Ambulance Crews Research Articles

A retrospective study on the safety and effectiveness of olanzapine versus midazolam for pre-hospital management of excited delirium syndrome

Objective: To evaluate the safety and effectiveness of olanzapine compared to midazolam for the pre-hospital management of excited delirium syndrome. Methods: A retrospective review of patients who were treated by ambulance crew for excited delirium syndrome from 2016 to 2019 was performed. The drug of choice was given per Fire Service Department’s paramedic protocol (intramuscular midazolam January 2016 to October 2018 and intramuscular olanzapine October 2018 to December 2019). The primary outcome was the proportion of patients experienced at least one adverse event. The secondary outcome was the successful sedation rate. Results: A total of 201 patients were included in the study. Ninety-nine patients had pre-hospital midazolam and 102 received olanzapine. Thirty-one patients experienced adverse event after arrival to A&E, including a drop of Glasgow Coma Scale score to below 8 (90%), hypotension (6%), and airway obstruction (3%): 17 (17% patients; 1 airway obstruction and 16 Glasgow Coma Scale score below 8) in midazolam group and 14 (14% patients; 2 hypotension and 12 Glasgow Coma Scale score below 8) in olanzapine group (p = 0.41). Sixty-eight patients (69%) in midazolam group achieved successful sedation, compared with 79 (77%) in olanzapine group (p = 0.20). More adverse events were seen with midazolam than olanzapine in alcohol intoxication subgroup with statistical significance (12 vs 2, p = 0.03). Conclusion: Both midazolam and olanzapine can achieve a satisfactory success rate of sedation. More adverse events are associated with midazolam use in patients with acute alcohol intoxication, especially over-sedation and airway compromise. Olanzapine would be a safer choice in the pre-hospital setting where the resource is limited, and differentiation of underlying causes is not always possible.

Prehospital Assessment of Non-Traumatic Abdominal Pain

Background: Non-traumatic abdominal pain may have several causes and often needs physicians’ consultation. In a pilot study, a template was used to assist ambulance nurses and technicians to assess this medical condition. Objective: This study aimed to evaluate the use of the template and the outcome of the pilot study. Methods: A prehospital template (protocol) consisting of validated physiological and clinical scales, such as “Rapid Emergency Triage and Treatment Scale-Ambulances”, “Patient Behavioral Pain Scale”, and “Visual Analog Scale” were used to assist the ambulance crew in Shiraz, Iran, to assess all cases with non-traumatic abdominal pain. The outcome of the evaluation in this group was compared with a control group using the normal routine of assessment. Results: Of 200 prehospital patients, 170 cases were eligible for evaluation. The majority of the patients in the protocol (n=88) and control groups (n=82) were males (n=46 and n=43, respectively). There was a slight but statistically significant difference between the two groups in favor of the protocol group concerning the need for ambulance transport and direct admission to the hospital (P<0.02). Conclusion: Although prehospital assessment and management of non-traumatic abdominal pain continue to be challenging for emergency medical staff, educational initiatives together with prehospital guidelines may improve the accuracy of prehospital decision-making and open up for new fast-track diagnosis and direct admission to the hospital.

Winning in winter with marginal gains: enhancing welfare on the frontline

Winter pressures on the NHS challenge every one of us. Patients may experience delays waiting for emergency ambulances and face extended waiting times at hospital emergency departments (ED). During this season, GPs, hospitals, NHS organisations and staff will face increased demand for services; yet are still required to deliver on agreed performance targets with only a finite availability of resources. Add Brexit and the second wave of COVID-19 wave into the mix and it might appear difficult to make improvements in any of these areas. During the winter of 2019–2020, a large ambulance service in England introduced a ‘welfare van’ to support busy emergency ambulance crews in one of its busy urban areas. It was tasked to see if it could make a positive difference to staff welfare and uphold or improve on ambulance service performance during a period of expected increased demand.

