Emergency Medical Service Center Research Articles

Multiple Patients with Burn Injury Induced by a Chemical Explosion Managed by Physician-staffed Helicopters

Introduction:The management of chemical and explosive events is critical to reducing morbidity and mortality. However, initial patient care considerations and protective actions for staff are unfamiliar to most frontline clinicians.Methods:This study evaluated an Incident report.Results:On December 1, 2017, a factory of chemical industries in Japan exploded. Dust forming as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. A local fire department requested the dispatch of two physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome.Discussion:Chemical, biological, radiological, nuclear, and explosive incidents are rare, but can be fatal for responders to this kind disaster. As such, all who work at such scenes should be prepared and train adequately to ensure they have the knowledge and skill to both manage patients and protect themselves from harm.

Multiple Patients With Burn Injury Induced by a Chemical Explosion Managed by Physician-Staffed Helicopters.

On December 1, 2017, the Fuji factory of Arakawa Chemical Industries exploded. Dust that formed as a byproduct from the crushing and packing process of the resin for ink exploded at the facility. The Fuji City Fire Department requested the dispatch of 2 physician-staffed helicopters (known as a doctor helicopter [DH] in Japan). The first party of emergency services established a headquarters and first-aid station. However, this area was feared to be at risk of a second explosion. Physicians performed re-triage for all 11 burned patients. Three severely injured patients were transported to emergency medical service centers either by ground ambulance or the DH without undergoing any decontamination. The physician who escorted the patient by ground ambulance complained of a headache. One of the severely injured patients was treated at a local hospital and then transported to an emergency medical service center after undergoing decontamination and intubation. Fortunately, all patients who were transported to medical facilities obtained a survival outcome. Chemical, biological, radiological, nuclear, and explosive incidents are rare but can be fatal for responders to these types of disaster. Therefore, all who work in these settings should be prepared and trained adequately to ensure that they have the knowledge and skill to both manage patients and protect themselves from harm. (Disaster Med Public Health Preparedness. 2019;13:799-805).

Innovation in the use of motor ambulance for prehospital emergency care.

BACKGROUND:Prehospital emergency care system is one of the important parts of the health system. Heavy traffic, increasing urban population, and growing demands for prehospital emergency services are challenges faced by this section of the health system. One of the approaches to deal with this issue is using motor ambulances.AIMS:This study aims to investigate the missions of motor ambulances, ambulances, and the effects of motor ambulance services on response time and ambulance missions.MATERIALS AND METHODS:This applied research has been designed as a descriptive and cross-sectional study. Overall, 267,836 missions carried out by ambulances and motor ambulances of Tehran emergency medical service (EMS) Center in the years 2014 and 2015 were investigated. The data were gathered personally by visiting Tehran EMS Center. The data were analyzed by Excel (2013) software.RESULTS:The average response time for ambulances and motor ambulances were 16 min and 14 min and 13 s, respectively. Most of the ambulance and motor ambulance missions were reportedly due to weakness (20%) and heart problems (16%). In 57% of ambulance missions and 71.5% of motor ambulance missions, the patients refused to being transferred to the hospital. Most of the transport missions to hospital (24%) were caused by traffic accidents.CONCLUSIONS:According to the results, the response time was higher than the national standards. Locating motor ambulances on the streets and outside emergency stations during peak traffic times decreased the response time by 2 min and by providing the necessary services in the scene and transferring fewer patients to the hospital, it is possible to provide further services by assigning ambulances to more urgent missions. Thus, it is recommended to employ more seasoned staff, multiply motor ambulances, and locate motor ambulances precisely to decrease response time and also at a lower cost more citizens are provided with prehospital care.

