Efficient Emergency Medical Services Research Articles

Supporting Fair and Efficient Emergency Medical Services in a Large Heterogeneous Region

AbstractEmergency Medical Services (EMS) are crucial in delivering timely and effective medical care to patients in need. However, the complex and dynamic nature of operations poses challenges for decision-making processes at strategic, tactical, and operational levels. This paper proposes an action-driven strategy for EMS management, employing a multi-objective optimizer and a simulator to evaluate potential outcomes of decisions. The approach combines historical data with dynamic simulations and multi-objective optimization techniques to inform decision-makers and improve the overall performance of the system. The research focuses on the Friuli Venezia Giulia region in north-eastern Italy. The region encompasses various landscapes and demographic situations that challenge fairness and equity in service access. Similar challenges are faced in other regions with comparable characteristics. The Decision Support System developed in this work accurately models the real-world system and provides valuable feedback and suggestions to EMS professionals, enabling them to make informed decisions and enhance the efficiency and fairness of the system.

The Location Problem of Medical Drone Vertiports for Emergency Cardiac Arrest Needs

The implementation of medical drones can quickly and efficiently expand the coverage range of an area, allowing for a faster response to incidences of out-of-hospital cardiac arrest and improving the subsequent survival rate of such incidences, while promoting sustainable health development goals under the configuration standards for automatic external defibrillators in China. In response to the problem of the selection of locations for medical drone vertiports (for take-off and landing) that are equipped with automatic external defibrillation facilities, a survival function was introduced to establish a model for site selection, with the primary optimization objective of maximizing the average survival rate of patients and taking the operating costs of a system into account. At the same time, considering the constraints of drone phase operation time, energy consumption, coverage range, etc., a medical drone vertiport site selection model was established for emergency cardiac arrest needs. An improved immune algorithm was applied to the model’s calculations and the analysis of the results, using the Jinnan District in Tianjin as an example. The results show that the proposed model and algorithm are feasible and applicable. The Jinnan District in the city of Tianjin requires a total of 24 medical drone vertiports in order to achieve full coverage of an area under the “golden 4-minute” rescue time. When the average survival rate of patients is 0.9, the operation results are deemed optimal, and the average survival rate of patients is 64.06%. Compared to ground ambulances currently used in hospitals, the implementation of medical drones could significantly shorten response time, improve the average survival rate of patients by 41.96%, and effectively improve the existing low survival rate and the accessibility of medical services. The results of this study can provide decision-making support for the planning of automatic external defibrillators in public places and the construction of sustainable and efficient emergency medical service systems.

Differences between the dispatch priority assessments of emergency medical dispatchers and emergency medical services: a prospective register-based study in Finland

BackgroundResponsive and efficient emergency medical services (EMS) require accurate telephone triage. In Finland, such services are provided by Emergency Response Centre Agency (ERC Agency). In 2018, a new Finnish computer-assisted emergency dispatch system was introduced: the Emergency Response Integrated Common Authorities (ERICA). After the introduction of ERICA, the appropriateness of EMS dispatch has not been investigated yet. The study´s objective is to determine the consistency between the priority triage of the emergency medical dispatcher (EMD) and the on-scene priority assessment of the EMS, and whether the priority assessment consistency varied among the dispatch categories.MethodsThis was a prospective register-based study. All EMS dispatches registered in the Tampere University Hospital area from 1 August 2021 to 31 August 2021 were analysed. The EMD’s mission priority triaged during the emergency call was compared with the on-scene EMS’s assessment of the priority, derived from the pre-set criteria. The test performance levels were measured from the crosstabulation of true or false positive and negative values of the priority assessment. Statistical significance was analysed using the chi-square test and the Kruskal–Wallis H test, and p-values < 0.05 were considered significant.ResultsOf the 6416 EMS dispatches analysed in this study, 36% (2341) were urgent according to the EMD’s dispatch priority, and of these, only 29% (688) were urgent according to the EMS criteria. On the other hand, 64% (4075) of the dispatches were non-urgent according to the EMD’s dispatch priority, of which 97% (3949) were non-urgent according to the EMS criteria. Moreover, there were differences between the EMD and EMS priority assessments among the dispatch categories (p < 0.001). The overall efficiency was 72%, sensitivity 85%, specificity 71%, positive predictive value 29%, and negative predictive value 97%.ConclusionWhile the EMD recognised the non-urgent dispatches with high consistency with the EMS criteria, most of the EMD’s urgent dispatches were not urgent according to the same criteria. This may diminish the availability of the EMS for more urgent missions. Thus, measures are needed to ensure more accurate and therefore, more efficient use of EMS resources in the future.