Review of “Bandage, Sort, and Hustle: Ambulance Crews on the Front Lines of Urban Suffering”

Review of “Bandage, Sort, and Hustle: Ambulance Crews on the Front Lines of Urban Suffering”

Prehospital emergency medical technicians can perform ultrasonography and blood analysis in prehospital evaluation of patients with chronic obstructive pulmonary disease: a feasibility study

IntroductionCrowding of the emergency departments is an increasing problem. Many patients with an exacerbation of chronic obstructive pulmonary disease (COPD) are often treated in the emergency departments for a very short period before discharged to their homes. It is possible that this treatment could take place in the patients’ homes with sufficient diagnostics supporting the treatment.In an effort to keep the diagnostics and treatment of some of these patients in their homes and thus to reduce the patient load at the emergency departments, we implemented a prehospital treat-and-release strategy based on ultrasonography and blood testing performed by emergency medical technicians (EMT) or paramedics (PM) in patients with acute exacerbation of COPD.MethodEMTs and PMs were enrolled in a six-hour educational program covering ultrasonography of the lungs and point of care blood tests. During the seasonal peak of COPD exacerbations (October 2018 – May 2019) all patients who were treated by the ambulance crews for respiratory insufficiency were screened in the ambulances. If the patient had uncomplicated COPD not requiring immediate transport to the hospital, ultrasonographic examination of the lungs, measurements of C-reactive protein and venous blood gases analyses were performed. The response to the initial treatment and the results obtained were discussed via telemedical consultation with a prehospital anaesthesiologist who then decided to either release the patient at the scene or to have the patient transported to the hospital. The primary outcome was strategy feasibility.ResultsWe included 100 EMTs and PMs in the study. During the study period, 771 patients with respiratory insufficiency were screened. Uncomplicated COPD was rare as only 41patients were treated according to the treat-and-release strategy. Twenty of these patients (49%) were released at the scene. In further ten patients, technical problems were encountered hindering release at the scene.ConclusionIn a few selected patients with suspected acute exacerbations of COPD, it was technically and organisationally feasible for EMTs and PMs to perform prehospital POCT-ultrasound and laboratory testing and release the patients following treatment. None of the patients released at the scene requested a secondary ambulance within the first 48 h following the intervention.

Effective Communication During a Homebirth Transfer to Hospital

Although the likelihood of a women requiring transfer is low, all midwives should be familiar with the process of requesting an emergency transfer, the time they can expect to wait before an ambulance arrival and any additional interventions required with the ambulance crew.1 Communication and teamwork are key skills to support a safe and reassuring transfer and minimise a traumatic experience for the birthing woman, partner, midwives and ambulance clinicians.1,2 Midwifery transfers fall into two categories: those that are not immediately life threatening to the woman and her baby and those in which interventions may be necessary and ongoing while emergency assistance is requested.3

Evaluationof measures to reduce the number ofemergency physician missions in Tyrol during the COVID-19 pandemic

