Basic Life Support Ambulances Research Articles

Abstract 294: Is Use Of An Interactive Voice Server In An Emergency Medical Dispatch Center An Efficient And Safe Measure?

Introduction: In the first wave of COVID-19 pandemic, Emergency Medical Dispatch Centers (EMDC) faced an influx of calls. During this time, with the scope of handling emergency calls more quickly, it was decided to use an Interactive Voice Server (IVS). The objective of this study was to identify whether the implementation of an IVS is efficient and safe. Methods: From 20/03/19 until 20/04/26, an IVS was activated between 8 AM and midnight. IVS offered the caller to choose either 1- press the 'zero' key for Coronavirus Syndrome with no respiratory difficulties; or 2- stay on line for any other reason. If the caller typed "zero", the call was directed to a "crisis dispatcher" specially trained to handle COVID cases. If he stayed on line, his call was placed in the same queueing list as all emergency calls and handled by a “conventional dispatcher”. All medical dispatch files picked up during IVS activation period were included and classified in 2 groups: “IVS Yes” if caller pressed ‘zero’ and “IVS No” if not. Patient’s age, gender and profile of the caller (patient or third party) were collected. The level of severity of the patients was assessed upon the dispatcher’ decision ranging from sending an Advanced Life Support ambulance (ALS), a Basic Life Support ambulance (BLS) or no transport. Data were compared between the 2 groups with Chi-square tests. Results: 2846 callers were in the group “IVS Yes” and 12111 in “IVS No”. Main results are in table 1. Conclusion: IVS allowed almost 15% of calls to be directed to a specialized provider where they waited to be processed by staff trained within a few days to deal exclusively with COVID cases. This has led to decrease the number of calls handled by the conventional dispatch and allowed more time to respond to severe emergency calls. Moreover, because only 0.07% “IVS Yes” needed an ALS ambulance, we can assume that the use of IVS is safe. IVS is therefore an effective tool, which allows safe triage of less serious patients and frees up time to answer to severe calls.

Development of two-wheeler towed emergency purpose trailer for rescue operation

Ambulances are designed for quick response of emergency cases and to take a level of care for patients. Ambulances types are classified into four types based on their facilities. They are type A, type B, type C, type D. Type A is first responder. Type B is patient transport vehicle. Type C is basic life support ambulance. Type D is advanced life support ambulance. This work falls under category of type B. Type B ambulance is used to carry patient. Current work plan is to implement some main medical kit which is similar to type C ambulance. The project purpose is to focus on rural people to connect nearest health centre in the town area during emergency cases. Construction of trailed ambulance design is based on to overcome the problem faced by four wheeled ambulances in rural area. Also, the concept is based on to reduce death rate in village area and comfort ride in traffic places. Manufacturing cost of the ambulance is drastically reduced and also it could carry a patient and main necessary medical kit. Full body covered with sheet metal and patient compartment trailer unit is coupled with bike chassis frame during emergency cases. Trailer clamp is designed with adjustable length and width. Bike is uncoupled with trailer compartment and free to use when there is no emergency case.

Two Server Dynamic Coverage Location Model Under Stochastic Travel Time

This paper describes an optimization location model that minimizes the number of two kinds of ambulances, which are; advance life support (ALS) and basic life support (BLS), while meeting the coverage requirement. The purpose of this research is to improve the performance of the emergency medical service (EMS) by developing a two-server dynamic covering location model (TS-DCL). This model is considered with realistic operating conditions for the EMS system that is solved using a developed incremental search algorithm (ISA). The TS-DCL model includes the stochastic nature of travel time in response to service, so the ambulance location model becomes more realistic. Also, the approximate hypercube model is used to determine the dependence of ambulance busy fractions. An experimental study is carried out to examine the effects of the proposed model on the design of the ambulance services system. It is also including the application of the proposed model to a 144-node problem representing Al-karkh District in Baghdad City in Iraq. The experimental study shows that the TS-DCL model requires at least 26 ALS, 12 BLS backups and 24 BLS ambulances to meet the 95% coverage requirement of both the critical and non-critical calls.

