Emergency Ambulance Research Articles

DRAMATURGI KELUARGA PASIEN COVID-19 DAN PERAWAT AMBULAN GAWAT DARURAT SAAT PENJEMPUTAN

In the momentum of picking up Covid-19 patients, there was a relatively short communication process in an effort to provide mutual support. Patients' families often experience an ironic phenomenon, on the one hand they must persuade the patient to be willing to be picked up, on the other hand it is impossible to refuse the arrival of an ambulance. On the other hand, AGD nurses are required to have effective impression management skills in motivating patients. The purpose of the study was to find out the dramaturgy of the family of Covid-19 patients and AGD (Emergency Ambulance) nurses at the time of pickup with a qualitative approach with the phenomenological method. The results show that on the family backstage, they convince each other that picking up patients is the most appropriate thing, because covid-19 can be contagious and deadly. On the front stage, they asked nurses to provide guarantees of recovery and information as soon as possible when patients could be visited. As for the backstage of the AGD nurses, they coordinate with each other among the pick-up team members to consistently implement the communication protocol, which contains strategic actions and communicative actions towards patients and their families. Meanwhile, on the front stage, nurses build sympathetic, empathetic and altruistic meanings, that in tackling COVID-19, a coordinating role is needed at all levels of communication.

19 Utilization of Advanced Providers in the Field for Medical Custody Clearance

19 Utilization of Advanced Providers in the Field for Medical Custody Clearance

Association between prescribed opioid dose and risk of motor vehicle crashes.

Opioid-involved motor vehicle traffic fatalities have increased over the past 2 decades. However, the extent to which prescribed opioids increase the risk of motor vehicle crashes remains uncertain. This study used real-world healthcare claims data to examine the association between prescription opioid dose and motor vehicle crash risk. Using nationwide US commercial insurance claims data for 2010 to 2018, we identified 772,404 adults who received incident, noncancer opioid therapy. We examined associations between daily prescription opioid dose, calculated in morphine milligram equivalents (MME) from filled prescription claims, and risk of motor vehicle crashes, assessed as diagnoses of motor vehicle injuries in claims for emergency visits, inpatient hospitalizations, and ambulance transportation. We estimated associations using a within-individual design, which ruled out all time-stable confounding. We complemented the design with time-varying statistical adjustment for other pharmacotherapies and a negative control pain pharmacotherapy analysis (with incident cyclic antidepressant prescriptions). During 2,150,009 person-years of follow-up, there were 12,123 motor vehicle crashes (5.64 crashes per 1000 person-years). In within-individual comparisons, crash risk was greater during opioid prescription periods involving doses ≤60 MME/day (odds ratio [OR], 3.86; 95% confidence interval [CI], 3.54, 4.21), >60 to 120 MME/day (OR, 5.46; 95% CI, 4.44, 6.73), and >120 MME/day (OR, 3.45; 95% CI, 2.31, 5.15) than during off-treatment periods. The negative control analysis supported the specificity of the results to opioids rather than to other processes associated with pharmacologic pain management. These findings suggest that the receipt of prescription opioids, even at doses ≤60 MME/day, is associated with an increased risk of motor vehicle crashes.

‘Mum, I think we might ring the ambulance, okay?’ A qualitative exploration of bereaved family members’ experiences of emergency ambulance care at the end of life

Background: In the context of a sudden or unexpected event, people with a life-limiting illness and their family caregivers may be dependent on emergency ambulance services Aim: To explore bereaved family members’ experiences of emergency ambulance care at the end of life. Design: A qualitative study using reflexive thematic analysis of data collected from semi-structured phone interviews. Setting/Participants: A purposive sample of 38 family caregivers identified from a database of deaths in Aotearoa, New Zealand. Results: Emergency ambulance personnel assist, inform and reassure patients and family caregivers managing distressing symptoms, falls, infections, unexpected events and death itself. Family members and patients are aware of the pressure on emergency services and sometimes hesitate to call an ambulance. Associating ambulances with unwanted transport to hospital is also a source of reluctance. Conclusions: The generalist palliative care provided by emergency ambulance personnel is a vital service for patients in the last year of life, and their caregivers. This must be acknowledged in palliative care policy and supported with training, specialist consultation and adequate resources.

