Dispatch Center Research Articles

Decision to deploy coronary reperfusion is not affected by the volume of ST-segment elevation myocardial infarction patients managed by prehospital emergency medical teams.

Mortality in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with the volume of activity of percutaneous coronary intervention (PCI) facilities. This observational study investigated whether the coronary reperfusion-decision rate is associated with the volume of activity in a prehospital emergency setting. Prospectively collected data for the period 2003-2013 were extracted from a regional registry of all STEMI patients handled by eight dispatch centers (SAMUs) in and around Paris [41 mobile ICU (MICUs)]. A possible association between volume of activity (number of STEMIs) and coronary reperfusion-decision rate, and subsidiarily between volume of activity and choice of technique (fibrinolysis vs. primary PCI), were investigated. Explanatory factors (patient age, sex, delay between pain onset and first medical contact, and access to a PCI facility) were analyzed in a multivariate analysis. Overall, 18 162 patients; male/female 3.5/1; median age 62 (52-72) years were included in the analysis. The median number of STEMIs per MICU was 339 (IQ 220-508) and that of reperfusion-decisions was 94% (91-95). There was no association between the decision rate and the number of STEMIs (P = 0.1). However, the decision rate was associated with age, sex, delay, and access to a PCI facility (P < 0.0001) in a highly significant way. Fibrinolysis was a more frequent option for low-volume (remoter PCI facilities) than high-volume MICUs (30 vs. 16%). The decision of coronary reperfusion in a prehospital emergency setting depended on patient characteristics, delay between pain onset and first medical contact, and access to a PCI facility, but not on volume of activity. Promoting fibrinolysis use in underserved areas might help increase the reperfusion-decision rate.

Overall setting and cooperation method for power protection of large hydropower plants

Aiming at solving the operation risk problems caused by the improper protection settings, this paper proposed a new method for the protection setting of the auxiliary power of large hydropower plants. This method applied the idea of setting from LV grade to HV grade, where each type of protection sets the value based on the setting principles and calibrates their sensitivity with their own protection range. This method handled the insufficient sensitivities of protection at the price of sacrificing the lower levels of the protection. Then based on the settings from the dispatch and control center, it vertically conducted the verification of protection setting coordination, preventing the override tripping and expanded scope of accidents. The practical applications indicate that this method could improve the protection setting accuracy of large hydropower plants and limit the operation risks of the auxiliary power within a low level.

Abstract 150: AED Transportation System With Smartphone Application Cooperating With Dispatch Center

Background: Although public access automated external defibrillators (AEDs) have been widely installed in Japan, defibrillation by public access AEDs was still rare. Methods: Study design: Case series. We developed an AED transportation system with smartphone application cooperating with dispatch center. When a cardiac arrest occurs and lay-person call the emergency service, the dispatcher share information of out-of-hospital cardiac arrest OHCA locations and near-by AEDs via the application with pre-registered volunteers near the victim. This application presents the shortest route to the OHCA scene via nearby AED, and the volunteers bring AED to the OHCA scene. The purpose of this study is to use this system in real settings and to make the task of the system clear. We conducted the experimental study in Owariasahi city, Aichi and Kashiwa city, Chiba. Research period were from January 2017 to March 2019 in Owariasahi city, and from December 2018 to March 2019 in Kashiwa city. We collected the number of registered volunteers, the timeline data of system activation, and the number of responses to occurrence of OHCA by registered volunteers during the study period. Results: In Owariasahi city, total of 304 volunteers were registered. 276 suspected OHCAs occurred, 179 cases were eligible excluding the hazardous cases in the scene, and of which 169 cases actually activated the system by the dispatcher. The average time from call to send notification was 3:11 (minutes and seconds) and from call to emergency medical service (EMS) arrival 6:37 (minutes and seconds). The registered volunteer took actions in 94/169 cases (55.6%), transported AEDs in 6 cases, and arrived on the scene in 10 cases. A registered volunteer arrived on the scene earlier than EMS personnel in one case. In Kashiwa city, total of 636 volunteers were registered, and the system was activated in 17 suspected OHCA cases. In one case, a volunteer arrived earlier than EMS and attempted resuscitation. Conclusions: This AED transportation system worked well and safe on the actual emergency scene. By increasing the number of registered volunteers, it is expected to increase the number of AED use.

