Emergency Medical Center Research Articles

I INTERNATIONAL SCIENTIFIC AND PRACTICAL CONFERENCE “DOCTORS AND NURSING – MEDICAL FRONT IN UKRAINE AND THE WORLD”

On May 11–12, 2023, the I International Scientific Practical Conference “Doctors and Nursing – Medical Front in Ukraine and the World” took place in Lutsk, Ukraine. The conference was dedicated to the 150th anniversary of the Shevchenko Scientific Society (SSS).
 The conference was organized by the Municipal Institution of Higher Education Volyn Medical Institute of Volyn Region Council, in collaboration with Danylo Halytsky Lviv National Medical University, I.Y. Horbachevsky Ternopil National Medical University, Vilnius University (Lithuania), Higher Private Educational Institution Lviv Medical University, the Shevchenko Scientific Society, and Health Tech Without Borders (Switzerland, USA). The conference was held with the support of the State Institution “Center for Nursing Development of the Ministry of Health of Ukraine”. Partners in conference organization also included Volyn Orthodox Theological Academy, Maastricht University (the Netherlands), Volyn Region Emergency Medical Center and Disaster Medicine Municipal Enterprise, German-Ukrainian Association of Nurses, NeanderklinikHarzwald (Germany), “Myloserdia” Association of Volyn Nurses PO and Lviv Association of Allergists, Immunologists, and Rehabilitologists Charitable Organization.
 During the course of the event, a total of over 100 speeches were delivered by medical scientists and practicing physicians, as well as researchers in diverse disciplines from Ukraine, the United States, Great Britain, Poland, Lithuania, Germany, the Netherlands, and Switzerland. Workshops were conducted on relevant issues in medical practice in times of war.
 A total of approximately 1100 individuals participated in the conference, comprising physicians from diverse disciplines and nurses, emergency medical professionals and disaster medicine specialists, scientific and pedagogical personnel, employees of the State Emergency Service, physical rehabilitation specialists, psychologists, representatives of the clergy and public organizations, and young scientists.
 A new interdisciplinary format of scientific dialogue has been started between representatives of medical and nursing specialities, the education sector, psychologists, and clergy. It helps find ways to address relevant issues in the medical sector in complex conditions of the present day.

“Calling for help: I need you to listen” - A qualitative study of callers’ experience of calls to the emergency medical communication centre

BackgroundThe Emergency Medical Communications Center (EMCC) is essential in emergencies and often represents the public’s first encounter with the healthcare system. Previous research has mainly focused on the dispatcher’s perspective. Therefore, there is a lack of insight into the callers’ perspectives, the attainment of which may contribute significantly to improving the quality of this vital public service. Most calls are now made from mobile phones, opening up novel approaches for obtaining caller feedback using tools such as short-message services (SMS). Thus, this study aims to obtain a better understanding of callers’ actual experiences and how they perceived their interaction with the EMCC.MethodsA combination of quantitative and qualitative study methods was used. An SMS survey was sent to the mobile phone numbers of everyone who had contacted 113 during the last months. This was followed by 31 semi-structured interviews with people either satisfied or dissatisfied. Thematic analysis was used to investigate the interviews.ResultsWe received 1680 (35%) responses to the SMS survey, sent to 4807 unique numbers. Most respondents (88%) were satisfied, evaluating their experience as 5 or 6 on a six-point scale, whereas 5% answered with 1 or 2. The interviews revealed that callers were in distress before calling 113. By actively listening and taking the caller seriously, and affirming that it was the right choice to call the emergency number, the EMCC make callers experience a feeling of help and satisfaction, regardless of whether an ambulance was dispatched to their location.If callers did not feel taken seriously or listened to, they were less satisfied. A negative experience may lead to a higher distress threshold and an adjusted strategy before the caller makes contact 113 next time. Callers with positive experiences expressed more trust in the healthcare systems.ConclusionsFor the callers, the most important was being taken seriously and listened to. Additionally, they welcomed that dispatchers express empathy and affirm that callers made the right choice to call EMCC, as this positively affects communication with callers. The 113 calls aimed to cooperate in finding a solution to the caller’s problem.

