Ambulance Personnel Research Articles

Methamphetamine use and emergency services in Australia: a scoping review

Methamphetamine use in Australia has been the topic of considerable attention by the media, political parties and the general public in recent years. This occurrence, along with the need for ambulance services and personnel to be adequately prepared, warrant further research in this area. This scoping review aims to determine who is currently using methamphetamines, whether prevalence has changed over time, and the impact is this having on emergency ambulance services in Australia. Key Findings: users of methamphetamine in Australia are mostly male, aged late twenties to early thirties and born in Australia. They generally have low levels of education and high levels of unemployment, homelessness, and rates of dependence. Overall rates of methamphetamine usage has not changed, however the proportion of users taking stronger forms of the substance has increased dramatically leading to adverse health consequences and emergency service intervention. Implications: Methamphetamine use is a societal issue which has far reaching consequences impacting on individuals, families, communities and healthcare personnel. Conclusion: the related health issues and aggression associated with methamphetamine affected patients, coupled with the increasing hospital and ambulance utilisation by this population warrants more research being undertaken on this issue.

Medical training for police officers in specialist role (D13): A retrospective review of patient report forms from 2010–2015

Introduction D13 is a nationally agreed bespoke medical training package for specialist firearms police officers introduced in 2010. Patient report forms are completed after every episode of care provision. Methods A review of patient report forms submitted by police firearms officers in five regions of England over the five years since the introduction of D13. Results Officers attended a large range of incidents, both traumatic and medical, minor and life critical. The majority (69.5%) were responded to as part of a normal police response, while 30.5% of cases were due to primary firearm deployments. Catastrophic haemorrhage was dealt with in 8.1% of cases including the use of haemostatic dressings and tourniquet application. Airway interventions were required in 36.1% of patients and 50.4% required interventions for external bleeding. Discussion From a background of a minimum of 18 h for Standard and 24 h for Enhanced courses and with regular simulation refreshers, specialist police officers, who are part of a robust clinical governance process, play an important role in providing immediate medical care in non-permissive or dangerous environments where ambulance personnel will not be present and when the officers are frequently first on scene.

Hypothermia in trauma victims at first arrival of ambulance personnel: an observational study with assessment of risk factors

BackgroundHypothermia is common in trauma victims and is associated with increased mortality, however its causes are little known. The objective of this study was to identify the risk factors associated with hypothermia in prehospital management of trauma victims.MethodsThis was an ancillary analysis of data recorded in the HypoTraum study, a prospective multicenter study conducted by the emergency medical services (EMS) of 8 hospitals in France. Inclusion criteria were: trauma victim, age over 18 years, and victim receiving prehospital care from an EMS team and transported to hospital by the EMS team in a medically equipped mobile intensive care unit. The following data were recorded: victim demographics, circumstances of the trauma, environmental factors, patient presentation, clinical data and time from accident to EMS arrival. Independent risk factors for hypothermia were analyzed in a multivariate logistic regression model.ResultsA total of 461 trauma patients were included in the study. Road traffic accidents (N = 261; 57%) and falls (N = 65; 14%) were the main causes of trauma. Hypothermia (<35 °C) was present in 136/461 cases (29%). Independent factors significantly associated with the presence of hypothermia were: a low GCS (Odds Ratio (OR) = 0,87 ([0,81-0,92]; p < 0.0001), a low air temperature (OR = 0,93 [0,91-0,96]; p < 0.0001) and a wet patient (OR = 2,08 [1,08-4,00]; p = 0.03).ConclusionThe incidence of hypothermia was high on EMS arrival at the scene. Body temperature measurement and immediate thermal protection should be routine, and special attention should be given to patients who are wet.Level of evidenceProspective, multicenter, open, observational study; Level IV.