The potential of new prediction models for emergency medical dispatch prioritisation of patients with chest pain: a cohort study

ObjectivesTo develop emergency medical dispatch (EMD) centre prediction models with high sensitivity and satisfying specificity to identify high-priority patients and patients suitable for non-emergency care respectively, when assessing patients with chest pain.MethodsObservational cohort study of 2917 unselected patients with chest pain who contacted an EMD centre in Sweden due to chest pain during 2018. Multivariate logistic regression was applied to develop models predicting low-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.ResultsPrediction models were developed for the identification of patients suitable for high- and low-priority dispatch, using 11 and 10 variables respectively. The area under the receiver-operating characteristic curve (AUROC) for the high-risk prediction model was 0.79 and for the low-risk model it was 0.74. When applying the high-risk prediction model, 56% of the EMS missions were given highest priority, compared with 65% with the current standard. When applying the low-risk model, 7% were given the lowest priority compared to 1% for the current standard. The new prediction models outperformed today’s dispatch priority accuracy in terms of sensitivity as well as positive and negative predictive value in both high- and low-risk prediction. The low-risk model predicted almost six times as many patients as having low-risk conditions compared with today’s standard. This was done without increasing the number of high-risk patients wrongly assessed as low-risk.ConclusionsBy introducing prediction models, based on logistic regression analyses, using variables obtained by standard EMD-questions on age, sex, medical history and symptomology, EMD prioritisation can be improved compared with using current criteria index-based ones. This will allow a more efficient emergency medical services resource allocation.

Development of Core Indicators for the Efficient Emergency Medical Service System

Development of Core Indicators for the Efficient Emergency Medical Service System

First Aid Practices for Injured Children in Rural Ghana: A Cluster-Random Population-Based Survey.

The majority of injury deaths occur outside health facilities. However, many low- and middle-income countries (LMICs) continue to lack efficient Emergency Medical Services (EMS). Understanding current first aid practices and perceptions among members of the community is vital to strengthening non-EMS, community-based prehospital care. This study sought to determine caregiver first aid practices and care-seeking behavior for common household child injuries in rural communities in Ghana to inform context-specific interventions to improve prehospital care in LMICs. A cluster-randomized, population-based household survey of caregivers of children under five years in a rural sub-district (Amakom) in Ghana was conducted. Caregivers were asked about their practices and care-seeking behaviors should children sustain injuries at home. Common injuries of interest were burns, laceration, choking, and fractures. Multiple responses were permitted and reported practices were categorized as: recommended, low-risk, or potentially harmful to the child. Logistic regression was used to examine the association between caregiver characteristics and first aid practices. Three hundred and fifty-seven individuals were sampled, representing 5,634 caregivers in Amakom. Mean age was 33 years. Most (79%) were mothers to the children; 68% had only completed basic education. Most caregivers (64%-99%) would employ recommended first aid practices to manage common injuries, such as running cool water over a burn injury or tying a bleeding laceration with a piece of cloth. Nonetheless, seven percent to 56% would also employ practices which were potentially harmful to the child, such as attempting manual removal of a choking object or treating fractures at home without taking the child to a health facility. Reporting only recommended practices ranged from zero percent (burns) to 93% (choking). Reporting only potentially harmful practices ranged from zero percent (burns) to 20% (fractures). Univariate regression analysis did not reveal consistent associations between various caregiver characteristics and the employment of recommended only or potentially harmful only first aid practices. Caregivers in rural Ghanaian communities reported using some recommended first aid practices for common household injuries in children. However, they also employed many potentially harmful practices. This study highlights the need to increase context-appropriate, community-targeted first aid training programs for rural community populations of LMICs. This is important as the home-based care provided for injured children in these communities might be the only care they receive.

Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke.

Background and Purpose- Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods- We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates' balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results- Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95-2.20] for onset-to-door time ≤2 hours, 2.32 [2.18-2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88-3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62-1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70-1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions- Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.