Hintergrund und FragestellungDie COVID-19-Hochphase im österreichischem Bundesland Tirol war für den Rettungs- und Notarztdienst sehr herausfordernd. Hauptziel war, unter Aufrechterhaltung der Versorgungsqualität die Personenkontakte am Einsatzort zu reduzieren. Diese Arbeit soll zum einen die getroffenen Maßnahmen evaluieren, zum anderen das Einsatzaufkommen während der ersten Monate der Pandemie beschreiben.Studiendesign und UntersuchungsmethodenAb dem 17.03.2020 wurden zu Notrufabfrageergebnissen, zu denen vormals sowohl Rettungswagen (RTW) wie auch ein Notarzt (NA) alarmiert wurden, nur noch ein RTW alarmiert. Diese reduzierten Einsätze sowie die allgemeine Einsatzentwicklung wurden im Zeitraum vom 15.03.2020 bis 15.05.2020 analysiert und mit Daten der Jahre 2017–2019 im gleichen Zeitraum verglichen.ErgebnisseBesonders durch den Wegfall von Touristen wird von einer Reduktion der zu versorgenden Bevölkerung um bis zu 30 % ausgegangen, trotzdem wurden zum Einsatzstichwort „Atemnot“ ein Anstieg um 18,7 % (1533 vs. 1291) bzw. bei Verkehrsunfällen ein Rückgang von 26,4 % (2937 vs. 2161) beobachtet. Notarzteinsätze verzeichneten einen Rückgang von 38,5 % (1511 vs. 2456,3), wobei die NACA-Scores III und IV mit über 40%igem Rückgang besonders auffielen. Die Notarztnachforderungsrate der reduzierten Einsatzcodes betrug 14,5 %, wobei die Krankheitsbilder „Bewusstlosigkeit“ und „Krampfanfall“ mit über 40%iger Nachforderung höher lagen.DiskussionEs zeigt sich eine absolute Reduktion des gesamten Einsatzaufkommens; zählt man die durch die Reduktion der Ausrückorder eingesparten Notarzteinsätze hinzu, wäre es zu einer Steigerung der notärztlichen Einsätze im Vergleich zu den Vorjahren gekommen. Betrachtet man zur Beurteilung der Versorgungsqualität ausschließlich die Notarztnachforderungsrate zeigt die Reduktion eine hohe Trefferquote, jedoch konnten die endgültigen Diagnosen aus den nachversorgenden Krankenhäusern/Arztpraxen in dieser Studie nicht erhoben werden, womit eine gesicherte Beurteilung der Versorgungsqualität nicht möglich ist.FazitDas primäre Ziel der Minimierung von Patientenkontakten unter Wahrung der Versorgungsqualität konnte erreicht werden. Vor Überführung der reduzierten Einsätze in den Routinebetrieb sind jedoch Anpassungen und eine Evaluierung unter Einbindung der Nachversorger nötig. Auch alternative Strategien zur Reduktion von Personenkontakten sollten geprüft werden.

Higher resuscitation guideline adherence in paramedics with use of real-time ventilation feedback during simulated out-of-hospital cardiac arrest: A randomised controlled trial

ObjectivesTo investigate whether real-time ventilation feedback would improve provider adherence to ventilation guidelines. DesignNon-blinded randomised controlled simulation trial. SettingOne Emergency Medical Service trust in Copenhagen. Participants32 ambulance crews consisting of 64 on-duty basic or advanced life support paramedics from Copenhagen Emergency Medical Service. InterventionParticipant exposure to real-time ventilation feedback during simulated out-of-hospital cardiac arrest. Main outcome measuresThe primary outcome was ventilation quality, defined as ventilation guideline-adherence to ventilation rate (8–10 bpm) and tidal volume (500−600 ml) delivered simultaneously. ResultsThe intervention group performed ventilations in adherence with ventilation guideline recommendations for 75.3% (Interquartile range (IQR) 66.2%–82.9%) of delivered ventilations, compared to 22.1% (IQR 0%–44.0%) provided by the control group. When controlling for participant covariates, adherence to ventilation guidelines was 44.7% higher in participants receiving ventilation feedback. Analysed separately, the intervention group performed a ventilation guideline-compliant rate in 97.4% (IQR 97.1%–100%) of delivered ventilations, versus 66.7% (IQR 40.9%–77.9%) for the control group. For tidal volume compliance, the intervention group reached 77.5% (IQR 64.9%–83.8%) of ventilations within target compared to 53.4% (IQR 8.4%–66.7%) delivered by the control group. ConclusionsReal-time ventilation feedback increased guideline compliance for both ventilation rate and tidal volume (combined and as individual parameters) in a simulated OHCA setting. Real-time feedback has the potential to improve manual ventilation quality and may allow providers to avoid harmful hyperventilation.