The infection prevention and control practices of the ambulance service

Objective: The aim of this research was to comprehensively evaluate the infection prevention and control practices of the ambulance service. Methods: This cross section survey was carried out in Izmir between June and September 2010. The study sample consisted of 213 ambulance service workers and all the emergency and rescue station buildings and ambulances. A questionnaire and two check-list forms were used as a means of data collection. Results: According to the employees’ responses, an average of 25 (24.86±4.09) of 40 items of infection prevention and control criteria that are required to be met for the ambulance service were met, while 15 were not. In the observations, it was found that the infection prevention and control criteria for ambulances were met at an average of 32.96±5.22 out of 40. It was found that 33 out of 50 items of the criteria for infection prevention and control in ambulances were met while 17 were not. According to observations, an average of 6 (5.88±1.52) of 17 items of infection prevention and control criteria for emergency and rescue station buildings, were met while 11 were not. Conclusion: The questionnaire responses given by the ambulance personnel and observations made by the researchers in the ambulances and emergency and rescue station buildings suggest that the criteria set for infection prevention and control practices were not met at a satisfactory level, which meant the infection prevention and control practices were not sufficient. It is advised that an IPC guideline should be prepared to include standards and procedures to be followed by ambulance service personnel.

Perceived Collaboration during Mining Incidents - Focus Group Discussions with Mining Workers and Managers, Rescue Service Personnel, and Ambulance Personnel

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Mental health simulation training in psychiatric skills for police and ambulance service personnel

IntroductionUK healthcare policy has highlighted a shift in mental health services from hospital to community, stressing the importance of training for professions not traditionally associated with healthcare. Recommendations have been made to introduce training for the police force designed with experts. Similarly, the value of further training for ambulance clinicians in assessing mental health, capacity, and understanding legislation has been highlighted.AimsTo investigate the effect of simulation training on the confidence, knowledge, and human factors skills of police and ambulance service personnel in working with people experiencing mental health conditions.MethodsOn completion of data collection from 14 training courses, approximately 90 police and 90 ambulance personnel (n = 180) will have completed the human factors skills for healthcare instrument, confidence and knowledge self-report measures, and post-course qualitative evaluation forms. A version of the hfshi for non-clinical professions will hopefully be validated following data collection. Results will also be compared by profession.ResultsAnalyses have not been fully completed, although preliminary statistical analyses demonstrate promising findings, with increases post-course for human factors skills, confidence and knowledge. Furthermore, qualitative feedback initially illustrates valuable learning outcomes and interesting findings from comparisons by professions.ConclusionsMental health simulation training appears to have a promising impact on the confidence, knowledge, and human factors skills of police and ambulance personnel for working with people experiencing mental health conditions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Prehospital intravenous fentanyl to patients with hip fracture: an observational cohort study of risk factors for analgesic non-treatment

BackgroundPatients with proximal femoral neck fracture have a high short-term mortality, a high risk of postoperative complications, and impaired quality of life. One of the challenges related to the prehospital treatment of these patients is to administer systemic opioids fast and properly. Effective analgesic prehospital treatment ought be initiated rapidly in order to alleviate the stress that follows acute pain, to facilitate transportation, and to improve quality of care. The objectives of this study were to explore the prevalence of prehospital administration of intravenous fentanyl to patients with proximal femoral neck fracture in the ambulances and to assess risk factors for analgesic non-treatment.MethodsThis was a register-based observational cohort study of patients with proximal femoral neck fracture from the North Denmark Region transported by ambulance. The patients were identified via the Danish Interdisciplinary Hip Fracture Registry over a 3-year period from 1 July 2011 to 30 June 2014. This hospital registry contains data on several patient characteristics used for the risk factor analysis. Data on prehospital treatment (intravenous fentanyl) and patient monitoring were registered in an electronic prehospital patient record. A modified Poisson regression with robust standard errors was carried out with intravenous fentanyl as the primary binary outcome and the following explanatory variables: age, sex, Charlson Comorbidity Index score, housing, body mass index, type of fracture, fracture displacement, prior consultation with general practitioner, dispatch triage level, and time with ambulance personnel.ResultsIn total, 2,140 patients with proximal femoral neck fracture were transported by ambulance, of which 584 (27.3%, 95% CI: 25.4-29.2) were treated with intravenous fentanyl. Risk factors for non-treatment were: older age, male sex (RR 0.77, 95% CI: 0.64-0.91), institutional housing (RR 0.72, 95% CI: 0.56-0.92), medial fracture (RR 0.74, 95% CI: 0.60-0.92), short time with ambulance personnel, Charlson Comorbidity Index score > 1, year of fracture (2011), low levels of urgency at dispatch, and if seen by general practitioners prior to transport.DiscussionEducation of ambulance personnel in assessing and treating patients with hip fracture seems to be required. Also, future studies should consider alternative or supportive pain treatment options with suitable analgesic effects and side effects.ConclusionsFew patients with proximal femoral neck fracture were treated with intravenous fentanyl, and several risk factors were associated with prehospital analgesic non-treatment. Future prospective studies should explore covariates of socioeconomic, cultural, and psychological origin to provide further insight into the multifactorial causes of non-treatment of acute pain.

Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology

BackgroundKnowledge about heart rhythm conversion from non-shockable to shockable rhythm during resuscitation attempt after out-of-hospital cardiac arrest (OHCA) and following chance of survival is limited and inconsistent. MethodsWe studied 13,860 patients with presumed cardiac-caused OHCA not witnessed by the emergency medical services from the Danish Cardiac Arrest Register (2005–2012). Patients were stratified according to rhythm: shockable, converted shockable (based on receipt of subsequent defibrillation) and sustained non-shockable rhythm. Multiple logistic regression was used to identify predictors of rhythm conversion and to compute 30-day survival chances. ResultsTwenty-five percent of patients who received pre-hospital defibrillation by ambulance personnel were initially found in non-shockable rhythms. Younger age, males, witnessed arrest, shorter response time, and heart disease were significantly associated with conversion to shockable rhythm, while psychiatric- and chronic obstructive pulmonary disease were significantly associated with sustained non-shockable rhythm. Compared to sustained non-shockable rhythms, converted shockable rhythms and initial shockable rhythms were significantly associated with increased 30-day survival (Adjusted odds ratio (OR) 2.6, 95% confidence interval (CI): 1.8–3.8; and OR 16.4, 95% CI 12.7–21.2, respectively). From 2005 to 2012, 30-day survival chances increased significantly for all three groups: shockable rhythms, from 16.3% (CI: 14.2%–18.7%) to 35.7% (CI: 32.5%–38.9%); converted rhythms, from 2.1% (CI: 1.6%–2.9%) to 5.8% (CI: 4.4%–7.6%); and sustained non-shockable rhythms, from 0.6% (CI: 0.5%–0.8%) to 1.8% (CI: 1.4%–2.2%). ConclusionConverting to shockable rhythm during resuscitation attempt was common and associated with nearly a three-fold higher odds of 30-day survival compared to sustained non-shockable rhythms.

The opinions of ambulance personnel regarding using a heated mattress for patients being cared for in a cold climate – An intervention study in ambulance care

ABSTRACTThe purpose of the study was to describe the opinions of ambulance personnel regarding differences between using a heated mattress and a standard ambulance mattress. This study was an intervention study with pre- and post-evaluation. Evaluations of the opinions of personnel regarding the standard unheated mattress were conducted initially. After the intervention with new heated mattresses, follow-up evaluations were conducted. Ambulance personnel (n=64) from an ambulance station in northern Sweden took part in the study, which ran from October 2014 until February 2016. There were differences in opinions regarding the standard unheated mattress and the new heated mattress. The evaluation of the proxy ratings by the personnel showed that the heated mattress was warmer than the standard mattress, more pleasant to lie on and that patients were happier and more relaxed than when the standard mattress was used. The ambulance personnel in this study rated the experience of working with the heated mattress as very positive and proxy rated that it had a good effect on patient comfort. A heated mattress can be recommended for patients in ambulance care, even if more research is needed to receive sufficient evidence.

Workplace belongingness, distress, and resilience in emergency service workers.

Ambulance personnel provide emergency medical services to the community, often attending to highly challenging and traumatic scenes in complex and chaotic circumstances. Currently, the assessment of predictors of psychological well-being remains limited. The current study investigated whether workplace belongingness was significant in predicting psychological distress as well as the presence of resilience in ambulance personnel while controlling for more routinely examined factors. Australian ambulance officers (N = 740) completed a survey battery including the Kessler 10, Brief Resilience Scale, and Psychological Sense of Organizational Membership scale. Controlling for more commonly examined factors such as severity of trauma exposure and length of service, hierarchical multiple regression analyses demonstrated that workplace belongingness was significantly associated with reduced distress levels and enhanced resilience levels. Results suggest that strategies to enhance a sense of workplace belongingness in emergency service organizations could promote the well-being of emergency workers despite routine exposure to potentially traumatic events. (PsycINFO Database Record

Targeted response? An exploration of why ambulance services find government targets particularly challenging.

