Emergency Life Support Research Articles

Medical Crisis Preparedness: A Survey among Dentists of Rajasthan

Abstract Introduction: There are circumstances and procedures in a dental office that can give rise to a medical emergency situation. The inability to manage medical emergency situations can cause serious life-threatening issues for the patient, and it can also land the dentist in legal issues. A basic understanding and preparedness about medical emergencies and timely management techniques can be life-saving. Aim and Objectives: To analyze the conception of medical emergency and basic life support (BLS) among dentists of Rajasthan, India. Materials and Methods: This is a web-based survey which is conducted using a questionnaire comprising 22 questions to collect the data pertaining to demographic details, understanding, and preparedness concerning medical emergencies and BLS. The questionnaire was distributed through Google form to 356 dentists who are registered under the Rajasthan Dental Council. The responses to the questionnaire so obtained were analyzed. Results: The results showed that 49.8% of the dentists have not attended any workshop on emergency training or management program in the last 5 years. Regarding awareness about emergency drugs and equipment, 15% of them answered that they do not have any emergency drugs or kits in their workplace. Conclusion: The study results highlight insufficient knowledge and preparedness in the surveyed dentist and the importance of including structured BLS training in the dental curriculum.

Abstract 186: Regional Cerebral Oxygen Saturation to Predict Neurologic Outcome During Out-of-Hospital-Cardiac -Arrest: An Ancillary Analysis of a Prospective Interventional Study

Background: Very few prognosis markers are available to help emergency medical services decide whether to continue or terminate cardiopulmonary resuscitation (CPR). ETCO 2 has been described to predict return of spontaneous circulation (ROSC) but its ability to predict neurologic outcome is poor. Cerebral tissue oxygen saturation (RSO 2 ) during CPR, as measured by near-infrared spectroscopy (NIRS) represents hemoglobin oxygenation within the cerebral tissue. The measure is feasible during CPR. It has been associated with the probability of ROSC. The aim of this study was to assess the predictive value of RSO2 regarding 30 days favorable neurologic outcome after out-of-hospital cardiac arrest (OHCA). Method: Data were collected during a prospective single center before-after interventional study comparing conventional CPR (C-CPR) with Automated head and thorax elevation CPR (AHUP). C-CPR was performed manually and AHUP-CPR was delivered using a LUCAS Active Decompression (Stryker Medical, USA), an EleGARD Patient Positioning System (AdvancedCPR Solutions, USA), and an impedance threshold device (ResQPOD-16, Zoll, USA). The study was carried out in four fire stations and one physician staffed advanced life support emergency medical services in France. ETCO2 (using an EMMA, Massimo or Lifepack 15, Stryker, USA) and RSO2 (H500, Nonin, USA) were collected as soon as possible during CPR. Favorable neurologic outcome was defined as MRS score of 0 to 3 at 30 days. Results are presented as mean ± standard deviation. Results: ETCO 2 was collected in 118 patients (11 with good neurologic outcome) and RSO 2 in 69 patients (6 with good neurologic outcome). Maximum ETCO 2 during CPR was 43±19mmHg in favorable neurologic outcome patients vs. 35±16mmHg (p=0.13). ETCO 2 alone had an AUC of 0,63 (IC95% 0.46-0.79). Maximum RSO2 during CPR was 68±13% for favorable neurologic outcome patients vs. 49±13% (p<0.001). For survival with favorable neurologic outcome, rSO 2 alone had an AUC of 0.85 (IC95% 0.71-0.99). With a maximum RSO 2 value below 51% there was no patient with favorable neurologic outcome. Conclusion: In this prospective interventional study, unlike EtCO 2 , RSO 2 values were significantly associated with favorable neurological survival at 30 days.

