Emergency Medical Services Delivery Research Articles

The Role of Informatics in Advancing Emergency Medicine: A Comprehensive Review.

Emergency Medicine Informatics (EMI) is a rapidly advancing field that utilizes information technology to enhance the delivery of emergency medical services. This comprehensive literature review explores the key components, benefits, challenges, and future directions of EMI. By integrating Electronic Health Records, Clinical Decision Support Systems, telemedicine, data analytics, interoperability, and patient monitoring systems, EMI has the potential to significantly improve patient outcomes and operational efficiency in emergency departments. However, the implementation of these technologies faces several obstacles, including interoperability issues, data security concerns, usability challenges, and high costs. This review highlights how these technologies are transforming emergency care, discusses the barriers to their implementation, and provides perspectives on potential solutions and future progress in the field.

Community First Responders' Contribution to Emergency Medical Service Provision in the United Kingdom.

We aimed to investigate community first responders' contribution to emergency care provision in terms of number, rate, type, and location of calls and characteristics of patients attended. We used a retrospective observational design analyzing routine data from electronic clinical records from 6 of 10 ambulance services in the United Kingdom during 2019. Descriptive statistics, including numbers and frequencies, were used to illustrate characteristics of incidents and patients that the community first responders attended first in both rural and urban areas. The data included 4.5 million incidents during 1 year. The community first responders first attended a higher proportion of calls in rural areas compared with those in urban areas (3.90% versus 1.48 %). In rural areas, the community first responders also first attended a higher percentage of the most urgent call categories, 1 and 2. The community first responders first attended more than 9% of the total number of category 1 calls and almost 5% of category 2 calls. The community first responders also attended a higher percentage of the total number of cardiorespiratory and neurological/endocrine conditions. They first attended 6.5% of the total number of neurological/endocrine conditions and 5.9% of the total number of cardiorespiratory conditions. Regarding arrival times in rural areas, the community first responders attended higher percentages (more than 6%) of the total number of calls that had arrival times of less than 7 minutes or more than 60 minutes. In the United Kingdom, community first responders contribute to the delivery of emergency medical services, particularly in rural areas and especially for more urgent calls. The work of community first responders has expanded from their original purpose-to attend to out-of-hospital cardiac arrests. The future development of community first responders' schemes should prioritize training for a range of conditions, and further research is needed to explore the contribution and potential future role of the community first responders from the perspective of service users, community first responders' schemes, ambulance services, and commissioners.

The Child Opportunity Index and Pediatric Emergency Medical Services Utilization

Background: The delivery of emergency medical services (EMS) is a resource-intensive process, and prior studies suggest that EMS utilization in children may vary by socioeconomic status. The Child Opportunity Index (COI) provides a multidimensional measure of neighborhood-level resources and conditions that affect the health of children. We evaluated EMS utilization and measures of acuity among children by COI. Methods: We performed a cross-sectional study using encounters for patients less than 18 years of age from 10,067 EMS agencies in 47 US states and territories contributing to the National Emergency Medical Services Information System 2019 dataset. We compared patient demographics, EMS encounter characteristics, and care provided to children stratified by ZIP code using the COI 2.0. Results: We included 1,293,038 EMS encounters (median age 10 years, IQR 3–15 years). The distributions of encounters in the five tiers of COI were 30.6%, 20.1%, 18.0%, 16.3% and 15.1%, (from Very Low to Very High, respectively). The distribution of diagnoses between groups was similar. Most measures of EMS acuity/resource use were similar between groups, including non-transport status, cardiac arrest, vital sign abnormalities, and EMS-administered procedures and medications. Among children with respiratory-related encounters, children in the Very Low group had a greater need for nebulized medications (26.4% vs 18.3% in Very High COI children). Among children with trauma, a lower proportion in the Very Low group were given analgesia (4.0% vs 7.4% in the Very High group), though pain scores were similar in all groups. Conclusion: Pediatric EMS encounters from lower COI neighborhoods occur more frequently relative to encounters from higher COI neighborhoods. Despite these differences, children from lower COI strata generally have similar encounter characteristics to those in other COI strata, suggestive of a greater number of true out-of-hospital emergencies among children from these areas. Notable differences in care included use of respiratory medication to children with respiratory diagnoses, and administration of pain medication to children with trauma.

Designing an App to Overcome Language Barriers in the Delivery of Emergency Medical Services: Participatory Development Process.