Ambulance services have historically found their targets particularly challenging. This article explores some areas of this multifaceted problem. Research articles, government publications and published audit data. Demand is increasing in many areas of healthcare, but whilst hospitals saw a 7% increase in demand in recent times, ambulance services saw nearly double that. The services ambulance trusts provide have evolved from that of a transport service to that of a mobile health provider, and they have become victims of their own success. Ambulance targets have never evolved to match evolving care. Ambulance personnel strive to avoid hospital attendance where appropriate, but this can be difficult for a 24-hour service, when not all referral pathways have 24-hour referral systems. We discuss why demand might be growing disproportionately for ambulance services, and challenge the appropriateness of the targets themselves. Possible formats for revised ambulance targets are discussed.

Staff perceptions and changing role of pre-hospital profession in the UK ambulance services

PurposeThere is a growing academic interest in the examination and exploration of work intensification in a wide range of healthcare settings. The purpose of this paper is to explore the differing staff perceptions in emergency ambulance services in the UK. It provides evidence on the challenges for the paramedic professionalisation agenda and managing operational demands and work intensity in emotionally challenging circumstances, with significant implications for patient safety.Design/methodology/approachDrawing on the evidence from an empirical study in a large National Health Service ambulance trust in England, this paper examines the challenges and differing staff perceptions of the changing scope and practice of ambulance personnel in the UK. Amidst the progress on the professionalisation of the paramedic agenda, individual trusts are facing challenges in form of staff attitudes towards meeting performance targets, coupled with rising demand, fear of loss of contracts and private competition.FindingsResearch findings highlight differing perceptions from various sub-cultural groups and lack of clarity over the core values which are reinforced by cultural and management differences. Need for greater management to explore the relationship between high sickness levels and implications for patient safety including the need for policy and research attention follows from this study. The implications of work intensity on gender equality within the ambulance settings are also discussed.Research limitations/implicationsAmbulance services around the world are witnessing a strain on their operational budgets with increasing demand for their services. Study evidence support inconclusive evidence for patent safety despite the growing specialist paramedic roles. Organisational implications of high staff sickness rates have been largely overlooked in the management literature. This study makes an original contribution while building upon the earlier conceptions of work intensification.Practical implicationsThe study findings have significant implications for the ambulance services for better understanding of the staff perceptions on work intensity and implications for patient safety, high sickness absence rates amidst increasing ambulance demand. Study findings will help prepare the organisational policies and design appropriate response.Social implicationsSocietal understanding about the organisational implications of the work intensity in an important emergency response service will encourage further debate and discussion.Originality/valueThis study makes an original contribution by providing insights into the intra-organisational dynamics in an unusual organisational setting of the emergency ambulance services. Study findings have implications for further research inquiry into staff illness, patient safety and gender issues in ambulance services. Evidence cited in the paper has further relevance to ambulance services globally.

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation

PurposeThe Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. Materials and methodsTwo ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. ResultsIn the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p<0.001). The mean chest compression rate was within the recommended range of 100–120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p<0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27). ConclusionPost-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses.

An inquiry into the perceived clinical handover of patients arriving in a large tertiary care emergency department

Background: Delays in clinical handover can compromise a patient's care. The handover is not the sole responsibility of the ambulance personnel or the emergency departments. Reducing delays requires the working together of the entire organization, as well as designing efficient emergency and ambulance departments. Objectives: The study aims at exploring the quality of clinical handover between the emergency department personnel and the ambulance personnel at Hamad General Hospital. Methods: This is a descriptive study using two kinds of anonymous questionnaire surveys to gauge the current opinion regarding patient handover. One was aimed at physicians, who are the hospital employees, and the second was intended for the ambulance personnel. The employees of the Emergency Department were asked to provide their opinion of the handovers that the ambulance employees provided in a given clinical situation. The clinical situations in question included: cardiac arrest, pediatric emergencies, sepsis, chest pain, head injury, and trauma. Results: A total of 65 ambulance employees and 70 medical employees completed the survey. The findings of the study indicate that there is a formal training procedure for patient handover, and that, in general, the quality of communication of history, the general quality of handover, and the knowledge of vital signs reported were high. The ambulance personnel were satisfied with their quality of handover. However, the medical staff were less positive, particularly for sepsis and pediatric emergencies. The findings also indicate that the ambulance employees perceived a high level of delay regarding patient handover. Conclusions: It was encouraging that both groups had a positive perception about the handover. The areas for improvement identified by the medical employees were sepsis and pediatric emergencies, while the ambulance employees perceived a significant delay in the handover. In conclusion, the study proposes the following recommendations as possible solutions: interdisciplinary training, addressing organizational culture, and flexibility in organizational processes.

