Emergency Life-saving Technicians Research Articles

Impact of Pre-Hospital Intravenous Infusion on Physiological Parameters in Severe Trauma Patients.

Introduction The relationship between pre-hospital intravenous (IV) infusions administered by emergency life-saving technicians (ELSTs) to trauma patients in shock and the resulting variability in their vital signs before hospital arrival remains unclear. In 2014, Japan approved the use of lactated Ringer's solution via IV by ELSTs for patients aged 15 and older with non-cardiac arrest and shock symptoms not caused by cardiogenic factors. However, the impact of pre-hospital IV infusions on physiological parameters in severely injured trauma patients is still unknown. Aim The aim of this study is to investigate the impact of pre-hospital IV infusions administered by ELSTs on trauma patients with shock, focusing on the resulting variations in the shock index and other physiological parameters in the pre-hospital setting. Methods This retrospective cohort study included patients registered in the Japan Trauma Data Bank who were transported by ambulance from the pre-hospital to the hospital by ELST between 2019 and 2021. First, the data were categorized based on pre-hospital IV access as either IV (+) or IV (-). Propensity score matching was then performed to estimate the average treatment effect for patients receiving IV (+). The primary endpoint was the delta shock index (DSI), while secondary endpoints included systolic blood pressure (sBP), heart rate (HR), and respiratory rate (RR). Welch's t-test was used to estimate mean differences and 95% CIs, and Cohen's d was calculated to measure effect sizes. Results A total of 88,817 patients were enrolled in the study, with 19,793 included in the analysis. Of these, 778 patients were matched for comparison. IV access (+) was not significantly associated with changes in the DSI, showing a small effect size (-0.09 vs. -0.06; difference [95% CI]: -0.04 [-0.08 to 0.00]). Additionally, IV (+) was not significantly associated with differences in HR (-0.23 vs. 1.16; difference [95% CI]: -1.40 [-3.59 to 0.80]) or RR (-1.95 vs. -1.08; difference [95% CI]: -0.87 [-1.83 to 0.09]), both of which demonstrated small effect sizes. However, IV (+) was significantly associated with an increase in sBP difference, although the effect size remained small (13.22 vs. 8.73; difference [95% CI]: 4.49 [0.35 to 8.62]). Conclusions IV access was not directly associated with variations in the shock index in the pre-hospital setting; however, it significantly increased sBP. Future studies should include the volume of IV infusion to further elucidate these findings.

Effect of timing of advanced life support on out-of-hospital cardiac arrests at home

AimIn cases of out-of-hospital cardiac arrests (OHCA) occurring at home, Japanese emergency medical services personnel decide whether to provide treatment on the scene or during transport based on their judgment. This study aimed to evaluate the association between the timing of advanced life support (ALS) (i.e., endotracheal intubation [ETI] or adrenaline administration) for OHCA at home and prognosis. MethodThis retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital ETI (n = 6806) and received adrenaline (n = 22,636) between 2016 and 2019. The timing of ETI or adrenaline administration was determined as “on the scene” or “in the ambulance.” Multiple logistic regression analysis was used to estimate the association among the timing of ALS implementation, pre-hospital return of spontaneous circulation (ROSC), and survival at 1 month. ResultETI on the scene was significantly positively associated with pre-hospital ROSC (adjusted odds ratio [AOR], 1.81; 95% confidence interval [CI], 1.57–2.09) and survival at 1 month (AOR, 1.81; 95% CI, 1.47–2.23). Adrenaline administration on the scene was significantly positively associated with pre-hospital ROSC (AOR, 2.51; 95% CI, 2.33–2.70) and survival at 1 month (AOR, 2.13; 95% CI, 1.89–2.40). ConclusionOur analysis suggests performing ALS on the scene was associated with pre-hospital ROSC and survival at 1 month. Further efforts are needed to increase the rate of ALS implementation on the scene by emergency life-saving technicians.

P7.2: Awareness and attitude emergency life-saving technicians toward organ donation in a certain prefecture in Japan.