Proposed Modifications in the 6-Minute Walk Test for Potential Application in Patients With Mild COVID-19: A Step to Optimize Triage Guidelines.

Proposed Modifications in the 6-Minute Walk Test for Potential Application in Patients With Mild COVID-19: A Step to Optimize Triage Guidelines.

Safety of Tiered-Dispatch for 911 Calls for Abdominal Pain.

IntroductionMany dispatch systems send Advanced Life Support (ALS) resources to patients complaining of abdominal pain even though the majority of these incidents require only Basic Life Support (BLS). With increasing 911-call volume, resource utilization has become more important to ensure that ALS resources are available for time-critical emergencies. In 2015, a large, urban fire department implemented an internally developed, tiered-dispatch system. Under this system, patients reporting a chief complaint of abdominal pain received the closest BLS ambulance dispatched alone emergency if located within three miles of the incident. The objective of this study was to determine the safety of BLS-only dispatch to abdominal pain by determining the frequency of time-sensitive events.MethodsThis was a retrospective review of electronic health records of one emergency medical service provider agency from May 2015–2018. Inclusion criteria were a chief complaint of abdominal pain from a first- or second-party caller, age over 15, and the patient was reported to be alert and breathing normally. The primary outcome was the prevalence of time-sensitive events, including cardiopulmonary resuscitation (CPR), defibrillation, or airway management. Secondary outcomes were hypotension (systolic blood pressure < 90 mmHg); or a prehospital 12 lead-electrocardiogram (ECG) demonstrating ST-elevation myocardial infarction (STEMI) criteria or a wide complex arrhythmia. Descriptive statistics were used.ResultsDuring the study period, there were 1,220,820 EMS incidents, of which 33,267 (2.72%) met inclusion criteria. The mean age was 49.9 years (range 16–111, standard deviation [SD] 19.6); 14,556 patients (56.2%) were female. Time-sensitive events occurred in seven cases (0.021%), mean age was 75.3 years (range 30–86, SD18.7); 85.7% were female. Airway management was required in seven cases (0.021%), CPR in six cases (0.018%), and defibrillation in one case (0.003%). Two of the seven (28.6%) cases involved dispatch protocol deviations. Hypotension was present in 240 (0.72%) cases; six (0.018%) cases had 12-lead ECGs meeting STEMI criteria; and no cases demonstrated wide complex arrhythmia.ConclusionAmong adult 911 patients with a dispatch chief complaint of abdominal pain, time-sensitive events were exceedingly rare. Dispatching a BLS ambulance alone appears to be safe.

Scheduling Non-Urgent Patient Transportation While Maximizing Emergency Coverage

Many ambulance providers operate both advanced life support (ALS) and basic life support (BLS) ambulances. Typically, only an ALS ambulance can respond to an emergency call, whereas non-urgent patient transportation requests can be served by either an ALS or a BLS ambulance. The total capacity of BLS ambulances is usually not enough to fulfill all non-urgent transportation requests. The remaining transportation requests then have to be performed by ALS ambulances, which reduces the coverage for emergency calls. We present a model that determines the routes for BLS ambulances while maximizing the remaining coverage by ALS ambulances. Different from the classical dial-a-ride problem, only one patient can be transported at a time, and not all requests are known in advance. Throughout the day, new requests arrive, and we present an online model to deal with these requests.