Patients’ experience of being badly treated in the ambulance service: A qualitative study of deviation reports in Sweden

ObjectivesThe Swedish healthcare system aims to provide the best care possible, thus fulfilling legal and program requirements despite the need for reducing costs. This study’s aim has been to acquire deeper understanding of the factors underlying patients’ experience of inappropriate treatment and care or personnel’s problematical attitudes during their contact with the Emergency Medical Services (EMS) (Ambulance Services). MethodsThis study used a care science perspective. It applied qualitative content analysis, analyzing data for meaning. Data comprised 32 deviation reports or complaints from patients in Stockholm, Sweden in 2014. ResultsPatients at the limits of their self-help experienced acute need for speedy transfer to hospital. Lack of recognition for their suffering caused them to feel badly treated by ambulance personnel. ConclusionPatients in this study felt objectified and not treated as individual human beings, i.e. they “suffered from care”. Ambulance personnel should avoid patient objectification by establishing an engaged relationship with attentiveness and committal, thus supporting patients’ health processes. The aim of this study has been to draw attention to patients’ experiences of the healthcare they received, in order to be able to improve and maintain healthcare standards, thus guaranteeing continued quality of care. This may be achieved by increasing the awareness of personnel concerning how their attitudes and treatment can influence patient well-being. Information, education and follow-up lead to increased awareness in personnel. The intended result of personnel’s increased awareness is greater well-being and feelings of security for patients.

The Dark Side of Resilience and Burnout: A Moderation-Mediation Model.

This study tested whether specific dark-side traits may be beneficial in manifesting and maintaining Resilience, whilst others are vulnerability factors for Burnout. Four hundred and fifty-one (50 female) ambulance personnel completed three questionnaires as a part of a selection and development assessment. The study utilised the Hogan Development survey as a measure of dark side personality, the Copenhagen Burnout Inventory to assess work-related burnout, and the Resilience Scale– 14 to measure resilience levels. Those high on Excitable and Cautious but low on Bold and Reserved were linked to an increased vulnerability to Burnout. Also those high on Bold and Diligent yet low on the Excitable, Cautious, and Imaginative scales were more resilient. Structural Equation Modelling revealed that resilience plays both a mediating and moderating role on personality and burnout. Theoretical implications suggest future research assessing the predictive capacity of psychological variables on burnout should account the indirect effect of resilience.

What do ambulance service personnel perceive to be the process of and issues with inter-hospital transfers?

At present, the inter-hospital transfer process has been described as suboptimal and current literature fails to describe or analyse the complete transfer process. In particular, the challenges and barriers from UK NHS ambulance services are yet to be described. To examine this further, a study has been undertaken to explore a NHS ambulance service personnel's experiences, perceptions and issues relating to the inter-hospital transfer process. The findings have shown that ambulance personnel approach inter-hospital transfers from a business perspective, which affects the way they process and perceive transfers. There exists a consensus among staff that the inter-hospital transfer policy or procedure is not fully understood, due to a lack of clarity and mixed messages throughout the process. Staff members view the inter-hospital transfer process as a nuisance and have acknowledged it was inadequately executed. Additionally, undertaking certain inter-hospital transfers is seen as challenging paramedics' professional identities.

Attitudes Towards and Experience of the Use of Triage Tags in Major Incidents: A Mixed Method Study.