P7.2: Awareness and attitude emergency life-saving technicians toward organ donation in a certain prefecture in Japan.

Establishment and activities of the meeting of the leading emergency life-saving technicians in the local medical control council consisting of the multiple fire departments

Establishment and activities of the meeting of the leading emergency life-saving technicians in the local medical control council consisting of the multiple fire departments

Prehospital emergency life-saving technicians promote the survival of trauma patients: A retrospective cohort study

ObjectiveAppropriate decisions by medical technicians at a trauma scene may influence a patient's prognosis. Emergency life-saving technicians (ELSTs) are certified specialists trained with the knowledge to provide advanced techniques for prehospital emergency care in Japan. However, the benefit of treatment by ELSTs compared to basic emergency medical technicians (BEMTs) remains unclear. The aim of this study is to determine whether treatment by ELSTs improves outcomes for trauma patients. MethodsWe retrospectively reviewed the Japan Trauma Data Bank for the years 2004 to 2017. Patients transferred to the hospital directly from the trauma scene and at least 16 years old were included in this study. The following criteria were used to exclude patients; presence of burns, untreatable severe traumas, unknown ELST attendance, and missing prognosis. We compared two groups (ELST group: patients transported by emergency medical services (EMS) with the presence of at least one ELST; BEMT group: patients transported only by BEMTs). Primary outcome was survival to discharge. Secondary outcomes were the need of definitive treatments defined by surgical intervention, intravascular radiology and blood transfusion at the receiving hospital within 24 h. A multivariable logistic regression model was used to calculate odds ratio (OR) and confidence intervals (CI) adjusted by age, sex, revised trauma score, and Injury severity score (ISS). ResultsOverall survival to discharge did not improve significantly (adjusted OR 1.13, 95% CI 0.99–1.30) with ELST intervention. In-hospital blood transfusion was more frequently required in the ELST group (adjusted OR 1.10, 95% CI 1.01–1.20). Emergency interventions (adjusted OR 1.03, 95% CI 0.97–1.09) were not different between the groups. In stratified analysis, the benefit of ELST attendance for survival was observed among patients with ISS <16 (adjusted OR 1.53, 95% CI 1.10–2.15), aged 65 years or older (adjusted OR 1.27, 95% CI 1.07–1.52), during the earlier study period (2004–2008, adjusted OR 1.50, 95% CI 1.14–1.97), and shorter transportation time (adjusted OR 1.21, 95% CI 1.03–1.41). ConclusionsDispatch systems with ELST should be considered for trauma transports, which may benefit elderly or moderate severity trauma groups, with shorter transportation time conditions.

Impact of emergency physician-staffed ambulances on preoperative time course and survival among injured patients requiring emergency surgery or transarterial embolization: A retrospective cohort study at a community emergency department in Japan.

Injured patients requiring definitive intervention, such as surgery or transarterial embolization (TAE), are an extremely time-sensitive population. The effect of an emergency physician (EP) patient care delivery system in this important trauma subset remains unclear. We aimed to clarify whether the preoperative time course and mortality among injured patients differ between ambulances staffed by EPs and those staffed by emergency life-saving technicians (ELST). This was a retrospective cohort study at a community emergency department (ED) in Japan. We included all injured patients requiring emergency surgery or TAE who were transported directly from the ED to the operating room from January 2002 to December 2019. The primary exposure was dispatch of an EP-staffed ambulance to the prehospital scene. The primary outcome measures were preoperative time course including prehospital length of stay (LOS), ED LOS, and total time to definitive intervention. The other outcome of interest was in-hospital mortality. One-to-one propensity score matching was performed to compare these outcomes between the groups. Of the 1,020 eligible patients, 353 (34.6%) were transported to the ED by an EP-staffed ambulance. In the propensity score-matched analysis with 295 pairs, the EP group showed a significant increase in median prehospital LOS (71.0 min vs. 41.0 min, P < 0.001) and total time to definitive intervention (189.0 min vs. 177.0 min, P = 0.002) in comparison with the ELST group. Conversely, ED LOS was significantly shorter in the EP group than in the ELST group (120.0 min vs. 131.0 min, P = 0.043). There was no significant difference in mortality between the two groups (8.8% vs.9.8%, P = 0.671). At a community hospital in Japan, EP-staffed ambulances were found to be associated with prolonged prehospital time, delay in definitive treatment, and did not improve survival among injured patients needing definitive hemostatic procedures compared with ELST-staffed ambulances.