Head Injuries due to Ladder-related Falls

We examined the clinical characteristics and outcomes of patients who had fallen from ladders and statistically analyzed the prognostic factors, highlighting the impact of the coexistence of head injuries on their prognoses. The clinical records of patients who had experienced ladder-related falls who were admitted to the Advanced Emergency Medical Service Center at Kurume University Hospital between April 2013 and August 2015 were retrospectively reviewed. A total of 86 patients were enrolled. The mean patient age was 69.2 years, and 82 patients were male. The median fall height was 2.55 m. Sixty patients fell during non-professional use of the ladder. Forty-four patients experienced some type of head injury. Although the older patients had more frequent complications with head injuries, the height of the fall was not related statistically. The group of patients with head injuries exhibited trends of older age, lower Glasgow Coma Scale scores, higher Injury Severity Score, and poorer outcomes than those of the group of patients without head injuries. Multivariate analysis showed that head injury and non-professional use were independent risk factors for poor outcomes. Our results revealed that ladder-related falls with head injury can occur when older people are working at home, even if they have fallen from a low height. Especially when older men work with the ladder at home, local community-based education and guidance for the prevention of ladder-related fall injuries are needed.

A Bi-objective Covering Location Problem

PurposeAmbulance response time is an important factor in saving lives and is highly linked with the ambulance location problem. The Maximum Expected Covering Location Problem (MEXCLP), introduced by Daskin (1983), is one of the most used ambulance location models that maximize the probability of stratifying demands for emergency medical service (EMS) centers. Due to huge increase in the operational costs of EMS centers, ambulance location models must consider the cost of coverage and the opportunity to use other companies’ private ambulances to answer emergency calls. The paper aims to discuss these issues.Design/methodology/approachIn this paper, the authors propose to extend the MEXCLP to a bi-objective optimization problem where the cost of satisfying emergency calls is minimized.FindingsThe proposed model is tested using data retrieved from the Lebanese Red Cross (LRC) in Beirut capital of Lebanon. The reported findings show significant enhancements in the results where the LRC can fully satisfy the perceived demands from all areas in Beirut within 9 min with an affordable cost.Originality/valueThe model is a first attempt to reduce operational costs of EMS centers while constraining the response time to satisfy emergency calls at an acceptable rate.

Need Assessment, Planning & Management for Health Resources; A case of Makkah Trauma Center level 1 and Makkah EMS & DMC

Objective: The study has aimed to focus on the importance of establishing trauma centers in Makkah. Methods: The study has incorporated quantitative research design, and gathered data from Makkah Emergency Medical Services (EMS) and Detroit Medical Center (DMC). A questionnaire was designed and distributed among the working staff; including administrators, specialists, academic professors, consultants, and others to explore their expert opinion about the significance of planning and management for health resources. The collected data was analyzed using SPSS version 20.0. Results: 85.2% of the respondents believed that it is extremely important that an ambulance is instructed to take an injured patient to trauma center. More than 50% of the respondents stated that it is extremely important that the injured person is treated in trauma center. However, few of the respondents (0.9%) did not consider the establishment of life flight system to be important for the well-being of injured patients. Conclusion: The study has concluded that the effectiveness of a trauma center, extensively depends on its integration with EMS system.

Management of Multiple Burned Patients with Inhalation Injuries

The fire department in Atami received an emergency call at 6:17 am, with notification of 4 or 5 casualties because of a fire. Because there was only 1 ambulance (O) at the station, an additional ambulance (P) was also requested. Ambulance O transported 2 patients (A and B), and ambulance P transported 2 patients (C and D). These 4 patients were judged to have severe inhalation injuries at the scene and were transported to 2 local hospitals (X and Y). After patients C and D arrived at hospital Y, the medical staff decided to transfer them to the emergency medical service center. Patient C was transported by an emergency medical helicopter (doctor helicopter), and patient D was transported to our hospital by ambulance P. After tracheal intubation, both patients (C and D) required intensive care and mechanical ventilation. Patient A at hospital X was also intubated and transported to another hospital by the doctor helicopter. Fortunately, all patients survived. After a review among the parties involved in the incident, initiating an early request for additional human resources, vehicles, and medical support was recognized as contributing a key role in achieving a successful outcome.