Introduction Disaster triage is the allocation of limited medical resources in order to optimize patient outcome. There are several studies showing the poor use of triage tagging, but there are few studies that have investigated the reasons behind this. The aim of this study was to explore ambulance personnel attitude towards, and experiences of, practicing triage tagging during day-to-day management of trauma patients, as well as in major incidents (MIs). A mixed method design was used. The first part of the study was in the form of a web-survey of attitudes answered by ambulance personnel. The question explored was: Is it likely that systems that are not used in everyday practice will be used during MIs? Two identical web-based surveys were conducted, before and after implementing a new strategy for triage tagging. This strategy consisted of a time-limited triage routine where ambulance services assigned triage category and applied triage tags in day-to-day trauma incidents in order to improve field triage. The second part comprised three focus group interviews (FGIs) in order to provide a deeper insight into the attitudes towards, and experience of, the use of triage tags. Data were analyzed using qualitative content analysis. The overall finding was the need for daily routine when failure in practice. Analysis of the web-survey revealed three changes: ambulance personnel were more prone to use tags in minor accidents, the sort scoring system was considered to be more valuable, but it also was more time consuming after the intervention. In the analysis of FGIs, four categories emerged that describe the construction of the overall category: perceived usability, daily routine, documentation, and need for organizational strategies. Triage is part of the foundation of ambulance skills, but even so, ambulance personnel seldom use this in routine practice. They fully understand the benefit of accurate triage decisions, and also that the use of a triage algorithm and color coded tags is intended to make it easier and more secure to perform triage. However, despite the knowledge and understanding of these benefits, sparse incidents and infrequent exercises lead to ambulance personnel's uncertainty concerning the use of triage tagging during a MI and will therefore, most likely, avoid using them. Rådestad M , Lennquist Montán K , Rüter A , Castrén M , Svensson L , Gryth D , Fossum B . Attitudes towards and experience of the use of triage tags in major incidents: a mixed method study. Prehosp Disaster Med. 2016;31(4):376-385.

Preventing and alleviating patients' symptoms of nausea and vomiting while in the care of the ambulance service – a qualitative study

AimThe aim of this study was to describe the ambulance personnel's experiences of preventing and alleviating patients' symptoms of nausea and vomiting. BackgroundNausea is a common symptom in patients taken care of by the ambulance service. It is a complex subjective phenomenon and can cause several different illnesses. The ambulance personnel have an important assignment in preventing and alleviating nausea through early interventions. MethodA descriptive and qualitative design including 16 semi-structured interviews and content analysis was used. ResultsOne main category was identified: Adjusting care and medical treatment based on the individual patient's needs. By adjusting the care and medical treatment based on patients' individual needs and previous experience, the ambulance personnel experienced a possible relief of the patients' suffering caused by nausea and vomiting. In addition to the known multitude of underlying pathologies of nausea, the way of driving and the environment in the ambulances also may have an impact on the patients' nausea. ConclusionA variety of nursing interventions and medical treatments are reported to be used to alleviate nausea for patients cared for by the ambulance service, but further research is needed to evaluate if and how the interventions have an effect on the patients' experiences. The findings in our study can be used when developing guidelines on how to care for patients suffering nausea and vomiting.

Prehospital use of hemostatic dressings in emergency medical services in the Netherlands: A prospective study of 66 cases

BackgroundUncontrolled haemorrhage is the leading cause of potentially preventable death in both civilian and military trauma patients. Animal studies and several case series have shown that hemostatic dressings reduce haemorrhage and might improve survival. One of these products is HemCon ChitoGauze®. The objective of this study was to determine the effectiveness and safety of ChitoGauze in achieving hemostasis in massive traumatic bleeding in civilian emergency medical services. MethodsFrom June 2012 to December 2014, all ambulances of two emergency medical services in the Netherlands were equipped with ChitoGauze. The dressing was used according to protocol; if conventional treatment (gauze dressing with manual pressure) failed to control external traumatic bleeding or if conventional treatment was unlikely to achieve hemostasis. The ambulance personnel filled in an evaluation form after each use. ResultsA total of 66 patients were treated with ChitoGauze during the study period. Twenty-one patients were taking anticoagulants or suffered from a clotting disorder. The injuries were located in the extremities (n=29), the head and face (n=29), or the neck, thorax and groin (n=8). In 46/66 patients, the use of ChitoGauze resulted in cessation of haemorrhage. In 13/66 patients, Chitogauze application reduced haemorrhage. ChitoGauze failed to control haemorrhage in 7/66 patients, whereby user error was a contributing factor in 3 of these failures. No side effects have been observed during treatment or transport of the patients and no adverse effects have been reported in discharge letters. ConclusionThis is the largest prospective study in civilian healthcare and the second largest case series with prehospital use of hemostatic dressings. It demonstrated that ChitoGauze is an effective and safe adjunct in the prehospital treatment of massive external traumatic haemorrhage.