A comparison between modified Kessler and modified Tsuge suture techniques in flexor tendon repair

Background and Objective: Severed digital flexor tendon needs to be repaired to restore flexion function of the finger. The aim is to evaluate tendon repair outcomes by using two different suturing techniques modified Kessler and modified Tsuge. Patients and Methods: This is a comparative study performed in Rozhawa Emergency Hospital and Emergency Medical Center in Erbil city, Kurdistan region-Iraq between 1st of December 2019 to 1st of June 2021. The study included (33) patients of both genders who presented with acute flexor tendons laceration in fingers which their number were (44) fingers underwent digital flexor repair by using two different suture techniques modified Tsuge and modified Kessler. Results: This study includes (30) males and (3) females, patients with digital flexor tendon cut the age ranged from 18 years to 58 years, mean age was 30.1 ± (10.5) years SD. The majority of the injuries (90.9%) were in zone 2, and the right hand was injured in 56.8% of the total injuries. The most common injured fingers were the ring (25%) and the little finger (25%). The Flexor digitorum profundus was the most common (79.5%) injured tendon. The proportion of the patients who were satisfied with the operation's outcome is 60.6%. Conclusions: Tendon repair by using modified Tsuge 4 strands suture technique showed significant strength and less complication rate.

ROMIAE (Rule-Out Acute Myocardial Infarction Using Artificial Intelligence Electrocardiogram Analysis) trial study protocol: a prospective multicenter observational study for validation of a deep learning-based 12-lead electrocardiogram analysis model for detecting acute myocardial infarction in patients visiting the emergency department.

Based on the development of artificial intelligence (AI), an emerging number of methods have achieved outstanding performances in the diagnosis of acute myocardial infarction (AMI) using an electrocardiogram (ECG). However, AI-ECG analysis using a multicenter prospective design for detecting AMI has yet to be conducted. This prospective multicenter observational study aims to validate an AI-ECG model for detecting AMI in patients visiting the emergency department. Approximately 9,000 adult patients with chest pain and/or equivalent symptoms of AMI will be enrolled in 18 emergency medical centers in Korea. The AI-ECG analysis algorithm we developed and validated will be used in this study. The primary endpoint is the diagnosis of AMI on the day of visiting the emergency center, and the secondary endpoint is a 30-day major adverse cardiac event. From March 2022, patient registration has begun at centers approved by the institutional review board. This is the first prospective study designed to identify the efficacy of an AI-based 12-lead ECG analysis algorithm for diagnosing AMI in emergency departments across multiple centers. This study may provide insights into the utility of deep learning in detecting AMI on electrocardiograms in emergency departments. Trial registration ClinicalTrials.gov identifier: NCT05435391. Registered on June 28, 2022.

Description of the prehospital emergency healthcare system in Norway

BackgroundNorway has a long coastline, steep mountains, and wide fjords, which presents some challenges to the prehospital emergency healthcare system. In recent years, the prehospital emergency medical services (EMS) have undergone significant changes, structurally, in terms of professionalisation of the services and in the education level of the personnel. In this article, we aim to describe the current structure for handling prehospital medical emergencies. MethodsFor healthcare, Norway is divided into four Regional Health Authorities, consisting of 19 Health Trusts, where 18 have an EMS. There is a dedicated medical emergency number, 113, that terminates in 16 emergency medical communication centres. The use of air and boat ambulances, in addition to traditional ambulances, seeks to meet the challenges in the EMS system. Strengths and limitationsThe Norwegian EMS is an advanced system with highly educated staff; however, this level of care comes with an equally high cost. ConclusionThe Norwegian EMS can handle emergencies nationwide, providing advanced care at the scene and during transport. The geography and demography challenge the idea of equal care, but the open publishing of data from national quality registries seeks to identify and address potential differences.