Abstract 294: Different Effect of Bystander CPR According to Dispatcher-Assistance on Neurologic Outcome in Out-Of-Hospital Cardiac Arrest

Introduction: Bystander CPR is an important prognostic factor for outcome in out-of-hospital cardiac arrest (OHCA). Dispatcher-assisted(DA) CPR program have shown to successfully increase rate of bystander CPR in communities. However DA-CPR is usually targeted for bystanders with no or lower level of CPR training compared to bystanders who are able to perform CPR without dispatcher assistance. We evaluated the effect of bystander CPR separately according to presence of dispatcher assistance on neurologic outcome. Methods: Retrospective analysis was performed using nationwide OHCA database from 2014 to 2017. Adult EMS treated OHCA with presumed cardiac origin were enrolled. EMS witnessed arrest and arrest occurred during ambulance transport were excluded. Bystander CPR was classified into 2 groups according to presence of DA-CPR instruction from emergency medical dispatch center. Rate of favorable neurologic outcome (CPC 1 or 2) was compared according to type of bystander CPR. Multivariable logistic regression model was used to estimate effect of bystander CPR type on outcomes. Results: Total of 72,314 eligible OHCA were enrolled for final analysis. Proportion of patients with favorable neurologic outcome was highest in bystander CPR without dispatcher assistance. (8.6% for bystander CPR without DA, 5.0% for bystander CPR with DA and 2.9% for no bystander CPR, p&lt;0.01). Bystander CPR with DA was associated with higher chance of good neurological recovery than no bystander CPR, effect on neurologic outcome was significantly different than bystander CPR without DA(adjusted OR with 95% CI (bystander CPR with DA as reference): 0.61[0.55-0.67] for no-bystander CPR , 1.24[1.14–1.36] for bystander CPR without DA) Conclusion: Bystander CPR with DA showed positive effect on neurologic outcome compared to no-bystander CPR. However bystander CPR with DA was less effective than bystander CPR performed without dispatcher assistance. To improve quality of bystander CPR with dispatcher assistance, strategy to monitor and give feedback bystander CPR during dispatcher assistance should be developed and implemented in dispatch center.

Abstract 290: Association Between Hourly Call Volume in Emergency Medical Dispatch Center and Dispatcher -Assisted Cardiopulmonary Resuscitation Instruction Time in Out-Of-Hospital Cardiac Arrest

Objectives: cardiac arrest recognition, ambulance dispatch and dispatcher assisted CPR by emergency medical dispatch (EMD) is crucial for good outcome of out-of-hospital cardiac arrest (OHCA).In EMD, crowding is caused by mismatch between numerous emergency calls and dispatchers per duty available Crowding in emergency department has been shown to decrease the performance and outcome, however little is known about effect of crowding in EMD. We aimed to evaluate incidence of crowding in emergency medical dispatch center and effect of emergency call crowding on dispatcher assisted CPR instruction performance in OHCA calls. Methods: We used nationwide OHCA database from 2013 to 2016, consisted of patients with presumed cardiac origin and dispatched by Seoul EMD. Main exposure was hourly number of total incoming emergency calls to EMD. Number of hourly calls were categorized into quartile (~4o calls, 41~51 calls, 52 ~61 calls and ~62 calls). Primary outcome was successful DA-CPR instruction provision within 120 seconds. Adjusted ratios (AORs) and 95% confidence intervals (CIs) were estimated to evaluate association between EMD crowding and outcome in multivariable logistic regression model. Results: Of a total of 12,722 patients, proportion of successful DA instruction were highest in least crowded quartile and lowest in the most crowded quartile (22.7% vs. 15.o% , p&lt;0.01). The adjusted odds ratios is 0.85 (95% CI 0.74 - 0.98) in most crowded EMD quartile with lesser proportion of DA instruction within 120 seconds. Crowding quartile 4 and quartile 3 was associated lesser favorable neurological outcome in multivariable logistic regression model.(adjusted OR(95% CI) 0.78 (0.60-0.99) and 0.70 (0.54- 0.91) respectively) . Conclusion: Crowding in emergency medicine dispatch caused by increased hourly call volume was associated with delayed dispatcher assisted CPR instruction provision. Medical directors might consider strategy approach to solve crowding in EMD according to crowding distribution.

