Dispatch Center Research Articles

Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER.

Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.

Assessment of a quality improvement programme to improve telephone dispatchers’ accuracy in identifying out-of-hospital cardiac arrest

IntroductionEarly recognition of out-of-hospital cardiac arrest (OHCA) by the medical dispatcher is a prerequisite for an effective chain of survival, leading to rapid dispatch of emergency medical services. AimTo analyse and compare the accuracy of the Emergency Medical Dispatch Centre in identifying OHCA before and after an educational intervention. MethodsA quality-assessment study collecting data from prehospital medical voice logs in Southern Denmark during two periods. Baseline data and post-interventional data were obtained during December, January, and February 2017/2018 and 2019/2020, respectively. We imposed an intervention consisting of a specifically targeted education in quick assessment of OHCA and instructions regarding telephone-assisted-CPR.The primary outcome measure was the dispatcher's ability to recognise OHCA. Secondary outcome measures were time from contact with the caller to the dispatcher formulated essential questions related to the NO-NO-GO algorithm. These questions included an assessment of the patients’ consciousness and respiratory efforts and if both negative, would ideally lead to the dispatcher initiating telephone-assisted-CPR. All data was analysed in accordance with the recommendations and performance goals made by Resuscitation Academy. ResultsBaseline data included 209 calls. Post-interventional data was based on 208 calls.The sensitivity for recognition of OHCA was 82.3% (95% CI: 76.4–87.2%) before and 92.7% (95% CI: 88.2–95.8%) after the intervention (p=0.0014). The median duration of calls before recognition of OHCA was 68 and 56s before and after the intervention (p=0.097). ConclusionAfter the period of intervention, the accuracy of OHCA recognition by dispatchers improved. The median time to identify OHCA or recognise the first compression did not differ significantly. This indicates that continuing education and quality assessment may be beneficial and necessary.

Impact of a visual indicator on the noise level in an emergency medical dispatch centre - a pilot study

BackgroundNoise levels are monitored in call centres. A maximum of 52 to 55 dB(A) is recommended in order to prevent adverse events. We aimed at assessing the noise level and the impact of a visual noise indicator on the ambient noise level in a French Regional Emergency Medical Dispatch Centre (EMDC).MethodsWe conducted an observational study in the EMDC of the SAMU25 (University Hospital of Besancon). We measured the noise level using a SoundEarII® noise indicator (Dräger Medical SAS, France). The measurement took place in two phases on three consecutive days from 00:00 to 11:59 PM. At baseline, phase 1, the device recorded the average ambient noise for each minute without visual indication. Secondly, phase 2 included a sensor mounted with a light that would turn on green if noise was below 65 dB(A), orange if noise ever exceeded 65 and red if it exceeded 75 dB(A).ResultsIn the presence of the visual noise indicator, the LAeq was significantly lower than in the absence of visual noise indicator (a mean difference of − 4.19 dB; P < 10–3). It was higher than 55 dB(A) in 84.9 and 43.9% of the time in phases 1 and 2, respectively.ConclusionsThe noise levels were frequently higher than the standards, and sometimes close to recommended limits, requiring preventive measures. The noise indicator had a positive effect on the ambient noise level. This work will allow the implementation of effective prevention solutions and, based on future assessments, could improve operators’ well-being and better care for patient.

Differences in Basic Life Support Knowledge Between Junior Medical Students and Lay People: Web-Based Questionnaire Study.