Awareness of Basic Life Support among Speech and Hearing Professionals

Abstract Introduction One of the most important aspects of happiness is one's health. Increased industrialization in developing nations has contributed to a change in disease patterns away from infectious illness as the major cause of morbidity and mortality toward chronic diseases such as heart disease and trauma. Most emergency circumstances need immediate medical attention before a person is taken to the hospital; therefore, public awareness and training programs can aid in providing efficient basic life support care and services. Only a few works of literature on basic life support and prehospital emergency care in an Indian context are available and are usually studied among school teachers. However, no comparable research including allied health experts such as speech and hearing professionals has yet been published in the literature. Aim The present study aimed at exploring the awareness of speech and hearing professionals regarding basic life support in an Indian context. Methods The questionnaire consisted of two sections where section A comprised 6 questions related to demographic details and participant's experience, and section B composed of 17 questions related to knowledge of normal bodily physiology, medical emergencies, and first aid and related aspects. A cross-sectional exploratory study design was conducted on 250 participants. Out of 250 responses, 42 of them were incomplete and so were removed from the study. Therefore, a total of 208 complete responses received from the participants in the age range of 22 to 60 years from across 23 states and 1 union territory of India were included in the study. Results The result revealed a low percentage of speech and hearing professionals with an adequate understanding of basic life support. The majority of them were found to have insufficient knowledge of normal bodily physiology, medical emergencies, and first aid and related aspects. Discussion Being the first of its kind, the present study revealed limited awareness about basic life support among professionals, and therefore, the need to improvise the knowledge of basic life support and prehospital emergency care. This may be achieved by introducing training programs of various natures and dimensions to speech and hearing professionals.

Activities of the Japan Council for Implementation of the Maternal Emergency Life Support System reduced direct causes of maternal deaths in Japan.

Here, we aimed to provide an overview of Japan Council for the Implementation of the Maternal Emergency Life-Saving System (J-CIMELS) and its simulation program, which has reduced maternal mortality due to direct causes in Japan. The Japan Association of Obstetricians and Gynecologists (JAOG), Japan Association of Obstetricians and Gynecologists, and Maternal Death Exploratory Committee (JMDEC) launched the Maternal Death Reporting Project in 2010. The project analyzed obstetricians' tendency to delay their initial response to sudden maternal deterioration. Obstetricians can predict small changes before deterioration by monitoring vital signs. In 2015, the J-CIMELS was established to provide practical education. J-CIMELS developed a simulation program (J-MELS; Japan Maternal Emergency Life Support) to ensure that the obstetricians acquire the latest knowledge of emergency physicians, anesthesiologists, and other general practitioners and apply it in clinical situations. In the last 7 years, the J-MELS basic course has been conducted 1000 times with a total attendance of 19 890 people. As a result, the incidence of obstetric hemorrhage progressively decreased from 29% in 2010 to 7% in 2020. We believe that the activities of J-CIMELS are improving obstetric care providers' medical practices in Japan.

Use of prehospital transfusion by French emergency medical services: A national survey.

Major bleeding is the leading cause of preventable mortality among trauma patients. Several studies have recently shown that prehospital plasma transfusion improves the outcomes of severely injured patients. Although no consensus has been reached, prehospital transfusion is regularly considered to reduce avoidable mortality. The objective was to assess the status of prehospital transfusion practices in France. A national survey among the 378 advance life support emergency teams (SMURs) in metropolitan France was conducted from December 15, 2020 to October 31, 2021. A questionnaire was distributed by e-mail to the physicians in charge of SMURs. The questions addressed the transfusion modalities, labile blood products (LBPs) used, and limitations encountered in implementing transfusion. The response rate was 48%, and 82% of the respondents performed prehospital transfusions. A designated pack was used by 44% of the respondents. The LBPs used were packed red blood cells (100%), of which 95% were group 0 RH:-1, fresh frozen plasma (27%), lyophilized plasma (7%), and platelets (1%). The LBPs were transported in isothermal boxes (97%) without temperature monitoring in 52% of the cases. Nontransfused LBPs were discarded in 43% of the cases. Reported limitations in implementing transfusion were the delivery time (45%), loss of LBPs (32%), and lack of evidence (46%). Prehospital transfusion was developed in France but access to plasma remains difficult. Protocols allowing the reutilization of LBPs and improving conservation could limit the waste of a rare resource. Implementing the use of lyophilized plasma could facilitate prehospital transfusion. Future studies will need to specify the role of each LBP in the prehospital setting.