2019 American Heart Association Focused Update on Systems of Care: Dispatcher-Assisted Cardiopulmonary Resuscitation and Cardiac Arrest Centers: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

Survival after out-of-hospital cardiac arrest requires an integrated system of care (chain of survival) between the community elements responding to an event and the healthcare professionals who continue to care for and transport the patient for appropriate interventions. As a result of the dynamic nature of the prehospital setting, coordination and communication can be challenging, and identification of methods to optimize care is essential. This 2019 focused update to the American Heart Association systems of care guidelines summarizes the most recent published evidence for and recommendations on the use of dispatcher-assisted cardiopulmonary resuscitation and cardiac arrest centers. This article includes the revised recommendations that emergency dispatch centers should offer and instruct bystanders in cardiopulmonary resuscitation during out-of-hospital cardiac arrest and that a regionalized approach to post-cardiac arrest care may be reasonable when comprehensive postarrest care is not available at local facilities.

Improving emergency call detection of Out-of-Hospital Cardiac Arrests in the Greater Paris area: Efficiency of a global system with a new method of detection

AimThe detection of cardiac arrests by dispatchers allows telephone-assisted cardiopulmonary resuscitation (t-CPR) and improves Out-of-Hospital Cardiac Arrest (OHCA) survival. To enhance the OHCA detection rate, in 2012, the Paris Fire Brigade dispatch center created an original technique called "Hand On Belly" (HoB). The new algorithm that resulted has become a central point in a broader program for dispatch-assisted cardiac arrests. MethodsThis is a repeated cross-sectional study with retrospective data of four 15-day call samples recorded from 2012 to 2018. We included all calls from OHCAs cared for by Basic Life Support (BLS) teams and excluded calls where the dispatcher was not in contact directly with a witness. The primary endpoint was the successful detection of an OHCA by the dispatcher; the secondary endpoints were successful t-CPR and measurements of the different time intervals related to the call. Logistic regressions were performed to assess parameters associated with detecting OHCAs and initiating t-CPR. ResultsFrom 2012 to 2018, among the detectable OCHAs, the proportion correctly identified increased from 54% to 93%; the rate of t-CPRs from 51% to 84%. OHCA detection and t-CPR initiation were both associated with HoB breathing assessments (adjustedOR: 89, 95%CI: 31–299, and adjustedOR: 11.2, 95%CI: 1.4–149, respectively). Over the study period, the times to answering calls and the time to sending BLS teams were shorter than those recommended by international guidelines; however, the times to OHCA recognition and starting t-CPR delivery were longer. ConclusionsThe HoB effectively facilitated OHCA detection in our system, which has achieved very high performance levels.