Calling an ambulance for non-emergency medical situations: Results of a cross-sectional online survey from an Australian nationally representative sample.

To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of non-emergency scenarios (n=8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for non-emergency scenarios. Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts.

Ambulance in Kyrgyzstan and Abroad (literature review)

This article presents the literature review on medical emergency ambulance service. The problems related to the organizing and improving the medical emergency ambulance service continue to be significant and relevant in modern world that requires further studying. The author has conducted the historical analysis of the literature sources of the medical emergency ambulance service in different countries of the world. The effectiveness of various forms of the emergency medical care at pre-hospitalization and hospitalization stages are studied. One of the areas in healthcare that needs improvement today is the advancement of the emergency medical care systems. The problems related to the ambulance service of Osh city are highlighted. Examining the emergency medical care (organizational forms) outside the Kyrgyz Republic makes it possible to compare the advantages and disadvantages of the service and can contribute to its improvement in Osh, considering the experience of foreign countries. To reduce the workload of the medical emergency ambulance service, the need for optimizing the emergency medical care at the centers of family medicine is determined. The literature review methods that was used in this article are from the databases of the elibrary, cyberleninka, Medline on the organization of the medical emergency ambulance service in different countries of the world.

Suicide among emergency service workers: a retrospective mortality study of national coronial data, 2001-2017.

Emergency service workers (ESW) are known to be at increased risk of mental disorders but population-level and longitudinal data regarding their risk of suicide are lacking. Suicide data for 2001-2017 were extracted from the Australian National Coronial Information Service (NCIS) for two occupational groups: ESW (ambulance personnel, fire-fighters and emergency workers, police officers) and individuals employed in all other occupations. Age-standardised suicide rates were calculated and risk of suicide compared using negative binomial regression modelling. 13 800 suicide cases were identified among employed adults (20-69 years) over the study period. The age-standardised suicide rate across all ESW was 14.3 per 100 000 (95% CI 11.0-17.7) compared to 9.8 per 100 000 (95% CI 9.6-9.9) for other occupations. Significant occupational differences in the method of suicide were identified (p < 0.001). There was no evidence for increased risk of suicide among ESW compared to other occupations once age, gender and year of death were accounted for (RR = 0.99, 95% CI 0.84-1.17; p = 0.95). In contrast, there was a trend for ambulance personnel to be at elevated risk of suicide (RR = 1.41, 95% CI 1.00-2.00, p = 0.053). Whilst age-standardised suicide rates among ESW are higher than other occupations, emergency service work was not independently associated with an increased risk of suicide, with the exception of an observed trend in ambulance personnel. Despite an increased focus on ESW mental health and wellbeing over the last two decades, there was no evidence that rates of suicide among ESW are changing over time.

112 ACİL YARDIM İSTASYONLARININ MEMNUNİYET, VERİMLİLİK, GÜVENLİK VE PERFORMANS AÇISINDAN DEĞERLENDİRME ÖLÇEĞİNİN GELİŞTİRİLMESİ VE UYGULAMA ÖRNEĞİ