BackgroundEarly cardiopulmonary resuscitation and prompt defibrillation markedly increase the survival rate in the event of out-of-hospital cardiac arrest (OHCA). As future health care professionals, medical students should be trained to efficiently manage an unexpectedly encountered OHCA.ObjectiveOur aim was to assess basic life support (BLS) knowledge in junior medical students at the University of Geneva Faculty of Medicine (UGFM) and to compare it with that of the general population.MethodsJunior UGFM students and lay people who had registered for BLS classes given by a Red Cross–affiliated center were sent invitation links to complete a web-based questionnaire. The primary outcome was the between-group difference in a 10-question score regarding cardiopulmonary resuscitation knowledge. Secondary outcomes were the differences in the rate of correct answers for each individual question, the level of self-assessed confidence in the ability to perform resuscitation, and a 6-question score, “essential BLS knowledge,” which only contains key elements of the chain of survival. Continuous variables were first analyzed using the Student t test, then by multivariable linear regression. Fisher exact test was used for between-groups comparison of binary variables.ResultsThe mean score was higher in medical students than in lay people for both the 10-question score (mean 5.8, SD 1.7 vs mean 4.2, SD 1.7; P<.001) and 6-question score (mean 3.0, SD 1.1 vs mean 2.0, SD 1.0; P<.001). Participants who were younger or already trained scored consistently better. Although the phone number of the emergency medical dispatch center was well known in both groups (medical students, 75/80, 94% vs lay people, 51/62, 82%; P=.06), most participants were unable to identify the criteria used to recognize OHCA, and almost none were able to correctly reorganize the BLS sequence. Medical students felt more confident than lay people in their ability to perform resuscitation (mean 4.7, SD 2.2 vs mean 3.1, SD 2.1; P<.001). Female gender and older age were associated with lower confidence, while participants who had already attended a BLS course prior to taking the questionnaire felt more confident.ConclusionsAlthough junior medical students were more knowledgeable than lay people regarding BLS procedures, the proportion of correct answers was low in both groups, and changes in BLS education policy should be considered.

Quantitative levels of norovirus and hepatitis A virus in bivalve molluscs collected along the food chain in the Netherlands, 2013–2017

Contamination of bivalve molluscs with viruses is well recognized as a food safety risk. A microbiological criterion for norovirus (NoV) and hepatitis A virus (HAV) in shellfish, however, does not exist in the European Union currently. The aim of this study was to evaluate the contamination levels of these viruses for fluctuation over a long period (2013–2017) in oyster (n = 266) and mussel samples (n = 490) using a method based on ISO/TS 15216-1: 2013. Samples were taken at different points in the food chain, either directly post-harvest, at Dutch dispatch centers or in retail stores, from September until March of each year. Altogether, 53.1% of the mussel and 31.6% of the oyster samples tested positive for NoV RNA. Simultaneous presence of NoV GI and GII RNA was observed in 31.6% of mussel and 10.2% of oyster samples. Contamination levels in NoV positive mussel samples collected post-harvest from B-areas were significantly higher than in those collected post-harvest from A-areas, or at dispatch centers or retail stores. Levels in oysters from dispatch were significantly lower than those collected in retail stores. Ready for sale mussels and oysters contained 2.04 and 1.76 mean log10 transformed NoV genome copies/gram (gc/g), respectively. GII levels were at a constant level in ready for sale mussels throughout all sampling periods in the study. This seemed to be true for oysters as well. HAV RNA was detected in only one of the tested mussel samples (n = 392) (typed HAV 1A) and in none of the tested oyster samples (n = 228). Critical evaluation of NoV and HAV levels in shellfish can be of help for risk assessment and risk management actions.

Patient triage system for supporting the operation of dispatch centres and rescue teams

BackgroundThe Thai medical application for patient triage, namely Triagist, is an mHealth application designed to support the pre-hospital process. However, since the functions of the application that are necessary for the pre-hospital process have been found not to be fully developed, the addition of a back-end system has been considered to increase its performance and usability.ObjectiveTo determine the ability of the previous version to effectively manage the pre-hospital process and analyse the current problems with the pre-hospital operation. Therefore, the new system was developed to support the connection of dispatch centres or operational centres to the Triagist mobile application and system evaluation.MethodDesign thinking methodology was used to analyse, design and develop a patient triage system to support the pre-hospital process in Thailand based on users’ requirements. 68 active members of the rescue teams and emergency medical staff in Chiang Mai and Lampang provinces were recruited to test the reliability of the system based on a prototype application.ResultsThe new medical mobile application for patient triage in Thailand was validated for use due to containing the two essential functions of Initial Dispatch Code (IDC) geolocation and IDC management. When the system was tested by emergency staff who were responsible for using it, those with the least experience were found to use it better than their highly experienced colleagues. Moreover, in cases where the system had been implemented, it was found to determine the frequency of symptoms, the time period during which cases occurred, and the density of cases in each area.ConclusionThis system, which has been developed based on the use of smart technology, will play an important role in supporting emergency services in Thailand by enhancing the efficiency of the pre-hospital process. Emergency centres will receive IDC information from the geolocation system so that they can determine patients’ location without undue delay. Emergency services will be able to rapidly prepare the necessary resources and administrative tasks will be supported by linking the dispatch centre to central rescue teams.

