Dispatch Services Research Articles

Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study

ObjectiveTo assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy.DesignObservational cohort study.SettingEmergency telephone triage provided...

Design of decision-making support system in power grid dispatch control based on the forecasting of energy consumption

Electric grids are constantly expanding, and supervisory control and management methods must also be improved and changed in order to maintain reliable and safe power supply to consumers. This article proposes a methodology for supporting the adoption of dispatch decisions on the base electrical load forecasting. The energy consumption forecast is based on a deep neural network, and depending on the value obtained, a recommendation for optimising the operation of the energy system is proposed. Thus, dispatch service employees will be able to make decisions on managing the energy system based on the recommendations received, which will increase the speed of decision-making and improve the efficiency of the entire dispatch centre. Also, intelligent data processing and the proposed decisions allow us to consider and compare the factors that may be missed because of the human factor when the information is processed directly by the dispatcher. The use of retrospective data about the consumed power, the ambient temperature, and the type of day of the week is proposed as a knowledge base for forecasting energy consumption and training a neural network. The proposed neural network made it possible to achieve a value of the average absolute error of MAPE prediction of 1.922%. The obtained accuracy allows the use of forecasting results for dispatch control.

Research of the cooperation technology between the air traffic control service and the aerodrome service

The article considers the process of cooperation between the ATC and airport operation services. The analysis considers the procedures of cooperation while inspecting a runway before performing flights, aircraft departure and arrival that encompass the entire range of coordinated operations. For each procedure, the costs of aircraft delays are calculated. The assessment was carried out by synthesizing the chronology of services cooperation in real conditions. On the basis of the collected data flowcharts of services cooperation to ensure flights of an airport and the ATM services were built. To provide a visual comparison of the existing and proposed model sof services cooperation the networks of services cooperation were built based on the mathematical model of the graphic chart. The operation network establishes the sequence of events to provide departure of one aircraft operating a scheduled flight of an airline. Within the given study the ATC service and the aerodrome service are involved to ensure a departure. Cooperation between the operation and dispatch service of the airport and an aircraft crew is conditional because in this case they do not impact the technology of cooperation. The network is a particular set of dots(summits)interconnected by lines (links). In the case of our study, circles are events (performed work). Directional segments (lines) are work connecting events to each other. While assessing the process of cooperation during arrival and departure, two cases were considered: the runway is occupied or clear.The runway could be occupied for different reasons: available vehicles, people, animals or flocks of birds on the runway. The study of the cooperation technology was carried out for 12 monthsof making scheduled flights at Zhukovsky and Ostafievo airports on the basis of every day flight plans.

Use of Fuzzy Coalition Games in Socially Oriented Decision Making During Hospitalization in Pandemic

The problems of organizing medical care in the context of the COVID-19 pandemic, associated with the uncertainty and limitedness of various resources, led to the need to improve decision-making systems for hospitalization of patients. Situational management can improve the decision-making process to fit the current situation better. At the same time, it becomes important to take into account the influence of psychological factors on decisions made during hospitalization. The paper proposes the use of coalition games for situational management during hospitalization of patients. The players and members of the coalition are hospitals, ambulance teams, patients and computed tomography centers. The goal of the game is to form a coalition of participants that provides the maximum benefit in terms of time and cost of hospitalization at the time of decision making. The general scheme of hospitalization, the main sources of information about the situation, the formulation and formalization of the problem are considered. An experiment was carried out in which the formation of a coalition during hospitalization was tested based on data obtained from analyzing the dynamics of the COVID-19 pandemic. Due to the small amount of data and the lack of approved models of the situation development, when carrying out the calculation, some of the parameters were estimated using heuristic models of the development of the situation, based on the analysis of information from open sources of information. The experiment result contains a set of coalitions that provide the maximum benefit under the specified constraints. At the same time, the calculation time of the coalition game allows using the proposed model of decision-making support during hospitalization in the dispatch service of ambulance stations.