EMT-led laryngeal tube vs. face-mask ventilation during cardiopulmonary resuscitation - a multicenter prospective randomized trial

BackgroundLaryngeal tube (LT) application by rescue personnel as an alternate airway during the early stages of out-of-hospital cardiac arrest (OHCA) is still subject of debate. We evaluated ease of handling and efficacy of ventilation administered by emergency medical technicians (EMTs) using LT and bag-valve-mask (BVM) during cardiopulmonary resuscitation of patients with OHCA.MethodsAn open prospective randomized multicenter study was conducted at six emergency medical services centers over 18 months. Patients in OHCA initially resuscitated by EMTs were enrolled. Ease of handling (LT insertion, tight seal) and efficacy of ventilation (chest rises visibly, no air leak) with LT and BVM were subjectively assessed by EMTs during pre-study training and by the attending emergency physician on the scene. Outcome and frequency of complications were compared.ResultsOf 97 eligible patients, 78 were enrolled. During pre-study training EMTs rated efficacy of ventilation with LT higher than with BVM (66.7% vs. 36.2%, p = 0.022), but efficacy of on-site ventilation did not differ between the two groups (71.4% vs. 58.5%, p = 0.686). Frequency of complications (11.4% vs. 19.5%, p = 0.961) did not differ between the two groups.ConclusionsEMTs preferred LT ventilation to BVM ventilation during pre-study training, but on-site there was no difference with regard to efficacy, ventilation safety, or outcome. The results indicate that LT ventilation by EMTs during OHCA is not superior to BVM and cannot substitute for BVM training. We assume that the main benefit of the LT is the provision of an alternative airway when BVM ventilation fails. Training in BVM ventilation remains paramount in EMT apprenticeship and cannot be substituted by LT ventilation.Trial registrationClinicalTrials.gov (NCT01718795).

Mathematical modeling for a p-mobile hub location problem in a dynamic environment by a genetic algorithm

• Developing a mathematical model for the p -mobile hub location problem. • Proposing a genetic algorithm augmented by a local search to solve the proposed model in large instances. • Analysis of proposed genetic algorithm operators performance in the proposed problem. • Comparison of the proposed model with classic networks to show mobile hub effectiveness in the networks. • Sensitivity analysis to show the model validation as well as the model applicability. In this study, a new mobile p -hub location problem in a dynamic environment is proposed, where there are mobile facilities inside hub nodes that can be transferred to other nodes in the next period. Mobile facilities have a mobility feature and can be transferred to other nodes in order to meet demand. Using such facilities will save extra hub establishment and closing costs in networks. This approach can be used in some real-world applications with rapidly changing demand, such as mobile post offices or emergency medical service centers, because designing immobile hub networks may be less efficient. In addition, designing dynamic hub networks entails establishing and closing costs in different periods. The model also considers a mobility infrastructure of hub facilities. The numerical examples confirm that a mobile hub network is more efficient than an immobile hub network in a dynamic environment. The effect of different parameters on the model is analyzed to consider its applicability conditions. A genetic algorithm, along with tuned parameters and a simulated annealing algorithm, are proposed to solve the model in large instances. Proposing of a model considering mobility feature in the hub location networks, proving its efficiency and finally proposing a proper solution algorithm are main contributions of this study. The model and solutions algorithms were analyzed by more numerical instances using Australia post (AP) dataset.

A national survey examining recognition, demand for antivenom, and overall level of preparedness for redback spider bites in Japan.

Redback spiders are rapidly becoming a nationwide problem in Japan. The domestic production of antivenom for redback spider bites has been started because of extremely low supply. The purpose of this study was to investigate the ability of emergency physicians to recognize redback spider bites and to examine the demand for antivenom and identify the ideal choice for storage. Questionnaires examining the ability to recognize redback spider bites, the demand for antivenom, and overall level of preparedness were sent to 271 emergency medical service centers in Japan in March 2015. Completed questionnaires were returned by 156 medical institutions (58%). Only 25% of the institutes correctly answered regarding the recognition of redback spider bites. A demand for the new, domestically produced antivenom was reported by 55% of the institutes. Antivenom demand was high and increased with the ability to recognize redback spider bites (0 correct answers, n = 24 [42.9%]; 1-2 answers, n = 32 [55.2%]; three answers, n = 28 [71.8%]; P = 0.02). The storage of antivenom within their prefectures or regions was the best option for initial supply planning. Approximately 90% of the emergency centers showed an ability to use the antivenom safely. The recognition of redback spider bites was low; however, the demand for antivenom was high. The storage of antivenom within their own prefectures or regions was considered to be the best option for initial supply planning. Emergency medical service centers are also good candidates for storage and safe use of antivenom.