Pre-hospital portable monitoring of cerebral regional oxygen saturation (rSO2) by ambulance personnel during cardiopulmonary resuscitation: A prospective observational analysis of 87 cases in Osaka city, Japan

BackgroundRegional cerebral oxygen saturation (rSO2) is a non-invasive method of measuring cerebral perfusion; However, serial changes in cerebral rSO2 values among out-of-hospital cardiac arrest (OHCA) patients in pre-hospital settings have not been sufficiently investigated. We aimed to investigate the association between the serial change in rSO2 pattern and patient outcome. MethodsWe evaluated rSO2 in OHCA patients using portable monitoring by emergency life-saving technicians (ELTs) from June 2013 to December 2019 in Osaka City, Japan. We divided the patterns of serial of rSO2 change into type 1 (increasing pattern) and type 2 (non-increasing pattern). Patients in whom measurement started after return of spontaneous circulation (ROSC) were excluded. The outcome measures were ‘Prehospital ROSC’, ‘Alive at admission’, ‘1-month survival’ and ‘Cerebral Performance Category (CPC) 1 or 2′. ResultsEighty-seven patients were eligible for this analysis (type 1: n=40, median age: 80.5 [IQR: 72–85.5] years, male: n=20 [50.0%]; type 2: n=47, 81 [72–85.5] years, male: n=28 [59.6%]). In a multivariable logistic regression adjusted for confounding factors, outcomes of ‘Prehospital ROSC’ and ‘Alive at admission’ were significantly higher in type 1 than type 2 pattern (11/40 [27.5%] vs. 2/47 [4.26%], AOR 5.67, 95% CI 1.04–30.96, p<0.045 and 17/40 [42.5%] vs. 6/41 [12.8%], AOR 3.56, 95% CI 1.11–11.43, p<0.033). There was no significant difference in ‘1-month survival’ and ‘CPC 1 or 2′ between patterns. ConclusionType 1 (increasing pattern) was associated with ‘Prehospital ROSC’ and ‘Alive at admission’. Pre-hospital monitoring of cerebral rSO2 might lead to a new resuscitation strategy.

Effect of fluid administration on scene to traffic accident patients by EMS personnel: a propensity score-matched study using population-based ambulance records and nationwide trauma registry in Japan

PurposeThe aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method.MethodsThe study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene.ResultsDuring the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500–1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055–0.967]; p = 0.045).ConclusionIn this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA.

Achievements and future prospects as work in hospital emergency life-saving technicians

Achievements and future prospects as work in hospital emergency life-saving technicians

Improved outcomes for out-of-hospital cardiac arrest patients treated by emergency life-saving technicians compared with basic emergency medical technicians: A JCS-ReSS study report