Power Flow Management by Active Nodes: A Case Study in Real Operating Conditions

The role of distributor system operators is experiencing a gradual but relevant change to include enhanced ancillary and energy dispatch services needed to manage the increased power provided by intermittent distributed generations in medium voltage networks. In this context, the paper proposes the insertion, in strategic points of the network, of specific power electronic systems, denoted as active nodes, which permit the remote controllability of the active and reactive power flow. Such capabilities, as a further benefit, enable the distributor system operators to provide ancillary network services without requiring any procurement with distributed generation systems owners. In particular, the paper highlights the benefits of active nodes, demonstrating their capabilities in reducing the inverse power flow issues from medium to high voltage lines focusing on a network cluster including renewable energy resources. As a further novelty, this study has accounted for a real cluster operated by the Italian distributor system operator Areti. A specific simulation model of the electrical lines has been implemented in DigSilent PowerFactory (DIgSILENT GmbH–Germany) software using real operating data obtained during a 1-year measurement campaign. A detailed cost-benefit analysis has been provided, accounting for different load flow scenarios. The results have demonstrated that the inclusion of active nodes can significantly reduce the drawbacks related to the reverse power flow.

Mobilisation of emergency services for chemical incidents in Sweden - a multi-agency focus group study

BackgroundIn chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emergency medical services, police services, and emergency dispatch services personnel.MethodsEight emergency service organizations in two distinct and dissimilar regions in Sweden participated in one organization-specific focus group interview each. The total number of respondents was 25 (7 females and 18 males). A qualitative inductive content analysis was performed.ResultsThree types of information processing were derived as emerging during acute-phase chemical incident mobilization: Unspecified (a caller communicating with an emergency medical dispatcher), specified (each emergency service obtaining organization-specific expert information), and aligned (continually updated information from the scene condensed and disseminated back to all parties at the scene). Improvable shortcomings were identified, e.g. randomness (unspecified information processing), inter-organizational reticence (specified information processing), and downprioritizing central information transmission while saving lives (aligned information processing).ConclusionsThe flow of information may be improved by automation, public education, revised dispatcher education, and use of technical resources in the field. Future studies should independently assess these mechanism’s degree of impact on mobilisation of emergency services in chemical incidents.

ANALYSIS OF EMERGENCY OPERATION OF WATER PIPELINES

In this work, the influence of individual sections of the water supply network on the dynamics of nodal heads in emergency operating modes is investigated. During accidents in the network sections, the dynamics of the head changes, the supply of water to the network decreases, areas with insufficient heads are formed. The subject of the analyzed stage of research is the influence of individual sections of the network on the location and size of areas with insufficient head. To determine the influence of individual sections of the network on head dynamics, methods of mathematical modeling of flow distribution in the water supply network, methods of hydraulic calculations of water supply networks were used. The results of studies of formation and change of areas with insufficient head taking into account emergency situations for networks with different structure and configuration are presented. The tasks to be performed by the flow management system at the network design stage are defined. Based on the results of the studies, the water supply conditions were evaluated during the formation of areas of insufficient pressure. Proposed algorithm consists of visualization of network structure, simulation of emergency situations, hydraulic calculations of network in normal and emergency operation modes, determination of actual head in network nodes, clarification of location of control nodes, calculation of required head of pumps in emergency operation mode. The proposed method allows you to determine the priority selection of network sections during its reconstruction and restoration. Modeling and analysis of pressure zones in the network allows you to change the number and location of pressure control units depending on the need. The proposed recommendations on flow management can be implemented in the work of utility dispatch services.