Patient handover between ambulance crew and healthcare professionals in Icelandic emergency departments: a qualitative study

BackgroundAmbulance services play an important role in the healthcare system when it comes to handling accidents or acute illnesses outside of hospitals. At the time of patient handover from emergency medical technicians (EMTs) to the nurses and physicians in emergency departments (EDs), there is a risk that important information will be lost, the consequences of which may adversely affect patient well-being. The study aimed to describe healthcare professionals’ experience of patient handovers between ambulance and ED staff and to identify factors that can affect patient handover quality.MethodsThe Vancouver School’s phenomenological method was used. The participants were selected using purposive sampling from a group of Icelandic EMTs, nurses, and physicians who had experience in patient handovers. Semi-structured individual interviews were conducted and were supported by an interview guide. The participants included 17 EMTs, nurses, and physicians. The process of patient handover was described from the participants’ perspectives, including examples of communication breakdown and best practices.ResultsFour main themes and nine subthemes were identified. In the theme of leadership, the participants expressed that it was unclear who was responsible for the patient and when during the process the responsibility was transferred between healthcare professionals. The theme of structured framework described the communication between healthcare professionals before patient’s arrival at the ED, upon ED arrival, and a written patient report. The professional competencies theme covered the participants’ descriptions of professional competences in relation to education and training and attitudes towards other healthcare professions and patients. The collaboration theme included the importance of effective teamwork and positive learning environment.ConclusionsA lack of structured communication procedures and ambiguity about patient responsibility in patient handovers from EMTs to ED healthcare professionals may compromise patient safety. Promoting accountability, mitigating the diffusion of responsibility, and implementing uniform practices may improve patient handover practices and establish a culture of integrated patient-centered care.

Coronary artery perforation secondary to lifesaving pericardiocentesis for cardiac tamponade: a case report

BackgroundPericardiocentesis is frequently performed when fluid needs to be removed from the pericardial sac, for both therapeutic and diagnostic purposes, however, it can still be a high-risk procedure in inexperienced hands and/or an emergent setting.Case presentationA 78-year-old male made an emergency call complaining of the back pain. When the ambulance crew arrived at his home, he was in a state of shock due to cardiac tamponade diagnosed by portable echocardiography. The pericardiocentesis was performed using a puncture needle on site, and the patient was immediately transferred to our hospital by helicopter. Contrast-enhanced computed tomography showed a small protrusion of contrast media on the inferior wall of the left ventricle, suggesting cardiac rupture due to acute myocardial infarction. Emergency coronary angiography was then performed, which confirmed occlusion of the posterior descending branch of the left circumflex coronary artery. In addition, extravasation of contrast medium due to coronary artery perforation was observed in the acute marginal branch of the right coronary artery. We considered that coronary artery perforation had occurred as a complication of the pericardial puncture. We therefore performed transcatheter coil embolization of the perforated branch, and angiography confirmed immediate vessel sealing and hemostasis. After the procedure, the patient made steady progress without a further increase in pericardial effusion, and was discharged on the 50th day after admission.ConclusionsWhen performing pericardial drainage, it is important that the physician recognizes the correct procedure and complications of pericardiocentesis, and endeavors to minimize the occurrence of serious complications. As with the patient presented, coil embolization is an effective treatment for distal coronary artery perforation caused by pericardiocentesis.

5G-Network-Enabled Smart Ambulance: Architecture, Application, and Evaluation

As the fifth generation (5G) network comes to the fore, the realization of 5G-enabled service has attracted much attention from both healthcare academics and practitioners. In particular, 5G-enabled emergency ambulance service allows to connect a patient and an ambulance crew at an accident scene or in transit with the awaiting emergency department team at the destination hospital seamlessly so as to improve the rescue rate of patients. However, the application of the 5G network in ambulance service currently lacks a reliable solution and simulation testing of performance in the existing literature. To achieve this end, the primary aim of this study is to propose a 5G-enabled smart ambulance service and then test the quality of service of the proposed solution in experimental settings. We also consider emergency scenarios to investigate the task completion and accuracy of 5G-enabled smart ambulance, and to verify the superiority of our proposed solution. Our study explores the value of a 5G-en-abled smart ambulance and provides practical insights for 5G network construction, business development, and network optimization of smart ambulance service.