A Multi-Period Location-Allocation-Inventory Problem for Ambulance and Helicopter Ambulance Stations: Robust Possibilistic Approach

For saving as many as possible human lives, designing an efficient Emergency Medical Services (EMS) network seems necessary, especially by considering world complicated conditions, such as multi-facility locations and multi-transportation modes (e.g., ambulance and helicopter ambulance). The aims of this study are to locate the stations, allocate the accident-prone points to them, determine the required hospital bed capacities provided for patients with critical conditions, and decide about the inventory levels at opened stations including blood banks, medicines, etc. The model is subjected to resource limitation (e.g. budget and a limited number of helicopter ambulances). Since the real-world uncertainty stated by fuzzy numbers, a possibilistic method is used for solving the given problem. To immune solutions in front of fluctuation, it is combined with robust optimization; therefore, a robust possibilistic approach is used. Finally, an augmented ∈-constraint method is used to cope with the bi-objective problem that minimizes the cost and the arrival time. In practice, the model is applied to a real case.

Factors Influencing Satisfaction with the Emergency Medical Services between Adults and the Elderly

Purpose: The purpose of this secondary data analysis study was to compare what factors influenced individual"s satisfaction with emergency medical services (EMS). Methods: Data were obtained from the Korea Health Panel Survey 2013 with 20,641 participants. A total sample of emergency room (ER) users (n=1,709) aged 20 and over were selected and divided into two age groups, one for 1,046 adults and the other for 663 elderly. Participants" responses were analyzed using descriptive statistics, x2 test and logistic regression. Results: Among adults and elderly who were transferred to other hospitals instead of being admitted or returned to their homes reported less satisfaction (x 2 =10.18, p=.006). Further, the adults who perceived their arrival to the ER as not delayed (x2=3.74, p=.049) or visited the ER for treatment for illness (x2=5.32, p=.021) reported more satisfaction than those who perceived their ER service being delayed or visited the ER for accident or poisoning. The elderly who visited ER by non-ambulance reported higher satisfaction than those who arrived by ambulance (x2=14.15, p<.001). Conclusion: In both adults and the elderly, satisfaction of EMS can be increased by avoiding transferring patients to other hospital. For adults to be satisfied with EMS, efficient and rapid EMS might be needed to avoid delay in ER arrival, especially for adults with accidents or poisoning.

Modern directions of personnel policy in system of emergency medical services

Relevance. In recent years, volumes of emergency care markedly decreased (from 47,5 million in 2010 to 45,4 million responses of emergency teams in 2016). One of the related problems – staff shortage in a system of emergency medical services.Intention. To assess personnel capacity of a system of emergency medical services, identify problems and search their solutions.Methodology. Federal statistical data (Form No 30 “Data on the medical organization”) for 2010–2016 were analyzed. Results and Discussion. The staff shortage was revealed (30 % in 2016), the number of doctors decreased by 20.2 %, structure and profiles of emergency teams changed, particularly 72.1 % of physicianled teams were replaced by doctor’s assistants. Concurrently, inpatient emergency systems developed. Conclusion. Overcoming the staff shortage is the priority task to maintain efficient emergency medical services. Special measures to improve the personnel policy have been developed.

Mortality in a Primary and Secondary Transported of STEMI Patients, a Prospective Study

In ST-elevation myocardial infarction (STEMI), the pre-hospital phase is the most critical and appropriate treatment in a timely manner which is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service (EMS) are pivotal. The first steps are devoted to minimizing patient’s delay in seeking care, quickly dispatching emergency personnel with equipped ambulance to be able to make the diagnosis on scene, deliver initial drug and therapy and also transport the patient to the most appropriate (not necessarily the closest) cardiac facility or hospital. Primary percutaneous coronary intervention (PCI) is a treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI are valid alternatives. Strong cooperations between cardiologists and emergency medicine doctors are mandatory for optimal pre-hospital STEMI care. In this study, we prospectively recorded door to balloon time (DBT) for consecutive patients with STEMI, treated by PCI. For six hundred and seventy seven patients with mean 64 ± 16 years, 475 (70%) males and 202 (30%) females were enrolled for the final analysis. From this number, 354 (52.3%) patients had primary transport by emergency services (PT) and 323 (47.7%) secondary transport (ST). Median of DBT was 34 ±15.9 mins for PT patients (n=354) and 100 ±28.8 mins for patients with ST (n=323) (p<0.00005). One month mortality rate was 4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality rate in the PT and ST groups were 7.3% vs 20.5% (p<0.005), respectively. We found out that patients who were sent directly to a PCI center had significantly shorter time for reperfusion and lower mortality.