Amaç: Çalışmanın amacı, çalışan personel görüşleri ile 112 acil yardım istasyonlarının memnuniyet, verimlilik, güvenlik ve performans açısından değerlendirilmesi için geçerli ve güvenilir bir ölçme aracının geliştirilmesidir.Gereç ve Yöntem: Betimsel tarzda yapılandırılan çalışmada aday ölçek maddelerinin elde edilmesi için 112 acil yardım istasyonlarında görevli 50 personelden açık uçlu soru uygulaması ile 44 maddeden oluşan soru havuzu elde edilmiştir. İlk uygulamada 112 acil yardım istasyonunda görev yapan 414 çalışandan elde edilen verilerle açıklayıcı faktör analizi ve güvenirlik analizi, ikinci uygulamada 230 çalışandan elde edilen verilerle doğrulayıcı faktör analizi gerçekleştirilmiştir. Araştırma kapsamında geliştirilen bağımsız dört ölçek ile yapılan örnek uygulamadan elde edilen skorlarla katılımcıların demografik özellikleri karşılaştırma testleri ile analiz edilmiştir. Verilerin analizinde SPSS 26,0 ve AMOS istatistik yazılımı kullanılmıştır. Araştırmada 59 faklı ilde görev yapan toplam 644 katılımcıdan veri toplanmıştır.Bulgular: Araştırmanın ilk aşamasında oluşturulan anket formu içerisinden bağımsız dört ölçek geliştirilmiştir. Ölçek alt boyutları açısından bakıldığında güvenilirlik değerleri memnuniyet alt boyutu için 0,878; verimlilik alt boyutu için 0,856; performans alt boyutu için 0,825 ve güvenlik alt boyutu için 0,935 olduğu belirlenmiştir. Araştırma kapsamında geliştirilen dört bağımsız ölçeğin 112 acil yardım istasyonlarını memnuniyet, verimlilik, performans ve güvenlik açısından geçerli ve güvenilir biçimde ölçtüğü sonucuna ulaşılmıştır. 112 acil yardı istasyonunda görev yapan personelin cinsiyetleri, unvanları ve görev süreleri ile 112 acil yardım istasyonlarının sağladığı performans, memnuniyet, verimlilik ve güvenlik boyutları ölçek puanları ile anlamlı bir fark tespit edilmemiştir (p&amp;gt;0,05).Sonuç: Geliştirilen ölçek, bu konudaki literatüre ve 112 acil yardım istasyonlarının güvenlik, performans, verimlilik ve memnuniyet açısından geliştirilmesine yönelik çalışmalara katkı sağlayacaktır.

Maintaining Continuity of Care for Expectant Mothers in Kenya During the COVID-19 Pandemic: A Study of MomCare.

In Kenya, early coronavirus disease (COVID-19) modeling studies predicted that disruptions in antenatal care and hospital services could increase indirect maternal and neonatal deaths and stillbirths. As the Kenyan government enforced lockdowns and a curfew, many mothers-to-be were unable to safely reach hospital facilities, especially at night. Fear of contracting COVID-19, increasing costs of accessing care, stigma, and falling incomes forced many expectant mothers to give birth at home. MomCare, which primarily serves communities in remote areas and urban slums, links mothers-to-be with payers and health care providers, following a standardized pregnancy program based on World Health Organization guidelines at a predetermined cost and quality. Expectant mothers gain access to care through a mobile wallet on their feature phone (voice, text, and basic internet), and providers are paid after appropriate care is given. Within the first 3 weeks of the pandemic in Kenya, the following services were added to the MomCare bundle: emergency ambulance services during curfew hours, extended bed allowances to encourage early care, phone calls to check on mothers approaching their delivery dates and to promote the generation of a birth plan, SMS messages to inform mothers of open facilities and COVID-19 protocols, and training for clinic staff in managing COVID-19 patients and infection prevention. We compare data collected through the MomCare platform during the 6 months before the first confirmed COVID-19 case in Kenya (September 2019-February 2020) with data collected during the 6 months that followed. This study shows that care-seeking behaviors (enrollment, antenatal/postnatal care, skilled deliveries) increased for mothers-to-be enrolled in MomCare during the COVID-19 lockdowns, while quality of care and outcomes were maintained. Public health practitioners can promote interactive, patient-driven technology like MomCare to augment traditional responses, quickly linking payments with patients and providers in times of crisis.

