Emergency Medical Providers Research Articles

Exploring stress management strategies among emergency medical service providers in Iran: a qualitative content analysis

BackgroundEmergency medical service providers are frequently exposed to a variety of stressors as a result of their work environment. These stressors can have detrimental effects on both the physical and mental well-being of individuals. This study was conducted with the aim of exploring stress management strategies in emergency medical service providers.MethodsThis study was conducted in 2023 using a qualitative approach and content analysis method. A purposive sampling method was used to include 16 emergency medical system providers from Hamadan city. Semi-structured interviews, with a duration of 45–60 min, were conducted for data collection. The Data were analyzed using Graneheim and Lundman’s conventional content analysis approach.ResultsThe analysis of the interview data revealed three themes: readiness for the worst conditions, assistance based on supportive partnerships, and striving for balance. The six categories within these three themes were mental preparation, risk management, collaborations in emergency response, supportive communication, adaptive behaviors, and maladaptive responses.ConclusionsThe results of this study shed light on the various stress management strategies employed by emergency medical service providers. Understanding and implementing effective stress management strategies can not only enhance the well-being of emergency medical service providers but also improve the quality of patient care. Further research and action are essential to promote the resilience and mental health of these professionals, ensuring their overall well-being and job satisfaction.

Prehospital medical care in pediatric burns: a literature review

The properly administered first aid is an important component in achieving better outcomes in the treatment of burn patients. One of the first stages of management of such patients is a pre-hospital one. The purpose of the study is to analyze the literature review on medical care for children with burns in the prehospital stage, to identify critical deviations and changes that require revision of the current recommendations. A review of trials and latest recommendations on providing medical care to burned children at the prehospital period was carried out. The search was done in PubMed, Medline, GoogleScholar, eLibrary databases, as well as in Yandex search system. Out of 8 168 sources, 17 publications were selected for the data analysis. The performed review has identified main challenges in providing the first aid to children with burns at the prehospital stage. Children will benefit from reaching the consensus between burn specialists and emergency medical providers before patients are taken to a burn center. These data should be used as the basis for future agreements between these specialists. Correctly placed accents on anesthesia, dressings, infusion therapy in children with burns before their arrival to the hospital dictate a need to revise the existing recommendations in our country.

Determining the Impact of Hurricane Dorian and the Covid-19 Pandemic on Moral Distress in Emergency Medical Providers at the Rand Memorial Hospital: Moral distress in emergency medical personnel.

The aim of this work was to determine the impact of Moral Distress (MD) in emergency physicians, nurses, and emergency medical service staff at the Rand Memorial Hospital (RMH) in the Bahamas, and the impact of Hurricane Dorian and the COVID-19 pandemic on Moral Distress. A cross-sectional study utilizing a 3-part survey, which collected sociodemographic information, Hurricane Dorian and COVID-19 experiences, as well as responses to a validated modified Moral Distress Scale (MDS). Participants with 2 negatively impactful experiences from COVID-19 had statistically significantly increased MD compared to participants with only 1 negatively impactful experience (40.4 vs. 23.6, P = 0.014). Losing a loved one due to COVID-19 was associated with significantly decreased MD (B = - 0.42, 95% CI -19.70 to -0.88, P = 0.03). Losing a loved one due to Hurricane Dorian had a non-statistically significant trend towards higher MD scores (B = 0.34, 95% CI -1.23 to 28.75, P = 0.07). The emergency medical staff at the RMH reported having mild - moderate MD. This is one of the first studies to look at the impact of concurrent disasters on MD in emergency medical providers in the Bahamas.

Prevalence of methicillin sensitive and resistant Staphylococcus aureus carriage among German emergency medical providers.