BackgroundEmergency life-saving technicians (ELSTs) are specially trained prehospital medical providers believed to provide better care than basic emergency medical technicians (BEMTs). ELSTs are certified to perform techniques such as administration of advanced airways or adrenaline and are considered to have more knowledge; nevertheless, ELSTs’ effectiveness over BEMTs regarding out-of-hospital cardiac arrest (OHCA) remains unclear. We investigated whether the presence of an ELST improves OHCA patient outcomes. MethodsIn a retrospective study of adult OHCA patients treated in Japan from 2011 to 2015, we compared two OHCA patient groups: patients transported with at least one ELST and patients transported by only BEMTs. The primary outcome measure was one-month favorable neurological outcomes, defined as Cerebral Performance Category ≤ 2. A multivariable logistic regression model was used to calculate odds ratios (ORs) and their confidence intervals (CIs) to evaluate the effect of ELSTs. ResultsIncluded were 552,337 OHCA patients, with 538,222 patients in the ELST group and 14,115 in the BEMT group. The ELST group had a significantly higher odds of favorable neurological outcomes (2.5% vs. 2.1%, adjusted OR 1.39, 95% CI 1.17–1.66), one-month survival (4.9% vs. 4.1%, adjusted OR 1.37, 95% CI 1.22–1.54), and return of spontaneous circulation (8.1% vs. 5.1%, adjusted OR 1.90, 95% CI 1.72–2.11) compared with the BEMT group. However, ELSTs’ limited procedure range (adrenaline administration or advanced airway management) did not promote favorable neurological outcomes. ConclusionsCompared with the BEMT group, transport by the ELST group was associated with better neurological outcomes in OHCA.

A case report in which emergency life-saving technicians broke up the child born with a caul at the mergency site.

A case report in which emergency life-saving technicians broke up the child born with a caul at the mergency site.

Abstract 322: Prehospital Care From Emergency Life-Saving Technicians Promotes the Survival of Trauma Patients

Introduction: Optimal trauma care strategies remain a matter of debate. Prehospital trauma care protocols for paramedics range from no intervention to full field stabilizations. In Japan, emergency life-saving technicians (ELSTs) are certified specialists trained to provide advanced techniques and knowledge for prehospital emergency care. They can give fluid resuscitation and inform the receiving hospital for definitive surgery. However, the effectiveness of ELSTs over basic emergency medical technicians (BEMTs) regarding trauma transport remains unclear. Hypothesis: We tested whether the presence of an ELST improves the outcomes of trauma patients. Methods: We retrospectively studied 2004- 2017 data from the Japan Trauma Data Bank (JTDB). Inclusion criteria were patients age ≥ 16 with at least one Abbreviated Injury Scale (AIS) score ≥ 3 trauma. Exclusion criteria were patients with burns, AIS score = 6 in any region, and missing data. We compared two trauma patient groups. ELST group: patients transported by EMS including at least one ELST. BEMT group: patients transported only by basic EMS personnel. The primary outcome measure was survival at discharge. A multivariable logistic regression model was used to adjust for patient baseline characteristics. Results: Included were 124,563 patients, with 119,352 patients in the ELST group and 5,211 patients in the BEMT group. Patients’ ages (ELST vs. BEMT [Mean ± SD]: 57 ± 22 vs. 59 ± 22 years, p &lt; 0.01) were lower and transportation time (15 ± 12 vs. 17 ± 14 min, p &lt; 0.01) was shorter in the ELST group. Gender (male: 64 vs. 64 %, p = 0.66), proportion of blunt trauma (96 vs. 96 %, p = 0.10), proportion of blood transfusion (15 vs. 14 %, p = 0.11) and Injury Severity Score (16 ± 11 vs. 16 ± 11, p = 0.28) were similar between groups. Revised Trauma Score (7.0 ± 1.9 vs. 7.1± 1.7, p &lt; 0.01) was lower in the ELST group and proportion of emergency surgery (12 vs. 11 %, p &lt; 0.01) was higher in the ELST group, indicating that ELSTs treat more severe cases. In the multivariable logistic regression, the ELST group had higher odds for survival (adjusted OR: 1.18, 95% CI: 1.01-1.37). Conclusions: ELSTs encountered more severe cases than BEMTs. After adjustment, transport by the ELST group was associated with improved survival of trauma patients.

Relationship between the depressive state of emergency life-saving technicians and near-misses.