Basic Life Support Access to Injectable Epinephrine across the United States

Background: Aggressive epinephrine administration has growing support in the treatment of anaphylaxis, a life-threatening allergic reaction. Emergency Medical Services (EMS) providers are frequently in a position to provide the first care to someone experiencing an anaphylactic reaction. Intramuscular injection of epinephrine is the definitive pharmacologic treatment for many associated symptoms. While easy to use, epinephrine autoinjectors (EAI) are prohibitively expensive, having increased in price ten-fold in ten years. Some states and EMS departments have begun expanding the scope of practice to allow Basic Life Support (BLS) providers, previously restricted to noninvasive therapies, to administer epinephrine by syringe. Objectives: To compile a current and comprehensive list of how epinephrine is carried and used by EMS across the USA. Methods: An online survey focusing on anaphylaxis protocols and epinephrine administration was sent to state EMS medical directors and officials in all 50 states. Follow-up telephone calls were made to ensure compliance. Data were analyzed with descriptive statistics. Results: Forty-nine of the 50 states in the USA provided a survey response. Texas responded but declined to participate in the survey because of practice variability across the state. In the other states, the form of epinephrine allowed or required on BLS ambulances was consistent with the scope of practice of their Basic Emergency Medical Technician (EMT). Thirteen states had training programs to allow BLS providers to inject epinephrine; 7 were considering it; 29 were not. Twenty-seven states specified EAI as the only form of epinephrine required or allowed on their BLS ambulances. No states reported allowing any level of EMS provider below EMT to use alternatives to EAI. Conclusion: This study confirms that many states have expanded the training of BLS providers to include the use of syringe injectable epinephrine. Even so, the majority of states relied on EAI in BLS ambulances.

Detection and characterization of surface microbial contamination in emergency ambulances.

A cross-sectional study was performed in 10 emergency basic life support ambulances operating in Bilbao, Spain, to assess surface bacterial contamination. Presence of clinically relevant bacterial contamination suggests that disinfection of the studied basic life support ambulances was not optimal and represents a potential risk of infection for the patients transferred in them. It is critical to implement existing infection control and prevention protocols to resolve this issue.

The Vehicle Mix Decision in Emergency Medical Service Systems

We consider the problem of selecting the number of advanced life support (ALS) and basic life support (BLS) ambulances—the vehicle mix—to deploy in an emergency medical service (EMS) system, given a budget constraint. ALS ambulances can treat a wider range of emergencies, whereas BLS ambulances are less expensive to operate. To this end, we develop a framework under which the performance of a system operating under a given vehicle mix can be evaluated. Because the choice of vehicle mix affects how ambulances are dispatched to incoming calls, as well as how they are deployed to base locations, we adopt an optimization-based approach. We construct two models—one a Markov decision process, the other an integer program—to study the problems of dispatching and deployment in a tiered system, respectively. In each case, the objective function value attained by an optimal decision serves as our performance measure. Numerical experiments performed with both models suggest that, under reasonable choices of inputs, a wide range of tiered systems perform comparably to all-ALS fleets.

Abstract 19091: Prognosis of Patients With Out-of-hospital Refractory Cardiac Arrest Referred for Extracorporeal Life Support: An Observational Study