Practices and Procedures in Clinical Pediatric Exercise Laboratories in North America

To describe current practices/procedures in CPELs and explore differences in CPELs employing exercise physiologists to those that do not. A 40-item survey was distributed to CPELs in North America focusing on (1)staffing; (2)exercise stress testing (EST) volumes, reporting, and interpretation; and (3)EST procedures/protocols. Of the 55 responses, 89% were in the United States, 85% were children's hospitals with university affiliation, and 58% were cardiology specific. Exercise physiologists were employed in 56% of CPELs, and 78% had master's degrees or higher. Certifications were required in most CPELs (92% emergency life-support, 27% professional, and 21% clinical). Median volume was 201 to 400 ESTs per year, 80% used treadmill, and 10% used cycle ergometer as primary modalities. Ninety-three percent of CPELs offered metabolic ESTs, 87% offered pulmonary function testing, 20% used institution-specific EST protocols, and 72% offered additional services such as cardiac/pulmonary rehabilitation. CPELS staffing exercise physiologists performed higher volumes of ESTs (P = .004), were more likely to perform metabolic ESTs (P = .028), participated in more research (P < .001), and provided services in addition to ESTs (P = .001). Heterogeneity in CPELs staffing and operation indicates need for standardization.

Maternal cardiopulmonary resuscitation.

The perinatal resuscitation history in Japan is short, with the earliest efforts in the field of neonatology. In contrast, the standardization and dissemination of maternal resuscitation is lagging. With the establishment of the Maternal Death Reporting Project and the Maternal Death Case Review and Evaluation Committee in 2010, with the aim of reducing maternal deaths, the true situation of maternal deaths came to light. Subsequently, in 2015, the Japan Council for the Dissemination of Maternal Emergency Life Support Systems (J-CIMELS) was established to educate and disseminate simulations in maternal emergency care; training sessions on maternal resuscitation are now conducted in all prefectures. Since the launch of the project and council, the maternal mortality rate in Japan (especially due to obstetric critical hemorrhage) has gradually decreased. This has been probably achieved due to the tireless efforts of medical personnel involved in perinatal care, as well as the various activities conducted so far. However, there are no standardized guidelines for maternal resuscitation yet. Therefore, a committee was set up within the Japan Resuscitation Council to develop a maternal resuscitation protocol, and the Guidelines for Maternal Resuscitation 2020 was created in 2021. These guidelines are expected to make the use of high-quality resuscitation methods more widespread than ever before. This presentation will provide an overview of the Guidelines for Maternal Resuscitation 2020.

Influence of the Type of Physician on Survival from Emergency-Medical-Service-Witnessed Cardiac Arrest: An Observational Study.

Out-of-hospital cardiac arrest resuscitation by non-emergency dedicated physicians may not be positively associated with survival, as these physicians have less experience and exposure than specialised dedicated personnel. The aim of this study was to compare the survival results of the teams led by emergency dedicated physicians (EDPhy) with those of the teams led by non-emergency dedicated physicians (N-EDPhy) and with a team of basic life support (BLS) emergency technicians (EMTs) used as the control group. A retrospective, multicentre study of emergency-medical-service-witnessed cardiac arrest from medical causes in adults was performed. The records from 2006 to 2016 in a database of a regional emergency system were analysed and updated up to 31 December 2021. Two groups were studied: initial shockable and non-shockable rhythms. In total, 1359 resuscitation attempts were analysed, 281 of which belonged to the shockable group, and 1077 belonged to the non-shockable rhythm group. Any onsite return of spontaneous circulation, patients admitted to the hospital alive, global survival, and survival with a cerebral performance category (CPC) of 1-2 (good and moderate cerebral performance) were studied, with both of the latter categories considered at 30 days, 1 year (primary outcome), and 5 years. The shockable and non-shockable rhythm group (and CPC 1-2) survivals at 1 year were, respectively, as follows: EDPhy, 66.7 % (63.4%) and 14.0% (12.3%); N-EDPhy, 16.0% (16.0%) and 1.96 % (1.47%); and EMTs 32.0% (29.7%) and 1.3% (0.84%). The crude ORs were EDPhy vs. N-EDPhy, 10.50 (5.67) and 8.16 (4.63) (all p < 0.05); EDPhy vs. EMTs, 4.25 (2.65) and 12.86 (7.80) (p < 0.05); and N-EDPhy vs. EMTs, 0.50 (0.76) (p < 0.05) and 1.56 (1.32) (p > 0.05). The presence of an EDPhy was positively related to all the survival and CPC rates.