Evaluation of Dynamic Ambulance Routing for the Transportation of Patients with Acute Coronary Syndrome in Saint-petersburg

Abstract Effective treatment of acute coronary syndrome (ACS) patients depends on the transportation time to a hospital. But selection of an optimal route and target hospital for an ambulance within a large city is a complex problem. It requires taking into account the dynamical nature of an urban environment. Such dynamic factors as traffic flow, changing road graph, population mobility, and hospital capabilities are sources of uncertainty in decision making on hospitalization, and eventually they influence the functioning quality of emergency medical services (EMS) in a city. This work is devoted to the analysis of this problem for the city of Saint-Petersburg (Russia) with the use of statistical data, public geographic information services (OpenStreetMap), and real-time data on traffic flow (Yandex.Maps). It is shown that dynamic traffic conditions influence selection of a hospital and have to be considered within the task of ambulance routing. The results may be applied in order to design a more efficient EMS decision support system for ambulance personnel and dispatchers.

Physical Infrastructure Assessment for Emergency Medical Response

The performance of an emergency medical service (EMS) depends on the existing infrastructure and allocation of medical resources. It is challenging to implement an efficient EMS owing to the spatial complexity of the population and geographical layout within urban areas. Management of ambulance headquarters and hospitals, which are part of the physical infrastructure, should be assessed to ensure a timely response. The objective of this research is to propose a general assessment process for a prehospital EMS by evaluating the physical infrastructure. A geographic information system is adapted to visualize and analyze the EMS of a region EMS from various perspectives. In the assessment process, the EMS is evaluated with incident data and the transportation network is evaluated through spatial and temporal analyses such as service area, clustering, and spatial interpolation. As a case study, the process is applied to New Taipei City for the assessment of its prehospital EMS. The results have shown that the proposed assessment process can help discover existing deficiencies and offer suggestions to the current EMS. Regions less accessible by the EMS were discovered; the spatial coverage of historical demand incidents was 93.8% for the union of ambulance headquarters and 70.52% for the union of hospitals in their respective 3 km service areas. Cluster analysis suggested an EMS performance gain of 0.68% compared with the current situation for the construction of an additional ambulance facility and 1.45% for an additional hospital. Future work will extend the proposed process with specialized spatial and temporal data mining techniques and to apply the process to more case studies.

Emergency medical services in rural areas of Finland

Finland is a comparatively large and sparsely populated country in Northern Europe. As such, providing efficient emergency medical services (EMS), particularly in remote areas, is challenging. There are 22 hospital districts in Finland, all offering 24/7 trauma care, and five university hospitals within these 22 districts. Each district is responsible for organising EMS in its area, either independently, together with the local fire and rescue services or by buying in the service from private EMS providers. Using Lapland as an example of a highly rural area—where, for example, the distance from the only hospital in Rovaniemi to the northernmost part of the district is over 400 km—the present article provides a concise description of the challenges and solutions involved in providing EMS in sparsely populated areas and illustrates how Finland has built up an EMS system with limited resources.

A robust counterpart approach to the bi-objective emergency medical service design problem

The paper presents a bi-objective robust program to design a cost-responsiveness efficient emergency medical services (EMS) system under uncertainty. The proposed model simultaneously determines the location of EMS stations, the assignment of demand areas to EMS stations, and the number of EMS vehicles at each station to balance cost and responsiveness. We develop a robust counterpart approach to cope with the uncertain parameters in the EMS system. Extensive numerical studies are performed to demonstrate the benefits of our robust optimization approach.

Modelling emergency medical services with phase-type distributions

Effective and efficient emergency medical services (EMS) are a critical part of a national healthcare system. This paper describes research to model EMS by better capturing ambulance service times using Coxian phase-type (PH) distributions. Distributions are fitted to both the overall cycle time for different classes of patient priorities, as well as to sub-cycles. Sub-cycles are the distinct identifiable parts of the ambulance cycle time, such as travel times, time on scene and turnaround time at the hospital. The Coxian PH fits have then been used within a priority simulation model to provide guidance on the number of ambulances required to meet response time targets. Results from using various numbers of phases from the fitted Coxian distributions are compared. The proposed benefit of using sub-cycle fits is that it more readily permits scenario modelling within the simulation, such as evaluating the impact of reducing the turnaround time on the overall response times in the ambulance system.