救命センターにおける急性喉頭蓋炎62例の臨床的検討

救命センターにおける急性喉頭蓋炎62例の臨床的検討

한정된 응급시설의 최적위치 문제

본 논문은 여러 구역으로 분할된 도시에서 응급환자가 발생하였을 때 이에 대처하기 위한 최대 허용 도착시간 T를 충족시키면서, 응급시설 수 p를 한정시켰을 때 최대한의 주민수를 커버할 수 있는 응급시설의 최적 위치를 결정하는 알고리즘을 제안하였다. 이 문제는 일반적으로 두 구역 간 소요시간이 최대허용 도착시간이내이면 1로, 그렇지 않으면 0으로 하는 정수계획법으로 변환시키고, 선형계획법 도구를 활용하여 해를 구한다. 본 논문은 p=1인 경우 최대로 커버하는 노드로 결정하며, <TEX>$p{\geq}2$</TEX>인 경우 최대한으로 커버할 수 있는 노드 상위 5개를 <TEX>$p_1$</TEX>기준으로 포함-배제 원칙을 적용하여 <TEX>$p_1$</TEX>이 커버하는 영역을 삭제하였을 때 남은 노드들 중에서 최대로 커버하는 노드를 <TEX>$p_2$</TEX>로, <TEX>$p_1,p_2$</TEX> 커버 영역을 삭제시 최대로 커버할 수 있는 노드를 <TEX>$p_3$</TEX>로 결정하였다. 이들 5개 기준 노드 집합 들 중에서 최대로 커버하는 노드 집합을 최적의 응급시설 위치로 결정하였다. 제안된 알고리즘을 12-노드 망, 21-노드 망과 Swain의 55-노드 망에 적용한 결과 최적해를 쉽고 빠르며, 정확하게 결정할 수 있었다. This paper proposes an EMS algorithm designed to determine the optimal locations for Emergency Medical Service centers that both satisfy the maximum ambulance response time T in case of emergency and cover the largest possible number of residents given a limited number of emergency medical services p in a city divided into different zones. This methodology generally applies integer programming whereby cases are categorized into 1 if the distance between two zones is within the response time and 0 if not and subsequently employs linear programming to obtain the optimal solution. In this paper, where p=1, the algorithm determines a node with maximum coverage. In cases where <TEX>$p{\geq}2$</TEX>, the algorithm selects top 5 nodes with maximum coverage. Based on inclusion-exclusion method, this selection entails repeatedly selecting a node with the maximum coverage when nodes with lower numbers are deleted. Among these 5 selected nodes, the algorithm selects a single node set with the greatest coverage and thereby as the optimal EMS location. The proposed algorithm has proven to accurately and expeditiously obtain the optimal solutions for 12-node network, 21-node network, and Swain's 55-node network.

중증외상특성화센터의 공간구성 및 면적구성에 관한 연구 - 권역응급의료센터를 중심으로

Purpose: As emergency medical service fund is further expanded due to amendment of the law on emergency medical services in 2008, Korean government has prepared to intervene in a comprehensive manner to strengthen a trauma treatment system. As a result, it announced a master plan to establish a serious trauma treatment center in 16 areas across the nation. Therefore, this study has attempted to investigate the current status of the serious trauma treatment centers and suggest the goal and improvement plan of future serious trauma treatment centers. Methods: As of 2011, Korea operates 23 emergency cerebrovascular service centers, 23 emergency heart disease centers and 35 severe trauma treatment centers across the country. 12 emergency medical service centers have been chosen among the serious trauma treatment centers. Then, top six (6) centers chosen at Emergency Medical Institute Assessment 2011 by Ministry of Health and Welfare have been selected, and floor layout and spatial allocation by usage have been reviewed and analyzed. Results: Consequently, this study has investigated the spatial components, circulation layout and spatial allocation of a serious trauma treatment. For construction planning in consideration of the fundamental objectives and goal of emergency medical services, it is essential to allot spaces and select exact spatial components. It appears that it is necessary to design spaces for emergency medical services and come up with construction planning through appropriate spatial allocation.