Practices And Procedures In Clinical Pediatric Exercise Laboratories In North America

Inter-institutional differences in clinical pediatric exercise laboratory (CPEL) practices may affect consistency of patient care and efficacy of multi-center research. PURPOSE: To 1) describe current practices and procedures in CPELs; and 2) explore differences in CPELs that employ an exercise physiologist (ExP) to those that do not. METHODS: A survey (min 37, max 68 items) was distributed to CPELs in the U.S and Canada focusing on three domains: 1) staffing (min 6, max 12 items); 2) volumes, reporting, and interpretation (min 12, max 22 items); and 3) procedures/protocols (min 19, max 34 items). RESULTS: Of the n = 73 responses, n = 18 were excluded for being ineligible, not completing the survey, or were duplicated responses, producing a final sample of n = 55 responses. Most responses were from the U.S. (89%), represented a children’s hospital with university affiliation (85%), and reported to be cardiology specific (58%). ExPs are employed in 56% of CPELs (78% ExPs with master’s degree or higher). Physicians, cardiovascular techs, respiratory therapists, or nurses were responsible for conducting clinical exercise stress tests (ESTs) in CPELs without an ExP. Emergency life-support, professional, and clinical certifications were required in 92%, 27%, and 21% of CPELs, respectively. 9.6% of CPELS had no certification requirements. The median volume was 201-400 ESTs/yr. with 20% of the respondents performing >800 ESTs/yr. Treadmill and cycle were the primary modalities utilized for ESTs (80% and 10% of ESTs, respectively). Institution-specific exercise protocols were used in 20% of CPELs. 72% of CPELs provide services in addition to ESTs such as cardiac and/or pulmonary rehabilitation. Non-parametric testing found that those CPELS with an ExP perform a higher volume of ESTs (p = 0.004), are more likely to perform metabolic ESTs (p = 0.028), participate in more research (p < 0.001), and provide services in addition to ESTs (p = 0.001). CONCLUSIONS: Inter-institutional differences in CPELs staffing and operation may warrant efforts for standardization.

Advanced Life Support for out-of-hospital Chest Pain: The Opals Study

ABSTRACT Context: As many as 14% of patients transported by ambulance with chest pain die prior to hospital discharge. To date, no high-quality controlled trials have revealed that prehospital advanced life support interventions affect survival for these patients. Objective: The Ontario Prehospital Advanced Life Support (OPALS) Study assessed the effect of adding an advance life support service to an existing basic life support emergency medical service program, on the rate of mortality and morbidity for patients with out-of-hospital chest pain. Design: Controlled clinical trial comparing survival for 9 months before and 9 after instituting an advanced life support program. Setting: Thirteen urban and suburban Ontario communities (populations ranging from 30,000 to 750,000; total, 2.5 million). Patients: All adult patients with a primary complaint of chest pain and transported by paramedics to the emergency department. Intervention: Paramedics were trained in standard advanced life support, which includes endotracheal intubation, intravenous furosemide and morphine, oral ASA, and sublingual NTG. Emergency medical services within each community had to meet predefined criteria in order to qualify for the advanced life support phase. Main Outcome Measure: Survival to hospital discharge. Results: Overall, 12,168 patients were enrolled in either the basic life support phase (N = 5,788) or the advanced life support phase (N = 6,380). The rate of mortality significantly decreased from 4.3% in the basic life support phase to 3.2% in the advanced life support phase (absolute change 1.1, 95% CI 0.4-1.8, P = 0.0013). We also demonstrated a decrease in mortality for the subgroup of patients with a discharge diagnosis of myocardial infarction (13.1 percent vs 8.2 percent, P = 0.002). Conclusions: The addition of a prehospital advanced life support program to an existing basic life support emergency medical service was associated with a significant decrease in the mortality rate among patients complaining of chest pain. Future research should clarify the most effective interventions and target specific populations. ClinicalTrials.gov Identifier: NCT00212953

Radiation in medical practice & health effects of radiation: Rationale, risks, and rewards.