Health care workers (HCW) in Emergency Medical Services (EMS) frequently come into contact with carriers of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA) strains and may acquire and transmit them to patients. However, there is little data on MSSA and MRSA colonization of medical personnel in the emergency services. Additionally, few studies have analyzed the association between personal hygiene of staff and colonization. Therefore, we examined the prevalence of MSSA and MRSA in EMS staff of two German regions and evaluated their personal hygiene behavior. Throat and nasal swabs from 300 EMS workers were analyzed. Both direct and pre-enriched cultures of the swabs were cultivated on culture media to identify MSSA and MRSA. Results were analyzed together with questionnaires about sociodemographic data and a self-assessment of hygiene behavior. Statistical analysis was done using the R statistical software. Of the total 300 swabs, 55% were from paramedics, 39% were from emergency medical technicians (EMT) and 5% were from emergency physicians. With 1%, the MRSA prevalence was comparable to that of the German population, while the MSSA rate - 43.7% - was higher than expected. Colonization with MSSA was significantly associated with poor hand hygiene and male sex, and was inversely correlated to time on the job in EMS. The sample size of 300 and a MRSA prevalence of 1% made a meaningful analysis of potential influencing factors on the prevalence of MRSA infeasible. The comparatively high prevalence of MSSA and the association with decreasing frequency of hand antisepsis suggests an influence of personal hygiene on MSSA colonization. HCW in EMS should be encouraged to make use of their personal protective equipment and practice frequent hand hygiene. The implementation of diagnostic tools such as the Hand Hygiene Self-Assessment Framework of the WHO could be utilized to reveal problems in organizations, followed by an individual program to promote hand hygiene.

Comparing effects and application of telemedicine for different specialties in emergency medicine using the Emergency Talk Application (U-Sim ETA Trial)

Telemedicine as a technology can support processes in the field of emergency medicine (EM) including therapies and diagnostics, but technically is often based on hardware solutions for local EM structures, especially when involving the field of pre-hospital EM. By developing an open-source, data protection compliant solution (EU GDPR and HIPAA) as well as using standardized web and open-source based technology the Emergency Talk Application (ETA) can be used as a technology that can connect emergency medical providers and include already available regional structures. By actively involving patients and connecting these with emergency or urgent care physicians ETA can be used not only as a teleconsultation system for paramedics and physicians, but in a wider network. Randomised simulation trial, comparing EM scenarios from the field of internal medicine, trauma and neurology. Participants were qualified as certified paramedics or emergency physicians (EP). Paramedics performed as ambulances crews and involved an EP if needed via ETA as Tele-Emergency Physicians (TEP). EP participated from a device of their choice, while being able to stay within their clinical workspace. From 141 scenarios 129 used ETA. Significant differences were found for the length of scenarios, duration of time the TEP was on scene, TEP arrival after scenario start, duration until TEP was called and the duration until a diagnosis was made. Also a strong positive and significant correlation between duration of the scenario and the time a TEP was bound could be described. Telemedicine is a technology that is increasingly used in the field of EM. Improving the use of telemedicine by using up-to date technology while allowing an integration of available technical and human resources is a challenge in the field of emergency medicine especially with its regional but also broad medical variety. When using one technical solution, understanding that different cases need a different medical and also telemedical approach can help in the understanding and improving therapies, diagnostics but also the involved processes and solutions. Such results are not only relevant for healthcare providers but especially by law and decision makers as to which type of solution could be introduced in each regional setting.

Caring for older patients with reduced decision-making capacity: a deductive exploratory study of ambulance clinicians’ ethical competence

BackgroundAs more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complex and difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability.MethodsA qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis.ResultsAmbulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting.ConclusionsAmbulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values.

An assessment of information needs and workflows for emergency service providers and caregivers of children with medical complexity

BackgroundThe goal of Project Austin, an initiative to improve emergency care for rural children who are medically complex (CMC), is to provide an Emergency Information Form (EIF) to their parents/caregivers, to local Emergency Medical Services, and Emergency Departments. EIFs are standard forms recommended by the American Academy of Pediatrics that provide pre-planned rapid response instructions, including medical conditions, medications, and care recommendations, for emergency providers. Our objective is to describe the workflows and perceived utility of the provided emergency information forms (EIFs) in the acute medical management of CMC.MethodsWe sampled from two key stakeholder groups in the acute management of CMC: four focus groups with emergency medical providers from rural and urban settings and eight key informant interviews with parents/caregivers enrolled in an emergency medical management program for CMC. Transcripts were thematically analyzed in NVivo© by two coders using a content analysis approach. The thematic codes were combined into a codebook and revised the themes present through combining relevant themes and developing of sub-themes until they reached consensus.ResultsAll parents/caregivers interviewed were enrolled in Project Austin and had an EIF. Emergency medical providers and parents/caregivers supported the usage of EIFs for CMC. Parents/caregivers also felt EIFs made emergency medical providers more prepared for their child. Providers identified that EIFs helped provide individualized care, however they were not confident the data was current and so felt unsure they could rely on the recommendations on the EIF.ConclusionEIFs are an easy way to engage parents, caregivers, and emergency medical providers about the specifics of a care for CMC during an emergency. Timely updates and electronic access to EIFs could improve their value for medical providers.