Emergency physician\u2019s dispatch by a paramedic-staffed emergency medical communication centre: sensitivity, specificity and search for a reference standard

BackgroundSome emergency medical systems (EMS) use a dispatch centre where nurses or paramedics assess emergency calls and dispatch ambulances. Paramedics may also provide the first tier of care “in the field”, with the second tier being an Emergency Physician (EP).In these systems, the appropriateness of the decision to dispatch an EP to the first line at the same time as the ambulance has not often been measured. The main objective of this study was to compare dispatching an EP as part of the first line emergency service with the severity of the patient’s condition. The secondary objective was to highlight the need for a recognized reference standard to compare performance analyses across EMS.MethodsThis prospective observational study included all emergency calls received in Geneva’s dispatch centre between January 1st, 2016 and June 30th, 2019. Emergency medical dispatchers (EMD) assigned a level of risk to patients at the time of the initial call. Only the highest level of risk led to the dispatch of an EP. The severity of the patient’s condition observed in the field was measured using the National Advisory Committee for Aeronautics (NACA) scale. Two reference standards were proposed by dichotomizing the NACA scale. The first compared NACA≥4 with other conditions and the second compared NACA≥5 with other conditions. The level of risk identified during the initial call was then compared to the dichotomized NACA scales.Results97′861 assessments were included. Overall prevalence of sending an EP as first line was 13.11, 95% CI [12.90–13.32], and second line was 2.94, 95% CI [2.84–3.05]. Including NACA≥4, prevalence was 21.41, 95% CI [21.15–21.67], sensitivity was 36.2, 95% CI [35.5–36.9] and specificity 93.2 95% CI [93–93.4]. The Area Under the Receiver-Operating Characteristics curve (AUROC) of 0.7507, 95% CI [0.74734–0.75397] was acceptable. Looking NACA≥5, prevalence was 3.09, 95% CI [2.98–3.20], sensitivity was 64.4, 95% CI [62.7–66.1] and specificity 88.5, 95% CI [88.3–88.7]. We found an excellent AUROC of 0.8229, 95% CI [0.81623–0.82950].ConclusionThe assessment by Geneva’s EMD has good specificity but low sensitivity for sending EPs. The dichotomy between immediate life-threatening and other emergencies could be a valid reference standard for future studies to measure the EP’s dispatching performance.

A compact model to coordinate flexibility and efficiency for decomposed scheduling of integrated energy system

The conflict between inflexible operation of high-efficient cogeneration system and demand for flexibility in power grid has engendered severe renewable energy curtailment, which raises a requirement of multi-energy management. Nowadays, researchers have focused on flexibility improvement, but rarely considered energy conversion efficiency of cogeneration systems based on the 2nd law of thermodynamics. This paper establishes a compact model of cogeneration systems by taking nonlinear energy conversion and heat transfer constraints of combined heat and power units into account, and further proposes a two-stage heat and power dispatch procedure. The lower stage conducts plant-level operation optimization to obtain the compact model, i.e., quantitation of the best trade-off relations between energy supply flexibility and conversion efficiency as well as the power generation feasible region in each cogeneration system. The upper stage formulates a convex optimal power flow problem based on the compact model to achieve the global coordination between energy supply flexibility and conversion efficiency in integrated energy system. To apply the model, we introduce a multi-energy management system consisting of a central power-grid dispatch system and multiple distributed plant-level energy management systems. Optimization results reveal that the proposed method saves 11.65% heat consumption comparing with traditional method.