Paramedic-Delivered Teleconsultations: A Scoping Review

Introduction Progression in the field of paramedicine has resulted in the development of novel roles within the profession, including the role of advanced paramedics providing teleconsultations for frontline paramedics. Little is known about the experience of paramedics providing or receiving teleconsultations. This scoping review aimed to investigate paramedic perceptions of physician and paramedic-delivered teleconsultations. Methods A scoping review of MEDLINE, CINAHL and EBM Reviews as well as paramedic-specific journals and the grey literature was conducted. Articles were included if they examined advanced paramedics, paramedics, emergency ambulance crew or emergency medical technicians receiving teleconsultations, or physicians and advanced paramedics providing teleconsultations. Results A total of 7461 unique citations were identified. Two citations were ultimately included in the review. One study examined the delivery of teleconsultations by advanced paramedics and one by physicians, both from the perspective of paramedics. Paramedics delivering teleconsultations generally considered the experience to be positive, while those receiving paramedic-delivered teleconsultations felt the level of advice was appropriate and assisted in expanding their own knowledge base. Paramedics receiving physician-delivered teleconsultations reported variable understanding of the unique challenges of out-of-hospital care and tension in the relationship between paramedics and physicians. Conclusion Little literature was identified examining the perceptions of paramedics delivering or receiving physician-delivered or paramedic-delivered teleconsultations. Given the continuing expansion of teleconsultation programs for out-of-hospital staff, this represents a significantly understudied area.

Binary Programming Model for Rostering Ambulance Crew-Relevance for the Management and Business

The nature of health care services is very complex and specific, thus delays and organizational imperfections can cause serious and irreversible consequences, especially when dealing with emergency medical services. Therefore, constant improvements in various aspects of managing and organizing provision of emergency medical services are vital and unavoidable. The main goal of this paper is the development and application of a binary programming model to support decision making process, especially addressing scheduling workforce in organizations with stochastic demand. The necessary staffing levels and human resources allocation in health care organizations are often defined ad hoc, without empirical analysis and synchronization with the demand for emergency medical services. Thus, irrational allocation of resources can result in various negative impacts on the financial result, quality of medical services and satisfaction of both patients and employees. We start from the desired staffing levels determined in advance and try to find the optimal scheduling plan that satisfies all significant professional and regulatory constraints. In this paper a binary programming model has been developed and implemented in order to minimize costs, presented as the sum of required number of ambulance crews. The results were implemented for staff rostering process in the Ambulance Service Station in Subotica, Serbia. Compared to earlier scheduling done ad hoc at the station, the solution of the formulated model provides a better and equable engagement of crews. The developed model can be easily modified and applied to other organizations with the same, stochastic, nature of the demand.

Organophosphorus poisoning: the wet opioid toxidrome

In The Lancet, David Steindl and colleagues describe the case of a 44-year-old man who was poisoned by a novichok organophosphorus nerve agent. 1 Steindl D Boehmerle W Körner R et al. Novichok nerve agent poisoning. Lancet. 2020; (published online Dec 22.)https://doi.org/10.1016/S0140-6736(20)32644-1 Summary Full Text Full Text PDF Scopus (7) Google Scholar The man was a passenger on a domestic flight in Russia when he became confused, and vomited and collapsed unconscious; 2 h later, he was hospitalised in Omsk, Russia, and treated for respiratory failure and coma. After transfer by air ambulance to Berlin, Germany, features of the cholinergic toxidrome (ie, small or pinpoint pupils, bradycardia, sweating, and hypersalivation) allowed a diagnosis of organophosphorus poisoning to be made. Assessments done by a doctor from the air ambulance crew before transfer to Germany did not indicate that organophosphorus poisoning had yet been diagnosed or antidotes used. However, atropine was later detected in urine. With administration of antidotes and intensive care at Charité-Universitätsmedizin Berlin, the man made a full recovery. Novichok nerve agent poisoningOn Aug 20, 2020, a 44-year-old man who was previously healthy suddenly became confused and began to sweat heavily on a domestic flight in Russia approximately 10 min after departure; he vomited, collapsed, and lost consciousness. After an emergency landing, the man was admitted to the toxicology unit of a local hospital in Omsk, Russia, approximately 2 h after symptom onset. According to the discharge report, the patient presented comatose with hypersalivation and increased diaphoresis and was diagnosed to have respiratory failure, myoclonic status, disturbed carbohydrate metabolism, electrolyte disorders, and metabolic encephalopathy. Full-Text PDF