Prediction of School Uniform Sales Using the K-Nearest Neighbor Method

Information regarding monitoring of operational expenditures of the Regional Public Service Agency at the Emergency Ambulance Service Unit of the DKI Jakarta Health Office. Because the finances issued or used must be accurately informed. In this case, monitoring the operational expenses of the Regional Public Service Agency at the Emergency Ambulance Service Unit of the DKI Jakarta Health Service still has many obstacles. Constraints faced are such as the technical executor. The activity of submitting an accountability letter still has a long stage, the Verifier is not there so that the process of checking the accountability letter stops, the input of reports is carried out one by one by the Spending Treasurer using Microsoft Excel. The process of monitoring the operational expenses of the Regional Public Service Agency at the Emergency Ambulance Service Unit of the DKI Jakarta Health Office takes a long time. And another obstacle is the occurrence of classifying the type of operational expenditure. In this data analysis method, using Balanced Scorecard (BSC) analysis, system design uses Visual Paradigm to create UML (Unified Modeling Language), PHP programming language, MySQL to create databases. The result of this research is that an information system for monitoring operational expenditures of the Regional Public Service Agency can create and submit a letter of accountability and verification letters are carried out computerized, the Expenditure Treasurer no longer enters the general cash books one by one, the Expenditure Treasurer no longer classifies the types of operational expenditure in recap operational expenditure.

Analysis of intelligent solar ICU water ambulance to optimize energy

To enhance health and medical facilities, some authorities have recently introduced an emergency special water vehicle known as a ‘water ambulance’. This vehicle is distinct for remote areas. To operate the ambulance service, environmental issues and energy resources have become major concerns. This is a scope of research to address the issues. First, the possibility of using solar energy as the sole power source for a vessel is a perfect solution to these issues. Second, solar vessels operate everywhere without polluting the environment. In addition, another contribution of the research is to integrate a control unit in a water ambulance which is called an ‘intelligent unit’. This unit will prioritize the source of energy to ensure uninterrupted power to emergency medical equipment and ambulances. This paper proposes a dynamic design of a solar water ambulance that is subject to replacing small conventional fuel-run watercraft vehicles.

Systematic review of the impact of heatwaves on health service demand in Australia

ObjectivesHeatwaves have been linked to increased levels of health service demand in Australia. This systematic literature review aimed to explore health service demand during Australian heatwaves for hospital admissions, emergency department presentations, ambulance call-outs, and risk of mortality.Study designA systematic review to explore peer-reviewed heatwave literature published from 2000 to 2020.Data sourcesArticles were reviewed from six databases (MEDLINE, Scopus, Web of Science, PsychINFO, ProQuest, Science Direct). Search terms included: heatwave, extreme heat, ambulance, emergency department, and hospital. Studies were included if they explored heat for a period of two or more consecutive days. Studies were excluded if they did not define a threshold for extreme heat or if they explored data only from workers compensation claims and major events.Data synthesisThis review was prospectively registered with PROSPERO (#CRD42021227395). Forty-five papers were included in the final review following full-text screening. Following a quality assessment using the GRADE approach, data were extracted to a spreadsheet and compared. Significant increases in mortality, as well as hospital, emergency, and ambulance demand, were found across Australia during heatwave periods. Admissions for cardiovascular, renal, respiratory, mental and behavioural conditions exhibited increases during heatwaves. The most vulnerable groups during heatwaves were children (< 18 years) and the elderly (60+).ConclusionsHeatwaves in Australia will continue to increase in duration and frequency due to the effects of climate change. Health planning is essential at the community, state, and federal levels to mitigate the impacts of heatwaves on health and health service delivery especially for vulnerable populations. However, understanding the true impact of heatwaves on health service demand is complicated by differing definitions and methodology in the literature. The Excess Heat Factor (EHF) is the preferred approach to defining heatwaves given its consideration of local climate variability and acclimatisation. Future research should explore evidence-based and spatially relevant heatwave prevention programs. An enhanced understanding of heatwave health impacts including service demand will inform the development of such programs which are necessary to promote population and health system resilience.