Priority accuracy by dispatch centers and Emergency Medical Services professionals in trauma patients: a cohort study

PurposePriority-setting by dispatch centers and Emergency Medical Services professionals has a major impact on pre-hospital triage and times of trauma patients. Patients requiring specialized care benefit from expedited transport to higher-level trauma centers, while transportation of these patients to lower-level trauma centers is associated with higher mortality rates. This study aims to evaluate the accuracy of priority-setting by dispatch centers and Emergency Medical Services professionals.MethodsThis observational study included trauma patients transported from the scene of injury to a trauma center. Priority-setting was evaluated in terms of the proportion of patients requiring specialized trauma care assigned with the highest priority (i.e., sensitivity), undertriage, and overtriage. Patients in need of specialized care were defined by a composite resource-based endpoint. An Injury Severity Score ≥ 16 served as a secondary reference standard.ResultsBetween January 2015 and December 2017, records of 114,459 trauma patients were collected, of which 3327 (2.9%) patients were in need of specialized care according to the primary reference standard. Dispatch centers and Emergency Medical Services professionals assigned 83.8% and 74.5% of these patients with the highest priority, respectively. Undertriage rates ranged between 22.7 and 65.5% in the different prioritization subgroups. There were differences between dispatch and transport priorities in 17.7% of the patients.ConclusionThe majority of patients that required specialized care were assigned with the highest priority by the dispatch centers and Emergency Medical Services professionals. Highly accurate priority criteria could improve the quality of pre-hospital triage.

Deep ensemble multitask classification of emergency medical call incidents combining multimodal data improves emergency medical dispatch

The objective of this work was to develop a predictive model to aid non-clinical dispatchers to classify emergency medical call incidents by their life-threatening level (yes/no), admissible response delay (undelayable, minutes, hours, days) and emergency system jurisdiction (emergency system/primary care) in real time. We used a total of 1 244 624 independent incidents from the Valencian emergency medical dispatch service in Spain, compiled in retrospective from 2009 to 2012, including clinical features, demographics, circumstantial factors and free text dispatcher observations. Based on them, we designed and developed DeepEMC2, a deep ensemble multitask model integrating four subnetworks: three specialized to context, clinical and text data, respectively, and another to ensemble the former. The four subnetworks are composed in turn by multi-layer perceptron modules, bidirectional long short-term memory units and a bidirectional encoding representations from transformers module. DeepEMC2 showed a macro F1-score of 0.759 in life-threatening classification, 0.576 in admissible response delay and 0.757 in emergency system jurisdiction. These results show a substantial performance increase of 12.5 %, 17.5 % and 5.1 %, respectively, with respect to the current in-house triage protocol of the Valencian emergency medical dispatch service. Besides, DeepEMC2 significantly outperformed a set of baseline machine learning models, including naive bayes, logistic regression, random forest and gradient boosting (α = 0.05). Hence, DeepEMC2 is able to: 1) capture information present in emergency medical calls not considered by the existing triage protocol, and 2) model complex data dependencies not feasible by the tested baseline models. Likewise, our results suggest that most of this unconsidered information is present in the free text dispatcher observations. To our knowledge, this study describes the first deep learning model undertaking emergency medical call incidents classification. Its adoption in medical dispatch centers would potentially improve emergency dispatch processes, resulting in a positive impact in patient wellbeing and health services sustainability.

Construction of a mathematical model of a by-pass turbojet engine as part of a complex aircraft model of an on-board navigation system

One of the main trends in the development of modern on-board navigation systems is aimed at increasing the predictability of the aircraft’s flight path in space and time. That in its turn should improve the accuracy of evaluation of fuel and operating costs, improving the quality dispatch services and bandwidth airspace. At the same time, the predictability of the trajectory can be an additional factor in ensuring the safety of flight operations. The current level of development of on-board computing systems allows to use the most effective method of forecasting - complex mathematical flight models for solving the problem of predicting a four-dimensional flight path and evaluating fuel costs. At the same time, a feature of the flight models implemented in on-board systems remains the orientation to minimize the computing resources used while ensuring the required accuracy of the estimation of the predicted parameters. One of the components of a complex mathematical model of flight is the engine model, which allows determining the fuel costs and energy capabilities of the aircraft. As one of the options for implementing the engine model as part of a complex mathematical model of the flight of an onboard navigation system, a mathematical description of the functioning model of a two-circuit turbojet engine is presented. For improving the accuracy of the parameter estimation, the model is built on the basis of thermogasdynamic calculation using a limited amount of initial data provided by the engine developer. The presented model of a by-pass turbojet engine provides the calculation of the main parameters of the engine operation, including fuel consumption and available thrust, at the specified values of the required thrust. And also, accordingly, determines the permissible operating modes of the engine when simulating operation as part of an aircraft. The results of the proposed model development are presented.