BackgroundIn emergencies, language barriers may have dangerous consequences for the patients. There have been some technical approaches to overcome language barriers in medical care but not yet in the prehospital emergency care setting. The use of digital technologies in health care is expanding rapidly. Involving end users at all stages of the development process may help to ensure such technologies are usable and can be implemented.ObjectiveWe aimed to develop a digital communication tool that addresses paramedic needs in the specific circumstances of prehospital emergency care and helps paramedics to overcome language barriers when providing care to foreign-language patients.MethodsWe actively engaged paramedics and software designers in an action-oriented, participatory, iterative development process, which included field observations, workshops, background conversations, questionnaires on rescue missions, studying the literature, and preliminary testing in the field.ResultsWith input from paramedics, we created an app with 600 fixed phrases supporting 18 languages. The app includes medical history–taking questions, phrases asking for consent, and phrases providing specific additional information. Children as patients, as well as their carers and other third parties, can be addressed with appropriate wording. All phrases can be played back audibly or displayed as text. The comprehensive content is grouped into categories and adapted to diverse scenarios, which makes the tool rapidly usable. The app includes a function to document patient responses and the conversation history. For evaluation in a clinical study, the app is run on a smartphone with extra speakers to be of use in noisy environments. The use of prototypes proved valuable to verify that the content, structure, and functions discussed in theory were of value and genuinely needed in practice and that the various device control elements were intuitive.ConclusionsThe nature of the paramedic work environment places specific demands on the communication options used and need for such devices. The active involvement of paramedics in the development process allowed us to understand and subsequently consider their experience-based knowledge. Software designers could understand the paramedics’ work environment and consider respective needs in the menu navigation and design principles of the app. We argue that the development of any medical software product should actively involve both end users and developers in all phases of the development process. Providing the users with the opportunity to influence technology development ensures that the result is closer to their needs, which can be seen as crucial for successful implementation and sustainable use.Trial RegistrationGerman Clinical Trials Register DRKS00016719; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00016719International Registered Report Identifier (IRRID)RR2-10.1186/s12913-020-05098-5

Comparison of pre-hospital emergency services time intervals in patients with heart attack in Arak, Iran.

:Background:After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables.Methods:This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13.Results:The total number of heart attack patients registered in Arak emergency medical services was 2,659 of which 51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3:30, 7:56, 15:15, 13:34, 11:07, 12:11, and 41:25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April.Conclusions:The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

Drones for Automated External Defibrillator Delivery: Where Do We Stand?

Out-of-hospital cardiac arrest (OHCA) is an important cause of mortality and disability worldwide. The health care community hoped that, with the development of the automated external defibrillator (AED), the mortality and functional outcomes of patients with OHCAs would improve. Despite their effectiveness, their use in OHCA has not yet become common practice. Unfortunately, in 18-59% of cases, public access AEDs were deemed to be in poorly accessible areas or not available all of the time. We present the existing literature on the implementation of drone delivery of AEDs to improve the response time of the emergency medical services. Test flights and mathematical/geographic models have been used to assess the effectiveness of drones in delivering AEDs to patients with OHCA. The results of those studies showed promising outcomes given that drone usage led to improved delivery times of AEDs compared with emergency medical services delivery. While drones have the potential to dramatically improve cardiac arrest patient care, further studies are needed to evaluate their effectiveness in real-life clinical scenarios.

Advanced Placement Paramedic Education for Health Care Professionals: A Descriptive Evaluation

IntroductionThe delivery of emergency medical services is primarily performed by emergency medical technicians and paramedics in the United States. More recently, nurses and physicians have become more involved in the delivery of emergency medical services. Advanced placement paramedic education bridging programs have been developed to prepare the workforce, but the success of these programs is unknown. This study evaluated the demographics and performance of nonemergency medical services health care professionals who attended an advanced placement paramedic education program at a Midwestern university. MethodsThis was a retrospective evaluation of student data from 2007 to 2017. Descriptive statistics were used to tabulate demographics, program performance, and individual performance in the National Paramedic Certification Examination. ResultsThe program admitted 305 students; registered nurses (95%) were the majority of students. Of the 305 admitted students, 271 (88.9%) fulfilled all program requirements and were eligible to take the National Registry of Emergency Medical Technicians paramedic certification examination. Of these 271 eligible students, 201 (74.2%) took the National Paramedic Certification Examination. A total of 195 (97%) obtained certification at the first test attempt, whereas 200 (99.5%) obtained certification within 3 attempts. Of the 200 who passed the test, 175 (88%) successfully demonstrated entry-level competency in paramedic-level psychomotor testing. DiscussionThe advanced placement paramedic program evaluated in this study had high rates of successful program completion, as well as high first-time and cumulative passing rates for the National Paramedic Certification Examination. Further research is needed to identify the best practices in determining student requirements and the methodologies in delivering advanced placement paramedic education bridging programs.