A historical retrospect of Pre-hospital emergency treatment

In 1240, the first organization of first aid medical service for rescuing and transferring the wounded in the world was established at Florence, Italy. The stations of Air Ambulances were set up in most of the developed countries at the end of the 1960s. In the middle of the 1970s, the International Red Cross put forward the principles of internationalization, international cooperation and its standardization, thus, promoting the development of pre-hospital emergency treatment. In 1972, the first Emergency Medical Service Center was established and in 1973, Congress of the United States passed the Emergency Medical Services Act (EMSS). In 1976, the legislative procedure was finished and the National Emergency Network was formed, afterwards, pre-hospital emergency treatment, on-site rescue and transfer care, patient monitoring system of ICU-CCU were set up successively. Since the first rescue group of "three failure" (heart failure, lung failure and renal failure) was first formed at Tianjin First Center Hospital in August 1974, the pre-hospital emergency of China had been developing gradually.

Infection control for a methicillin-resistant Staphylococcus aureus outbreak in an advanced emergency medical service center, as monitored by molecular analysis

A methicillin-resistant Staphylococcus aureus (MRSA) outbreak occurred in an advanced emergency medical service center between 2010 and 2011. Our objective was to evaluate the status of the MRSA outbreak, as monitored by molecular analysis. Twenty-eight MRSA strains were isolated from blood samples from 11 patients, from other specimens (pharynx, nasal cavity, etc.) from 12 patients, from two environmental samples, and from the skin, middle nasal meatus, and urine of one patient each from other wards. Pulsed-field gel electrophoresis (PFGE) was performed to evaluate horizontal transmission. Molecular typing by PFGE showed that the 28 MRSA strains presented 7 patterns in total, and that 11 of the MRSA strains had the same PGFE pattern. Unselective use of intranasal mupirocin ointment, MRSA monitoring for new inpatients, and prevention of direct or indirect contact infection were performed. However, the number of inpatients with MRSA did not quickly decrease, and additional molecular typing by PFGE showed that 10 of 19 MRSA strains found (5 of 6 from blood, 5 of 13 from other specimens) were the same as those found previously. Lectures and ward rounds were performed repeatedly, and staff participation in ward rounds was suggested. Finally, the number of inpatients with MRSA significantly decreased more than 6months after the intervention. Although the MRSA outbreak was thought to have ended, follow-up molecular typing by PFGE showed that horizontal transmission persisted. Our data suggest that various combinations of infection control measures are essential when dealing with an MRSA outbreak, and monitoring by molecular analysis using PFGE is useful to identify the status of the outbreak.

Factors Associated With Successful Resuscitation of Out-of-Hospital Cardiac Arrest at Rajavithi Hospital’s Narenthorn Emergency Medical Service Center, Thailand

The objective of this study is to determine factors associated with successful resuscitation of out-of-hospital cardiac arrest (OHCA) patients by Narenthorn Emergency Medical Service Center (EMS), Thailand. A retrospective observational study was conducted with 73 OHCA patients who were resuscitated from December 2004 to January 2007. Inferential statistics, univariate (χ(2)) and multivariate analyses (logistic regression) were applied for data analysis. A total of 73 OHCA patients were included. The mean age was 58.3 years; 86.3% were ≥40 years, 72.6% were male. The causes of arrest were cardiac problem 53.4%. In all, 46.6% were witnessed arrest; 53.4% had response time (RT) ≥10 minutes, and 27.4% had bystander cardiopulmonary resuscitation (CPR). Overall, 79.5% were found in the residence. Initial electrocardiogram showed that 74% were nonshockable rhythm. A total of 34.2% were resuscitated by an EMS team with <4 members, and 53.4% had return of spontaneous circulation, survival to admission was 61.5% and survival to discharge was 7.7%. Witnessed arrest (odds ratio [OR] = 7.403; 95% confidence interval [CI] = 2.169-24.683) and bystander CPR (OR = 5.619; 95% CI = 1.014-36.170) had correlation with successful resuscitation of OHCA patients. RT showed a trend toward statistical significance (OR = 1.051; 95% CI = 0.765-16.083). This study found that witnessed arrest and bystander CPR were major factors associated with successful resuscitation of OHCA patients. Our findings will be useful for the development of community programs to decrease the mortality from OHCA.