Radiation is important in health and disease. It is imperative to use properly and prevent misuse or overuse. Pertinent trends of increasing radiation in the environment need analysis. We gleaned important information, from published evidence and authoritative resources, for practicing safely and preventing harm. Science & technology progress is for the betterment of mankind, and all efforts should be made to prevent any untoward effects. Children and paediatric patients deserve special attention because of their vulnerability due to multiple reasons. Effective investigations & interventions in medical settings should be done based on best evidence. All those ordering radiological investigations should take into consideration the radiation exposure values & especially decide on clinical impact of the investigation. Prenatal exposure to radiation has risks. Computed Tomography is responsible for 24% of all radiation exposure. Dual-energy X-ray absorptiometry is useful for measuring changes in body tissue composition. Radiologists should tailor imaging individually. Radiotherapy is administered to more than half of all cancer patients. Acute toxicity alleviation and chronic toxicity consideration is important. Radiation emergencies can occur in isolation or as major catastrophe. Emergency life-support is needed. Decontamination along with using the ABCDE reduction approach components are elucidated. With increasing use of mobile phones the electro-magnetic fields produced by mobile phones use needs consideration. UV radiation overexposure prevention is with shade, clothing and hats. Applying sunscreen essential on those parts of the body that remain exposed like the face and hands. All the safety measures need popularization and continuous practice with precision & perfection.

Emergency medical care in dentistry: A cross sectional analysis of competencies for undergraduate students.

Background:The possibility of a medical crisis, albeit a relatively uncommon occurrence in a dental practice, is often overlooked and it is imperative that dental practitioners equip themselves with the knowledge and skills essential to manage potentially life-threatening situations. The aim of this study was to evaluate the knowledge and competency levels of dental undergraduate students training across universities in the UAE in basic life support (BLS) and medical emergencies in a dental setting.Methods:A cross-sectional survey-based study was conducted and 411 students undergoing clinical training (4th and 5th year of dental school) voluntarily participated in this study. The questionnaire comprised questions related to commonly occurring medical emergencies that they may have encountered in a dental setting. Data collected were then tabulated and subjected to descriptive statistical analysis.Results:More than half of the respondents (55.2%) reported that they had lower confidence in handling medical emergencies, with 54.7% claiming that they had not received training on the subject during their undergraduate course. Majority of the respondents (216) reported that they would only choose to record vital signs if the medical history of the patient was indicative of an underlying condition.Discussion:Findings from the present study strongly mandate the inclusion of training for BLS and medical emergencies in the existing dental curriculum to equip graduate dental practitioners to handle a medical crisis in their dental practice.

The fast response of academic spinoffs to unexpected societal and economic challenges. Lessons from the COVID‐19 pandemic crisis

The rapid emergence of the COVID‐19 crisis has challenged both private and public firms, requiring them to reshape their internal processes and external linkages in the fight against the virus, but also to survive the disrupting economic impact of the pandemic on their activities. Academic spinoffs have not been exempted from these dynamics. In this paper, we present and discuss a case study of an academic spinoff, Omnidermal, which has developed a new, efficient and easy‐to‐realize emergency life support machine for use in intensive and sub‐intensive care units. This case, apart from offering information on the best practices of how spinoffs may contribute socially to the fight against COVID‐19 and – more in general – against other exogenous shocks, also provides insights on their stages of development, evolution patterns and ability to define new solutions. The case shows that when the market needs are clear to a firm (as in the case of medical devices during the COVID‐19 crisis), the ‘legacy competences and practices’ of spinoffs (i.e., technical competences and work practices) can be fully exploited to compress the development time and to realize products demanded by the market. We also identify access to a network as being an essential boundary condition for this process. These results introduce an alternative scope for academic spinoffs. Given the ‘legacy competences and practices’ they are able to develop, they are ideal candidates to respond to the societal and economic challenges posed by a crisis over short periods of time. On the basis of these insights, we draw a series of implications for practitioners, policy makers and academics.