Hospital in the air: Royal Flying Doctor Service retrievals and challenges before, during and after, Australia's COVID‐19 lockdown in 2020

Hospital in the air: Royal Flying Doctor Service retrievals and challenges before, during and after, Australia's <scp>COVID</scp>‐19 lockdown in 2020

Adapting trauma workflows for severely injured trauma patients during the COVID-19 pandemic: experience in a regional trauma centre in Singapore.

Adapting trauma workflows for severely injured trauma patients during the COVID-19 pandemic: experience in a regional trauma centre in Singapore.

Dispatch of a helicopter emergency medicine service to patients with a sudden, unexplained loss of consciousness of medical origin

BackgroundSudden loss of consciousness (LOC) in the prehospital setting in the absence of cardiac arrest and seizure activity may be a challenge from a dispatcher’s perspective: The aetiology is varied, with many causes being transient and mostly self-limiting, whereas other causes are potentially life threatening. In this study we aim to evaluate the dispatch of HEMS to patients with LOC of medical origin, by exploring to which patients with a LOC HEMS is dispatched, which interventions HEMS teams perform in these patients, and whether HEMS interventions can be predicted by patient characteristics.MethodsWe performed retrospective cohort study of all patients with a reported unexplained LOC (e.g. not attributable to a circulatory arrest or seizures) attended by the Air Ambulance Kent, Surrey & Sussex (AAKSS), over a 4-year period (July 2013–December 2017). Primary outcome was defined as the number of HEMS-specific interventions performed in patients with unexplained LOC. Secondary outcome was the relation of clinical- and dispatch criteria with HEMS interventions being performed.ResultsDuring the study period, 127 patients with unexplained LOC were attended by HEMS. HEMS was dispatched directly to 25.2% of the patients, but mostly (74.8%) on request of the ground ambulance crews. HEMS interventions were performed in 65% of the patients (Prehospital Emergency Anaesthesia 56%, hyperosmolar therapy 21%, antibiotic/antiviral therapy 8%, vasopressor therapy 6%) and HEMS conveyed most patients (77%) to hospital. Acute neurological pathology was a prevalent underlying cause of unexplained LOC: 38% had gross pathology on their CT-scan upon arrival in hospital. Both GCS (r = − 0.60, p < .001) and SBP (r = 0.31, p < .001) were related to HEMS interventions being performed on scene. A GCS < 13 predicted the need for HEMS interventions in our population with a sensitivity of 94.9% and a specificity 75% (AUC 0.85).ConclusionHEMS dispatchers and ambulance personnel are able to identify a cohort of patients with unexplained LOC of medical origin who suffer from potentially life threatening (mainly neurological) pathology, in whom HEMS specific intervention are frequently required. Presenting GCS can be used to inform the triage process of patients with LOC at an early stage.

