Current Emergency Medical Services Research Articles

49 Exploring Current Emergency Medical Services Approaches to Manage Agitated Older Adult Patients: A Comprehensive Analysis of Statewide Protocols

49 Exploring Current Emergency Medical Services Approaches to Manage Agitated Older Adult Patients: A Comprehensive Analysis of Statewide Protocols

Improving urban emergency medical service systems through brownfield transformation in Huangshi, China

A comprehensive emergency medical service (EMS) system significantly enhances a city’s capacity to prevent and mitigate disasters. Using Huangshi as a case study, this research evaluated the service radium coverage rate of the current EMS system by examining its transport capacity, population density, and prevalence rate, finding it to be only 61.49% with an inefficient spatial layout. To address this, we proposed transforming urban brownfields into EMS parks. By selecting the most suitable brownfields based on capacity and service radius, we increased the coverage rate to 90.21%. We introduced a new "consultation-referral" model, where existing EMS facilities serve as pre-diagnosis and triage centers, and the urban brownfield EMS parks function as isolation and centralized treatment centers. GIS network analysis confirmed the feasibility, showing all transit times to be under 30 min. The methodology outlined in this study—comprising "demand assessment, supply optimization, and feasibility verification"—not only strengthens the city’s EMS system but also facilitates the renewal of urban brownfields. This approach can serve as a valuable reference for enhancing EMS systems in other cities.

Disposition Outcomes Following Prehospital Use of Naloxone in a Large Metropolitan City in the United States

Objectives During a drug overdose, research suggests individuals may not call 9-1-1 out of fear of criminal justice concerns. Of those that call, research is inconclusive about the disposition of the emergency transport. We evaluated transport outcomes for adults with opioid-related overdose in the Emergency Medical Services (EMS) of a large metropolitan city in the United States. Methods We reviewed the EMS incident report database from the patient care record system for years 2018 to 2022. We queried all records, searching for relevant terms, and two reviewers cross-checked the database to identify cases that did not result in death at the scene. Study outcome was defined as hospital transportation or no transportation. Multivariable logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI) for hospital transport with patient age, sex, race and ethnicity as the independent variables. Results We identified 5,482 cases of nonfatal opioid-related overdose. Of these, 4,984 (90.9%) were transported to the hospital; 37 (0.7%) were placed in police custody; 304 (5.5%) were not transferred; and 157 (2.9%) had unknown outcomes. Among 5,288 with data on the transport outcome, the majority were male (65%), and the highest proportion were White (39%). Compared to those who were not transported, each 1-year increase in age was related to a 2% increase in the odds of transportation (OR: 1.02, 95% CI: 1.01-1.02). Compared to White patients, Black and Hispanic patients were 43% OR: 1.43, 95% CI: 1.07-1.90) and 44% (OR: 1.44, 95% CI: 1.03-2.00) more likely to be transported. Conclusions Individuals with suspected opioid-related overdose who call 9-1-1 are most often transported to the hospital. Current EMS procedures are successful at on-scene treatment and transportation; however, data on the long-term impact of opioid-related overdoses are still needed.

Implications of interhospital patient transfers for emergency medical services transportation systems in the Netherlands: a retrospective study

ObjectivesInterhospital patient transfers have become routine. Known drivers are access to specialty care and non-clinical reasons, such as limited capacity. While emergency medical services (EMS) providers act as main patient...

Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices.

Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs. States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables. Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states. This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients' care.

Prehospital Care Standards in the Federal Wildland Fire Service

Abstract Objective Defining the role of federal wildland firefighters (WFF) in the context of emergency medical services (EMS) is a gap in the literature. Our work highlights the importance of standardizing and enhancing the EMS capabilities of federal WFF for their own occupational safety and well-being, while emphasizing their potential for responding to all disasters and providing medical safety net in rural communities. Methods A comprehensive academic literature review on the topic returned one non-peer reviewed manuscript. Study members analyzed National Wildfire Coordinating Group (NWCG) EMS policy to assess current EMS standards within the WFF service. Results The study reveals a lack of standardized, comprehensive support for EMS capabilities among federal WFF, despite need for their expertise in wide-ranging emergency situations. There are few incentives for individuals to obtain and maintain EMS certification. Various innovations, such as the Alaska Fire Medic Program and the BLM Operational Medical Support Program, are potential models for improving EMS across the entire NWCG. Conclusions To enhance the safety, professionalization, and efficiency of WFF, the NWCG should consider standardizing EMS guidelines, especially in providing consistent support for medical certifications. EMS certified WFF could contribute to nationwide disaster response capabilities if supported by NWCG.