The Value of Prehospital Early Warning Scores to Predict in - Hospital Clinical Deterioration: A Multicenter, Observational Base-Ambulance Study

Objectives Early warning scores are clinical tools capable of identifying prehospital patients with high risk of deterioration. We sought here to contrast the validity of seven early warning scores in the prehospital setting and specifically, to evaluate the predictive value of each score to determine early deterioration-risk during the hospital stay, including mortality at one, two, three and seven- days since the index event. Methods: A prospective multicenter observational based-ambulance study of patients treated by six advanced life support emergency services and transferred to five Spanish hospitals between October 1, 2018 and December 31, 2019. We collected demographic, clinical, and laboratory variables. Seven risk score were constructed based on the analysis of prehospital variables associated with death within one, two, three and seven days since the index event. The area under the receiver operating characteristics was used to determine the discriminant validity of each early warning score. Results: A total of 3,273 participants with acute diseases were accurately linked. The median age was 69 years (IQR, 54–81 years), 1,348 (41.1%) were females. The overall mortality rate for patients in the study cohort ranged from 3.5% for first-day mortality (114 cases), to 7% for seven-day mortality (228 cases). The scores with the best performances for one-day mortality were Vitalpac Early Warning Score with an area under the receiver operating characteristic (AUROC) of 0.873 (95% CI: 0.81-0.9), for two-day mortality, Triage Early Warning Score with an AUROC of 0.868 (95% CI: 0.83-0.9), for three and seven-days mortality the Modified Rapid Emergency Medicine Score with an AUROC of 0.857 (0.82-0.89) and 0.833 (95% CI: 0.8-0.86). In general, there were no significant differences between the scores analyzed. Conclusions: All the analyzed scores have a good predictive capacity for early mortality, and no statistically significant differences between them were found. The National Early Warning Score 2, at the clinical level, has certain advantages. Early warning scores are clinical tools that can help in the complex decision-making processes during critical moments, so their use should be generalized in all emergency medical services.

The effectiveness of resuscitation in patients with acute myocardial infarction according to the population register

Aim To study clinical and anamnestic features and tactics of managing patients with acute myocardial infarction (MI) in groups with different effectiveness of resuscitation procedures.Materials and methods Patients were selected using the "Acute Myocardial Infarction Registry" epidemiological program. 219 cases of acute MI recorded from 2007 through 2017, which required emergency life support, were studied. Two groups were formed based on success of the resuscitation: group 1 consisted of patients with acute MI who survived due to the cardiovascular life support (n=61); group 2 included fatal cases after resuscitation failure (n=158). Quantitative variables were described as median and interquartile range, Ме (Q1; Q3); comparison was performed in two independent samples using the Mann-Whitney test. Qualitative variables were presented as absolute and relative values (n (%)). Statistical significance of differences in nominal properties was determined with contingency tables (Pearson χ2; two-tailed Fisher's exact test). Critical level of two-tailed significance was set equal to 0.05.Results The groups consisted of severe cases at baseline. The groups were sex- and age-matched. Mean age of patients in groups 1 and 2 was 63.5±13.1 and 60.9±14.8 years, respectively (р=0.2); in both groups, females were considerably older than males. Analysis of preceding drug therapy showed that comparable proportions of patients received antihypertensive and/or anti-ischemic treatment; however, the qualitative composition of the therapies was significantly different in these group. Thus, survived patients more frequently than deceased patients received drugs from vitally important groups, including β-blockers (93 % and 13 %, р&lt;0.001), antiplatelets (97 % and 13 %, р&lt;0.001), statins (84 % and 5 %, р&lt;0.001), and angiotensin-converting enzyme (ACE) inhibitors (90 % and 8 %, р&lt;0.001). In additions. success of resuscitation procedures was interrelated with the clinical picture. Thus, in atypical MI, the rate of fatal outcomes was higher (89 % and 56.5 %, р&lt;0.001) despite the life support.Conclusion The patients who survived due to resuscitation procedures more frequently had a history of adequate drug therapy for ischemic heart disease and arterial hypertension with β-blockers, ACE inhibitors, antiplatelets, and statins. In this group, MI mostly had a clinical picture of a prolonged anginal attack. The long-term prediction for survivors after successful resuscitation presently remains important and requires further study.