Determining the Impact of Hurricane Dorian & the Covid-19 Pandemic on Moral Distress in Emergency Medical Providers at the Rand Memorial Hospital

Introduction:Cumulative disasters have been shown to influence mental and physical health in both responders and victims, with studies showing associations in rates of depression and Post Traumatic Stress Disorder. Systemic problems that impact patient care such as limited resources, overcrowding of emergency rooms, and staffing shortages can be morally challenging for healthcare workers. Andrew Jameton, in 1984 defined Moral Distress (MD) as the inability of a moral agent to act according to his or her core values and perceived obligations due to internal and external constraints. Unresolved MD can create significant long-term debilitating physical and mental damage. Emergency medical providers on the island of Grand Bahama had the unique experience of responding to both the aftermath of Hurricane Dorian and the Covid-19 Pandemic. The aim of this study is to determine the prevalence of Moral Distress (MD) in Accident & Emergency (A&E) Physicians, Nurses, and Emergency Medical Service (EMS) staff at the Rand Memorial Hospital (RMH) in the Bahamas.Method:This is a descriptive, qualitative, prospective cross-sectional study, utilizing a three-part survey sent to participants. Sociodemographic information, Hurricane Dorian & Covid-19 experiences, and responses to a validated modified Moral Distress Scale will be collected and uploaded to a secure, encrypted data management program. The data will be analyzed using the most current IBM SPSS statistical analysis package. Descriptive and Inferential statistics will be used to determine the impact of Hurricane Dorian & Covid-19 on MD and its associated sociodemographic factors.Results:Data collection and analysis are planned for completion by March 1, 2023.Conclusion:Addressing the causes of Moral Distress early can help improve healthcare systems’ resiliency by ensuring a healthy and supported workforce equipped with the resources to respond to future disasters.

Cranial ultrasound image acquisition in a moving ambulance feasibility for pre-hospital EMS applications: A review of literature (P10-7.004)