Emergency Medical Services in Taiwan: Past, Present, and Future.

This review assessed the development of Taiwan's emergency medical services (EMS) and focused on the optimizing initiatives of the EMS systems, the current state of Taiwan's EMS system, EMS benchmarks in different regions of Taiwan, EMS response during the coronavirus disease 2019 (COVID-19) pandemic, and future design. In the past decade, there has been a noticeable increase in prehospital services, numerous optimizing initiatives to improve patient prognosis, and the medical oversight model. Taiwan's current EMS system, including the dispatch system, out-of-hospital cardiac arrest (OHCA) patient management, time-sensitive critical illness in prehospital settings, and disaster response, has undergone significant improvements. These improvements have been demonstrated to have a measurable impact on patient outcomes, as supported by medical literature. Each region in Taiwan has developed a unique EMS system with local characteristics, such as the implementation of the Global Resuscitation Alliance 10 steps for OHCA-related quality control, hearing automated external defibrillator program, a five-level prehospital triage system, an island-hopping strategy for patients with major trauma, dispatcher-assisted teamwork for OHCA resuscitation, and optimized prehospital care for acute coronary syndrome patients. In response to the COVID-19 pandemic from 2019 to 2023, Taiwan's EMS implemented measures to combat the outbreak such as interagency collaboration to obtain patient's personal information, to optimize prehospital management initiatives, and to provide financial compensation and personal insurance for emergency medical technicians. The areas that need focus include integrating prehospital and in-hospital information to build a national-level database (One-Stop Emergency Management), increasing public awareness of first responders and emergency casualty care, and evolving the EMS system by incorporating private EMS system, initiating school-based education of paramedicine, and legally recognizing paramedics as medical and health care personnel. By improving these areas, we can better prepare for the future and ensure that Taiwan's EMS system continues to provide high-quality care to those in need.

Reinventing Medical Hazardous Materials Response for Radiological Emergencies: Building Resiliency in Emergency Medical Response Systems Through a Novel Approach to Education and Training

Introduction:The past three years have included multiple Public Health Emergencies of International Concern (PHEIC) and dramatically impacted all facets of Emergency Medical Response. During this time, simultaneous crises have demonstrated the value of the non-traditional responder in mitigating complex incidents. Current geopolitical climate has proliferated nuclear power and increases the necessity for readiness and awareness for radiological incidents. These are complex incidents a responder may face and requires even the lowest skilled practitioner to be fully engaged before special operations intervention.Limited research exists to determine whether current emergency medical services (EMS) training supplies the competency necessary to ensure safety of the prehospital provider during a radiological incident. Forthcoming research will investigate the effectiveness of this current training within the United States.Method:Survey data will be collected from multiple providers across the United States to evaluate their confidence level on two primary objectives during a radiological incident: competency of personal protective equipment donning and doffing, and management of contaminated patients.Data analyses of survey responses help drive future proposed educational activities that will be compliant with best practices set forth by organizations such as the United States Department of Health and Human Services Radiation Emergency Medical Management (REMM), the National Fire Protection Agency (NFPA), and Radiation Emergency Assistance Center/ Training Site (REAC/TS).Results:Data will be collected by survey responses to evaluate a diverse range of EMS services. Details such as skill level, type of EMS service, catchment of communities served, and their impressions upon the training will be analyzed.Conclusion:This is an ongoing project that will embrace the perspectives of the diverse group of delegates of WADEM throughout and become enriched through the organization's wealth of knowledge. Gaps highlighted during roll-out of this research can also be used to address logistics, doctrine, and policy shortfalls.

救急隊員の活動時の動作解析に基づく新たな活動服下衣の設計とその効果

The design for emergency medical personal uniforms should include not only “aesthetics and solidarity” required as uniforms, but also “functionality” necessary for emergency operations. Questionnaires and motion analysis were conducted to understand the current situation and identify problems with the current emergency medical services uniform (pants) to emergency medical services personnel and analysis of their movements during drills. With introduction of materials and textile structures that can follow dynamic motions (e.g., stretch), new designs for emergency medical personal uniforms and its effectiveness by clothing pressure measurement have been investigated. The results showed (1) A larger clothing pressure acts in the crouching exercise than that in the one-leg-raising exercise, (2) The stretchable fabric reduced overall clothing pressure on the lower limbs of the human body during both the one-leg-raising and crouching exercises, (3) The knee tack and the lumbar yoke reduced clothing pressure on the lower limbs of the human body locally.