Comparing the Prevalence of Poor Sleep and Stress Metrics in Basic versus Advanced Life Support Emergency Medical Services Personnel

Background: Emergency medical services (EMS) personnel frequently encounter occupational factors that increase the risk of poor sleep and stress. The national prevalence of poor sleep and stress in EMS personnel is unclear, especially differences between personnel at the basic (BLS) versus advanced (ALS) life support levels. The objectives of this study were to: (1) estimate the prevalence of sleep and stress metrics in EMS personnel; and (2) compare these metrics between BLS and ALS-certified personnel. Methods: This study was a survey of recertifying nationally-certified EMS personnel working in civilian settings. Respondents completed an electronic questionnaire assessing their sleep quality; workday, non-workday, and average sleep duration; sleep debt; perceived stress; and chronic stress. Survey-weighted Poisson regression models were used to estimate adjusted prevalence ratios (PR) comparing BLS (emergency medical technician) to ALS (advanced emergency medical technician and paramedic) for each metric. Models were adjusted for age, sex, minority status, education level, EMS agency type, service type, EMS role, and significant interactions. Results: A total of 17,913 (response rate = 19%) responses were received with 17,522 included in the analysis. Adjusted PRs were significantly higher for ALS-certified personnel compared to BLS-certified for poor sleep quality (PR: 1.23, 95% CI: 1.20–1.27) and short (<7 hours) or long (≥9 hours) workday sleep duration (PR: 1.17, 95% CI: 1.15–1.19). Significant interactions were found between certification level and sex (average sleep duration) or age category (sleep debt, perceived stress, and chronic stress). The highest prevalence of short or long average sleep duration was among ALS men. Sleep debt, perceived stress, and chronic stress differed by age group between certification levels with higher PRs for ALS regardless of age group. Conclusions: There is a high prevalence of poor sleep and stress in EMS personnel, with evidence of the highest prevalence among ALS-certified personnel. Evidence of effect modification by age category and among BLS and ALS personnel suggests that interventions could target certain subgroups, such as older ALS personnel, to be most effective. Continued focus on sleep health and stress reduction is needed to improve the health and well-being of the EMS workforce.

Bag-Valve Mask versus Endotracheal Intubation in Out-of-Hospital Cardiac Arrest on Return of Spontaneous Circulation: A National Database Study.

BackgroundOut-of-hospital cardiac arrest is the main issue for pre-hospital emergency care. There are several airway managements during the out-of-hospital cardiopulmonary resuscitation (CPR) such as endotracheal intubation (ETI) or alternative airway device: bag-valve mask (BVM). Data comparing both methods showed inconclusive results on survival and limited results on CPR outcome. This study aimed to add additional results on comparing the ETI and BVM in cardiac arrest outside hospitals; focused on the CPR outcome.MethodsThis study was a retrospective, analytical study. The inclusion criteria were adult patients (age of 18 years or over) with out-of-hospital cardiac arrest, who received emergency life support, and received either BVM or ETI. Data were retrieved from the Information Technology of Emergency Medical Service. The outcome was a return of spontaneous circulation (ROSC).ResultsDuring the study period, there were 1070 patients with out-of-hospital cardiac arrest who met the study criteria. Of those, 800 patients (74.77%) received BVM, while the other 270 patients (25.23%) received ETI. There were five significant factors between both groups including mean distance to scene, proportions of response time less than 8 mins, defibrillation, intravenous fluid administration, and adrenaline administration. There was no significant difference on the outcome: ROSC. The BVM group had slightly higher rate of ROSC than the ETI group (19.63% vs 15.56%; p value 0.148).ConclusionThe BVM and ETI had comparable ROSC rate for out-of-hospital cardiac arrest victims. However, the study population of the BVM group had less severe conditions and received faster treatment than the ETI group.