Effectiveness of call system implementation for postpartum hemorrhage in a tertiary emergency medical center: a retrospective cohort study

BackgroundPostpartum hemorrhage is the leading cause of maternal death and severe maternal morbidity worldwide. Previous studies have reported the importance of multidisciplinary treatment approaches for postpartum hemorrhage; however, only a few studies have shown a clear improvement in maternal outcomes. Therefore, this study aimed to investigate the efficacy of a call system for postpartum hemorrhage in a tertiary emergency facility for rapid multidisciplinary treatment and its effect on maternal outcomes.MethodsThis single-center retrospective cohort study included patients transferred to our hospital due to postpartum hemorrhage between April 1, 2013, and March 31, 2019. The primary outcome was mortality, and the secondary outcomes were morbidity (duration of hospital stay, duration of intensive care unit stay, admission to the intensive care unit, respirator use, duration of ventilator support, acute kidney injury, transfusion-associated circulatory overload/transfusion-related acute lung injury, hysterectomy, composite adverse events, blood transfusion initiation time, blood transfusion volume, and treatment for postpartum hemorrhage). An in-hospital call system implementation commenced on April 1, 2016. The study outcomes were compared 3 years before and after implementing the call system.ResultsThe blood transfusion initiation time and duration of hospital stay were significantly shortened after implementing the call system for postpartum hemorrhage. No maternal deaths were observed after implementing the system.ConclusionsImplementing call systems specialized for postpartum hemorrhage in tertiary emergency facilities may improve maternal outcomes.

Telemedicine in Nursing Home Residents Requiring a Call to an Emergency Medical Communication Center

ObjectivesTo compare the proportion of nursing home residents dispatched to an emergency department (ED) after a call to the emergency medical communication center (EMCC) according to the availability or nonavailability of telemedicine. DesignThis prospective, observational trial was conducted in the EMCC and 74 nursing homes in a French county. Setting and ParticipantsAll nursing home residents who needed to contact the EMCC between June 2019 and April 2020 were included in the study. We excluded calls notifying the death of a resident, for completing data from a previous call, and for nursing home staff. MethodsThe primary outcome was the proportion of residents dispatched to an ED after their first call to the EMCC. The secondary outcomes were the proportion of second calls, proportion of residents dispatched to an ED after a second call, and proportion of death within 30 days. ResultsWe included 3103 calls in the final analysis (355 from equipped nursing homes and 2748 from unequipped nursing homes). The proportion of patients dispatched to an ED after the first call was lower among telemedicine-equipped than among telemedicine-unequipped nursing homes (41% vs 50%; odds ratio, 0.71; 95% CI, 0.56–0.90). The proportion of a second call for the same purpose within 72 hours, proportion of dispatching to an ED at the second call, and proportion of deaths within 30 days were similar between the groups. Conclusion and ImplicationsThe use of telemedicine by nursing home residents requiring a call to the EMCC is associated with a reduction in the number of dispatches to an ED without any increase in the number of 72-hour callbacks or 30-day mortality rates.

Temporal Generalizability of Machine Learning Models for Predicting Postoperative Delirium Using Electronic Health Record Data: Model Development and Validation Study.

Although machine learning models demonstrate significant potential in predicting postoperative delirium, the advantages of their implementation in real-world settings remain unclear and require a comparison with conventional models in practical applications. The objective of this study was to validate the temporal generalizability of decision tree ensemble and sparse linear regression models for predicting delirium after surgery compared with that of the traditional logistic regression model. The health record data of patients hospitalized at an advanced emergency and critical care medical center in Kumamoto, Japan, were collected electronically. We developed a decision tree ensemble model using extreme gradient boosting (XGBoost) and a sparse linear regression model using least absolute shrinkage and selection operator (LASSO) regression. To evaluate the predictive performance of the model, we used the area under the receiver operating characteristic curve (AUROC) and the Matthews correlation coefficient (MCC) to measure discrimination and the slope and intercept of the regression between predicted and observed probabilities to measure calibration. The Brier score was evaluated as an overall performance metric. We included 11,863 consecutive patients who underwent surgery with general anesthesia between December 2017 and February 2022. The patients were divided into a derivation cohort before the COVID-19 pandemic and a validation cohort during the COVID-19 pandemic. Postoperative delirium was diagnosed according to the confusion assessment method. A total of 6497 patients (68.5, SD 14.4 years, women n=2627, 40.4%) were included in the derivation cohort, and 5366 patients (67.8, SD 14.6 years, women n=2105, 39.2%) were included in the validation cohort. Regarding discrimination, the XGBoost model (AUROC 0.87-0.90 and MCC 0.34-0.44) did not significantly outperform the LASSO model (AUROC 0.86-0.89 and MCC 0.34-0.41). The logistic regression model (AUROC 0.84-0.88, MCC 0.33-0.40, slope 1.01-1.19, intercept -0.16 to 0.06, and Brier score 0.06-0.07), with 8 predictors (age, intensive care unit, neurosurgery, emergency admission, anesthesia time, BMI, blood loss during surgery, and use of an ambulance) achieved good predictive performance. The XGBoost model did not significantly outperform the LASSO model in predicting postoperative delirium. Furthermore, a parsimonious logistic model with a few important predictors achieved comparable performance to machine learning models in predicting postoperative delirium.

Relaxation and strain among emergency medical service personnel and emergency control center dispatchers during the first two waves of the SARS-CoV-2 pandemic.

Workloads of emergency medical service personnel (EMP) and emergency control center dispatchers (CCDs) were manifold. The SARS-CoV-2 pandemic presented new challenges for the prehospital emergency medical service. The purpose of this study was to compare the status of stress/strain and recovery of Recovery-Stress Questionnaire among EMP and CCDs in Germany during the first 2 waves of the SARS-CoV-2 pandemic both between occupational groups and over time. A total of 2426 emergency medical service personnel and control center dispatchers were questioned with the Recovery-Stress Questionnaire based on Kallus. The results from the first 2 waves of the pandemic (June-August 2020 and January-February 2021) were compared. During the first and second wave of SARS-CoV-2 pandemic, the subjectively perceived stress of emergency medical service personnel and control center dispatchers increased, but recovery decreased. The CCDs showed more unfavorable values compared to EMP. Health promotion interventions are necessary to counteract possible career changes or mental or other diseases due to insufficient management. Med Pr Work Health Saf. 2023;74(5):353-62.

The influence of COVID-19 epidemic on the number of orthopaedic surgeries in Japan

BackgroundThere is limited data on the impact of COVID-19 epidemic on the number of orthopaedic surgeries in Japan. MethodsWe conducted a nationwide hospital survey asking for the monthly number of orthopaedic surgeries performed at each facility from January 2019 to June 2021. Those facilities that had performed at least 100 surgeries in 2019 were included for analyses. The facilities were further grouped by prefecture and by hospital characteristics. A brief health economic evaluation was also performed. Risk ratios were compared using univariate analyses with P < 0.05 considered statistically significant. ResultsQuestionnaire was sent to 1988 hospitals with 1671 hospitals (84%) responding. The survey data indicated a total number of orthopaedic surgeries decreased in 2020 compared to 2019 (1,061,541 vs 1,119,955 P < 0.01), and also for the first six months of 2021 compared to the same period in 2019 (530,388 vs 550,378 P < 0.01). In 2020, over 50% of all facilities in nearly all of the prefectures saw a decline in surgical procedures.The risk of incurring more than a 25% decease in the number of surgeries was significantly higher in 2020 for class I designated medical institutions compared to those that were not designated for any types of infectious diseases among the institutions with a tertiary emergency medical center in 2020 (crude risk ratio 2.9: 95% CI 1.2–7.4, p = 0.02) and in 2021 (crude risk ratio 4.7: 95% CI 1 0.9–12.1, p < 0.01).The estimated total nationwide decrease of revenue were in the range of approximately ¥29.2 to ¥116.8 billion per year for orthopaedic surgeries alone. ConclusionThere was a statistically significant decrease in the number of orthopaedic surgeries in Japan. The magnitude of the decline varied by prefectures and hospital characteristics, with the greater impact imposed on medical institutions with higher classification functions. The estimated immediate health economic impact was sizable.

Incidence of overtriage and undertriage and associated factors: A cross-sectional study using a secondary data analysis.

Improving triage accuracy for accurate patient identification and appropriate resource allocation is essential. Little is known about the trend of triage accuracy, and factors associated with mistriage vary from study to study. To identify incidence and risk factors of mistriage, such as overtriage and undertriage. This is a cross-sectional study. The data came from the National Emergency Department Information System database in 2016-2020. All patients 15 years and older visiting emergency departments in Korea were assessed for eligibility, and 20,641,411 emergency patients' data were used. Multivariable logistic regressions were conducted to confirm the associated factors with overtriage and undertriage compared to expected triage. Demographic characteristics, disease-related signs and triage-related factors were independent variables. Expected triage decreased from 96.8% in 2016 to 95.7% in 2020. Overtriage (0.5%-0.7%) and undertriage (2.4%-3.3%) increased. The occupation that performed triage the most (over 85%) was nurses. Associated factors with overtriage were demographic characteristics (40-64 age group, female), disease-related signs (known disease, direct visit) and triage-related factors (regional emergency medical centre). Risk factors to undertriage were disease-related signs (systolic/diastolic blood pressure and pulse rates within normal range). While the acuity degree remained within the recommended range, the accuracy of triage decreased, and there was a gradual increase in mistriaged cases. Nurses have performed most of the triage and played a key role in expected triage. Associated factors with overtriage were demographic characteristics, disease-related signs and triage-related factors and risk factors to undertriage were disease-related signs. No patient or public contribution. Nurses should be aware of what factors are associated with mistriage and why the factors cause mistriage to improve the triage accuracy because they are responsible for the majority of the triage assessments.

The new QST bioassay laboratory in Chiba, Japan.

Japan's National Institutes for Quantum Science and Technology (QST) was designated as the core radiation emergency medical support center by the country's Nuclear Regulation Authority (NRA) in 2019. One of the main missions of the QST is to maintain and improve its dose assessment capability for radiation-exposed individuals. Toward the goal of effectively fulfilling this mission, a new facility-the Dose Assessment Building for Advanced Radiation Emergency Medicine-was constructed at the Chiba base of the QST in 2020. An integrated bioassay laboratory was installed in this facility for assessing subjects' internal doses, along with a new integrated in vivo counter. The bioassay capability of the new laboratory is currently expected to screen 5-10 persons simultaneously assuming internal contamination with actinides such as Pu, Am/Cm and U, although this is dependent on the specific contamination circumstances.

Can video communication in the emergency medical communication centre improve dispatch precision? A before–after study in Norwegian helicopter emergency medical services

ObjectivesDispatching helicopter emergency medical services (HEMS) to the patients with the greatest medical or logistical benefit remains challenging. The introduction of video calls (VC) in the emergency medical communication centres...

The Relationship Between Resilience and Conflict Management Styles from the Perspective of the Prehospital Emergency Medicine Operational Staff: A Cross-sectional Descriptive Study

Background: The numerous pre-hospital emergency medicine operational staff interactions with different people cause many conflicts. In addition to affecting their physical and mental health, these conflicts lead to severe problems for the health of society and patients. Objectives: This study aimed to determine the relationship between resilience and conflict management styles from the perspective of pre-hospital emergency medicine operational staff of the Medical Emergency and Accident Management Center in Golestan Province in 2022. Methods: This descriptive correlational study recruited 200 operational staff working in the pre-hospital emergency center in Golestan Province. They were selected using a stratified sampling method with proportional allocation. The data were collected using a demographic questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), and the Rahim Organizational Conflict Inventory-II (ROCI-II). Results: Pearson correlation results demonstrated a direct and significant relationship between resilience and conflict management styles (P = 0.011, r = 0.180); the resilience score increased with an increase in the score of conflict management styles. In addition, resilience was directly associated with compromising (P = 0.012, r = 0.178) and integrating styles (P = 0.001, r = 0.276). Finally, a direct and significant relationship existed between job interest and resilience (P = 0.01). The linear regression analysis showed a significant relationship between the resilience score and the score of conflict management styles (β = 0.17). Conclusions: Resilience can improve the conflict management styles of pre-hospital emergency medicine operational staff. Moreover, job interest can enhance resilience, indirectly affecting conflict management. Pre-hospital emergency managers and officials should hold resilience training courses for pre-hospital emergency operatives.

Improving Diabetes Self-Help in Natural Disasters: Qualitative Parameters and Recommendations

Background: When natural disasters occur, people with diabetes face more physical and mental challenges than healthy individuals. Therefore, innovative programs and policies are crucial for providing ongoing education to patients on how to better manage their condition. Objectives: The present study aimed to identify the components of empowerment literacy for diabetic patients during disasters. Methods: The present research employed a qualitative content analysis approach using a conventional deductive method. Purposive sampling was conducted, and data were collected through semi-structured interviews. The panel consisted of 24 participants, including native Iranian endocrinologists, nurses, emergency medical center managers, and experts in the field of medical librarianship and information. These participants had direct experience in relief efforts during critical situations such as natural disasters. The interviews were recorded and transcribed into written format. Data analysis was performed using thematic analysis with the assistance of MaxQDA software. Results: The content analysis resulted in identification of 10 main categories, 61 sub-categories, and five themes, including Disaster risk perception literacy, Medication literacy, Resilience literacy, Nutrition literacy, and Self-help literacy. Conclusion: The obtained findings have informed the creation of targeted health literacy education materials for policymakers in disaster scenarios specifically designed for individuals with diabetes. Diabetic individuals, particularly those residing in disaster-prone areas, should possess knowledge of emergency and disaster policies to enhance their health literacy. They should actively manage their condition while keeping abreast of policymakers' guidelines.

The Trend of Change in Oral and Maxillofacial Injuries of Pediatric Patients in the COVID-19 Pandemic: a Regional Emergency Medical Center and Dental Hospital Study

The purpose of this study is to analyze changes in dental trauma in children under the age of 12 during the period of Coronavirus Disease 2019 (COVID-19). March 2020, when COVID-19 was officially declared a pandemic by the World Health Organization, was set as the starting point for COVID-19. From March 2018 to February 2020, subjects in the pre-COVID-19 period were classified as the Pre-COVID-19 group, and from March 2020 to March 2022, subjects in the post-COVID-19 period were classified as the COVID-19 group. Information related to trauma was collected through electronic medical records. The number of trauma patients before and after the outbreak of COVID-19 decreased significantly. During the COVID-19 period, there was no significant difference in the male-female ratio or the distribution order of age groups. In the COVID-19 group of permanent teeth, the ratio of trauma caused by personal mobility was higher than trauma caused by sports. In the COVID-19 group of permanent teeth, the ratio of crown fracture with pulp involvement was significantly higher than the ratio of crown fracture without pulp involvement. Changes in trauma patterns caused by COVID-19 were observed more clearly in school-aged children than in preschool children. In a pandemic situation such as COVID-19, it is expected to be used as a good educational basis for knowing that frequent diagnoses can change due to changes in the environment.

닥터헬기 응급의료종사자의 직무분석

This study utilized the Developing a Curriculum(DACUM) method to conduct a comprehensive job description of Doctor Helicopter emerge medical workers. The participants included four emergency medical workers in Doctor Heli, two experts in operating the Central Emergency Medical Center, and a nursing professor with experience in job descriptions. As a result, the duties of seven jobs, 45 tasks, and 68 elements of task associated with Doctor helicopter emergency medical work were identified. Based on the research results, it was confirmed that emergency medical workers frequently perform certain duties in buliding and maintaining cooperative relationship (18), utilization of medical equipment (9), equipment management (5), and medical records (5). Building and maintaining cooperative relationship prioritizing safety were identified as important tasks in air transportation. The results of this study should be used as basic evidence for the developing systematic and standardized training program aiming to strengthen the job competency of Doctor Helicopter emergency medical workers.

Clinical support system for triage based on federated learning for the Korea triage and acuity scale

Background and aimsThis study developed a clinical support system based on federated learning to predict the need for a revised Korea Triage Acuity Scale (KTAS) to facilitate triage. MethodsThis was a retrospective study that used data from 11,952,887 patients in the Korean National Emergency Department Information System (NEDIS) from 2016 to 2018 for model development. Separate cohorts were created based on the emergency medical center level in the NEDIS: regional emergency medical center (REMC), local emergency medical center (LEMC), and local emergency medical institution (LEMI). External and temporal validation used data from emergency department (ED) of the study site from 2019 to 2021. Patient features obtained during the triage process and the initial KTAS scores were used to develop the prediction model. Federated learning was used to rectify the disparity in data quality between EDs. The patient's demographic information, vital signs in triage, mental status, arrival information, and initial KTAS were included in the input feature. Results3,626,154 patients' visits were included in the regional emergency medical center cohort; 8,278,081 patients' visits were included in the local emergency medical center cohort; and 48,652 patients’ visits were included in the local emergency medical institution cohort. The study site cohort, which is used for external and temporal validation, included 135,780 patients visits. Among the patients in the REMC and study site cohorts, KTAS level 3 patients accounted for the highest proportion at 42.4% and 45.1%, respectively, whereas in the LEMC and LEMI cohorts, KTAS level 4 patients accounted for the highest proportion. The area under the receiver operating characteristic curve for the prediction model was 0.786, 0.750, and 0.770 in the external and temporal validation. Patients with revised KTAS scores had a higher admission rate and ED mortality rate than those with unaltered KTAS scores. ConclusionsThis novel system might accurately predict the likelihood of KTAS acuity revision and support clinician-based triage.