2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

Disparity in Receipt and Utilization of Telecommunicator CPR Instruction

Introduction: Telecommunicator Assisted Cardiopulmonary Resuscitation (T-CPR) is independently associated with improved survival and improved functional outcome after adult Out of Hospital Cardiac Arrest (OHCA). The objective of this study was to evaluate whether there are racial and socioeconomic disparities in the provision of T-CPR instruction and subsequent CPR performance. Methods: We performed a retrospective review of a convenience sample of EMS agencies throughout the United States that utilized the Cardiac Arrest Registry to Enhance Survival (CARES) dispatch registry during the period 1/2014–12/2017. Data were collected by dispatch agencies after review of 9-1-1 OHCA audio recordings. Elements related to dispatcher CPR instruction, barriers to bystander CPR (BCPR) performance, patient race (White, Black, Hispanic-Latino, or other) and Utstein data were captured from the CARES database. These data were merged with census tract data from incident locations. The effects of race and income (Socioeconomic status, SES) on outcome were analyzed using multilevel logistic regression. Results: A total of 3,807 cases were identified from 37 dispatch agencies in 6 states. The sample was predominantly White (57.5%) and male (64.9%) with an average age of 60.3 ± 19.9. In the adjusted analysis, there were no differences in the odds of receiving CPR instruction by race (black vs white), OR = 0.96 (95% CI. 0.70, 1.32) or for increased income, (OR = 1.00, 95% CI 0.99, 1.02). There was a significant difference in receipt of T-CPR instruction by patient age, OR = 0.99 (95% CI, 0.98, 0.99). Subsequent utilization of T-CPR instruction to perform BCPR was less likely for patients that had a lower income, OR = 1.03 (95% CI 1.01, 1.05). There was also a decreased rate of BCPR provision by patient age OR = 0.99 (95% CI, 0.99, 1.00), but there was no difference in rate of BCPR provision by race, OR = 0.86 (95% CI 0.61, 1.23). Conclusion: We identified differences in age but not race or SES in the provision of T-CPR instruction by dispatch centers. We also identified decreased CPR provision by age and income after receipt of T-CPR instructions. In this sample, we found no evidence of racial disparities in the provision of T-CPR instruction or subsequent provision of BCPR.

Network architecture for demand response implementation in smart grid

The most important function of a power system grid is to feed the demand at all times. However, power demand is very dynamic in nature, which is levying more and more stress on the network at peak load times. Also, power generation is limited, therefore to have a continuous power supply, the load has to be prioritized so that demand and generation equality can be maintained by slashing excess lower priority load for the time being. For the same, the demand response strategy has been utilized that offers lower electrical consumption when the power system network is overburdened. A multi-layered architecture is proposed for implementing demand response wherein the utility’s concern for maximum load balance as well as consumers’ concern of having a continuous supply of power to priority load is catered at the same time. Thus, this paper is about defining the priority of load and designing of information payload about demand, which would be communicated to the server at a load dispatch center from load point switches and vice versa. This paper also proposes a system architecture for implementing demand response and design of payload and their effect on the calculation of throughput, latency and maximum permissible nodes at different levels of power flow. For actualizing such scenarios, the information of different parameters at the load end needs to be conveyed to the utility. Cisco Packet Tracer is utilized to show the flow of information.

Design and Analysis of the Task Distribution Scheme of Express Center at the End of Modern Logistics

With the rise and improvement of artificial intelligence technology, the express delivery industry has become more intelligent. At the terminal of modern logistics, each dispatch center has hundreds of express mail deliveries to be dispatched every day, and the number of dispatchers is far less than the number of express mail deliveries. How to assign scientific tasks to each courier dispatch is the main target of this paper. The purpose is to make the number of tasks between the various couriers in the express center roughly the same in each cycle, so that there is a more balanced income between the couriers. In the simulation experiment, the delivery addresses are clustered according to the balanced k-means algorithm. Then, the ant colony algorithm is used to plan the delivery order of the express items in each class. Then, the time cost model is established according to the delivery distance of the express items in each class and the delivery mode of the express items to calculate the delivery time cost. Through a large amount of experimental data, the standard deviation of delivery time cost of each courier gradually decreases and tends to stabilize, which suggests that this method has a good effect on the dispatching task assignment of the express center. It can effectively make the delivery workload between the distributors roughly the same, and improve the delivery efficiency of the courier, save energy, and promote sustainable development.

P6210Pathway of care and life course of patients with recurrent ST-elevation myocardial infarction

Abstract Background We hypothesized that patients having experienced one coronary event in their life must present differences in their pathway of care in the acute phase and within 12-month life course. Purpose This study aimed to compare pathways between current and recurrent Myocardial Infarction. Methods All patients from the OSCAR registry with ST Elevation Myocardial Infarction (STEMI) as final diagnosis from 2013 to 2016 were included. We defined recurrent STEMI as a reinfarction occurring within 12-month post-current-STEMI and STEMI with prior MI occurred before the inclusion date. Results Recurrent STEMI called more often the medical dispatch center (71.32% vs 62.36%, p&lt;0.0001) and benefited from out-of-hospital medical care by Emergency Mobile Services (67.07% vs 59.70%, p=0.0007). The hospital management delays did not differ but the delay symptom-ECG tended to be 26 minutes longer for recurrent STEMI admitted directly to the emergency department (182 [109; 314] vs 156 [89; 291], p=0.0510). They also underwent less percutaneous coronary interventions (PCI) (90,24% vs 95,07%, p&lt;0.0001). At 12 months post-discharge, we observed a better adherence to BASIC-treatment (Beta-blockers, Anti-platelet medications [aspirin, clopidogrel, prasugrel], Statins and Converting Enzyme Inhibitor Combination-treatment) for recurrent STEMI (64,06% vs 52,98%, p=0.0062) but the key lifestyle interventions were less applied. Conclusion Comparison of care and life course of current and recurrent STEMI highlighted a different use of pre-hospital care and hospital resources. They also showed better adherence to BASIC-treatment during recurrent events compared to current STEMI. Acknowledgement/Funding The RESCUe Network is funded by the Regional Agency for Health from Auvergne-Rhône-Alpes region (Agence Régionale de Santé Auvergne-Rhône-Alpes).

Active power dispatch strategy of the wind farm based on improved multi‐agent consistency algorithm

With the increase of wind power penetration in the power system, wind farm (WF) needs to limit active power and accurately track the instructions from the dispatch centre. Since a WF has many distributed wind turbines (WTs), it is a crucial issue to reasonably distribute power reference values to WTs. In this study, a novel active power dispatch (APD) strategy based on dynamic grouping of WTs is proposed. This strategy considers the characteristics and operating conditions of WTs, which can smoothen the power reference values to WTs and reduce fluctuations of key parameters of WTs. Then, a distributed dispatch strategy based on multi-agent system consistency algorithm (MASCA) is applied for APD, which provides a dispatch strategy for WTs that does not require a centralised control centre. And the segmental virtual consistency algorithm is presented as an improvement of MASCA, which innovatively allows MASCA to support the grouping strategy for APD. Finally, the simulations show that the proposed strategy can enable WTs to obtain smoother reference power to track the dispatching instruction while reducing fluctuations of rotor speed and pitch angle, which is helpful to alleviate the fatigue of WTs. The dispatch strategy also shows good robustness when some communication is interrupted.

Heat dispatch centre – Symbiosis of heat generation units to reach cost efficient low emission heat supply

The application of renewable heat supply technologies underlies various constraints. To overcome these limitations to their application in this research, an interconnection of different heat sources in the so-called Heat-Dispatch-Centre is derived from the main characteristics of renewable heat supply technologies. A season-dependent operation state of generation and storage units allows low-emission and efficient heat supply. In addition, alternative connection possibilities are discussed and a visualization method for an analysis of heat generation units connected in series is introduced. For an exemplary network an overall primary energy factor of 0.09 and a specific CO2 emission factor of 27 gCO2/kWh is reached, with costs of overall heat generation at 11–12 €ct/kWh. In contrast to this, a parallel connection of the heat sources reduces overall efficiency, increases the costs to 13 €ct/kWh and increases the CO2-emissions in the overall energy supply system by decreasing renewable electricity infeed into the grid.

Effectiveness of dispatcher instructions-dependent or independent bystander cardiopulmonary resuscitation on neurological survival among patients with out-of-hospital cardiac arrest

BackgroundWe evaluated the association between survival and bystandercardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel’s contact with the patient (i.e. time to EMS arrival). MethodsThis prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest who were ≥18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients’ age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient’s arrival at the hospital. The effective estimated “time to EMS arrival” was also calculated. ResultsFor analyses 10,925 individuals were eligible. Independent CPR had a significantly higher one-month favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47–2.46] and 1.16 [0.91–1.47], respectively). The estimated “time to EMS arrival” for a one-month favorable neurological survival after independent CPR was ≤13min. ConclusionsBystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated “time to EMS arrival” of ≤13min.