332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

332 The Hidden Factors of Health: A Mixed Methods Study of EMS Provider Knowledge and Perceptions of Social Risk Factors

140 Factors Influencing Emergency Medical Services Burnout

140 Factors Influencing Emergency Medical Services Burnout

The Role of Drones in Out-of-Hospital Cardiac Arrest: A Scoping Review.

Drones may be able to deliver automated external defibrillators (AEDs) directly to bystanders of out-of-hospital cardiac arrest (OHCA) events, improving survival outcomes by facilitating early defibrillation. We aimed to provide an overview of the available literature on the role and impact of drones in AED delivery in OHCA. We conducted this scoping review using the PRISMA-ScR and Arksey and O’Malley framework, and systematically searched five bibliographical databases (Medline, EMBASE, Cochrane CENTRAL, PsychInfo and Scopus) from inception until 28 February 2022. After excluding duplicate articles, title/abstract screening followed by full text review was conducted by three independent authors. Data from the included articles were abstracted and analysed, with a focus on potential time savings of drone networks in delivering AEDs in OHCA, and factors that influence its implementation. Out of the 26 included studies, 23 conducted simulations or physical trials to optimise drone network configuration and evaluate time savings from drone delivery of AEDs, compared to the current emergency medical services (EMS), along with 1 prospective trial conducted in Sweden and 2 qualitative studies. Improvements in response times varied across the studies, with greater time savings in rural areas. However, emergency call to AED attachment time was not reduced in the sole prospective study and a South Korean study that accounted for weather and topography. With growing interest in drones and their potential use in AED delivery spurring new research in the field, our included studies demonstrate the potential advantages of unmanned aerial vehicle (UAV) network implementation in controlled environments to deliver AEDs faster than current EMS. However, for these time savings to translate to reduced times to defibrillation and improvement in OHCA outcomes, careful evaluation and addressing of real-world delays, challenges, and barriers to drone use in AED delivery is required.

Emergency medical services in rural and urban Saudi Arabia: A qualitative study of Red Crescent emergency personnel' perceptions of workforce and patient factors impacting effective delivery.

Individuals who experience a traumatic injury or an acute illness are often reliant on initial healthcare assessment and support from a pre-hospital emergency medical service (EMS). These community-based support models perform a vital role in the provision of life-saving support, but research indicates that the availability, accessibility and resources of EMS are not equivalent in rural and urban areas, and there has been little recognition of the issues facing rural EMS provision outside of the USA, Europe and Australia. The purpose of the current study was to examine the lived experiences of Saudi Arabian EMS personnel, defined as emergency medical technicians, paramedics and local station managers. A semi-structured interview approach was used to collect data from 20 interviewees (10 each with rural and urban personnel) in the Riyadh region of the Kingdom of Saudi Arabia. This methodology was used to identify the key issues that these staff face in their day-to-day work practice and ascertain factors that may lead to service delivery issues in rural and urban areas. Data analyses identified three thematic categories impacting EMS delivery; two of these, Personnel Factors and Patient Factors, are the focus of this paper. The participants noted a number of key issues, including a lack of appropriate local training and limited resources in rural areas, as well as general areas of concern regarding the wider EMS staff demographic makeup and poor public awareness about the exact role of the EMS. Three key recommendations arising from this study include specialised training and ongoing accessible education for rural EMS staff to allow for better support for patients; consideration of supplementing the current EMS with additional external specialist staff; and the development and implementation of national public education programmes focusing on the role of the EMS within the community.

Optimization of the Pre-Hospital Rescue System for Out-of-Hospital Cardiac Arrest in China.

Out-of-hospital cardiac arrest (OHCA) presents a significant public health challenge in China. A sharp contrast in survival rate after OHCA exists between China and more developed countries. Due to the short life-saving time window, emergency medical services (EMS) and bystanders peripheral to EMS are key contributors to survival after OHCA. Here we discuss limitations and challenges for current EMS in rescuing OHCA by reviewing requirements for EMS in China. We call for an updated public health-based pre-hospital rescue system that includes establishing a cardiac arrest registry, promoting a “Three Early’s” campaign [early dialing of emergency hotline 120, early cardiopulmonary resuscitation (CPR), and early defibrillation], and operating a mechanism comprised of professional public health institutions (EMS, CDC, specialized disease prevention and control institutions, and health education institutions) as well as many governmental departments, such as healthcare, industry and information technology, and education, and non-governmental organizations, such as the Red Cross Society. Following the optimization of the pre-hospital rescue system and the participation of the whole population in self-rescue and mutual rescue, we believe that a dramatic improvement in OHCA survival will come about in China.