ON THE QUESTION OF THE EFFECTIVENESS OF NETWORK TECHNOLOGIES IN AUTOMATED GAS SUPPLY SYSTEMS

The topical issues of development of automated control systems of gas control stations (GCS) and ways of reliable and economical functioning of the gas supply system in modern conditions have been considered in the article. The implementation of European innovative technologies, which are associated with using the modern equipment, telemetry tools to transmit the equipment operation parameters to the dispatcher control panel are the one of the ways to increase the safety and efficiency of GCS performance. The characteristic of the modern complex of telemetry, the raising of efficiency, reliability and safe operation of the gas supply systems due to the possibility of monitoring, technological control and management from the central dispatcher control room are given. The complex of telemetry helps to prevent emergency situations at facilities and to ensure control over unauthorized entry into the GCS premises by unauthorized persons. The article discusses the use of the automated system of operative-dispatching management (ASODM). It is a multi-level automated system that ensures the reliable functioning of the gas supply system at all levels of the hierarchy. It has been shown that the result of the creation of the ASODM are equipping of the control object with microprocessor control and management devices, the integration of various automation tools into a single information management system. It has been proven that the development of ASODM of GCS on the basis of local control and management modules using traditional approaches to creation of automation systems and using the cellular telephone communication as data transmission channels based on GSM-technologies are most rational. The digital control device, which is made on the technological platform of the programmable logic integrated circuit (PLIC), is the main element of the local control and management module. Digital control device (PLIC controller) is a relatively inexpensive and reliable equipment in an automated local GCS control system. The method of data transmission via GSM / GPRS wireless communication channel is considered. The use of GSM-modems and GPRS technology allows to remove restrictions on the distance of data transmission, as well as allows to fully automate the process of transmission and processing of information. The use of GSM / GPRS-technologies in the vehicles of the emergency dispatch service is also shown. The dispatcher can fully monitor the movement of the car with registration on the map of the city where the car is located.

Research on Intelligent Technology of Dispatching and Control to Ensure Power Supply Based on Multivariate Information

The development of power dispatch services to ensure power supply has put forward new requirements for the digitalization, intelligence and servitization of the dispatching system. Based on the data of power dispatch and control, the characteristics of power dispatch services to ensure power supply, and research on intelligent technology of dispatching and control to ensure power supply based on multivariate information, by establishing the data model of power supply services, and applying forms of expression such as knowledge graph, with deep neural network and rule learning technology, this paper explores and develops an intelligent robot of dispatching and control to ensure power supply based on multivariate information, which realizes the functions of interface integration of various service platforms, visualized monitoring of power supply information, and release and submission of power supply information, etc. By building intelligent applications according to the requirements of power dispatch services to ensure power supply, it effectively improves the risk prevention and control level and emergency response capacity of power system to ensure power supply, and comprehensively upgrades the safe and stable operation of power system to ensure power supply.

Геоінформаційна система управління пожежними підрозділами

The architecture of the fire information management geographic information system has been developed using standard extensions for SQL servers and includes at least 7 layers, some of which have interactive connections with additional databases. The developed architecture allows to solve a complex of questions of management of fire divisions, both at a stage of designing of building of local territory and during management of process of fire extinguishing in this territory. Integrating data with the distribution of fire risk in the local area and the location of fire and rescue units in an interactive form will optimize the location of fire and rescue units at the construction stage, as well as determine the relevance of existing buildings to fire risk levels. Integration into the geographic information system of the database with the description of poten-tially dangerous objects and objects of increased danger allows the fire chief to promptly obtain information about the object, to determine in advance the existing dangers, methods of extinguishing, location of forces and means and to establish operational communication with representatives of the object for successful firefighting. Interactive information on the availability of rescue equipment in the relevant units and the state of the transport network on the way to the fire allows the fire chief and the operational dispatch service to quickly determine what type and number of equipment and personnel can be used to eliminate a fire, determine the arrival time to the place of the call, as well as quickly redirect reserves if necessary. The combined use of the developed architecture of the geographic information system with a satellite traffic control system allows to control the movement of rescue units and redistribute forces and resources within the local area.