Does harmonization of payment mechanisms enhance equitable health outcomes in delivery of emergency medical services in Thailand?

There are different reimbursement rates by the various insurance schemes in Thailand, which include the Universal Coverage scheme (UCS), civil servant medical benefit scheme (CSMBS) and social security scheme (SSS). Hence, there are concerns about inequitable care standards. Harmonization of the rates of emergency medical services has been started since April 2012. This study analyzed the impact of harmonization on clinical outcomes in private hospitals. Analysis of 22 900 records of the dataset accrued from April 2012 to June 2013 using multiple logistic modelling revealed that beneficiaries under UCS were the worst off [Odds ratio 2.56 95% of confidence interval: 2.35 to 2.80 for non-trauma and 2.19 (1.59-3.0) for trauma, corresponding to 21.26 and 25.09% of bad outcomes, respectively] in terms of not improved or dead outcomes at discharge compared with those under the CSMBS (8.45 and 12.78%, respectively) controlling for age, sex, hospital location, triage priority code, length of stays and adjusted Relative weight (RW) score. Using propensity score, matching analysis found the outcome rates of not improved including dead were highest in UCS 26.27% for trauma and 21.26% for non-trauma patients. Payment mechanism alone is inadequate to ensure equitable distribution of health outcomes in provision of emergency medical care by private providers in urban settings across the country. A secondary finding was that patients accessing hospital services directly showed better improvement or lower in-hospital mortality compared with access through formal pre-hospital means (P < 0.001). Plausible explanations have been discussed with policy implications and recommendations for further studies.

Medical Care for Mass Gathering Events

A “mass gathering”—which is any event where a large number of people are involved in a coordinated activity—is different from a “mass casualty,” which is defined by the number and severity of injuries. Planning for the delivery of emergency medical services at large-scale public events are reviewed in this article.

A Review on Development and Optimization of Emergency Medical Services in Malaysia

This paper presents a review on emergency medical services delivery in Malaysia. The background and the development of emergency medical services in Malaysia are highlighted. Emergency medical services delivery in Malaysia is currently categorized as in developing phase. The efficiency of the delivery in Malaysia is lagged behind other developed countries. Moreover, we also explain the current problems of emergency medical services in Malaysia. The related works to optimize the delivery of emergency medical services in Malaysia are also discussed.

Racial Disparities in Healthcare: Are We Prepared for the Future? Brief Report on Emergency Medical Services in a County Health Department in California

Demographic trends indicate that ethnic minority populations constitute 25 percent of the current population and will be the majority of the United States population in 2050. Forty percent of the demographic in California are ethnic minorities making encounters between healthcare workers and patients from different cultural backgrounds commonplace. Research also indicates that ethnic minority patients are more likely to utilize emergency medical services as an entry point into the health system due to lack of medical insurance and access to primary care. Our qualitative study attempts to understand health disparities through focus groups with 76 patients and their feedback on the use of emergency medical services. Patients revealed challenges in both service provision and delivery of emergency medical services. Implications include the development of cultural competence training programs and the selection of diverse groups of county emergency medical first responders in California.

Models of International Emergency Medical Service (EMS) Systems

An Emergency Medical Service (EMS) can be defined as “a comprehensive system which provides the arrangements of personnel, facilities and equipment for the effective, coordinated and timely delivery of health and safety services to victims of sudden illness or injury.” 1 The aim of EMS focuses on providing timely care to victims of sudden and life-threatening injuries or emergencies in order to prevent needless mortality or long-term morbidity. The function of EMS can be simplified into four main components; accessing emergency care, care in the community, care en route, and care upon arrival to receiving care at the health care facility. 2 Today’s global EMS has advanced so much that it contributes widely to the overall function of health care systems. The World Health Organization regards EMS systems as an integral part of any effective and functional health care system. 3 It is the first point of contact for the majority of people to health care services during emergencies and life-threatening injuries and act as a gate-keeping step for accessing secondary and tertiary services. Emergency medical providers around the world have developed an extended role to deal with medical and trauma emergencies utilizing advanced clinical technology. In many countries where proper EMS system exists, providers can administer controlled medications such morphine and epinephrine, perform invasive procedures for instance, endotracheal intubation and placement of intravenous line, and make complex clinical judgment or even pronounce death. 4,5 The rapid development of medical technology has also reformed the international EMS systems with the introduction of multifunctional compact monitoring systems making the task of monitoring patients manageable in an uncontrolled environment of pre-hospital settings. Since 1970s, the mode of emergency health care delivery in pre-hospital environment evolved around two main models of EMS with distinct features. These are the Anglo-American and the Franco-German model. These categorical distinctions were obvious during the 1970s until the end of the 20th century. Today, most EMS systems around the world have varied compositions from each model. The delivery of emergency medical services in pre-hospital settings can be categorized broadly into Franco-German or Anglo