<h3>Objective:</h3> Investigate available literature for the use of prehospital ultrasound for neurological indications. <h3>Background:</h3> Ultrasound is an invaluable resource for rapid diagnosis in the hospital setting. With the advent of handheld devices, it is an ideal imaging modality in the prehospital setting. It is affordable, easily placed on ambulances, and now within the scope of non-physician emergency medical providers. Data demonstrates that earlier intervention is key to improving patient outcomes with intracranial pathologies like hemorrhage. Ultrasound could play a vital role in the early detection and treatment of intracranial pathologies in the prehospital setting. <h3>Design/Methods:</h3> A systematic literature review was completed to find studies examining the role of point-of-care ultrasound in the prehospital setting for a neurological indication. Studies included those with human subjects that underwent ultrasound imaging. Imaging was completed by EMTs either in the field or while in transit to the hospital, by ambulance or helicopter. Studies where imaging was completed by someone other than an EMT in the field were excluded. <h3>Results:</h3> Ten studies met the inclusion criteria noted above. Only one demonstrated the use of ultrasound for a neurological indication. Nine studies showed EMTs were capable of providing consistent images in the field. One found lung scans acquired by EMTs inadequate. In all studies, images captured in the field were compared to repeat imaging by physicians in the hospital or standard hospital imaging modalities such as CT. Various methods were employed to educate EMTs on using and interpreting ultrasound, including lectures, pre and post-assessments, and ongoing education modules. <h3>Conclusions:</h3> Handheld ultrasound performed by EMTs in a moving ambulance is intuitive, accessible, and has been shown to be capable of providing consistent images. Further studies are needed to understand the potential application of ultrasound for neurological indications in the prehospital setting. <b>Disclosure:</b> Mr. Malinda has nothing to disclose. Dr. Sarwal has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Critical Care Medicine. The institution of Dr. Sarwal has received research support from Butterfly, Inc. The institution of Dr. Sarwal has received research support from Bard. The institution of Dr. Sarwal has received research support from Biogen. The institution of Dr. Sarwal has received research support from Novartis. The institution of Dr. Sarwal has received research support from CVR Global. The institution of Dr. Sarwal has received research support from NIH/NIA R01 AG066910-01 . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker/Faculty, CME courses with Society of Critical Care Medicine . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Intensive Care Society. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker at annual congress with Indian Society of Critical Care. Dr. Sarwal has received personal compensation in the range of $0-$499 for serving as a Subject expert for thesis review with UNIVERSITY OF TECHNOLOGY . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Research participation in clinical trial funded by AHRQ with MEDSTAR HEALTH RESEARCH INSTITUTE . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a speaker/Faculty for Annual meeting, travel compensation with European Society of Intensive Care Medicine. Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Speaker for CME event with Thomas Jefferson University . Dr. Sarwal has received personal compensation in the range of $500-$4,999 for serving as a Visiting Professor with University of Pittsburgh. Dr. Sarwal has a non-compensated relationship as a Social Media Editor with Neurocritical Care that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a Board of Directors with American Society of Neuroimaging that is relevant to AAN interests or activities. Dr. Sarwal has a non-compensated relationship as a President with Association of Indian Neurologists in America that is relevant to AAN interests or activities. Dr. Kapoor has nothing to disclose.

Factors Affecting Paramedic Personnel in the Assessment and Management of Emergency Pediatric Patients within the Prehospital Settings in the United Kingdom.

A paramedic's role in the United Kingdom is to primarily respond and provide emergency medical care to patients in the community. Pediatric patients form a small percentage of ambulance call-outs per year, which impacts a paramedic's confidence and competence when implementing effective healthcare protocols due to few attempts and existing opportunities to address pediatric patients' needs. There are also pre-existing gaps and barriers in pediatric emergency paramedic education and the lack of exposure to that specific patient group for emergency medical service healthcare providers in the prehospital settings when responding to pediatric medical emergencies. Further guidance and support in paramedic practice and education could be advantageous in providing effective tools and knowledge to improve pediatric emergency care in prehospital settings.

140 Factors Influencing Emergency Medical Services Burnout

140 Factors Influencing Emergency Medical Services Burnout

Medical Emergency Data and Networks: A German-Canadian Comparison.

A significant number of problems in emergency care are caused by a lack of provider access to pre-existing patient information at the point of care. Medical Emergency Datasets (MEDs) are brief summarizations of an individual's medical history, providing vital patient information to emergency medical providers. The German MED was validated by German physicians and - based on an international research project - also by Canadian physicians. Physicians in both countries considered the content very useful. The MED is currently being introduced in Germany as part of the Telematic Infrastructure. At the same time, the COVID pandemic forced healthcare professionals around the work to optimize the digital information exchange among different healthcare providers. While the exchange of data is important, additional personal expert advice is sometimes vital. Real time virtual support systems (RTVS) were introduced in Germany and Canada to support team-based healthcare delivery, independent of the actual location. Such systems have been implemented for intensive care, emergency medicine, primary care and several other medical specialties. These systems serve as a safety net, a funnel (appropriate utilization; linking patients back to primary care networks - thus reducing fragmented or disrupted services) and a medical network by building interprofessional relationships.

National EMS Memorial Service: Honoring the Emergency Medical Services and Air Medical Fallen

It was 30 years ago that Emergency Medical Technician (EMT) Kevin Dillard and a group from the Virginia Association of Volunteer Rescue Squads who founded the volunteer-based National EMS Memorial Service (NEMSMS) to honor and recognize emergency medical services (EMS) and air medical providers who died in the line of duty, held the first service. They realized that although there were memorial services for police and fire professionals, there was no formal recognition of EMS and air medical providers who made the ultimate sacrifice in the service to others.

NBOMe Toxicity and Fatalities: A Review of the Literature

In the decade since the introduction of the novel synthetic hallucinogen NBOMe into the consumer market, this drug has become an increasingly prevalent, yet poorly understood cause of altered mental status (AMS) resulting in hospitalization. In this literature review, we conducted a PubMed query for mentions of NBOMe ingestion since Suzuki et al.’s publication of their 2015 review. Among English language publications published between October 2014 and June 8, 2021, were sixteen case reports and six case series detailing a total of 42 cases of NBOMe toxicity. Notably, 26 (62%) patients experienced tachycardia, 22 (52%) had hypertension, 34 (81%) experienced hallucinations. Nine of 42 cases ended in fatality, including six cases of apparent direct NBOMe toxicity, one death by suicide, and two cases of fatalities from trauma after “excited delirium.” At least seven individuals believed that they had purchased and consumed LSD. This updated review of the literature underlines the high prevalence of fatality associated with NBOMe ingestion, as well as the need for increased knowledge among law enforcement and emergency medical providers of the toxidrome of NBOMe when responding to cases of AMS.

Emergency Clinicians' Perceptions of Communication Tools to Establish the Mental Baseline of Older Adults: A Qualitative Study.

BackgroundEvaluating older adults with altered mental status in emergency settings can be challenging due to the inability to obtain a history from patients directly and limited collateral information about the change from a patient’s mental status baseline. Documents and videos establishing a patient’s mental baseline could represent useful communication tools to aid emergency clinicians.MethodsQualitative interviews conducted with 22 emergency clinicians (12 physicians and 10 advanced practice providers) identified methods they use to determine baseline mental status of older adults in the ED and the perceived utility of document- and video-based information about an older adult’s baseline mental status. Interview transcripts were coded for dominant themes using deductive and inductive approaches.ResultsParticipants determine an older adult’s baseline mental status by obtaining information about the patient’s baseline cognition (memory and communication) and function (activities of daily living and mobility). The techniques they use include 1) reviewing the electronic medical record, 2) speaking with family members or caregivers by phone or in person, and 3) obtaining verbal or phone reports from emergency medical services personnel or health care providers from short- or long-term care facilities. The majority of participants thought that a document or video with information about a patient’s baseline mental status would be useful (n=15, 68%), qualifying that content ought to be brief, clearly dated, and periodically updated.ConclusionsDocuments or videos could assist emergency clinicians in establishing baseline cognitive function when evaluating geriatric patients and may have implications for improving the detection of delirium.

248 Analysis of Albuterol Prescriptions Written by Emergency Medical Providers for the Treatment of Pediatric Patients With Acute Asthma Exacerbation

The most recent guidelines for the treatment of acute asthma exacerbation in children, including those from the American Academy of Pediatrics, emphasize weight-based dosing of rescue albuterol for optimal symptom relief. The objective of this study is to assess the adherence of emergency medical providers who care for children in a tertiary pediatric emergency department to these guidelines. We also assess whether level of training or primary training background affects adherence to these guidelines.

Emergency Medical Providers’ Knowledge Regarding Disasters during Mass Gatherings in Saudi Arabia

The Hajj is a recurring annual mass gathering event with over three million attendants taking place at the same site for six days. During such events, major incidents and disasters can occur. It is crucial that Emergency Medical Services providers are sufficiently trained regarding disaster preparedness to respond appropriately. EMS-providers of the Saudi Red Crescent Authority who worked during the Hajj in 2016 were asked to complete a web-based survey, utilizing predetermined responses with 5-point Likert scale responses. Seven hundred respondents identified real disasters as the most common source of information about disaster preparedness and also indicated that a disaster management course was the most desired course for improving knowledge. The study has also highlighted a list of Life Support Courses providers feel should be offered as part of a disaster response training package. These findings highlight the importance of continuing education, which may be obtained through short, focused courses, or for small numbers of specialists through higher educational degrees, such as masters or doctorates. This study also examines the importance of media and its impact on increasing knowledge and awareness for EMS-providers. Consideration should be given to pairing novice providers with experienced personnel to disseminate knowledge and practical experience during Hajj missions. Simulated disaster drilling should be considered to introduce novices to the stress of mass casualty disaster response.

Mass shooting incidents: evolution of preventive procedures, preparation, treatment, and medical care supply

"Abstract: Mass shootings incidents occur with increasing frequency over time. Studying these cases proved that, despite their diversity, several common features could be taken into account in the early detection and possible prevention of certain future cases. Accepting that such incidents may occur anywhere and anytime, societies need to be prepared for their more effective response. Informing citizens about the best way to react to a mass shooting event is considered crucial and essential. The ""Run-Hide-Fight"" guideline/directive seems to be the most appropriate guideline given to the public. Proper training, of both the Suppression Forces and the emergency medical care providers, is considered of utmost importance. The role of the Incident Commander, regarding the incident management, as well as the external bleeding control of the injured people, are factors of paramount importance in trying to mitigate the casualties from such an incident. The alertness of both citizens and organizations/structures may lead to early detection of potential perpetrators and thereby averting a mass shooting incident. To achieve increased survival and a reduced number of casualties from a mass shooting event it is vital proper education be present at all levels. The response to a mass shooting event should be imprinted in an Emergency plan. Such a plan should have been decided and made, by the Security and Suppression Forces, the Healthcare Institutions, and the Public Safety Answering Point. Keywords: mass shooting incident, first responder, active bleeding, tourniquet, Incident Commander"

Approach to the Poisoned Patient.

This video lecture is appropriate for emergency medical providers who are not comfortable with initial assessment of poisoned patients. Ideal learners include medical students and residents. Poisoning is the leading cause of injury-related mortality in the United States, with more than 40,000 deaths annually.1 Of all ED injury-related visits, 2.4% are related to poisoning.2 While providers may have access to support services (poison control center, medical toxicology consulting service), they are often responsible for the initial evaluation of poisoned patients. While a large portion of poisoned patients have good outcomes regardless of the care they receive, inappropriate risk assessment and lack of knowledge about basic interventions can put patients at risk. A standardized approach as outlined in the video will help evaluate and treat the vast majority of poisoned patients. By the end of the lecture, learners should be able to: 1) initiate the evaluation of a poisoned patient, 2) identify key interventions to support airway, breathing, and circulation, 3) identify the three components of risk assessment in the poisoned patient, 4) list the four options for gastric decontamination, and 5) select standard diagnostic labs and tests commonly used in evaluating poisoned patients. This is an enhanced live action greenscreen recording with video animation. This video has been made available for a variety of learners on social medial (Facebook and YouTube) and written feedback has been collected on YouTube. The video has been seen over three thousand times and has received positive comments on social media (Facebook, YouTube). Comments include "dropping some tox knowledge bombs, proving yet again that #ToxRocks," and "This is an excellent talk, thank you very much, but I think it would be worth mentioning antidotes." The goal is to expose learners to basic concepts in approaching poisoned patients and focusses on cognitive knowledge and diagnostic frameworks. The learner may watch the on-demand video as part of a flipped classroom experience with clinical cases, or as a just-in-time resource before seeing a patient who has been poisoned. Poisoning, resuscitation, risk assessment, gastric decontamination, occult ingestion, supportive care.

Characteristics of Emergency Medical Services Utilized by Elderly Residents in Nursing Homes

This study aims to analyze the characteristics of emergency medical services (EMS) utilization among elderly patients divided into two groups depending on place of living: nursing homes and places other than nursing homes. The data includes patients aged 65 years old and over for whom ambulances were requested by the 119 Dispatch Center in Gyeonggi Province from January 1st to December 31st, 2018. Statistical analysis was performed using IBM SPSS Statistics 21.0. The findings showed that EMS ambulances were requested more frequently for female patients in nursing homes than males in other places. Brain disease was the most common medical history of the EMS users at nursing homes (P=0.000). Also, critical medical conditions, such as cardiac arrest (5.4%), altered mental status (16.4%), difficulty breathing (18.6%), and fever (19.2%), were found more than twofold higher among the EMS patients in nursing homes, which were classified as emergency by EMS crews. This study suggests a review and amendment of the legal standards regarding support for emergency medical providers and allocation of ambulances.