Effect of topography and weather on delivery of automatic electrical defibrillator by drone for out-of-hospital cardiac arrest

Delivery of automatic electrical defibrillator (AED) by unmanned aerial vehicle (UAV) was suggested for out-of-hospital cardiac arrest (OHCA). The goal of this study is to assess the effect of topographic and weather conditions on call to AED attach time by UAV-AED. We included OHCA patients from 2013 to 2016 in Seoul, South Korea. We developed a UAV-AED flight simulator using topographic information of Seoul for Euclidean and topographic flight pathway including vertical flight to overcome high-rise structures. We used 4 kinds of UAV flight scenarios according to weather conditions or visibility. Primary outcome was emergency medical service (EMS) call to AED attach time. Secondary outcome was pre-arrival rate of UAV-AED before current EMS based AED delivery. Call to AED attach time in topographic pathway was 7.0 min in flight and control advanced UAV and 8.0 min in basic UAV model. Pre-arrival rate in Euclidean pathway was 38.0% and 16.3% for flight and control advanced UAV and basic UAV. Pre-arrival rate in the topographic pathway was 27.0% and 11.7%, respectively. UAV-AED topographic flight took longer call to AED attach time than Euclidean pathway. Pre-arrival rate of flight and control advanced UAV was decreased in topographic flight pathway compared to Euclidean pathway.

Status of US Emergency Medical Service Protocols Regarding Pre-Transfer Cooling for Exertional Heat Stroke

Objective: Exertional heat stroke (EHS) is a significant cause of morbidity and mortality in athletes and active individuals. In the field, initial management of exertional heat illness is based on rapid whole-body cooling. Cold-water immersion (CWI) is considered the superior cooling modality for EHS treatment. However, there often is a disconnect between the sports medicine community and the emergency medical service (EMS) community. Well-written emergency action plans may fail if EMS protocols do not allow for CWI in initial management. This is the first study to look at the current national EMS protocols regarding prehospital management of EHS. The purpose of our study was to assess the status of heat illness protocols regarding CWI for EHS in all 50 states plus Washington, DC. Methods: An internet search was performed to find EHS protocols. Statewide protocols were preferred. Several parameters were recorded for each protocol including whether: 1) CWI was the recommended cooling treatment for EHS and 2) CWI was explicitly permitted to be completed prior to transportation.Results: We found nine of the 51 protocols, or 17.6%, explicitly recommended CWI and 11 of the 51, or 21.6%, specifically instructed EMS personnel to complete CWI or cooling methods prior to transport. However, six protocols, or 11.8%, provided the recommendation instructing some variation of the phrase “do not delay transport to cool the patient.”Conclusion: Despite the medical literature endorsing CWI as the most effective treatment modality in a prehospital setting for exertional heat illness, EMS protocols largely fail to reflect this which leads to mismanagement and inadequate care of EHS patients. While CWI is not always available, all EMS protocols should include a systematic practical guideline for a heat illness patient when employing cooling treatment with an emphasis on CWI when available as the preferred treatment technique for EHS and the concept of “cool first, transport second.”

Review of Emergency Medical Services Vulnerability to High Consequence Infectious Disease in the United States.

Purpose: Emergency medical services (EMS) responders are a group of medically skilled professionals who perform a wide range of essential medical services within a community including emergency response, patient transport, and mobile integrated healthcare. The proper functioning of the EMS system is paramount to the well-being of the medical system and public health. The intent of this paper is to review current EMS standards and practice to determine the danger a high consequence infectious disease (HCID) may pose to these healthcare workers and the community.Areas Addressed: Through the review of EMS practice several areas were identified as vulnerabilities to the EMS network. These vulnerabilities consisted of the lack of standardized licensing practice, inconsistent medical direction, and the inability to properly implement the use of personal protective equipment (PPE). The compounding of these vulnerabilities allows for HCIDs to pose a serious threat to EMS personnel with the possibility of devastating and crippling the EMS infrastructure within the US.Discussion: The vulnerabilities identified must be addressed both to protect EMS providers and to enhance the resilience of the US healthcare system. Ways to address the identified vulnerabilities should focus on improving the EMS curriculum and increasing minimum levels of education for first responders. Targeting minimum education and training standards could be the most effect method of reducing the dangers of HCIDs to EMS systems.