Development of 3D workspace and methodology for assessing operator’s functional state during the work in virtual environment

The article presents the current results of a research project aimed at developing software and hardware solutions that optimize an operation of dispatch services based on immersive technologies. The results of the virtual operator’s office creation for the subsequent program-protocol communication of the displayed information with the data sources of the dispatching object are presented. The virtual workspace is implemented in the form of large-scale objects, textures, lighting, etc. “animated” in virtual reality glasses. The results of the initial approbation of the methodology for assessing the psychophysiological state of operators during virtualization of the working information space are also presented in framework of multistage studies of effects of virtual reality on the user.

Организационные аспекты оптимизации работы службы скорой медицинской помощи г. Сургута

Aim. To analyze the quantitative and qualitative indicators of the ambulance and emergency medical services in Surgut in the conditions of redirecting calls with urgent conditions to the emergency departments of outpatient clinics. Materials and methods. The study was conducted in the period from 2013 to 2018 on the basis of the Surgut city clinical ambulance station in Surgut. In accordance with the set aim of the research was defined these forms of statistical reporting № 40 “Report of the station (Department), hospital of emergency medical care” (app. by order of the Ministry of health and social development of the Russian Federation from December 2, 2009 № 942 “On approval of statistical tools stations (offices), hospital emergency medical service”). Results. The experience of redirecting calls with urgent conditions to emergency departments of outpatient clinics in Surgut, which began at the end of 2012, showed that during the period from 2013 to 2018, with an increase in the number of calls (by 15.9%) to the ambulance service, there was a decrease (by 6.4%) in the daily load on the team from 15.8 visits in 2013 to 14.8 visits in 2018. At the same time, the share of departures of the ambulance with the arrival time to the patient in less than 20 minutes after the call, the total number of calls, with an increase from 63.9% in 2013 to 78.1% in 2018, mortality before the arrival of the ambulance, with a reduction (36.1%) from 302,0%000 in 2013 to 192,8%000 in 2018, successful resuscitation at the exit from height (22.3%) from 8.5%000 in 2013 to 10.4%000 in 2018. Conclusion. Reducing the number of visits of emergency medical service teams for urgent conditions, by redirecting requests from patients with chronic diseases to the emergency departments of medical organizations of outpatient clinics during the operation of these institutions, reduced mortality at the pre-hospital stage of medical care, and increased the efficiency of the ambulance station when providing emergency medical care. Due to the control of the standard time for making emergency calls by the dispatcher service of the ambulance station, cases of unintentional failure to provide medical care are excluded. All cases of return of forwarded calls to the ambulance service are transferred to the ambulance team for execution, followed by an analysis of the reasons for violation of the quality criteria established by the Territorial program of state guarantees of free medical care to the population of the Khanty-Mansiyskiy Autonomous okrug – Yugra.

The current state of national system of normative regulation in the field of chemical safety

Problem statement. Chemicals and industrial waste adversely affect human health and the environment. At present, the main problem at chemically hazardous facilities is to timely provide relevant authorities with information on environmental pollution with hazardous chemicals for decision-making on emergency response. Purpose of the article. Studying the current state of chemically hazardous facilities in Ukraine, modern EU projects regulatory documents, draft laws of Ukraine with the aim of improving state regulation of the circulation of chemical products and ensuring their safe use or use with minimal risks to human health and the environment. Conclusions. Chemical industry enterprises pose a potential danger to life, human health and the ecosystem, especially in emergencies caused by the release of chemically hazardous substances with a possible complex of damaging effects (explosions, fires, toxic injuries of people and animals). For chemically hazardous enterprise it is advisable to implement: 1. “The Rules of technogenic safety” on the territory of hazardous facilities in the urban zone, which allow containing hazardous chemicals in volumes provided for by the design storage standards and technological regulations. 2. “A methodology for observing the assessment of radiation and chemical conditions”, which will help to timely provide the governing bodies of the unified state system of civil protection with information on environmental pollution with hazardous chemicals for decision-making on emergency response related to the release of hazardous chemicals. 3. Enterprise dispatch service, radiation and chemical observation post, settlement and analytical group. 4. The law “About chemical safety” will determine the legal framework in the field of chemical safety aimed at limiting the negative impact of technological activities on the state of the environment and the livelihoods of the population, and establish relations in the field of circulation of chemical products, to determine the powers of executive authorities, the rights and obligations of enterprises, institutions, organizations and citizens, taking into account the international obligations of Ukraine in this area.