Live Tissue Training on Anesthetized Pigs for Air Ambulance Crews

ObjectivePatients with life- or limb-threatening severe injuries pose a challenge to prehospital services. Time-critical decision making and treatment are challenging because of occasional incomplete information, limited resources, adverse environments, and a range of basic and advanced technical skills available. To prepare for these infrequent critical situations, medical personnel from the helicopter emergency medical service at Oslo University Hospital developed a 1-day advanced trauma training course focusing on individual skills and teamwork during resuscitative procedures. MethodsParticipants were trained under supervision in teams on an established live tissue model with anesthetized pigs. A questionnaire-based evaluation was conducted before and after training to measure the feasibility of covering the allocated learning objectives in the time allotted and participants’ perception of any change in their skills as a result of the course. ResultsThe self-reported skill level in all learning objectives improved significantly. Combining all learning objectives, the median self-reported skill level was significantly increased from 4 to 6 points (P < .001). ConclusionExperienced prehospital physicians and other health staff reported an increased level of skill and competence in lifesaving and limb-saving procedures after completing a brief, intense 1-day course using living anesthetized pigs and cadaver models.

Diagnostic markers for discriminating between acute aortic dissection and acute myocardial infarction during the pre-hospital phase: analysis of 3,195 cases

Abstract Both acute aortic dissection (AAD) and acute myocardial infarction (AMI) present with chest pain and are life-threatening diseases that require early diagnosis and treatment for better clinical outcome. However, two critical diseases in the very acute phase are sometimes difficult to differentiate, especially prior to arrival at the hospital for urgent diagnosis and selection of specific treatment. The aim of our study was to clarify the diagnostic markers acquired from the information gathered from medical history taking and physical examination for discriminating AAD from AMI by using data from the Tokyo Cardiovascular Care Unit (CCU) Network database. We examined the clinical features and laboratory data of patients with AAD and AMI who were admitted to the hospital in Tokyo between January 2013 and December 2015 by using the Tokyo CCU Network database. The Tokyo CCU Network consists of &amp;gt;60 hospitals that fulfil certain clinical criteria and receive patients from ambulance units coordinated by the Tokyo Fire Department. Of 15,061 patients diagnosed as having AAD and AMI, 3,195 with chest pain within 2 hours after symptom onset (537 AAD and 2,658 AMI) were examined. The patients with out-of-hospital cardiac arrest were excluded. We compared the clinical data of the patients with chest pain who were diagnosed as having AAD and AMI. The following indicators were more frequent or had higher values among those with AAD: female sex (38% vs. 20%, P&amp;lt;0.001), systolic blood pressures (SBPs) at the time of first contact by the emergency crew (142 mmHg vs. 127 mmHg), back pain in addition to chest pain (54% vs. 5%, P&amp;lt;0.001), history of hypertension (73% vs. 58%, P&amp;lt;0.001), SBP ≥150 mmHg (39% vs. 22%, P&amp;lt;0.001), back pain combined with SBP ≥150 mmHg (23% vs. 0.8%, P&amp;lt;0.001), and back pain with SBP &amp;lt;90 mmHg (4.5% vs. 0.1%, P&amp;lt;0.001). The following data were less frequently observed among those with AAD: diabetes mellitus (7% vs. 28%, P&amp;lt;0.001), dyslipidaemia (17% vs. 42%, P&amp;lt;0.001), and history of smoking (48% vs. 61%, P&amp;lt;0.001). The multivariate regression analysis suggested that back pain with SBP ≥150 mmHg (odds ratio [OR] 47; 95% confidence interval [CI] 28–77; P&amp;lt;0.001), back pain with SBP &amp;lt;90 mmHg (OR 68, 95% CI 16–297, P&amp;lt;0.001), and history of smoking (OR 0.49, 95% CI 0.38–0.63, P&amp;lt;0.001) were the independent markers of AAD. The sensitivity and specificity of back pain with SBPs of ≥150 mmHg and back pain with SBPs &amp;lt;90 mmHg for detecting AAD were 23% and 99%, and 4% and 99%, respectively. In patients with chest pain suspicious of AAD and AMI, “back pain accompanied by chest pain with SBP ≥150 mmHg” or “back pain accompanied by chest pain with SBP &amp;lt;90 mmH” is a reliable diagnostic marker of AAD with high specificity, although the sensitivity was low. The two SBP values with back pain are markers that may be useful for the ambulance crew at their first contact with patients with chest pain. Funding Acknowledgement Type of funding source: None

Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services.

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary.