Ambulance Equipment Research Articles

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

Effect of skill-based educational training for ambulance personnel on neonatal transportfor newborn care in coastal South India - a single arm intervention study.

Education of '108' ambulance personnel involved in transporting neonates may improve outcomes. We assessed i) perceptions/practices of '108' ambulance personnel for transporting neonates, ii) clinical parameters of transported neonates at arrival, and iii) outcomes such as survival/mortality and NICU stay (before and after skill-based educational intervention). We conducted a single-arm intervention study (pre-and post) over 18 months. We assessed the perceptions and practices of 77 ambulance personnel on neonatal transport pre- versus post-intervention. Checklists assessed ambulance equipment availability/usage in both phases. We compared clinical parameters and outcomes of transported neonates between the pre-intervention (n=62) and post-intervention (n=53) phases. We analyzed data using SPSS version 25. Post-intervention, there was a significant reduction in the levels of hypothermia (p < 0.001), hypoglycemia (p=0.010), and prolonged capillary refill time (p=0.042), along with improvement in the use of intravenous fluids (p <0.001), a reduction in the positivity of umbilical swab growth (p=0.002) and in the duration of NICU stay (p = 0.001), significant improvement (p < 0.001) in the perceptions/practices of ambulance personnel towards neonatal transport. There was an improvement in the ambulance equipment availability/usage post-intervention. The perceptions and practices of the '108' ambulance towards transporting neonates had significantly improved post-educational intervention. Further, a significant decrease in hypothermia, hypoglycemia, and duration of NICU stay was seen in neonates transported post-intervention.

Experiences of nurses involved in air ambulance service: A qualitative study

Introduction: Nurses undertaking air ambulance service encounter environmental, equipment, and personnel limitations during their work. Moreover, they must cope with various types of injuries and illnesses, as well as changes in patient conditions. These factors pose a significant pressure on nurses. Currently, there is a lack of qualitative research on the experiences of nurses performing air ambulance tasks. The purpose of this study is to explore the experiences of nurses undertaking air ambulance service, with a focus on capturing their personal perceptions regarding this field of work. Methods: Twelve nurses were selected using purposive sampling, and semi-structured interviews were conducted to collect data. Content analysis was used to analyze the data. Results: The analysis identified three major themes: "Ambiguous and risky emergency missions," "Challenges during air transfer," and "Nurses’ personal limitations.” Eight categories were formulated within these themes, including "Mission uncertainty," “Urgency of medical conditions," “Hazards at high altitude," "Cabin environment limitations," "Inadequate equipment," "Incomprehensive operating mechanisms," "Physical discomfort," and "Recognition of professional shortcomings." Conclusions: Improving the performance and well-being of nurses engaged in air ambulance services necessitates the implementation of a psychological adaptation program. This includes the utilization of psychological stress assessment tools or engaging in role-playing activities. Successful patient rescues demand the establishment of comprehensive standard operating procedures, involving an interprofessional team. Supporting nurses in adeptly managing challenges during air ambulance services requires an expanded scope of education and training, facilitated through initiatives like situational simulation and similar approaches.

Navigating into the unknown: exploring the experience of exposure to prehospital emergency stressors: a sequential explanatory mixed-methods

IntroductionThe unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment.MethodsSequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively.ResultsThe study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: “the overall impact of the stress crisis on technicians,” “missing links in the communication network in incident management,” "professional shortcomings in pre-hospital care,” and “the complex and multifaceted context of stressful pre-hospital emergencies.” Additionally, the study's theme was centered around “surveying the experiences of EMTs in stressful environments.”ConclusionAs the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies.

A Study to Assess the Knowledge Regarding Cardiopulmonary Resuscitation Among Staff of Ambulance, Equipped Status of Ambulances, and their Utilization

Introduction Most patients are quickly transferred to the hospitals by ambulances worldwide. Hence, it is imperative that ambulance should be well equipped with all emergency equipment and well-trained staff to provide cardiopulmonary resuscitation (CPR) or basic life support (BLS) to victim in pre-hospital environment, if required. Purpose To assess knowledge regarding CPR of ambulance staff, equipped status of ambulances, and their utilization during CPR or first aid. Methods Total 400 ambulance staff were purposively recruited after obtaining informed written consent. They were interviewed as per validated interview schedule regarding CPR knowledge and utilization of equipment during CPR or first aid. Using an observation checklist for assessment of available equipment for CPR and first aid in the ambulance was checked. Results Mean age of participants was 35.57 ± 7.63 years. All were males. Among them 63.75% were posted in private ambulance, and 73.50% ambulances had solo staff. Most (98.25%) ambulances were equipped with oxygen cylinder and only 3.5% had portable ventilator. Majority (75%) lacked the essential equipment as per AHA/national guidelines. Mean knowledge score of participants was 2.85 ± 4.10 and 62.25% and they had poor knowledge regarding CPR and only 12.25% had good/very good knowledge. Conclusion There is a lack of knowledge regarding CPR among ambulance staff and there is lack of equipped status of ambulances. They were not fully aware regarding the use of equipment, which were available in the ambulance in emergency. So, there is a need to train them about CPR as well utilization of ambulance equipment.

The condition of pre-hospital emergency ambulance equipment in Guilan province Iran

The condition of pre-hospital emergency ambulance equipment in Guilan province Iran

A Novel Resource Oriented DMA Framework for Internet of Medical Things Devices in 5G Network

The Internet of Medical Things (IoMT) mobile devices such as ambulance, medical done, and emergency mobile medical equipment face severe signal distortions due to interference, end-to-end packet loss, handoff delays, and lower throughputs during mobility. Network mobility basic support protocol (NBSP) has been proposed using the IP-based Wi-Fi solution to solve these issues. However, the weak signal, extra signaling overhead, and higherdelays were identified during handover due to patients' excessive requisites, resulting in radio link failure. Therefore, this article proposes a novel resource-efficient flow-enabled distributed mobility anchoring (FDMA) framework enhancing the functionalities of the centralized network entities and mobility entities.The performance of the proposed FDMA framework is evaluated and compared with the standard NBSP and proxy NEMO (PNEMO) scheme in terms of the variable number of cell residence time and mobile routers, where the proposed framework outperformed NBSP and PNEMO schemes for IoMT Mobile devices in 5G network.

Analysis of costs and utilization of ambulance services in the ministry of health facilities, Malaysia.

Despite emergency ambulance services playing a pivotal role in accessibility to life-saving treatments in Malaysia, there are still numerous gaps in knowledge in terms of their utilization and cost. This leads to current policies on procurement, maintenance, and allocation being predicated on historical evidence and expert opinions. This study thus aims to analyse the cost and utilization of ambulance services in selected public health facilities in Malaysia. A cross-sectional study was employed involving 239 ambulances from selected hospitals and clinics. Ambulance service utilization was based on the number of trips, distance and duration of travel obtained from travel logbooks. A mixed top-down and activity-based costing approach was used to estimate the monthly cost of ambulance services. This constituted personnel, maintenance, fuel, overhead, consumables, ambulance, and medical equipment costs. The utilization and costs of ambulance services were further compared between settings and geographical locations. The average total cost of ambulance services was MYR 11,410.44 (US$ 2,756.14) for hospitals and MYR 9,574.39 (US$ 2,312.65) for clinics, albeit not significantly different. Personnel cost was found to be the main contributor to the total cost, at around 44% and 42% in hospitals and clinics, respectively. There was however a significant difference in the total cost in terms of the type and age of ambulances, in addition to their location. In terms of service utilization, the median number of trips and duration of ambulance usage was significantly higher in clinics (31.88 trips and 58.58 hours) compared to hospitals (16.25 trips and 39.25 hours). The total cost of ambulance services was higher in hospitals compared to clinics, while its utilization showed a converse trend. The current findings evidence that despite the ambulance services being all under the MOH, their operating process and utilization reflected an inherent difference by setting.

Predicting Hospitalization among Medicaid Home- and Community-Based Services Users Using Machine Learning Methods.

We compare multiple machine learning algorithms and develop models to predict future hospitalization among Home- and Community-Based Services (HCBS) Users. Furthermore, we calculate feature importance, the score of input variables based on their importance to predict the outcome, to identify the most relevant variables to predict hospitalization. We use the 2012 national Medicaid Analytic eXtract data and Medicare Provider Analysis and Review data. Predicting any hospitalization, Random Forest appears to be the most robust approach, though XGBoost achieved similar predictive performance. While the importance of features varies by algorithm, chronic conditions, previous hospitalizations, as well as use of services for ambulance, personal care, and durable medical equipment were generally found to be important predictors of hospitalization. Utilizing prediction models to identify those who are prone to hospitalization could be useful in developing early interventions to improve outcomes among HCBS users.

Knowledge Level of Pre-Hospital Emergency Medical Services Personnel about Ambulance Equipment in Rasht, Iran

Background: Emergency Medical Services (EMS) personnel are often the first to provide healthcare services to the patient in different situations outside the hospital. Due to the sensitivity of this work, knowledge of ambulance equipment can affect the performance of Emergency Medical Services personnel. Objective This study aims to assess the knowledge of pre-hospital EMS personnel in Rasht, Iran about ambulance equipment. Methods: This cross-sectional analytical study was conducted on 84 EMS personnel who were selected from 17 medical centers in Rasht, Iran using a convenience sampling method. The data collection tool was a two-part questionnaire. The first part surveys demographic characteristics (age, gender, work experience, type of employment, education, field of study, history of retraining courses) and the second part assesses the knowledge of ambulance equipment according to the Pre-hospital Emergency Medicine/Equipment User Manual of Iranian Ministry of Health and Medical Education (fourth edition). The data were analyzed in SPSS v. 22 software and the significance level was set at 0.05. Results: Most of participants had a bachelor’s degree, were under permanent employment, and had a degree in nursing and emergency medicine. Their mean work experience was 9.84±6.41 years, and most of them had a history of participating in retraining courses. Their knowledge of ambulance equipment was at a good level. Kruskal-Wallis test showed that their knowledge level had a significant relationship with their type of employment (P&lt;0.001). Conclusion: It is necessary to increase the knowledge level of pre-hospital EMS personnel about ambulance equipment by holding short-term training courses and using simulation methods.

Comparison of the Antimicrobial Effect of Zataria Multiflora Essence and Deconex Surface on Microbial Load of Emergency Ambulances.

This study aimed to compare the antimicrobial effect of Deconex Surface, a common disinfectant, and Zataria multiflora essence on microbial load of Emergency ambulance equipment in Iran. The samples were selected from all the ambulances through convenience sampling. Before the intervention, the cultures were obtained from the contact surfaces and the surfaces were then disinfected with Deconex and Zataria multiflora. Then, repeated cultures were obtained from the same surfaces. Next, the samples were immediately sent to a microbiology lab. The obtained data were entered into SPSS 2016 and analyzed using statistical tests. Results showed that disinfecting effect of Zataria multiflora is better than Deconex in eliminating certain bacterial species such as Staphylococcus and Bacillus. So Zataria multiflora essence can be used as a surface and hospital equipment disinfectant along with other disinfectant compounds.

Assessment of ambulance services performance by queuing theory, at the Center for Disaster and Emergency Management: A descriptive-analytical study.

The emergency departments of the hospitals and emergency medical services (EMSs) centers have a critical role for providing urgent medical care for patients. The statistical data of the present study were provided by the EMS headquarters of the city of Isfahan, from August to November 2017. The findings showed that on average, 210 missions were accomplished each day by the emergency call center, with an average duration of about 53 minutes, for each mission. In addition, the average time for response time (the time between a call and dispatch of the ambulance) was less than 3 minutes, and the average time for arrival time (the time between request of ambulance and the arrival to the scene) was 8.1 minutes. Adequacy of current number of ambulances and staff is evaluated. Considering an average of 8.1 minutes for arrival time, we conclude that the EMS of Isfahan is within an acceptable range, compared to the international standards. In fact, it is shown that the infrastructures of EMS system including ambulance fleets, staff, and equipment are sufficient, and as an effective step for reducing the total time of the mission, the EMS has to operate seamlessly with the patient's admission process in hospitals. Information such as workload hours, availability of resources and staff, etc. ought to be shared between the EMS and the hospital.

Towards a Safer and More Efficient Neonatal Transfer System in South Africa: A Qualitative Inquiry with Advanced Life Support Paramedics

Introduction The inter-healthcare transfer of the critically ill neonate is a critical aspect of larger neonatal intensive care, as it influences the safe transport of neonates from the receiving to the referring hospital. It is crucial then that the transfer process be safe and efficient so as not to compromise the already fragile condition of the neonate. The aim of the study was to understand the challenges advanced life support (ALS) paramedics face during neonatal transfers and to understand how the process could be made safer and more efficient. The objectives related to understanding the transfer process, the challenges linked to the critically ill neonate and the difficulties associated with the ambulance vehicle and equipment. Methods Using a qualitative research approach we sought the views of ALS paramedics at the forefront of transfers nationally. In-depth interviews were held with eight paramedics in KwaZulu-Natal and four focus group discussions with ALS paramedics in KwaZulu-Natal, Gauteng, Free State and the Western Cape in South Africa. A total of 35 ALS paramedics were involved in these group discussions. Results The study uncovered several challenges that paramedics face related to poor organisational preparation for transfer of the critically ill neonate, and other crucial issues that compromise the transfer such as inadequate or defective equipment. Conclusion There is a need for greater scrutiny of the transfer process and a commitment from stakeholders to begin addressing the challenges confronting the safe transfer of critically ill neonates.

Transport and Retrieval on Extracorporeal Membrane Oxygenation (ECMO): Setup and Activities of an Immersive Transport and Retrieval on ECMO Workshop

Extracorporeal life support and extracorporeal membrane oxygenation (ECMO) are widely used for acute severe refractory cardiac and respiratory failure. An increasing number of patients are treated with ECMO worldwide. This can be attributed to technical and technologic advancements, easier access to modern equipment, and more regular and accessible training opportunities for practitioners to maintain current skills and develop new ones. Typically, ECMO is provided at tertiary or regional centers that often are university- affiliated. In a significant number of patients, ECMO may be initiated at a peripheral hospital before they are transported to a tertiary facility by a specialized multiprofessional ECMO team. The transport phase is, however, fraught with challenges and untoward events are not uncommon during ECMO transportation, so a robust education and training program is critical to ensure patient safety and optimum outcome. This article describes the authors' experience of developing and running a simulation-based ECMO Transport and Retrieval workshop, with multiple immersive scenarios and opportunities for participants to familiarize themselves with the process and the ambulance equipment and environment. Preparation is a key element to successfully run scenarios that are technically challenging to facilitate due to the environment and equipment involved. To date, 136 multidisciplinary ECMO providers have attended the workshop and no incidents have been reported by the authors' teams during actual transfers and retrieval missions with patients on ECMO.

Improving Prehospital Stroke Services in Rural and Underserved Settings With Mobile Stroke Units.

In acute stroke management, time is brain, as narrow therapeutic windows for both intravenous thrombolysis and mechanical thrombectomy depend on expedient and specialized treatment. In rural settings, patients are often far from specialized treatment centers. Concurrently, financial constraints, cutting of services and understaffing of specialists for many rural hospitals have resulted in many patients being underserved. Mobile Stroke Units (MSU) provide a valuable prehospital resource to rural and remote settings where patients may not have easy access to in-hospital stroke care. In addition to standard ambulance equipment, the MSU is equipped with the necessary tools for diagnosis and treatment of acute stroke or similar emergencies at the emergency site. The MSU strategy has proven to be effective at facilitating time-saving stroke triage decisions. The additional on-board imaging helps to determine whether a patient should be taken to a primary stroke center (PSC) for standard treatment or to a comprehensive stroke center (CSC) for advanced stroke treatment (such as intra-arterial therapy) instead. Diagnosis at the emergency site may prevent additional in-hospital delays in workup, handover and secondary (inter-hospital) transport. MSUs may be adapted to local needs—especially in rural and remote settings—with adjustments in staffing, ambulance configuration, and transport models. Further, with advanced imaging and further diagnostic capabilities, MSUs provide a valuable platform for telemedicine (teleradiology and telestroke) in these underserved areas. As MSU programmes continue to be implemented across the world, optimal and adaptable configurations could be explored.

Existing Science on Human Factors and Ergonomics in the Design of Ambulances and EMS Equipment

Background: Emergency medical services (EMS) personnel face a disproportionally high risk for fatality and injury due to the nature of their work; and current ambulance and EMS equipment design standards do not adequately safeguard EMS personnel from sacrificing personal safety for patient care, a known human factors and ergonomic (HFE) design challenge. Despite the desire to include HFE interventions or considerations into a standard, the effectiveness of existing HFE interventions for EMS is unclear. Objective: Therefore, this study aimed to synthesize the peer-reviewed literature on the design features of patient compartments and EMS equipment that affect EMS personnel’s performance or well-being. Methods: A scoping review methodology was applied to systematically search and screen for relevant articles, and extract data. Three databases (EmBase, Scopus, and PubMed) were searched, and search results were screened for articles that pertained to the performance or well-being of EMS personnel when interacting with the patient compartment or its associated equipment. Results and Discussion: Of the 4,125 search results, 48 relevant articles were retained, and then sorted into one of 3 categories: general design, patient handling, and patient transport. It was concluded that, although research has progressed over the past 15 years, more research, development, and resources are needed. Newer generations of ambulances have not been shown to be safer during collisions and there is a knowledge gap in how occupants and contents of a patient compartment behave during a collision. Crash-tests have been performed with restrained occupants and supplies; however, that scenario is unrealistic in the field. While the existing literature provided initial ideas and innovations for improving the HFE of patient handling and patient transport, it is important for future research to convey findings in a manner that can be used to inform design standards.

Acute coronary syndromes in the practice of the emergency medical team

An acute coronary syndrome (ACS) is described when myocardial ischemia occurs due to impeding blood flow through the coronary vessels, which in turn results in insufficient supply of oxygen. As a disease entity, it causes almost half of all deaths in Poland. The high mortality of ACS is primarily in the pre-hospital setting. The classification of acute coronary syndromes is based on criteria such as clinical symptoms, the nature and type of changes in the electrocardiogram, and indicators of myocardial necrosis. In the conditions of the emergency medical team, the division is based on the image of the ECG test. On this basis, ACS with elevation of the ST segment (STEMI) and without ST segment elevation (NSTEMI) are defined. Pre-hospital diagnosis of ACS includes an interview with the patient and a 12-lead ECG performed preferably in no more than 10 minutes since the first medical contact. The task of the emergency medical team is to quickly recognize, perform teletransmission to the interventional cardiology centre and implement pharmacological treatment, and then provide transport to the nearest centre of invasive cardiology, where the procedure should be performed to clear the blocked coronary artery. Therefore, it is important that the staff of medical emergency teams have appropriate knowledge and proper equipment for ambulances.

Imbalance between ambulance equipment and clinical training of emergency medical personal in two German state regions

Imbalance between ambulance equipment and clinical training of emergency medical personal in two German state regions

The Pattern of Pre-hospital Medical Service Delivery in Iran; a Cross Sectional Study.

Pre-hospital emergency systems provide service by Franco-German and Anglo American models. This study was carried out to compare the Iranian emergency medical service (EMS) with the two models regarding timing and equipment. In this cross sectional study, response time, scene time, and transport time to hospital as well as ambulance equipment of five hundred thousand Tehran EMS recorded missions, during one year, were compared with Franco-German and Anglo American models, trying to determine the pattern of EMS delivery in Iran. The mean response time, scene time, and transport time to hospital were 15.00 ±10.88, 18 ±11.48, and 15.00 ±11.20 minutes, respectively. The mean response time (p<0.035), scene time (p<0.033), and transport time to hospital (p<0.015) were more than the standard time. Percentage of ambulances quipped with automated external defibrillator (45%, p<0.001), ventilator (2%, p<0.001), disposable splint (0%, p<0.001), and wheelchair (0%, p<0.001) were very far from standards. The pattern of EMS delivery in Iran was a combination of Anglo American and Franco-German system.

The impact of missing or incorrect addresses

The impact of missing or incorrect addresses