Use of social media by Emergency Medical Care students and qualified Advanced Life Support providers in South Africa

Background: Social media has emerged as a powerful tool for the dissemination of information across a wide range of health professions, including emergency medical care. While social media platforms can be very effectively used in support of educational and operational information sharing, the ubiquitous presence of smart devices and social media access in the clinical environment has led to concerns about professionals’ ethical behaviour; in particular, infringements of patients’ privacy rights. Aim: To explore the use of social media by pre-hospital emergency medical care students and qualified Advanced Life Support (ALS) emergency care personnel. Methods: A cross-sectional survey was used, with a custom-developed questionnaire consisting mostly of closed-ended questions, with some confirmatory open-ended questions. The questionnaire was directly administered to emergency medical care students across all four academic years of study at a large urban university in [Redacted]. ALS providers who were members of an email list were also invited to participate in the survey, by completing the same questionnaire online. Data analysis was descriptive in nature. Results: Response rates were 66% for students and 10% for ALS providers. Social media use was reported by almost all participants, with between 78% and 71% indicating that they used social media for professional or learning purposes. The majority of ALS providers (79%) indicated they were aware of organisational policies on social media use, while only 44% of students indicated awareness of this, and most (53%) were unsure. Between 92% and 73% of participants stated that they had seen unethical or unprofessional postings on social media. Most participants (84%) indicated that they were concerned or very concerned about such postings. Conclusion: Social media is a powerful tool with both positive and negative outcomes. While its use can facilitate educational interactions and support clinical operations, there are concerns for patients’ rights in terms of social media use in the clinical environment – particularly the right to privacy. The development of and compliance with organisational or institutional social media policies may help to enhance the positive aspects of social media use, together with appropriate ethical and professional behaviour.

Adrenaline use as a poor predictor for the return of spontaneous circulation among victims of out-of-hospital cardiac arrest according to a national emergency medical services database.

OBJECTIVE:This study aimed to determine additional predictors of cardiopulmonary resuscitation success using a national emergency medical services (EMS) database.METHODS:This retrospective study was conducted by retrieving data from the Information Technology of Emergency Medical Service, a national EMS database. The inclusion criteria were adult patients (18 years old or over) who suffered from out-of-hospital cardiac arrest and received emergency life support. The outcome was a return of spontaneous circulation (ROSC). Predictors for ROSC were determined using multivariate logistic regression analysis.RESULTS:During the study period, 1070 patients met the study criteria, among whom 199 (18.60%) belonged to the ROSC group. Five factors were eligible for multivariate logistic regression analysis for predicting ROSC. Accordingly, only adrenaline administration was independently and negatively associated with ROSC with an adjusted odds ratio of 0.722 (95% confidence interval: 0.522, 0.997) and a Hosmer–Lemeshow Chi-square of 5.84 (P = 0.665).CONCLUSIONS:Adrenaline use may be a poor predictor for ROSC during out-of-hospital cardiac arrest.

Progress of nursing participation in quality control of Intensive Care Unit emergency life support medical equipment

Emergency life support equipment refers to medical equipment that can save the life of patients or maintain normal vital signs of patients. Intensive Care Unit (ICU) is a highly centralized department of hospital emergency life support equipment. Good equipment quality control is an important measure to ensure the quality of medical care. ICU nurses, as a group of clinical users and maintenance of emergency life support equipment, play an important role in its quality control. This paper reviews the concept of ICU emergency life support equipment, the role of nurses participating in quality control of ICU emergency life support equipment, existing problems and countermeasures, etc. Key words: Intensive Care Unit; Emergency life support medical equipment; Medical equipment; Quality control