Swedish emergency medical dispatch centres’ ability to answer emergency medical calls and dispatch an ambulance in response to out-of-hospital cardiac arrest calls in accordance with the American Heart Association performance goals: An observational study

AimTo investigate the ability of Swedish Emergency Medical Dispatch Centres (EMDCs) to answer medical emergency calls and dispatch an ambulance for out-of-hospital cardiac arrest (OHCA) in accordance with the American Heart Association (AHA) performance goals in a 1-step (call connected directly to the EMDC) and a 2-step (call transferred to regional EMDC) procedure over 10 years, and to assess whether delays may be associated with 30-day survival. MethodObservational data from the Swedish Registry for Cardiopulmonary Resuscitation and EMDC. ResultsA total of 9,174,940 medical calls were answered (1-step). The median answer delay was 7.3 s (interquartile range [IQR], 3.6–14.5 s). Furthermore, 594,008 calls (6.1%) were transferred in a 2-step procedure, with a median answer delay of 39 s (IQR, 30–53 s). A total of 45,367 cases (0.5%, 1-step) were registered as OHCA, with a median answer delay of 7.2 s (IQR, 3.6–14.1 s) (AHA high-performance goal, 10 s). For 1-step procedure, no difference in 30-day survival was found regarding answer delay. For OHCA (1-step), an ambulance was dispatched after a median of 111.9 s (IQR, 81.7–159.9 s). Thirty-day survival was 10.8% (n = 664) when an ambulance was dispatched within 70 s (AHA high-performance) versus 9.3% (n = 2174) > 100 s (AHA acceptable) (p = 0.0013). Outcome data in the 2-step procedure was unobtainable. ConclusionThe majority of calls were answered within the AHA performance goals. When an ambulance was dispatched within the AHA high-performance standard in response to OHCA calls, survival was higher compared with calls when dispatch was delayed.

Dispatch of Volunteer Responders to Out-of-Hospital Cardiac Arrests

BackgroundSystems for dispatch of volunteer responders to collect automated external defibrillators and/or to provide cardiopulmonary resuscitation (CPR) in cases of nearby out-of-hospital cardiac arrest (OHCA) are widely implemented. ObjectivesThis study aimed to investigate whether the activation of a volunteer responder system to OHCAs was associated with higher rates of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. MethodsThis was a retrospective observational analysis within the ESCAPE-NET (European Sudden Cardiac Arrest network: Towards Prevention, Education, New Effective Treatment) collaborative research network. Included were cases of OHCA between 2015 and 2019 from 5 European sites with volunteer responder systems. At all sites, systems were activated by dispatchers at the emergency medical communication center in response to suspected OHCA. Exposed cases (system activation) were compared with nonexposed cases (no system activation). Risk ratios (RRs) were calculated for the outcomes of bystander CPR, bystander defibrillation, and 30-day survival after inverse probability treatment weighting. Missing data were handled using multiple imputation. ResultsIn total, 9,553 cases were included. In 4,696 cases, the volunteer responder system was activated, and in 4,857 it was not. The pooled RRs were 1.30 (95% CI: 1.15–1.47) for bystander CPR, 1.89 (95% CI: 1.36–2.63) for bystander defibrillation, and 1.22 (95% CI: 1.07–1.39) for 30-day survival. ConclusionsActivation of a volunteer response system in cases of OHCA was associated with a higher chance of bystander CPR, bystander defibrillation, and 30-day survival vs no system activation. A randomized controlled trial is necessary to determine fully the causal effect of volunteer responder systems.