in driving, fourth regarding unit and service procedures, and fifth, additional rules required in service. This SOP was created through several stages, namely operational update assessment, planning, focus group discussion (FGD), review, validation and legitimacy, policy implementation, and evaluation. All stages have been carried out thoroughly and maximally over a period of three months, resulting in a structured standard guide in the form of Standard Operational Procedures for Muhammadiyah Ambulance Services. This SOP has now been used in your Ambulance service. The planning for making this SOP was carried out well thanks to the collaboration between MBKM humanitarian project students and the Yogyakarta Special Region Ambulance Service agency.

Quality of inter-facility transfer for Type A aortic dissection patients in a medical center in Taiwan: a retrospective observational study

Inter-facility transfer of patients with type A aortic dissection (AD) requires timely and efficient medical care. However, the quality of care provided during the transfer remains largely unknown. This study aimed to evaluate the quality of care of patients with type A AD who underwent inter-facility transfer at a single medical center in Taiwan. This retrospective cohort study enrolled all patients with type A AD who underwent inter-facility transfer between January 2017 and December 2019. Patients with complete transfer records and electronic medical charts in the emergency department (ED) were included. Patients who experienced a cardiac arrest episode before transfer were excluded due to poor outcomes. Patients were divided into two groups based on their hemodynamic status: the ideal group with values within the desirable range heart rate (HR) <60 bpm and systolic blood pressure (SBP): 100–120 mmHg and the control group with values out of range (HR >60 bpm or SBP <100 or >120 mmHg) before the transfer. We conducted an analysis of variations of hemodynamic status after the transfer. Among the 378 patients transferred with type A AD, 36 (31.9%) in the ideal group and 255 (96.2%) in the control group experienced hemodynamic deterioration after the transfer. In the ideal group and control group, the presence of nurses and emergency physicians assisting in the transfer accounted for only 6.2% and 7.95%, respectively. The ideal group had a significantly better survival outcome (adjusted OR (aOR): 1.25, 95%confidence interval (CI): 1.12–2.45) compared to the control group. The quality of inter-facility transfer in patients with type A AD is inadequate. Hemodynamic deterioration should be managed by ambulance crews during the transfer.

Ambulance Crew Waiting Time: Causes, Impacts and Solutions- A Review

Ambulance crew waiting time, defined as the duration spent by emergency medical services (EMS) teams at hospitals before transferring a patient to hospital care, is a critical concern globally. This delay impacts patient outcomes, leads to operational inefficiencies, and increases healthcare costs. Various factors contribute to this issue, including hospital overcrowding, increased demand for emergency services, and poor communication between hospitals and EMS teams. This paper explores the causes and impacts of ambulance crew waiting time and reviews potential solutions for mitigating these delays, emphasizing the need for systemic improvements and technological innovations.

A114Multiple Trauma Simulation - An Introduction for Medical and Nursing Students

In a number of medical schools, students often feel unprepared to manage acutely unwell trauma patients, with a majority of students reporting they had received less than five hours of trauma-based teaching and clinical skills exposure [1]. Despite the lack of previous training, newly graduated doctors are often one of the first professionals to initiate assessment and management of trauma patients on arrival to hospital [2]. Our scenario design aims to help both medical and nursing students gain experience of multiple trauma patients in a simulated environment. We wished to incorporate the skills of prioritization, leadership, role allocation and delegation whilst also covering some technical skills of trauma management. This scenario aims to simulate a high-pressure, busy clinical environment where students can practise the management of patients requiring immediate care in a resuscitation room setting. The students were briefed collectively for the multiple trauma simulation, as if there were a ‘stand-by call’ as a pre-alert from the ambulance crew. The students were informed that there was a nearby road traffic accident and there would be three casualties arriving: a patient with a head injury who was on an anticoagulant, a patient who had a chest wall injury and a patient who had suffered burns at the scene. They were allocated 5-10 minutes to assist with assigning roles and identifying how they planned to divide up tasks before starting the simulation. The initial assessment and management plans were commenced by the students, and a member of the faculty team would come in around half-way through as a ‘senior emergency physician’, who could offer advice and guidance. Verbal and written feedback collected from both medical and nursing students was positive, with many stating that they felt their teamwork and leadership abilities had been enhanced. Multiple people commented on the impact of clear communication, task delegation and leadership on the outcome of the scenario. Several students also commented on the positive impact of multidisciplinary working by combining both medical and nursing students for simulation training, and felt they had a greater appreciation and understanding of each other’s roles. Students felt that their confidence in both technical and non-technical skills had improved as a result of participating in the scenario, and many felt they had learnt valuable leadership and teamwork abilities. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

214 Practical application of recommended ALS actions for twomember ambulance crew

214 Practical application of recommended ALS actions for twomember ambulance crew

451 Two's Company: Towards Adapting Resuscitation Guidelines for Two-Member Ambulance Crews

451 Two's Company: Towards Adapting Resuscitation Guidelines for Two-Member Ambulance Crews

Implementing Body Worn Cameras to Reduce Violence Against Ambulance Crew

Objectives
 Following the launch of its ‘Long Term Plan’ in 2019, the English National Health Service (NHS England) started piloting body worn cameras (BWCs) in ambulance services. The intervention rationale was that BWCs would act as a deterrent and facilitate the prosecution of assailants, thus improving the safety and wellbeing of ambulance crew. This paper explores views on the purpose and value of BWCs among ambulance crews and leadership staff who have used them or supported their implementation.
 Methods
 We conducted a qualitative investigation with ambulance crew and leadership staff (N=16) in the first 7-10 months of the BWC pilot. Semi-structured interviews were held online between August 2021 and November 2021. Normalisation process theory was used to guide and structure the data analyses. 
 Results 
 There was only partial shared understanding between crew members and leadership staff on the purpose and value of BWCs. Drawing on their practical professional experiences of using BWCs, crews challenged the theory of change that BWCs function as deterrents while recognising their potential to facilitate prosecutions. Crews also highlighted technical, operational and social factors that are likely to mitigate the positive effects of (the implementation of) the cameras.
 Conclusions
 Violence reduction policies for health services should take heed of the variation in theories of change put forward by different stakeholders. Further research is required to better understand the range of factors that affect the occurrence and management of assaults against ambulance crew and the operational challenges and cost-effectiveness of body worn cameras relative to other interventions.

Medical emergencies at sea: an analysis of ambulance-supported and autonomously performed operations by lifeboat crews

BackgroundVery little data is available about the involvement of lifeboat crews in medical emergencies at sea. The aim of this study is to analyze the medical operations at sea performed by the Royal Netherlands Sea Rescue Institution (KNRM).MethodsThis is a retrospective descriptive analysis of all medical operations at sea performed by the KNRM between January 2017 and January 2020. The operations were divided in three groups: with ambulance crew aboard the lifeboat, ambulance crew on land waiting for the arrival of the lifeboat, and autonomous operations (without ambulance crew involvement). The main outcome measures were circumstances, encountered medical problems, follow-up and crew departure time.ResultsThe KNRM performed 282 medical operations, involving 361 persons. Operations with ambulance crew aboard the lifeboat (n = 39; 42 persons) consisted mainly of persons with serious trauma or injuries; 32 persons (76.2%) were transported to a hospital. Operations with ambulance crew on land (n = 153; 188 persons) mainly consisted of situations where time was essential, such as persons who were still in the water, with risk of drowning (n = 45, 23.9%), on-going resuscitations (n = 9, 4.8%) or suicide attempts (n = 7, 3.7%). 101 persons (53,7%) were transported to a hospital. All persons involved in the autonomous operations (n = 90; 131 persons) had minor injuries. 38 persons (29%) needed additional medical care, mainly for (suspected) fractures or stitches. In 115 (40.8%) of all operations lifeboat crews did not know that there was a medical problem at the time of departure. Crew departure time in operations with ambulance crew aboard the lifeboat (13.7 min, min. 0, max. 25, SD 5.74 min.) was significantly longer than in operations with ambulance crew on land (7.7 min, min. 0, max 21, SD 4.82 min., p < 0.001).ConclusionThis study provides new information about the large variety of medical emergencies at sea and the way that lifeboat and ambulance crews are involved. Crew departure time in operations with ambulance crew aboard the lifeboat was significantly longer than in operations with ambulance crew on land. This study may provide useful indications for improvement of future medical operations at sea, such as triage, because in 40.8% of operations, it was not known at the time of departure that there was a medical problem.

Feasibility of HEMS performed prehospital extracorporeal-cardiopulmonary resuscitation in paediatric cardiac arrests; two case reports

IntroductionA broad range of pathophysiologic conditions can lead to cardiopulmonary arrest in children. Some of these children suffer from refractory cardiac arrest, not responding to basic and advanced life support. Extracorporeal-Cardiopulmonary Resuscitation (E-CPR) might be a life-saving option for this group. Currently this therapy is only performed in-hospital, often necessitating long transport times, thereby negatively impacting eligibility and chances of survival. We present the first two cases of prehospital E-CPR in children performed by regular Helicopter Emergency Medical Services (HEMS).Case presentationsThe first patient was a previously healthy 7 year old boy who was feeling unwell for a couple of days due to influenza. His course deteriorated into a witnessed collapse. Direct bystander CPR and subsequent ambulance advanced life support was unsuccessful in establishing a perfusing rhythm. While doing chest compressions, the patient was seen moving both his arms and making spontaneous breathing efforts. Echocardiography however revealed a severe left ventricular impairment (near standstill). The second patient was a 15 year old girl, known with bronchial asthma and poor medication compliance. She suffered yet another asthmatic attack, so severe that she progressed into cardiac arrest in front of the attending ambulance and HEMS crews. Despite maximum bronchodilator therapy, intubation and the exclusion of tension pneumothoraxes and dynamic hyperinflation, no cardiac output was achieved.InterventionAfter consultation with the nearest paediatric E-CPR facilities, both patients were on-scene cannulated by regular HEMS. The femoral artery and vein were cannulated (15-17Fr and 21Fr respectively) under direct ultrasound guidance using an out-of-plane Seldinger approach. Extracorporeal Life Support flow of 2.1 and 3.8 l/min was established in 20 and 16 min respectively (including preparation and cannulation). Both patients were transported uneventfully to the nearest paediatric intensive care with spontaneous breathing efforts and reactive pupils during transport.ConclusionThis case-series shows that a properly trained regular HEMS crew of only two health care professionals (doctor and flight nurse) can establish E-CPR on-scene in (older) children. Ambulance transport with ongoing CPR is challenging, even more so in children since transportation times tend to be longer compared to adults and automatic chest compression devices are often unsuitable and/or unapproved for children. Prehospital cannulation of susceptible E-CPR candidates has the potential to reduce low-flow time and offer E-CPR therapy to a wider group of children suffering refractory cardiac arrest.

Aspects of eliminating medical and sanitary consequences of the flood disaster in the Republic of Crimea on June 17–18, 2021

Relevance. In current realities, various models of disaster management and response have been implemented in disaster medicine across regions. In natural emergency scenarios, management and response efforts would hardly ever see functional unity of all the emergency response units of disaster medicine and civil defense with an integral management hierarchy and 24h duty.The study objective is to assess the efficiency of a new organizational model of disaster medicine service deployed in the Republic of Crimea to eliminate medical and sanitary consequences of heavy precipitation, large-scale flooding and mudslides, that hit the urban districts of Kerch, Yalta, on June 17-18, 2021.Methods. We studied the operations and response efforts undertaken in natural emergency setting by the Kerch disaster medicine and civil defense service and Yalta ambulance stations, both being part of the Regional Center for Disaster Medicine of the Republic of Crimea. In addition, we analyzed the abnormal atmospheric front passage with heavy precipitation in urban districts of Kerch (17.06.2021) and Yalta (18.06.2021).Results and discussion. At the very onset of natural emergency situation in the Republic of Crimea on June 17-18, 2021, dispatchers of the disaster medicine service, as well as dispatchers and managers of Yalta and Kerch ambulance stations implemented timely and adequate measures to ensure smooth operation of emergency medical units deployed in the emergency area. Those measures include prompt notification and engagement of management staff, deployment of transport vehicles and workforce to safe areas, recruitment of backup power sources into the grid, mobilized additional ambulance crews, as well as adequate assessment of incurred damages. The study provided the disaster medicine service with an unprecedented opportunity for real-time 24h. monitoring of the civil defense Center for Disaster Medicine operation in a natural emergency.Conclusion. The study allows to assess the format of integrating civil defense and disaster medicine forces under the shared management by the Disaster Medicine Center of the Republic of Crimea.