Опыт внедрения системы прогнозирования последствий аварий в режиме реального времени TOXI+Прогноз на производстве аммиака и карбамида

The article is devoted to the systems for forecasting accidents with the release of toxic and explosion and fire hazardous substances into the atmosphere in real time. The presence of forecasting systems at the production facility allows dispatcher services and other interested parties to provide the required information for making decisions on minimizing the consequences of an accident, formed taking in to account current weather conditions, current data on the technological process and gas pollution detectors readings. The TOXI+Prognosis software developed by CJSC «Scientific and technical center of industrial safety problems research» is considered as an example of such a fore casting system. The main capabilities of this software, as well as the experience of its implementation in the dispatcher service of a hazardous production facility of URALCHEM, JSC engaged in the production of ammonia and carbamide are presented. In the process of impl ementation, a terrain map was entered into TOXI+Prognosis software parameters and location of hazardous equipment, as well as gas pollution detectors, places of presence of people were specified, the list of possible accident scenarios was determined, conditions for automatic start-up of accident scenarios based on the readings of gas pollution detectors were developed, receipt and accounting for these readings, as well as data on weather conditions from the meteorological station of the enterprise were organized. In the process of operation, TOXI+Prognosis software analyzes the readings of the pollution detectors and checks the conditions for starting the accid ent forecast. If these conditions are met, then the calculation is carried out: the exposure areas are determined and visualized on the terrain plan taking into account the current weather conditions based on the parameters of the exposed areas, the locations and the number of people (taking into account the current number) entering these zones are identified and sent to the dispatcher. The specified information is stored in the program and can be provided to the interested parties, including in automatic mode. The calculation can also be performed by the command of the dispatcher.

Abstract 365: The Minnesota Mobile Extracorporeal Cardiopulmonary Resuscitation Consortium for Treatment of Out-of-hospital Refractory Ventricular Fibrillation: Program Description and Outcomes

Background: Extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation has been shown to improve the survival rate for patients with refractory VF/VT cardiac arrest. However, survival decreases as CPR duration increases and metabolic derangement progresses. We describe here a first of its kind multi-healthcare system consortium to rapid deploy ECMO-facilitated resuscitation to patients across a metropolitan area. Methods: This retrospective cohort study analyzed 58 consecutive patients prospectively enrolled in the Minnesota Mobile Resuscitation Consortium’s ECMO-facilitated resuscitation program. Inclusion criteria included: 1) age 18 to 75 years, 2) VF/VT as presenting rhythm, 3) refractory cardiac arrest despite 3 shocks, 4) body habitus accommodating a LUCAS mechanical CPR device, 5) estimated transfer time of < 30 min from a cannulating center. The consortium included multiple healthcare systems, dispatch services, and emergency medical services. Essential components included EMS, selection of 3 ECMO cannulation sites in geographically favorable emergency departments, a centralized ECMO center for post-arrest care, and a 24/7 mobile ECMO cannulation team. The cannulation team provided ECMO cannulation and medical care until the patient reached the ECMO center. Results: From December 1, 2019 to April 1, 2020, 58 consecutive patients were treated by the mobile ECMO team. Mean age was 57 ± 1.8 years. Of these, 25/58 (43%) were discharged from the hospital with neurologically favorable survival. Patients were cannulated at all three cannulation sites with transport to the nearest site leading to mean professional CPR time of 52 min. Conclusions: This represents the first community-wide ECMO-facilitated resuscitation program in the United States. A consortium including multiple healthcare systems and emergency medical services coordinated efforts to rapidly deliver patients with refractory VF/VT cardiac arrest to a highly trained and equipped mobile ECMO cannulation team resulting in improved neurologically favorable survival.