Out-of-hospital cardiac arrest surveillance in Canada: a survey of national resources

The general objective of this study was to explore the challenges of establishing an out of hospital cardiac arrest (OOHCA) surveillance program in Canada. More specifically, we attempted to determine the organizational structure of the delivery of emergency medical services (EMS) in Canada, describe the cardiac arrest data collection infrastructure in each province and determine which OOHCA variables are being collected. We conducted a national survey of 82 independent EMS health authorities in Canada. Methodology experts developed the survey and distribution using a modified Dillman technique. We distributed 67 surveys electronically (84%) and the rest by regular mail. We weighted each survey response by the population of the catchment area represented by the responding health authority (2004 census). Descriptive statistics are reported. We received 60 completed surveys, representing a 73% response rate. The responding health authorities' catchment areas represented 80% of the Canadian population (territories excluded). Our survey results highlight a lack of common OOHCA data definitions used among health authorities, sporadic use of data quality assurance procedures, rare linkages to in hospital survival outcomes and potential confidentiality issues. Other challenges raised by respondents included determining warehousing location and finding financial resources for a national OOHCA registry. Results from this survey demonstrate that, although it is challenging, it is possible to collect OOHCA data and access in hospital survival outcomes. Collaborative efforts with the Resuscitation Outcomes Consortium and other potential provincial partners should be explored.

167: A Novel Civilian-Military Partnership in Emergency Medical Services During a Prolonged Disaster: Patient Characteristics, Resource Utilization, and Future Recommendations

1) To describe an unprecedented civilian-military partnership in the delivery of emergency medical services (EMS) in a disaster area. 2) To describe the demographic characteristics, medical needs, and resource utilization of patients presenting to an EMS unit in a prolonged disaster event. 3) To make recommendations for emergency medical efforts in future prolonged disasters.

Post-war Kosovo: Part 3. Development and rehabilitation of emergency services.

The recent crisis in Kosovo led to nearly complete destruction of a healthcare system serving the needs of approximately 2 million people. Even prior to the crisis, the pre-existing healthcare system had inadequate provisions for the delivery of Emergency Medical Services. More than 440 diverse governmental and non-governmental organizations (NGOs) arrived to assist (and often compete) in the rehabilitation of Kosovo's healthcare needs. Each brought with them individual biases and strategies for how this rehabilitation should occur, and each faced numerous unforeseen barriers to the implementation of its programs. The authors used a four-step, multi-modal, needs assessment to gather information on the needs and potential barriers to the implementation of a program to rehabilitate emergency services as discussed in Part II. This paper chronicles the phases of the Emergency Medicine program development and the process of responding to barriers and changing needs. The program's successes and failures are noted, and the actual barriers encountered are reviewed. Overall, the needs assessment tool employed in this program was useful in the implementation of a program to restore and rehabilitate Emergency Services in Kosovo. The authors recommend the use of combined quantitative and qualitative methods for developing priorities for interventions in post-conflict settings following complex emergencies.

Development of an Equipment and Supply List for Emergency Medical Services Delivery at an Annual Air Show

Reports of medical care at mass gatherings reflect variability in mission and delivery models. Equipment recommendations are similarly varied. Thoughtful pre-planning and experience-based analysis are the best mechanisms for defining general and specific equipment recommendations. This report presents a suggested supply and equipment list developed over a six-year period of medical coverage at an air show, with an emphasis on the usage and cost of expendable supplies. The authors were involved in the planning for and execution of emergency medical care for a large, local, military air show on an annual basis, including provision of expendable medical supplies. A list of such supplies was developed over the initial two to three years, formalized and refined over the subsequent two years, and analyzed in the final, highest patient volume year of coverage. Detailed usage and cost was tracked over the final year for expendable supplies. The results of this analysis indicate that comprehensive emergency medical care from first aid to mass casualty care can be offered at reasonable equipment and supply costs, if existing equipment resources can be supplemented by expendable supplies from a pre-determined list. Given the need for large quantities of supplies for a mass casualty contingency and the low likelihood of occurrence, a loan arrangement with a supplier, with return of unused supplies, is particularly convenient and economical. The approach used in this study should be appreciable in other similar settings. In concurrent scheduled events, the iterative process described can lead to greater specificity of needs for expendable supplies.