High-resolution mapping of epilepsy prevalence, ambulance use, and socioeconomic deprivation in an urban area of Sweden.

Geographic differences in epilepsy prevalence between areas of different socioeconomic standing have been demonstrated in the United Kingdom, but knowledge from other health care systems is scarce. Our objective was to compare epilepsy prevalence and emergency medical service (EMS) assignments for seizures in areas of different socioeconomic standings in the urban area of Gothenburg. Register-based study in Gothenburg (population 690000), the second largest city in Sweden. Epilepsy cases were identified in the comprehensive national patient register in 2014-2015. EMS assignments were identified in the EMS dispatch system in 2013-2018. Socioeconomic variables were mean income and proportion of welfare recipients. Significant correlations were seen between epilepsy prevalence and the proportion of welfare recipients (r=.49, P=.0014) and annual income per capita (r=-.42, P=.0071). There were 7907 assignments for seizures during the study years. GPS-based analysis showed that most assignments occurred in the city center. In addition, several high-density areas correlated with areas with a high proportion of inhabitants receiving welfare. Correlation analysis showed significant associations between the number of EMS assignments per capita and the proportion of welfare recipients (r=.31, P<.0001) and income (r=-.19, P<.0001). When comparing representative areas, a greater proportion of assignments was given the highest priority in high status areas compared to low status areas, both by the dispatch center and EMS clinicians on scene. Our findings that epilepsy prevalence and seizure frequency differ with socioeconomic status on a microgeographic level considerably strengthen the generalizability of previous observations across different health care systems. Differences in priority may reflect health utilization behavior or access to neurologic care.

Effect of bystander CPR initiated by a dispatch centre following out-of-hospital cardiac arrest on 30-day survival: Adjusted results from the French National Cardiac Arrest Registry

AimCardiac arrest (CA) was considered irreversible until 1960, when basic cardiopulmonary resuscitation (CPR) was defined. CPR guidelines include early recognition of CA, rapid and effective CPR, effective defibrillation strategies and organized post-resuscitation to ensure a strengthening of the survival chain. Bystanders are the key to extremely early management, which is associated with the early medical care provided by EMS. This study aims to assess the prognosis of a bystander’s cardiac CPR when it is initiated by the Dispatch Centre (DC). MethodsWe included patients in 3 groups according to who initiated the CPR. The groups were matched according to multiple propensity partition methods. We presented our results in terms of 30-day survival and neurological prognosis. Results85,634 patients were included. Statistical study focused on 18,185 patients once the exclusion criteria were applied. 12,743 (70.1%) are men and the average age is 70.1 years. Survival at D30 was 5.11% in the absence of CPR, 8.86% with bystander initiation and 7.35% with DC initiation (p < 0.001). Survival at D30 with favourable neurologic prognosis (CPC 1–2) was 76.30%, 83.69% and 82.82%, respectively. Our results show a 3.75% increase in the chance of survival at D30 if CPR was initiated by bystanders compared to patients for whom CPR was not initiated, a 2.25% increase in survival in the group that received from CPR initiated by the DC compared to the group that did not receive CPR. ConclusionsBystander CPR initiated by the DC represents a suitable option following out-of-hospital cardiac arrest.

Epidemiology of Prehospital Care at the San Diego (USA) - Tijuana (Mexico) International Border Crossing