AimA depressive state is a key risk factor for medical errors made by emergency life‐saving technicians (ELSTs). However, no study has examined the occurrence of near‐misses in ELSTs. We investigated the association between a depressive state and near‐misses among ELSTs.MethodsA cross‐sectional study was undertaken in 345 ELSTs using an anonymous self‐administered questionnaire. The main exposure was a depressive state that was measured using the Quick Inventory of Depressive Symptomatology. For the main outcome, near‐miss events, we calculated odds ratios (OR) of depressive states, adjusted for age and work‐related factors by multivariable logistic regression. For exploratory purposes, we also undertook secondary analyses to determine whether work‐related factors were associated with a depressive state.ResultsWe obtained 254 responses. Compared to ELSTs without a depressive state, the adjusted OR for near‐misses among ELSTs with a mild depressive state was 3.14 (95% confidence interval [CI], 1.37–7.16; P = 0.007), and that among ELSTs with a moderate or greater depressive state was 5.29 (95% CI, 1.46–19.09; P = 0.011). For a depressive state, in the exploratory analyses, the OR of nap duration while on duty for less than 2 h was 3.34 (95% CI, 1.15–9.67; P = 0.027), that for irregular mealtime while on duty was 3.71 (95% CI, 2.00–6.86; P < 0.001), and that for a duration of desk work of 4 h or longer was 2.21 (95% CI, 1.15–4.25; P = 0.017).ConclusionA depressive state was significantly associated with the occurrence of near‐misses among ELSTs. That a depressive state among ELSTs was related to nap duration and excessive office work indicates that improved management of the work environment and operations of ELSTs is necessary for the provision of safe emergency medical services.

Out-of-hospital endotracheal intubation experience, confidence and confidence-associated factors among Northern Japanese emergency life-saving technicians: a population-based cross-sectional study

ObjectiveClinical procedural experience and confidence are both important when performing complex medical procedures. Since out-of-hospital endotracheal intubation (ETI) is a complex intervention, we sought to clarify clinical ETI experience among...

Antecedents influencing the coaching behaviors of emergency life-saving technicians: The effects of implicit specialization, experience of being coached by managers, and experiential learning

The purpose of this study is to clarify the influence of preceding factors on the coaching behaviors of emergency life-saving technicians. The antecedents include implicit person theories (IPTs) about the personality and personal attributes (e.g., personality and ability), experiential learning behaviors, and experiences of being coached from their managers. We investigated and analyzed 351 emergency life-saving technicians concerning the relationship with these factors and coaching behaviors. The results showed that the incremental theory, experiential learning behaviors, and experiences of being coached by their managers had a positive influence on their own coaching behaviors. It was also found that experiences of being coached by their managers mediated experience learning behaviors, affecting their coaching behaviors. Implications for coaching behaviors research and practice are discussed.

The utilization of pre-hospital 12 lead electrocardiogram by emergency life-saving technicians and its education

The utilization of pre-hospital 12 lead electrocardiogram by emergency life-saving technicians and its education

－日本蘇生学会蘇生医療検討委員会報告－ 「救急救命士によるビデオ硬性挿管用喉頭鏡に関する実態調査」（第２報）

－日本蘇生学会蘇生医療検討委員会報告－ 「救急救命士によるビデオ硬性挿管用喉頭鏡に関する実態調査」（第２報）

－日本蘇生学会蘇生医療検討委員会報告－ 「救急救命士によるビデオ硬性挿管用喉頭鏡に関する実態調査」（第１報）

－日本蘇生学会蘇生医療検討委員会報告－ 「救急救命士によるビデオ硬性挿管用喉頭鏡に関する実態調査」（第１報）

Evaluation of intravenous access for shock and glucose administration for hypoglycemia patient by prehospital emergency life-saving technicians for first 6 months in Akita

Evaluation of intravenous access for shock and glucose administration for hypoglycemia patient by prehospital emergency life-saving technicians for first 6 months in Akita

A questionnaire on troubles about communication and informed consent and the effects of retraining for Aichi prefecture emergency life-saving technicians retraining program attenders

A questionnaire on troubles about communication and informed consent and the effects of retraining for Aichi prefecture emergency life-saving technicians retraining program attenders