Методика комплексной оценки надёжности линий электропередачи в режиме реального времени

The article considers the reliability assessment of the power transmission lines operation with voltage of 110 kV and above in real time based on the analysis of the main causes of emergency outages and the determining factors of its reliability. A probability index of emergency power line shutdown is proposed, which is determined in comparison with the reference power line with the worst indicators and its qualitative representation based on the generalized Harrington desirability function. A visual representation on the diagram of the electric power system of weak points in the operating zone of the dispatch center in real time is formulated which can be used in the operational information complex of the dispatch center for information support of dispatch personnel and the procedure for actions of this personnel at different probability index of power lines emergency shutdown. The proposed method can be used by dispatch center in the management of power system modes and network organizations in the probability assessing of emergency power line outages. It will ensure a high reliability level of the power system operation due to the timely preparation of preventive measures aimed at reducing the consequences of emergency outages.

Analysis of the emergency medical service call centre actions in patients with cardiac arrest

Background/Aim: Cardiac arrest (CA) is a leading cause of mortality in the last forty years worldwide. Immediately initiated cardiopulmonary resuscitation (CPR) improves chances for survival. Aim of this study was to determine the efficiency of the Emergency medical service (EMS) dispatch centre in the absence of the uniform emergency medical dispatch assessment protocols in the management of cardiac arrest. Methods: The retrospective and observational study was conducted in Institute for Emergency Medical Service Novi Sad (IEMS Novi Sad) Serbia during a one-year follow-up. The study included patients with out-of-hospital cardiac arrests who underwent CPR. Results: EMS teams of the IEMS Novi Sad had 198 CPRs in the follow-up period. In 142 (71.72 %) calls, the EMS dispatcher got information that the patient was unconscious. The reported reaction time I by the dispatchers for the unconscious patients was 1.37 ± 1.27 minutes, actual duration of the conversation between the dispatcher and a caller - was longer: 138.21 ± 103.02 seconds (p &lt; 0.001). The average conversation time with a caller was 61.37 ± 31.13 seconds. In 6 (4.22 %) cases, the EMS team was dispatched to a patient before the phone call was terminated. At the moment of arrival, all patients were unconscious, 194 (94.37 %) were pulseless, while the remaining 8 (5.63 %) experienced cardiac arrest during the examination. The cardiac arrest was witnessed by a layman in 120 (84.51 %) cases and CPR was initiated by bystanders, before the arrival of the EMS team, only in 13 (10.83 %) patients. Twenty-seven (19.01 %) patients arrived in a hospital with vital signs. Conclusion: The absence of the uniform EMS dispatch assessment protocols for the triage of incoming calls and phone assisted CPR for lay rescuers decreases the survival rate of patients with cardiac arrest.

High Impedance Fault Detection in Overhead Distribution Feeders Using a DSP-Based Feeder Terminal Unit

High impedance faults (HIFs) often draw too little current to activate conventional overcurrent protection, making the detection of a HIF event a difficult task. A practical and implementable solution to HIF detection and location is presented. In the proposed methodology, wavelet transform used for extracting features of HIFs signals and neural network used for HIF detection are used to develop a novel HIF detector called enhanced feeder terminal unit (FTU). The designed enhanced FTU is a high-performance HIF detector that is the retrofitting of the ready-made FTU with an embedded digital signal processor and a high-frequency current sensor. The enhanced FTU monitors the operation of distribution feeder system and sends a fault flag signal to feeder dispatch and control center when a HIF occurs. Based on the feeder automation mechanism, the HIF detection, isolation, and service restoration can be activated. Consequently, the power reliability can be significantly improved by reducing the outage area and repair time. The validation of the presented technique was evaluated through staged fault testing. Compared with the existing related research, the proposed enhanced FTU is available and feasible.