Emergency Medical Services Communication Barriers and the Deaf American Sign Language User

Objective: We sought to identify current Emergency Medical Services (EMS) practitioner comfort levels and communication strategies when caring for the Deaf American Sign Language (ASL) user. Additionally, we created and evaluated the effect of an educational intervention and visual communication tool on EMS practitioner comfort levels and communication. Methods: This was a descriptive study assessing communication barriers at baseline and after the implementation of a novel educational intervention with cross-sectional surveys conducted at three time points (pre-, immediate-post, and three months post-intervention). Descriptive statistics characterized the study sample and we quantified responses from the baseline survey and both post-intervention surveys. Results: There were 148 EMS practitioners who responded to the baseline survey. The majority of participants (74%; 109/148) previously responded to a 9-1-1 call for a Deaf patient and 24% (35/148) reported previous training regarding the Deaf community. The majority felt that important details were lost during communication (83%; 90/109), reported that the Deaf patient appeared frustrated during an encounter (72%; 78/109), and felt that communication limited patient care (67%; 73/109). When interacting with a Deaf person, the most common communication strategies included written text (90%; 98/109), friend/family member (90%; 98/109), lip reading (55%; 60/109), and spoken English (50%; 55/109). Immediately after the training, most participants reported that the educational training expanded their knowledge of Deaf culture (93%; 126/135), communication strategies to use (93%; 125/135), and common pitfalls to avoid (96%; 129/135) when caring for Deaf patients. At 3 months, all participants (100%, 79/79) reported that the educational module was helpful. Some participants (19%, 15/79) also reported using the communication tool with other non-English speaking patients. Conclusions: The majority of EMS practitioners reported difficulty communicating with Deaf ASL users and acknowledged a sense of patient frustration. Nearly all participants felt the educational training was beneficial and clinically relevant; three months later, all participants found it to still be helpful. Additionally, the communication tool may be applicable to other populations that use English as a second language.

Nontransported Cases after Emergency Medical Service Callout in the Rural and Urban Areas of the Riyadh Region.

Background:Callouts resulting in patient nontransportation can impact the overall quality of prehospital Emergency Medical Service (EMS), as resources in health care are finite. While some studies have investigated the causes of nontransportation, few have examined whether there are differences between urban and rural patients. Similarly, there has been limited research focused on rural EMS in locations such as the Middle East.Objectives:This study investigated EMS cases that resulted in nontransportation in the urban and rural areas of the Riyadh region in the Kingdom of Saudi Arabia.Methods:A cross-sectional study of 800 (400 rural and 400 urban) patient records was undertaken, using 12 months (January 1 to December 31, 2017) of data from the Saudi Red Crescent EMS. A random sampling method was used to select ambulance records from the 78 urban and rural EMS stations in the Riyadh region, with demographic data and reasons for patient nontransport analyzed comparatively.Results:A total of 310 cases were nontransported (39%) (rural: 146; urban = 164). The highest rates of nontransportation cases were of medical and trauma callouts (44.6% and 39.6%, respectively), which was consistent in both areas. The most common reason for nontransportation in both urban and rural areas was refusal of treatment and transportation (66.5% and 59.9%, respectively). Further, 10 patients were treated on-scene and released by rural EMS, while no urban patients were treated and released. Overall, the case presentations of nontransported patients did not differ significantly between both areas, and it was found that gender, age, and geographic location were not predictors for nontransportation.Conclusions:The high rate of nontransportation, particularly in medical and trauma callouts, indicates that a review of current EMS protocols may be required, along with consideration of relevant community education programs.

Generating a spatial coverage plan for the emergency medical service on a regional scale: Empirical versus random forest modelling approach

Adequate spatial coverage by the emergency medical service and the ability to reach any location in the area of interest in the shortest possible time are crucial for the survival of patients with serious conditions. Knowledge of blind spots (i.e. sites that cannot be reached within the required time) represents key information for improving the service quality and may lead, e.g. to a relocation of bases or to other active interventions. Spatial coverage can be derived from experience based on historical data. Such an approach may be problematic if a larger area is being analysed, especially if data is not available for some parts of such areas or if no data is available. To eliminate such problems, we created a prediction model utilising the random forest ensemble learning method. The model is capable of predicting the travel time based on available historical data on ambulance movements (GPS) and the geometric and construction characteristics of individual road segments. We therefore collaborated with the regional public administration and emergency medical service authorities to deliver a time- and resource-efficient solution for emergency spatial planning practice. The outputs from the newly built model were subsequently validated against data from an empirical model currently used by the regional authorities. The results from both models were compared from the perspective of performance in various seasonal and time-of-day conditions. The prediction of travel times using the new model improved according to all the evaluated validation metrics. The importance and applicability of the foregoing model lies in the fact that it can be incorporated into the current emergency medical service management system in a simple manner in terms of data availability and the required computational resources. We conclude that the dynamic model presented in this paper represents an improvement relative to the reference data, and discuss the possibilities of further improving the proposed model.