Regionalization strategy of the emergency medical service system

A regionalization strategy is a model for improving the performance of the emergency medical service (EMS) system. The regionalization strategy has goals to provide appropriate, timely, effective, and efficient EMS in a region. However, the current EMS regionalization model in Korea is insufficient to achieve these goals due to a shortage of resources in rural regions, crowded emergency departments in metropolitan regions, and non-customized and mismatched levels of emergency departments. Recently, the concept of the regionalization model has been changed from a general regionalized model to a specialty care regionalization one. For example, the trauma care system, cardiac arrest care system, stroke care system, and ST elevation myocardial infarction care system are modern regionalization strategies to improve the performance of EMS. This is a new method of customizing and matching between region-based needs and the supply of EMS. If we can implement this strategy, we can expect improved performance of regional EMS systems.

현 병원 전 단계 응급의료서비스의 선진화 전략

고품질의 맞춤형 서비스는 사회가 고령화, 초핵가족화, 재난 취약 계층의 증가로 인하여 급격히 늘어나게 되었다. 급성 질환, 심뇌혈관 질환, 자살 등 예방 가능한 사망률이 선진국에 비해 높으므로 빠르고 전문적인 구조 및 구급 서비스가 요구된다. 본 논문에서는 응급 환자가 발생하여 병원에 도착하기 전에 환자의 정보를 이용하여 응급처치가 가능하도록 한다. 그리고 응급 의료 기관에서는 환자 진료 준비를 사전에 갖출 수 있도록 하여 응급 환자 진료의 효율성을 높였다. 사회적 인지도가 높은 119번호를 이용하여 다양한 복합 응급 신고를 접수하고 있고, 유관기관과 통합적 대응 체계를 구축하는 효율적 응급의료서비스 선진화 전략을 제시하고자 한다. High-quality customized services demand was growing due to the increase of aging, extremely nuclear family, disaster vulnerable of society. Ambulance service is required of fast and professional rescue and emergency service because of preventable death rate such as acute diseases, cerebral and cardiovascular diseases, suicides, etc. was higher than in developed countries. First aid will be available using patients information when emergency occurs, before arriving at the hospital. And emergency department is equipped with that patient care can be prepared in advance, increase the efficiency of emergency care. We received a variety of complex emergency call using high social awareness of 119 number and propose an efficient emergency medical service advancement strategy building an integrated response system with relevant organization.

Pre-hospital treatment of STEMI patients. A scientific statement of the Working Group Acute Cardiac Care of the European Society of Cardiology

In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on scene, deliver initial drug therapy and transport the patient to the most appropriate (not necessarily the closest) cardiac facility. Primary PCI is the treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI is a valid alternative, according to patient's baseline risk, time from symptoms onset and primary PCI-related delay. Paramedics and nurses have an important role in pre-hospital STEMI care and their empowerment is essential to increase the eff ectiveness of the system. Strong cooperation between cardiologists and emergency medicine doctors is mandatory for optimal pre-hospital STEMI care. Scientific societies have an important role in guideline implementation as well as in developing quality indicators and performance measures; health care professionals must overcome existing barriers to optimal care together with political and administrative decision makers.

Tratamiento prehospitalario de los pacientes con IAMCEST. Una declaración científica del Working Group Acute Cardiac Care de la European Society of Cardiology

In ST-elevation myocardial infarction (STEMI) the pre-hospital phase is the most critical, as the administration of the most appropriate treatment in a timely manner is instrumental for mortality reduction. STEMI systems of care based on networks of medical institutions connected by an efficient emergency medical service are pivotal. The first steps are devoted to minimize the patient's delay in seeking care, rapidly dispatch a properly staffed and equipped ambulance to make the diagnosis on scene, deliver initial drug therapy and transport the patient to the most appropriate (not necessarily the closest) cardiac facility. Primary PCI is the treatment of choice, but thrombolysis followed by coronary angiography and possibly PCI is a valid alternative, according to patient's baseline risk, time from symptoms onset and primary PCI-related delay. Paramedics and nurses have an important role in pre-hospital STEMI care and their empowerment is essential to increase the eff ectiveness of the system. Strong cooperation between cardiologists and emergency medicine doctors is mandatory for optimal pre-hospital STEMI care. Scientific societies have an important role in guideline implementation as well as in developing quality indicators and performance measures; health care professionals must overcome existing barriers to optimal care together with political and administrative decision makers.