Introduction: In case of no return of spontaneous circulation (ROSC) after conventional cardio-pulmonary resuscitation (CPR), out-of-hospital cardiac arrest (OHCA) patients could be referred for extracorporeal life support (ECLS). Guidelines have been published concerning this specific situation (1). The aim of our study was to describe the prognosis of OHCA patients and verify if referral to ECLS was compliant with these recommendations mainly studying time intervals (no-flow &lt; 5 min, low-flow &lt; 100 min). Methods: A prospective survey on OHCA referred to ECLS was implemented from 03/01/12 until 06/11/15 in an Emergency Medical Service (EMS) located in Paris area (France). This survey included 43 patients referred to hospital for ECLS. Variables were given as means and percentages. Results: Patients referred to ECLS were more often men (77%), with a mean age of 51 years old. Most of 43 OHCA occurred at home (51%), although 26% occurred on public area and 16% at workplace. In 40% of cases, CPR was performed by a witness and in 33% by a health professional. A first Basic Life Support ambulance arrived on scene within 7 min 50 sec, whereas EMS ambulance arrived on scene within 18 min 27 sec after OHCA. At EMS arrival on scene, patients were on asystole (44%), ventricular fibrillation (37%), and on spontaneous circulation (12%). The no-flow time interval was 4 min 10 sec on average (6 patients had a no-flow over 5 min) with 43% of patients with no no-flow. Low-flow time-interval was 44 min. External electric shock was delivered before EMS arrival on 21% of cases, and EMS itself delivered a shock in 40% of cases. Epinephrine was used for all patients, 10.35 mg on average. No patient survived OHCA after referral to ECLS. Discussion: Although this is a small series of 43 patients, no OHCA patient referred to ECLS survived. These results are mainly due to a non-shockable initial condition or too long no-flow time intervals. In order to improve the outcome and bring benefit to the proper expected patients through a cost-effective pathway, we released a reminder of the right recommendations in our EMS. (1) Riou B., Adnet F., Baud F et al. A. Recommandation sur les indications de l’assistance circulatoire dans le traitement des arrêts cardiaques réfractaires. Ann Fr Anesth Réanim 2009 ; 28 : 182-6.

Variabilidad circadiana en la frecuencia de episodios extrahospitalarios de parada cardiorrespiratoria

ObjectiveTo evaluate the circadian variability in the frequency and characteristics of out-of-hospital sudden cardiac arrests. MethodsAn observational retrospective study, confined to the Basque Country (Spain), was performed. It was recovered clinical data from cardiologic etiology cardiac arrests considered for resuscitation by basic life support ambulances during 18months. All cases were stratified according to time to emergency alert in 3 sections of 8hours and it was studied the statistical association with the frequency of events and the main characteristics defined in Utstein style records. ResultsWe analyzed 269 events of cardiac arrest. During the first time slot (8:00 to 15:59h) 127 events (47.2%, 95%CI 41.2 to 53.2) were recorded, 93 cases (34.6%, 95%CI 28.9 to 40.3) on the second slot (16:00 to 23:59h) and 49 (18.2%, 95%CI 13.6 to 22.8) in the third (24:00 to7:59h). The 51.2% (95%CI 42.2 to 60.1) of electrocardiographic rhythms detected in the 8:00 to 15:59 time range were shockable, a significantly higher proportion than other time slots. We also founded a lower probability that a bystander initiate any resuscitation to the arrival of the ambulance (14.3%, 95% CI 5.9 to 27.4) during the night (24:00 to 7:59h). ConclusionsThe frequency of events of sudden cardiac death is highest during the morning hours and the probability of having a defibrillation electrocardiographic rhythm. The number of resuscitations performed by bystanders before the arrival of the first medical team is low, especially in the night time.

Heuristic Approach for Optimizing Emergency Medical Services in Road Safety within Large Urban Networks

Emergency medical service (EMS) providers participating in vehicle crash-induced incident management aim to offer as wide and efficient coverage as possible to meet the demand for incident responses effectively; however, the design and provision of efficient and cost-effective services are tough issues faced by emergency management authorities. This paper introduces a double standard model (DSM), along with a genetic algorithm (GA) for assigning EMS fleet from vehicle locations to intersection vehicle crash sites such that crash demand sites can be covered in accordance with two service coverage standards. Specifically, all demand sites are required to receive single coverage according to the secondary coverage standard and at least a portion (α) of demand sites need to maintain single coverage as per the primary coverage standard. The proposed model is applied for top 200 intersections in the City of Chicago selected using intersection crash records for 2004–2010 according to crash frequency-based and severity-based scenarios. The top 200 intersections are split into high and low severity sites for model application. Using the EMS vehicle fleet size currently maintained by the Chicago Fire Department as 15 basic life support (BLS) and 60 advanced life support (ALS) ambulances, almost 100% of double vehicle coverage can be achieved. Extended model application is conducted by keeping 15 BLS ambulances unchanged and reducing the 60 ALS ambulances by 50% to 30. Results show that nearly 90% of double coverage according to the primary standard can still be reached.