Emergency care: need for reform from an outpatient perspective

Seit Jahren stehen Reformen der Akut- und Notfallversorgung auf der gesundheitspolitischen Agenda. So auch im aktuellen Koalitionsvertrag. Zur Einordnung der Ausgangslage werden ein inhaltlicher Rückblick sowie eine Analyse der Abrechnungsdaten aus der ambulanten und stationären Notfallversorgung vorgenommen. Folgt man der Hypothese, dass bisherige Reformansätze insbesondere auf einen Anstieg ambulant vertragsärztlich behandelbarer Fälle in der Notfallversorgung reagierten, muss die Fallzahlentwicklung in der Dekade bis zum Pandemiebeginn (2010–2019) zur Kenntnis genommen werden. Sie zeigt eine Stagnation der Fallzahl in Notaufnahmen und einen seit 2016 rückläufigen Trend insbesondere bei ambulanten Notfallbehandlungen durch Krankenhäuser. Dieser Effekt kann nicht zweifelsfrei auf bereits eingeführte Maßnahmen zur Patientensteuerung (Bereitschaftspraxen, Telefontriage) zurückgeführt werden. Die Analyse der Abrechnungsdiagnosen spricht dafür, dass eine klare Arbeitsteilung zwischen Bereitschaftspraxen und Notaufnahmen besteht. Die konsistente Verlagerung der Fälle hochbetagter Patienten in die ambulante Versorgung durch Notaufnahmen legt aber eine notwendige Weiterentwicklung dieser Arbeitsteilung nahe. Weitere Maßnahmen der Steuerung durch Weiterleitung von Patienten aus Notaufnahmen in die vertragsärztliche Versorgung müssen noch im Detail beschlossen und umgesetzt werden (§ 120 Abs. 3b Sozialgesetzbuch [SGB] V). In der Diskussion wird die Auffassung vertreten, dass Implementierung und Evaluation dieser Maßnahmen abgewartet werden sollten, bevor weitergehende Reformschritte ergriffen werden.

P15 Audit of outcome of ambulatory care emergency surgery patients

Abstract Introduction A proportion of emergency surgical patients are discharged with outstanding tasks (clinical review, imaging to be requested or results followed-up) pending. The turnaround time of these tasks typically placed at the bottom of the emergency surgical on-call list is dependent on the on-call registrar or house officer. The aim was to analyse the outcomes of pending tasks on ambulatory care emergency surgical patients and explore means to improve. Methods A retrospective audit of emergency surgical patients from October to December 2021 was performed using the daily on-call list database. Results Among the 149 patients with pending tasks on an ambulatory care basis, 80 were excluded (duplicate entries, unclear tasks, non-valid reasons). 38% of patients remained on the list for more than 24 hours with pending tasks. Only 75% of patients had pending tasks completed. Patients waited for 3.3 hours on average (59 to 350 minutes) for clinical review by the registrar or house-officer. The reasons for the delay in clinical review and task completion narrowed down to inappropriate timing (scheduled return in the mornings, when the on-call team are either busy with the ward round or in theatres) and time restraints. Conclusion Based on the above findings, it would be beneficial for our hospital to have a surgical hot clinic with staggered appointments rather than ad hoc return to the ambulatory unit. This would improve waiting times and would allow outstanding tasks to be completed by the surgical registrar or clinical fellow during clinic, increasing patient satisfaction. Take-home message A dedicated surgical hot clinic will reduce patient waiting times, increase overall patient satisfaction and ensure completion of outstanding clinical tasks.

The need for location-specific biometeorological indexes in Taiwan.