Abstract 273: Exploring the Role of the Emergency Medical System in Promoting Bystander Cardiopulmonary Resuscitation During Out-of-hospital Cardiac Arrests

Introduction: Early bystander initiated cardiopulmonary resuscitation (BCPR) is a key link in the cardiac arrest chain of survival. Prior work indicates that BCPR has a greater impact on survival outcomes when arrests are witnessed, and bystanders are actively prepared. This study explores the role of the emergency medical system—including dispatch, police, fire, and emergency medical services (EMS), in promoting timely bystander response during an out-of-hospital cardiac arrest (OHCA) event. Methods: This sequential mixed-methods study used 2014-2017 data from the Michigan Cardiac Arrest Registry to Enhance Survival (MI-CARES) to analyze the effect of BCPR on OHCA survival outcomes. Logistic regression models were used to analyze the effect of BCPR on sustained ROSC with pulse upon emergency department (ED) arrival and secondary outcomes. These data were supplemented with semi-structured key informant interviews and multidisciplinary focus groups conducted during site visits to 9 emergency medical systems across Michigan including dispatch, police, fire, EMS, and ED. Results: A total of 21,044 OHCA incidents met inclusion criteria. OHCA patients who received BCPR had 1.32 times higher odds of achieving ROSC with pulse upon ED arrival than those that did not after multivariable adjustment (Table 1). Qualitative data from interviews suggest that emergency medical systems can play a critical role in promoting BCPR. Several salient themes emerged across stakeholders including: 1) Preparing the community for proactive bystander response through educational campaigns; 2) Facilitating BCPR during an event through dispatch-assisted CPR and on-scene responders providing positive reinforcement to bystanders; and 3) Reinforcing the importance of performing bystander CPR to the involved community after post arrest care. Conclusion: We found that BCPR was associated with statistically significant improvements in survival outcomes compared to those that did not receive BCPR. These findings emphasize the importance of training bystanders to initiate and perform CPR, and points to engaging the emergency medical system as a leader for this initiative to improve OHCA survival across US communities.

System and analytical research of the development of transport and technological systems of railway ferries

The object of research is the development processes of transport and technological systems of railway ferries as complex technical systems. In the course of the study, a systematic approach to solving the scientific and technical problem of increasing the efficiency of maintenance of railway ferry services is used, for which a graphical method is used to analyze the formation of cause and effect ties with the construction of Ishikawa diagrams. According to the most informational criterion, the reserve for accelerating the speed of railcars on railway ferries is selected – a qualitative characteristic of the efficient use of the railway fleet, which directly depends on the reduction of railway outages in the port area, is promising. The research results provide a multifaceted picture that shows the possibility of reducing the time spent on the ship at the port by increasing the technical level of organizational work with rolling stock on access roads and loading them on a ferry. It also affects the state of the material and technical base for servicing rolling stock and the port base for loading ferries, the compatibility of operations of dispatch services and the need for appropriate information support. However, the development of these areas is impossible without ensuring conditions for the reliability of railway automation, automation and telemechanics, as well as advanced training of personnel for their maintenance. The compatibility of operations of dispatch services is implemented through the use of flexible forms of organization of cargo flows with the preparation of an optimal cargo plan for loading a railway ferry. The implementation of information support should take into account the synchronization of the information systems of the railway and port, as well as the relationship of automation with the work of the ferry, constantly updated with new software products. Based on the analysis, a program of measures has been drawn up for the development of transport and technological systems of railway ferries.The obtained results are aimed at increasing the efficiency, validity and effectiveness of management work on the operation of means of transport and can be used in carrying out research work of other objects of railway-water communication, in particular port railways.