Mortality of Non-Transported EMS Patients

Annually, approximately 37% of emergency ambulance calls in Helsinki emergency medical services (EMS) concluded in a nontransport decision. According to clinical experience, nontransport decisions have been estimated to be safe and also economically beneficial. However, mortality of nontransported patients after call has not been studied. The Helsinki Dispatching Center serves the capital city of Helsinki (population 588,500). The dispatching center prioritizes emergency medical calls into four urgency categories from A to D. In this study, we analyzed category A, B, and C calls concluded with a nontransport decision. EMS system provided by the Rescue Department consists of eight Basic Life Support ambulances, which are manned by emergency medical technicians (EMTs), three Advanced Life Support ambulances manned with paramedics, and one medical supervisor unit. One physician-staffed mobile intensive care unit serves on a 24/7 basis.

Risk Stratification-based Surveillance of Bacterial Contamination in Metropolitan Ambulances

We aimed to know the risk-stratification-based prevalence of bacterial contamination of ambulance vehicle surfaces, equipment, and materials. This study was performed in a metropolitan area with fire-based single-tiered Basic Life Support ambulances. Total 13 out of 117 ambulances (11.1%) were sampled and 33 sites per each ambulance were sampled using a soft rayon swab and aseptic containers. These samples were then plated onto a screening media of blood agar and MacConkey agar. Specific identification with antibiotic susceptibility was performed. We categorized sampling sites into risk stratification-based groups (Critical, Semi-critical, and Non-critical equipment) related to the likelihood of direct contact with patients' mucosa. Total 214 of 429 samples showed positive results (49.9%) for any bacteria. Four of these were pathogenic (0.9%) (MRSA, MRCoNS, and K. pneumoniae), and 210 of these were environmental flora (49.0%). However, the prevalence (positive/number of sample) of bacterial contamination in critical, semi-critical airway, semi-critical breathing apparatus group was as high as 15.4% (4/26), 30.7% (16/52), and 46.2% (48/104), respectively. Despite current formal guidelines, critical and semi-critical equipments were contaminated with pathogens and normal flora. This study suggests the need for strict infection control and prevention for ambulance services.

Out-of-hospital cardiac arrest (OHCA) and cardiopulmonary resuscitation in Thessaloniki, Greece, an Utstein style analysis

Purpose of the study: The purpose of this study was to describe the data and outcome of OHCA (according to the Utstein style) in Thessaloniki, which is the second largest city in Greece (population approximately: 1,000,000).1National Statistical Service of Greece. De Facto population of Greece [Census 2001]. Athens: 2003. ISSN: 1106-1499.Google Scholar Materials and methods: Emergency medical service (EMS) in Greece is two-tiered and provides basic life support (BLS) by the ambulance crew (which are in most cases the first responders) and advanced life support (ALS) by a mobile intensive care unit (MICU) with a physician on the head of the crew.2Papaspyrou E. Setzis D. Grosomanidis V. Manikis D. Boutlis D. Ressos C. International EMS systems: Greece.Resuscitation. 2004; 63: 255-259Abstract Full Text Full Text PDF PubMed Scopus (18) Google Scholar The patients of our study were treated over a 5-year period (from January 1, 2000 to December 31, 2004). Automatic external defibrillators (AEDs) were introduced in the standard BLS ambulance equipment after this period. Results: From a total of 1700 cardiac arrests, resuscitation was attempted in 1458 (85.8%) cases, whereas in 242 (14.2%) cases resuscitation was not attempted. Cardiac arrest was witnessed by bystanders in 1470 (86.5%) and by the EMS personnel in 75 (4.4%) cases. Mean EMS arrival time was 8.18 ± 6.8 min for BLS ambulances and 14.59 ± 10.5 min for MICU. Initial rhythm was ventricular fibrillation in 750 (44.1%), ventricular tachycardia in 18 (1.1%), asystole in 858 (50.5%) and other in 74 (4.3%) cases. 596 (40.9%) patients received classical chest compressions, whereas 862 (59.1%) received active compressions decompressions. Return of spontaneous circulation was achieved in 597 (40.9%) patients, whereas in 167 (11.5%) cases, patients were brought to the Emergency Department under cardiopulmonary resuscitation. 149 patients were discharged from hospital (overall survival rate: 10.2%). Conclusion: Our study results that the survival rate after OHCA is relatively poor but in accordance to other similar studies.3Fischer M. Fischer N. Schiittlert J. One-year survival after out-of-hospital cardiac arrest in Bonn city: outcome report according to the ‘Utstein style’.Resuscitation. 1997; 33: 233-243Abstract Full Text PDF PubMed Scopus (134) Google Scholar A further study is now conducted concerning data collected after the AEDs introduction in all BLS vehicles.