ObjectiveAs most available biometeorological indexes were developed decades ago in western countries, the benefit of using these indexes to study the effect of weather on human health in modern eastern countries is questionable. This study aimed to reconfirm the effectiveness of applying these biometeorological indexes when analyzing demand for daily emergency ambulance services (EAS) in Taipei.MethodsMore than 370,000 EAS usage records were analyzed in this study. The records were first allotted into different time-series data by age, gender, triage level, and case nature (trauma/non-trauma) in order to represent different kinds of daily EAS demand. They were then regressed on biometeorological indexes [Apparent Temperature (AT) and Net Effective Temperature (NET)]; the indexes' additional descriptive power to describe the daily EAS demand over traditional weather factors was then assessed.ResultsNo significant difference was observed in the descriptive powers in terms of effect on daily EAS demand of the biometeorological indexes and traditional weather factors. The largest improvement on the regression models' adjusted-R2 using NET and AT was only 0.008.ConclusionIt may not be a good idea to make direct use of the biometeorological indexes developed in western countries decades ago. Taiwan should have a tailor-made biometeorological index for a better representation of its unique situation.

Evaluation of Prior Authorization in Medicare Nonemergent Ambulance Transport

Some Medicare-reimbursed services are overused or improperly used, resulting in payments for unnecessary services. To determine if prior authorization of services vulnerable to improper use is associated with reduced use and costs without changing patient access or health outcomes. This study involved repeated cross-sectional evaluation with a state-level matched control group construction and inverse propensity score weighting at the Medicare beneficiary level. Eight states plus the District of Columbia requiring prior authorization were compared with 13 matched comparison group states not subject to prior authorization. Observations on approximately 1.7 million Medicare beneficiaries spanned January 2012 through December 2019. Depending on their state of residence, this included 3 or 4 preintervention years and 4 or 5 postintervention years. Data analysis was performed from September 2020 to July 2021. Ambulance suppliers were directed to request prior authorization for Repetitive, Scheduled, Non-Emergent Ambulance Transport (RSNAT) services; failure to do so resulted in prepayment claim review. The goal of prior authorization is to reduce use of nonemergency ambulance transports that do not meet Medicare coverage criteria. Primary outcomes included total cost of care, RSNAT use rates and expenditures, unplanned hospital admission, emergency department admission, and emergency ambulance use per beneficiary-year. All measures were constructed from Medicare claims. Approximately 1.7 million Medicare beneficiaries were observed in the study (mean [SD] age, 71 [15] years; 50% female beneficiaries; 30% Black beneficiaries, 64% White beneficiaries; 20% rural residence; 35% dually eligible for Medicare and Medicaid; 58% with end-stage renal disease; and 44% with severe [stage 3 or 4] pressure ulcers). After controlling for covariates, the results showed that prior authorization was associated with a 2.4% reduction in total annual expenditures for a total of $1530 per beneficiary-year (95% CI, -$1775 to -$1285; P < .001); a 61% reduction in the probability of RSNAT use for a total of 4.1 percentage points per beneficiary-year (95% CI, -4.26 to -3.94; P < .001); a 77% reduction in RSNAT expenditures for a total of $1136 per beneficiary-year (95% CI, -$1179 to -$1093; P < .001); a 1.4% reduction in the probability of emergency department use by 0.99 percentage points per beneficiary-year (95% CI, -1.17 to -0.81; P < .001); no change in the probability of emergency ambulance use (0.07 percentage points, 95% CI, -0.15 to 0.29; P = .50); a 2.6% reduction in the probability of unplanned hospital admission for a total of 1.53 percentage points per beneficiary-year (95% CI, -1.71 to -1.35; P < .001); and a 19% annual increase in the probability of emergency dialysis use for a total of 1.4 percentage points per beneficiary with end-stage renal disease (95% CI, 1.28 to 1.60; P < .001). In this difference-in-differences analysis of Medicare beneficiaries, the results suggest that the RSNAT Prior Authorization Model was associated with reduced costs with little or no change in the quality or access indicators examined. Targeted approaches to prior authorization may be an appropriate control measure for Medicare services vulnerable to improper use.

Frequency of admission to prehospital emergency medical services and satisfaction level of prehospital emergency care during active chemotherapy

Objective: In this study, we aimed to investigate the frequency of admission to prehospital emergency medical services (PEMS) and the satisfaction level of prehospital medical care in cancer patients during the chemotherapy process. Material and Methods: A total of 218 patients receiving active chemotherapy were included in the study. A personal information form and the 112 Emergency Health Services Patient Satisfaction Scale (EHSPSS) were used to collect data. Sociodemographic characteristics and data on admission to PEMS were compared, Results: Among the patients, 162 (74.3%) had visited EMS in the previous three months. Ninety-eight (60.5%) patients had visited EMS as outpatients, and 64 (39.5%) patients had arrived via PEMS. The PEMS admission rate of patients who visit EMS from rural areas (71.9%) was significantly higher than that of patients who visit from urban areas (p &lt; 0.001). The total satisfaction score was determined to be 89±18.1 points. According to these scores, it could be interpreted that the satisfaction rate of the patients was high. Regarding the dimension scores, the ambulance staff and emergency call center staff scores were high, while the care provided in the venue and ambulance technical equipment scores were above moderate Conclusion: Patients receiving active chemotherapy frequently visit EMS. Although these patients mostly visited EMS as outpatients, the rate of patients who visited EMS with PEMS was substantial. The PEMS patient satisfaction rate was found to be high among active chemotherapy patients. High patient satisfaction is a prominent patient-centered indicator in measuring the quality of care

Improved understanding of non-epileptic seizures and reduced emergency health care usage following a single psychoeducational group for children and their parents

Rationale: The aim of this study was to evaluate the effectiveness of a three-hour psychoeducation group in improving understanding of non-epileptic seizures (NES), health outcomes and quality of life in young people with NES. Background: Multi-session psychoeducational groups for adults with NES have reported improved psychosocial functioning and reduced NES compared to those who do not receive psychoeducational interventions. To date there have been no studies in young people examining the effects of a single session of psychoeducation. Method: 15 young people with NES and their families attended a psychoeducation group within a specialist hospital following a multidisciplinary assessment. The group's effectiveness was evaluated in terms of perceptions of seizure controllability, seizure severity, the management of the condition and health-related quality of life measures. Results: A significant decrease in accident and emergency (A&E) visits and ambulance call outs was observed following the psychoeducation group. Young people additionally reported increased knowledge of NES and ability to cope with the condition which was maintained at 6-week follow-up. Significant reduction in NES occurrence or quality of life was not observed. Conclusion: Significant reduction in A&E attendance and ambulance use was found following group psychoeducation and improvements in psychosocial functioning and knowledge about NES. Group psychoeducation has the potential to increase child and parental understanding of NES and reduce inappropriate healthcare usage.

Descriptive Study of Ambulance Attendances for Older Adults with and without Dementia in Western Australia

Objective To describe and compare characteristics of ambulance attendances for older adults with and without dementia Methods A retrospective cohort study was conducted using electronic patient care records from the main ambulance service in Western Australia. All attendances for people aged 65 years or older in the years 2019-21 were included. Dementia status was adjudicated from the clinical history and medication lists. Patient and case characteristics of those with and without dementia were compared and stratified by type of residence. Results There were 277,996 emergency ambulance attendances made by 124,711 older adults, of whom 23.5% had dementia. The mean number of attendances per person was 3.3 in the dementia cohort vs 2.0 in those without dementia. Falls were the leading reason for ambulance attendance. People with dementia were significantly frailer, required longer at-scene intervals, were less likely to be transported as the highest priority, and had lower 30-day survival. Conclusions Dementia is common amongst older adults attended by paramedics and is associated with higher ambulance utilization per person. People with dementia attended by paramedics have stronger signals of vulnerability, such as increased frailty. As the number of people living with dementia increases in the future, there are implications for workforce training and service planning. There are opportunities for developing alternatives to emergency department transportation for some people with dementia.

Measuring the impact introducing NHS 111 online had on the NHS 111 telephone service and the wider NHS urgent care system: an observational study

ObjectivesTo explore what impact introducing the National Health Service (NHS) 111 online service had on the number of phone calls to the NHS 111 telephone service and the NHS urgent...