A Simplified LSTM Neural Networks for One Day-Ahead Solar Power Forecasting

In recent years, exploration and exploitation of renewable energies are turning a new chapter toward the development of energy policy, technology and business ecosystem in all the countries. Distributed energy resources (DERs) are being largely interconnected to electrical power grids. This dispersed and intermittent generational mixes bring technical and economic challenges to the power systems in terms of operations, stability, reliability, interoperability and the policy making. In additional, DERs cause the significant impacts to the operation of traditional centralized generation power plants and the dispatch control centers. Under such circumstances, the accuracy of DERs power forecasting is one of the critical problems for TSO and DSO such as unit commitment, smooth fluctuations, peak load shifting, demand response, etc. In this paper, a simplified LSTM algorithm built over the architecture of Machine Learning methodology to forecast one day-ahead solar power generation is introduced. Through the machine learning processes of data processing, model fitting, cross validation, metrics evaluation and hyperparameters tuning, the result shows that the proposed simplified LSTM model outperform the MLP model. Moreover, the forecast of LSTM model can successfully capture intra-hour ramping on different weather scenarios. The average RMSE is 0.512 which is quite promising to inspire that the proposed methodology and architecture can best fit the short-term solar power forecasting applications.

Оценивание состояния воздушной линии переменного тока методом релинеаризации

As is well known, dispatch control centers receive information about the electric power system operation mode from a supervisory control and data acquisition system (SCADA) and phasor measurement units (PMU) in the form of remote measurements and remote signals. The remote measurements contain information on the power system operating parameters, and remote signals contain information on the positions of switching equipment. The controlled facility state estimation problem is conventionally solved using iteration methods because the system of state equations is nonlinear in nature. The application of the Kipnis-Shamir method makes it possible to transform the nonlinear system of algebraic equations into a linear system in a non-iterative manner by replacing quadratic state variables, after which the obtained linear system is solved parametrically. By applying a second transformation of variables, the system of algebraic equations is transformed into a second system of linear equations, after which the solution of this system and the quadratic system of linear equations, and, hence, also the initial system of nonlinear equations are found. The application of the non-iterative approach is considered on the example of estimating the state of a 500 kV overhead power line.

Методика построения интегральных показателей комплексной оценки свойств узлов электроэнергетических систем

The problem of selecting the electric power system control nodes is studied. By performing control of these modes, matters concerned with providing reliable power supply of the required quality to consumers can be settled in the most efficient manner. As an example, a fragment of the electric power system mathematical model used in the Finist mode-setting simulator for a power system dispatch control center operator is considered, which represents a highly branched electrical network consisting of eleven 110 kV nodes, three 220 kV nodes connected with the system, and two generator nodes. A new procedure for selecting the control nodes is proposed, which takes into account a combination of different indicators having different measurement units, dimensions and scales is proposed. These indicators characterize the following properties of power system nodes: the reactive power fraction absorbed at a node, the sensitivity of voltage to reactive load variations, the number of connected power lines, and statistical indicators characterizing the change of voltage at the nodes and reactive power flows for different options of installing the reactive power compensation devices. For combined use of these indicators, they were ranked according to the efficiency of installing reactive power compensation devices in the system. For each indicator, a scale of five ranks (intervals) is set, which determine the preferences (qualitative judgments) of the researcher in evaluating the reactive power compensation devices installation efficiency at the system nodes. The highest rank (5) corresponds to the maximum efficiency, and the lowest rank (1) corresponds to the minimum efficiency. To calculate the individual (integral) priority indicator of installing reactive power compensation devices, the ranks of indicators are added together, and their sum is divided by the product of the number of ranks by the number of the used indicators (features). Based on the calculation results, the rating (location) of each node is determined, and the nodes for installing the reactive power compensation devices are selected according to their effect on ensuring the electric power system operation reliability, active power losses in the network, and voltage regulation. Thus, a new procedure is presented for determining the integral indicators for comprehensively estimating the properties of complex electric power system nodes and selecting the controlled nodes using a system of various indicators. These indicators characterize the studied nodes in terms of the efficiency of installing reactive power compensation devices to reduce active power losses in the network, voltage regulation, and ensuring the electric power system operational reliability. The validity of the results obtained in the study is confirmed by their comparison with the indicators of the balance-conductivity method, which has proven itself in solving problems connected with determining the nodes for controlling electric power system operation modes.