Introduction: San Diego has one of the busiest international land border crossings in the world. The epidemiology of prehospital care at the San Diego (California, USA)–Tijuana (Baja California, Mexico) border crossings are previously unreported. Investigators sought to describe prehospital care provided at the San Diego border crossings. Methods: This was a cross-sectional, retrospective data collection from April 2014 to March 2017 evaluating prehospital provider (PHP) contacts at 2 international border crossing addresses in San Diego. The 9-1-1 dispatch center and first response were provided by a single municipal fire agency with ambulance transportation provided by a contracting private agency. Patient dispatch data and electronic patient care records were queried for patient demographics, PHP arrival time, incident complaint, assessment narrative, and treatments provided. Natural language processing techniques were applied to map the narrative to the National Library of Medicine's Unified Medical Language System. Descriptive analysis was performed in the R software program. Results: A total of 6,261 PHP patient contacts were made at the 2 border crossings during the study period. 87% of the calls were at the San Ysidro border crossing compared to 13% at Otay Mesa. The population, composed of 50.8% males, had ages ranging from 0 days—103 years old, with a median age of 45 years old. There were 606 (9.7%) pediatric patients (<18 years) and 1,416 (22.6%) geriatric patients (>65 years). The top 3 incident complaints were respiratory distress (830, 10.8%), blunt trauma (827, 10.7%), and abdominal pain (814, 10.6%); and, the top 3 medications provided were oxygen (481, 7.7%), normal saline (393, 6.3%), and ondansetron (352, 5.6%). Conclusion: This was the first study of PHP assessment and care at the San Diego-Tijuana border crossings. We found a large diversity in patient ages. Respiratory distress and blunt trauma were the most frequent complaints and oxygen was the most frequent medication. The busiest day of the week was Sunday, and the busiest month of the year was July. Our newly described findings may assist EMS agencies with optimizing staff, equipment, and training at international border crossings.

Accuracy of judgment of urgency as perceived by emergency medical dispatch centres in Denmark- a quality assurance study

Background: Since 2011, dispatch of the emergency pre-hospital resources has been performed by health care providers. The dispatch of the prehospital resources takes place using a criteria-based nationwide dispatch system, The Danish Medical Aid Index. 1 Andersen M.S. et al. Scand J Trauma Resusc Emerg Med. 2013 Jul 9; 21: 53 Crossref PubMed Scopus (96) Google Scholar This is a tool that classifies the patients into 37 different symptom groups system to determine the level of urgency required. 1 Andersen M.S. et al. Scand J Trauma Resusc Emerg Med. 2013 Jul 9; 21: 53 Crossref PubMed Scopus (96) Google Scholar Following prehospital contact with the Emergency Medical System, an electronic medical record is created. This record includes variables such as type of response and response time, vital parameters, treatment, etc. Furthermore, the electronic medical record system enables the emergency medical technician (EMT) to provide feedback to the dispatcher by reporting whether the condition reported by the dispatcher matches the findings at the scene.

Effectiveness of dispatcher instructions-dependent or independent bystander cardiopulmonary resuscitation on neurological survival among patients with out-of-hospital cardiac arrest

Abstract Background We evaluated the association between survival and bystandercardiopulmonary resuscitation (CPR) with or without dispatcher instructions (DI) considering the time from emergency call receipt by the dispatch center to emergency medical services (EMS) personnel’s contact with the patient (i.e. time to EMS arrival). Methods This prospective study conducted in Osaka City, Japan, from 2009 to 2015 included patients with medical cause-related out-of-hospital cardiac arrest who were ≥18 years old. The primary outcome was one-month favorable neurological survival. Using multiple logistic regression models, the adjusted odds ratios (AOR) of independent and DI-dependent CPR for the primary outcome were compared with no CPR. Adjustments were made for patients’ age, sex, activities of daily living before the cardiac arrest, year of cardiac arrest, location, presence or absence of witnesses, etiology of cardiac arrest, and the time from EMS contact with the patient to patient’s arrival at the hospital. The effective estimated “time to EMS arrival” was also calculated. Results For analyses 10,925 individuals were eligible. Independent CPR had a significantly higher one-month favorable neurological survival than no CPR whereas there was no significant difference between DI-dependent CPR and no CPR (AOR, 1.90 [1.47–2.46] and 1.16 [0.91–1.47], respectively). The estimated “time to EMS arrival” for a one-month favorable neurological survival after independent CPR was ≤13 min. Conclusions Bystander CPR that did not need DI was associated with significantly higher one-month favorable neurological survival than no CPR, with an effective estimated “time to EMS arrival” of ≤13 min.