Paramedic Intercepts with Basic Life Support Ambulance Services in Rural Minnesota

In rural Minnesota, it is common for paramedics providing advanced life support (ALS) to rendezvous with ambulances providing only basic life support (BLS). These "intercepts" presumably allow for a higher level of care when patients have certain problems or need ALS interventions. The aim of this study was to review and understand the frequency of paramedic intercepts with regard to the actual care rendered and transport urgency (lights and sirens vs. none). All paramedic intercepts occurring between January 2003 and December 2007 for one multi-site emergency medical services (EMS) provider were reviewed for ALS interventions and treatments provided. In addition, the urgency of responses to the dispatch call or "intercept" and transport to a receiving facility were analyzed. During the study period, 1,675 paramedic intercepts occurred and were reviewed. The ALS ambulances responded to the dispatch emergently (lights and sirens) in 97.5% of intercepts (1,633), but emergently transported only 24.2% of the patients (405). Paramedics performed no interventions above BLS levels in 11.6% (194) of the cases. Of the remaining 1,481 patients who received ALS interventions, 955 (64.4%) received no treatment or diagnostic testing other than electrocardiographic monitoring, intravenous access, or both. A significant discrepancy between emergent responses and actual ALS care rendered during intercept calls was demonstrated. Given the significant rate of EMS worker fatalities and transferable patient care costs, further study is needed to determine whether costs and safety are potentially improved by decreasing emergent responses. Future directions include developing or emulating Medical Priority Dispatch System triage protocols for advanced services providing intercepts. In addition, further study of patient outcomes between intercept and non-intercept cases is necessary.

State Requirements for Physician Emergency Medical Services Providers

Objective. To describe requirements of physicians wishing to function as primary field emergency medical services (EMS) providers and variation of these requirements among states. Methods. A simple mailed survey was developed and distributed to all 50 U.S. state EMS directors. The survey gathered information about each state's regulations concerning physicians performing as a primary EMS crew member. Data were entered into a Microsoft Excel spreadsheet and reported using simple descriptive statistics, including proportions and 95%% confidence intervals (CIs). Results. Forty-four (88%%) of the states responded. In 32 states (73%%), physicians can work as a primary member of either a basic life support (BLS) or an advanced life support (ALS) ambulance crew without any specific additional training. In 30 states (68%%), physicians can work as a primary member of either a BLS or an ALS ambulance crew without any specific prehospital certification. All of the reporting states will allow a physician to become certified as an emergency medical technician (EMT) or paramedic and then work as a primary member of a BLS or ALS ambulance crew. Seventy-nine percent allow the provision of physician-level care on BLS ambulances, and 81%% on ALS ambulances. There was no meaningful difference between the training requirements for becoming a certified BLS provider vs. a certified ALS provider. States were significantly less likely to require a skills examination of physicians wishing to become certified as a BLS provider (9%%) compared with those wishing to become certified as an ALS provider (82%%). Conclusion. Most states allow physicians to become certified prehospital care providers, although few states require physicians wishing to work as a primary EMS provider to do so, or even to undergo any specific EMS training. There is no national standardization of the preparatory requirements of physicians wishing to provide in-field EMS.