Transmission of Frequency Balance Instructions and Secure Data Sharing Based on Chaos Encryption in Smart Grid-Based Energy Systems Applications

Data communication security between power systems, which has become a chronic problem in the classical network, is characterized by the application of information communication technology (ICT) in modern network models. Nowadays, the electricity network is spread over very large areas, and the load taking, and load shedding instructions are transmitted one-way and unsafe in the current structure. However, utilities in the smart grid are developing new methodologies to secure the communication infrastructure. This article presents a design that will make the current grid model more reliable and provide a secure data communication in accordance with the modern grid infrastructure. This design provides auxiliary communication codes such as chaotic codes embedded in the communication instructions between power systems, which are generation balance instructions sent to the power plants by the load dispatch center to achieve frequency balance. Used as a case study, one-day instructions are transmitted and encoded four times a day, which is the amount of capacity that only the receiver and transmitter can understand with two-sided encryption. The necessary reserve capacity, chaotic encryption and suitability for real-time applications were evaluated using experimentally obtained power system data for frequency control, which is very important in terms of sustainability in energy and economy against cyber-attacks, and very accurate results were obtained.

Efficient Electricity Forecasting in Multiple Residential Buildings considering Demand-Side Management

Gateway based Home Area Network (HAN ) to Neighbourhood Area Network (NAN); NAN to HAN improved the communication in the Smart grid. The gateway reduces the Load dispatch centre (LDC) work in varying power consumption in a short time interval. The proposed work explains the working of gateway, reducing the work of LDC using the load scheduling procedure. Deep learning methods incorporated gateway will aid in achieving the requirement. It reduces black start operation and it may be prevented by indulging consumers in the supply automation of the grid. It will produce the grid to maintain the operating frequency, avoiding the substations' disciplinary charges. A variety of types of abrupt load variation and load kinds has been taken in this function. The analysis shows that the gateway achieves a decrease in complexity in the proposed work. This method provides the detail of employment of deep learning for predicting the load forecasting performances in smart grids that can be made better through a gateway between SMs-DCU. The Proposed work compares with systems that employ the predictable profound estimating methods for load forecasting, which has provided better performance. Load Prediction, Deep Learning, Gateway, Smart Grid, Estimation

Reorganisation of stroke care in prehospital emergency medical services: results through transformative learning

Background: Rapid recanalisation is important when treating ischaemic stroke patients. In Finland, the reorganisation of the prehospital emergency medical system and the establishment of emergency medicine as an independent speciality occurred some years ago. These reforms offered the opportunity to develop new prehospital and in-hospital pathways for stroke patients. Methods: In this retrospective study, we examined the immediate impact of implementing a new operating model in prehospital stroke care. We introduced a modified “load-and-go” model using a transformative learning process. We observed the immediate effects of the reorganisation by comparing prehospital time intervals three months before and three months after the reorganisation. Results: The new operating model was implemented using a transformative learning process. There was an immediate reduction of 35.1% from 21.4 to 13.9 minutes (P &lt; 0.001) in the median on-scene time and of 18.2% from 52.7 to 43.1 minutes (P &lt; 0.05) in the median total time, i.e. the time interval between the alarm from the dispatch centre to patient hand-over to ED. Conclusion: By using a transformative learning process in implementing a modified load-and-go operation model in the EMS, we could immediately reduce median on-scene time and median total time in the treatment of acute stroke patients.