(A315) Improvement of the Prehospital Healthcare System in Iran

BackgroundThe prehospital time delay in acute health problem still is a problem in most low- and middle-income countries, like Iran. It often is possible to minimize adverse consequences by promptly providing effective prehospital servicesAimThis study was designed to compare the response time interval occurring during the prehospital care process in Tehran during the last decade.MethodsA retrospective, comparative study was designed, and the mean response time intervals in relation to prehospital care were identified from September 1999 until September 2000 were compared with data from September 2009 until September 2010. Data were collected from Tehran emergency medical services (EMS) center registries.ResultsThe EMS center of Tehran dispatched 213 ambulances every day in 1999–2000 compared with 1,200 in 2009–2010. During the 2009–2010 period, the mean response time for city locations was 14.18(+ /−4) minutes, compared with 1999–2000 the mean response time for city location was 16(+ /− 8). The mean response time from the time period of 1999–2000 also was longer than for 2009–2010 (14.18 vs. 16.58 minutes).ConclusionsDespite the prominent increase in the number of ambulance dispatching everyday, the mean response time in Tehran decreased during last decade. This improvement can be due to the improvement of the prehospital system in Tehran, including the number of: ambulances, trained staff, EMS stations, etc. However, it still is far from a national standard (eight minutes for city).

Stress among Croatian physicians: comparison between physicians working in emergency medical service and health centers – pilot study

AimTo determine the sources of stress, its intensity, frequency, and psychophysical and behavioral reactions in physicians working in emergency medical service and those working in health centers.MethodsTo a convenience sample of primary care physicians employed in emergency medical service (n = 79) and health centers (n = 81), we administered the list of demographic questions, Scale of Sources of Stress, Scale of Intentions of Leaving the Job, and Scale of Psychosomatic Symptoms.ResultsEmergency medicine physicians experienced significantly more intense and more frequent uncontrollable working situations, conflict between work and family roles, and unfavorable relationships with coworkers than physicians working in health centers. They were also more likely to leave the job during the next few years and/or change jobs within the profession (scores 2.2 ± 0.9 vs 1.7 ± 0.9 out of maximum 5.0, F = 12.2, P = 0.001) and they had a poorer physical health status (scores 1.8 ± 0.5 vs 1.7 ± 0.5 out of maximum 4.0, F = 5.3, P = 0.023).ConclusionPhysicians working in emergency medical service experience more stress in almost all aspects of their work than physicians working in health centers. They also have a stronger intention of leaving the job, which decreases with years of experience.

Emergency Medicine in Japan

There have been few reports published in English on emergency medicine (EM) in Japan; the main reason for this is that the concept of EM was different in Japan from that in western countries. In the 1960s, legislation was passed in Japan that implemented emergency medical services, and emergency hospitals were designated by the government. There were no emergency medicine specialists, and so surgeons/physicians without specialist training in emergency medicine provided care to emergency patients (the multispecialist-type model). The Japanese Association for Acute Medicine (JAAM), an academic society for emergency physicians, was founded in 1973. In its pioneering days, this association focused mostly on trauma/burn care and also influenced policymaking. In 1977, the government built emergency medical service centers (the ICU-type model) and reorganized all emergency medical facilities into three levels. With the aging of society, the number of non-trauma patient! s presenting at hospitals, especially in the elderly population, has increased and has resulted in some cases of refusal by hospitals to accept emergency patients. A new postgraduate medical education curriculum was legislated in 2004 that mandated EM training for all postgraduates and encouraged reinforcement of emergency departments in teaching hospitals. The JAAM established a committee to promote the ER-type model of EM in 2003. By 2007, more than 150 JAAM-affiliated hospitals had implemented this type of EM. In conclusion, emergency medicine in Japan is currently based on a mixture of three models: the multispecialist-type, the ICU-type and the ER-type models.