Treating critical supraventricular and ventricular arrhythmias.

Atrial fibrillation (AF), atrial flutter, AV-nodal reentry tachycardia with rapid ventricular response, atrial ectopic tachycardia and preexcitation syndromes combined with AF or ventricular tachyarrhythmias (VTA) are typical arrhythmias in intensive care patients (pts). Most frequently, the diagnosis of the underlying arrhythmia is possible from the physical examination (PE), the response to maneuvers or drugs and the 12-lead surface electrocardiogram. In unstable hemodynamics, immediate DC-cardioversion is indicated. Conversion of AF to sinus rhythm (SR) is possible using antiarrhythmic drugs. Amiodarone has a conversion rate in AF of up to 80%. Ibutilide represents a class III antiarrhythmic agent that has been reported to have conversion rates of 50-70%. Acute therapy of atrial flutter (Aflut) in intensive care pts depends on the clinical presentation. Atrial flutter can most often be successfully cardioverted to SR with DC-energies <50 joules. Ibutilide trials showed efficacy rates of 38-76% for conversion of Aflut to SR compared to conversion rates of 5-13% when intravenous flecainide, propafenone or verapamil was administered. In addition, high dose (2 mg) of ibutilide was more effective than sotalol (1.5 mg/kg) in conversion of Aflut to SR (70 versus 19%). Drugs like procainamide, sotalol, amiodarone or magnesium were recommended for treatment of VTA in intensive care pts. However, only amiodarone is today the drug of choice in VTA pts and also highly effective even in pts with defibrillation-resistant out-of-hospital cardiac arrest (CA). There is a general agreement that bystander first aid, defibrillation and advanced life support is essential for neurologic outcome in pts after cardiac arrest due to VTA. Public access defibrillation in the hands of trained laypersons seems to be an ideal approach in the treatment of ventricular fibrillation (VF). The use of automatic external defibrillators (AEDs) by basic life support ambulance providers or first responder (FR) in early defibrillation programs has been associated with a significant increase in survival rates (SRs). However, use of AEDs at home cannot be recommended.

A multicasualty event: out-of-hospital and in-hospital organizational aspects.

In a wedding celebration of 700 participants, the third floor of the hall in which the celebration was taking place suddenly collapsed. While the walls remained intact, all three floors of the building collapsed, causing Israel's largest disaster. To study the management of a multicasualty event (MCE), in the out-of-hospital and in-hospital phases, including rescue, emergency medical services (EMS) deployment and evacuation of casualties, emergency department (ED) deployment, recalling staff, medical care, imaging procedures, hospitalization, secondary referral, and interhospital transfer of patients. Data on all the victims who arrived at the four EDs in Jerusalem were collected through medical files, telephone interviews, and hospital computerized information. The disaster resulted in 23 fatalities and 315 injured people; 43% were hospitalized. During the first hour, 42% were evacuated and after seven hours the scene was empty. Ninety-seven basic life support ambulances, 18 mobile intensive care units, 600 emergency medical technicians, 40 paramedics, and 15 physicians took part in the out-of-hospital stage. At the hospitals, about 1,300 staff members arrived immediately, either on demand or voluntarily, a number that seems too large for this disaster. Computed tomography (CT) demand was over its capability. During this MCE, the authors observed "rotating" bottleneck phenomena within out-of-hospital and in-hospital systems. For maximal efficiency, hospitals need to fully coordinate the influx and transfer of patients with out-of-hospital rescue services as well as with other hospitals. Each hospital has to immediately deploy its operational center, which will manage and monitor the hospital's resources and facilitate coordination with the relevant institutions.

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care