The Utilization of Bicycles in the Delivery of Emergency Medical Services: A Preliminary Report

Bicycles may be useful in the delivery of out-of-hospital emergency medical services. The use of bicycles in providing emergency medical services was investigated by surveying currently existing bicycle-medic systems. Two questionnaires were developed to gain information on service areas, injuries, gear used, missions, and specific data from bicycle-medic response. Of 210 surveys mailed to bicycle-medics, 21 (10%) were completed and returned by the pre-established deadline. Of 11 surveys mailed to bicycle-medic supervisors, four (36%) were returned. Preliminary results showed that 76% of respondents are career providers and the remainder serve as volunteers. Mean age for respondents was 33 +/- 7.4 years, with 96% being males. Most teams have been in existence for three to four years. Job satisfaction was greater when participating on the bicycle crews than when not performing on the bicycle crew, t = 4.15, p = 0.0002. The teams varied in size (6-100 persons) with a mean value of 31. On the average, team size represented 10% of total number of personnel for the respective organizations. The majority of bicycle teams operate all year in all conditions. Most bicycle-medic teams were initiated for special events. Nineteen percent reported injuries while on duty or in training. Ninety percent of units that responded use existing agency protocols and have no special protocols related to the bicycle team. Eighty percent of the units are dispatched through the normal agency procedures. Eighty-five percent of respondents coordinate for transport units via dispatch. Reported response times were under two minutes for special event responses. These were within established agency response times. In approximately 25% of the responses, the patients refused transport, and another 65% of the responses were for relatively minor injuries or complaints that did not require transport to a hospital. This survey begins to characterize the utilization of bicycles as a tool to gain patient access in specialized situations. The use of bicycle-medics may be cost-effective, may help to improve employee morale, and possibly reduce employee health-care costs. Further study is needed to determine the impact of bicycle-medics on patient outcomes and response times.

Delivery of Emergency Medical Services in Kathmandu, Nepal

We describe the delivery of emergency medical services in the developing country of Nepal and identify areas of need and potential collaboration. We conducted interviews with emergency department directors and staff, analyzed ED patient records, and prospectively surveyed a convenience sample of patients visiting three Kathmandu, Nepal, EDs. The three principal EDs in Kathmandu have a collective yearly volume exceeding 100,000 visits. Injury is the reason for more than 30% of all visits; 27% of ED patients are admitted. Equipment and emergency laboratory tests essential to the practice of emergency medicine are often unavailable. Emergency physicians receive no formal training in emergency medicine, and continuing medical educational opportunities are limited. We determined that the three EDs in Kathmandu provide high-volume, high-acuteness care. Emergency physicians lack critical resources to manage the breadth of clinical problems encountered. A substantial emergency medical infrastructure exists in Kathmandu from which to address emerging problems. Injury is currently the single greatest threat to public health and may benefit from a multi-level international collaborative approach. [Meskin S, Huyler F, Gupta SK, Berger L: Delivery of emergency medical services in Kathmandu, Nepal. Ann Emerg Med March 1997;29:409-414.]

In Memoriam, Michael Pozen

The relatively young scientific field of health services research, whose practitioners are still struggling to establish legitimacy within the vast domain of health care, owes much to Michael Pozen. Indeed, Michael must be counted as one of the founders of this new speciality in that his brief but incredibly productive career began as the field of health services research took form and emerged as a distinct career specialty. His very significant contributions to health care can be assessed from two perspectives.The most visible perspective upon Michael Pozen's professional work can be obtained from a review of his research as reported in his published articles and presented papers. Michael clearly established himself as a creative and resourceful scholar and researcher who had a particular interest in improving the design and delivery of emergency medical services as well as the clinical aspects of emergency medical care.

The Delivery of Disaster Emergency Medical Services: Recommendations from Systematic Field Studies

A 28-month study was made of the delivery of emergency medical services (EMS) in disasters and large casualty-producing situations. Focus was on the organizational and human aspects of EMS in such situations rather than technical medical matters. Intensive interview, observational, documentary and statistical data were obtained in field work in 29 actual natural and technological disasters, and five potentially high mass casualty pre-planned events (e.g., the Mardi Gras celebration); additionally, in-depth studies were made of hospital and medical sector EMS preparedness in six disaster prone communities. Quantitative and qualitative analyses were made of the data by using a model which linked the pre-impact conditions of the established EMS local community system to the characteristics of the emergent EMS system.