Declining Use of Pre-Hospital Emergency Medical Services During the COVID-19 Pandemic in 2020: Descriptive Study Based on Routinely Collected Dispatch Data in Bavaria, Germany

Background: The COVID-19 pandemic affects utilisation of health care services and posed organizational challenges. To determine the effect on utilisation of pre-hospital emergency medical care, we investigate utilisation throughout the year of 2020. Methods: This retrospective, descriptive analysis of routine data from 26 dispatch centres in Bavaria, Germany investigates the number of emergencies per 100,000 population as well as relative change in emergency rates and transport rates in 2020, compared to the two previous years. Boxplots show distributions across Bavarian districts per calendar week. Mean rates and standard deviations as well as relative changes are presented for specific periods and a paired samples t-test is used to compares rates. Findings: Compared to the average of the two previous years, emergency rates in 2020 were lower in 35 out of 52 calendar weeks. Strongest reductions were observed during the first wave, where the average emergency rate declined by 12∙9% (SD 6∙8, p Interpretation: Utilisation of pre-hospital emergency medical services decreased in 2020, especially during periods with strict measures. This could be due to lower morbidity from behavioural changes during the pandemic, but also to avoidance of medical services for probably both, less urgent and severe conditions. While a reduction in unnecessary care would be beneficial, patients must be encouraged to seek necessary urgent care, even during a pandemic. Funding: None to declare.Declaration of Interest: None to declare. Ethical Approval: The study was approved by the ethics committee of the medical faculty of the University of Munich (Project-No 21-0641 KB).

Impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease in Italy

The Covid-19 pandemic affected large part of Italy since February 2020; we, therefore, aimed to assess the impact of 2020 SARS-CoV-2 outbreak on telemedicine management of cardiovascular disease (CVD) in Italy. We analyzed data from three telemedicine dispatch centers, one located in Genoa, serving private clients (pharmacies, general practitioners), one in Brescia, serving pharmacies, and one in Bari, serving regional public STEMI network and emergency medical service in Apulia (4 million inhabitants). Demographic data and principal electrocardiogram diagnosis were collected and analyzed. Records from the time interval March 1, 2020 and April 1, 2020 were compared with the corresponding period in 2019. The comparative analysis of data shows a 54% reduction of telemedicine electrocardiogram transmission in Genoa telemedicine center (from 364 to 166), 68% in Brescia (from 5.745 to 1.905), 24% in Bari (from 15.825 to 11.716); relative reduction according to electrocardiogram diagnosis was 38% for acute coronary syndrome, 40% for other acute CVD in Genoa center, 24% for acute coronary syndrome, and 38% for other acute CVD in Bari. Male/female ratio remained substantially unchanged. A dramatic reduction of telemedicine access for CVD was observed during Covid-19 outbreak in March 2020 in Italy. The reduction was substantially consistent for all electrocardiogram findings, ACS, other acute CVD and normal.

The barriers and facilitators to the telephonic application of the FAST assessment for stroke in a private emergency dispatch centre in South Africa.

BackgroundStroke is one of the leading contributors to morbidity and mortality globally. The incidence of stroke is on the increase in Sub-Saharan countries such as South Africa. As stroke is a time-sensitive condition, emergency medical services (EMS) play an important role in the early recognition of stroke. The telephonic application of the FAST (Face, Arm, Speech, Time) assessment has been suggested to screen patients for stroke, but this is not applied consistently. This study aimed to identify the barriers and facilitators to the telephonic application of the FAST assessment.MethodsThis retrospective, exploratory study sampled 20 randomly selected emergency calls to a private EMS in South Africa, with suspected stroke. After verbatim self-transcription, data were analysed using inductive content analysis to identify the barriers and facilitators to the application of the FAST assessment. Results were arranged according to themes.ResultsResults indicated that in 15/20 (75%) of the calls, the FAST assessment was successfully applied. Eight barriers under three themes (practical barriers, emotionality, and knowledge and understanding) and three facilitators under one theme (clear communication) were identified. Most notably, language discordance, lack of empathy and caller frustration featured prominently as barriers while caller cooperation and clear instructions were prominent facilitators.ConclusionWith the barriers known, methods to address these may be constructed. Additional training and credentialing for call-takers may be a reasonable first step. These lessons can likely be applied to other telephonic acuity and recognition algorithms.