Emergency Medical Services Dispatch Research Articles

Factors associated with refusal of transport to hospital among patients experiencing suicidal crisis in South Korea

IntroductionPreventing suicide requires identifying psychosocial characteristics and risk factors of people who do not go to the hospital. This study examined factors associated with refusal of transport to the hospital after reporting suicidal ideation or suicide attempt to emergency medical services. MethodsThis retrospective observational study involved reviewing emergency medical service dispatch records collected from January 2019 to December 2020 in Gyeonggi Province, South Korea on patients seeking emergency assistance for suicidal ideation or attempt. Univariate and multivariable regression analyses were employed to identify factors associated with refusal of transport to the hospital. Additionally, predictors of refusal stratified by suicidal ideation and attempt were examined. ResultsA total of 3,449 cases were included in the analysis. Patients with suicidal ideation and no psychiatric or medical issues were more likely to refuse transport. In the suicide attempt group, certain patient characteristics were linked to a higher probability of refusal, including age 25 to 44 or 45 to 64, male gender, and/or not intoxicated by alcohol. ConclusionsThe pre-hospital phase is a critical link between patients and mental health services. Therefore, identifying the characteristics of patients who refuse transport to the hospital and developing intervention measures for them is essential.

Addressing out-of-hospital cardiac arrest with current technology advances: Breaking the deadlock with a mobile network.

Out-of-hospital cardiac arrest (OHCA) is a global public health problem, with survival rates remaining low at around 10% or less despite widespread cardiopulmonary resuscitation (CPR) training and availability of automated external defibrillators (AEDs). This is partly due to the challenges of knowing when and where a sudden OHCA occurs and where the nearest AED is located. In response, countries around the world have begun to use network technology-based smartphone applications. These applications are activated by emergency medical service dispatchers and alert preregistered volunteer first responders (VFRs) to nearby OHCAs using Global Positioning System localization. Accumulating evidence, although mostly from observational studies, shows their effectiveness in increasing the rate of bystander CPR, defibrillation, and patient survival. Current guidelines recommend the use of these VFR alerting systems, and the results of ongoing randomized trials are awaited for further dissemination. This article also proposed the concept of a life-saving mobile network (LMN), which uses opportunistic network and wireless sensor network technologies to create a dynamic mesh network of potential victims, rescuers, and defibrillators. The LMN works by detecting a fatal arrhythmia with a wearable sensor device, localizing the victim and the nearest AED with nearby smartphones, and notifying VFRs through peer-to-peer communication. While there are challenges and limitations to implementing the LMN in society, this innovative network technology would reduce the tragedy of sudden cardiac death from OHCA.

Video livestreaming from medical emergency callers’ smartphones to emergency medical dispatch centres: a scoping review of current uses, opportunities, and challenges

BackgroundTimely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as ‘callers’ in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers’ smartphones to emergency medical dispatch centres.MethodsA scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews.ResultsTwenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers’ (referred to as ‘dispatcher/s’ in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols.ConclusionResearch is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.

Population-Level Surveillance of Domestic Assaults in the Home Using the National Emergency Medical Services Information System (NEMSIS)

Violence in the home, including partner violence, child abuse, and elder abuse, is pervasive in the United States. An informatics approach allowing automated analysis of administrative data to identify domestic assaults and release timely and localized data would assist preventionists to identify geographic and demographic populations of need and design tailored interventions. This study examines the use of an established national dataset, the NEMSIS 2019, as a potential annual automated data source for domestic assault surveillance. An algorithm was used to identify individuals who utilized emergency medical services (EMS) for a physical assault in a private residence (N = 176,931). Descriptive analyses were conducted to define the identified population and disposition of patients. A logistic regression was performed to predict which characteristics were associated with consistent domestic assault identification by the on-scene EMS clinician and dispatcher. The sample was majority female (52.2%), White (44.7%), urban (85.5%), and 21–29 years old (24.4%). A disproportionate number of those found dead on scene were men (74.5%), and female patients more often refused treatment (57.8%) or were treated and then released against medical advice (58.4%). Domestic assaults against children and seniors had higher odds of being consistently identified by both the dispatcher and EMS clinician than those 21–49, and women had lower odds of consistent identification than men. While a more specific field to identify the type of domestic assault (e.g., intimate partner) would help inform specialized intervention planning, these data indicate an opportunity to systematically track domestic assaults in communities and describe population-specific needs.

Effect of Daytime versus Nighttime on Prehospital Care and Outcomes after Severe Traumatic Brain Injury.

Background/Objectives: Severe traumatic brain injury (TBI) is a frequent cause of morbidity and mortality worldwide. In the Netherlands, suspected TBI is a criterion for the dispatch of the physician-staffed helicopter emergency medical services (HEMS) which are operational 24 h per day. It is unknown if patient outcome is influenced by the time of day during which the incident occurs. Therefore, we investigated the association between the time of day of the prehospital treatment of severe TBI and 30-day mortality. Methods: A retrospective analysis of prospectively collected data from the BRAIN-PROTECT study was performed. Patients with severe TBI treated by one of the four Dutch helicopter emergency medical services were included and followed up to one year. The association between prehospital treatment during day- versus nighttime, according to the universal daylight period, and 30-day mortality was analyzed with multivariable logistic regression. A planned subgroup analysis was performed in patients with TBI with or without any other injury. Results: A total of 1794 patients were included in the analysis, of which 1142 (63.7%) were categorized as daytime and 652 (36.3%) as nighttime. Univariable analysis showed a lower 30-day mortality in patients with severe TBI treated during nighttime (OR 0.74, 95% CI 0.60-0.91, p = 0.004); this association was no longer present in the multivariable model (OR 0.82, 95% CI 0.59-1.16, p = 0.262). In a subgroup analysis, no association was found between mortality rates and the time of prehospital treatment in patients with combined injuries (TBI and any other injury). Patients with isolated TBI had a lower mortality rate when treated during nighttime than when treated during daytime (OR 0.51, 95% CI 0.34-0.76, p = 0.001). Within the whole cohort, daytime versus nighttime treatments were not associated with differences in functional outcome defined by the Glasgow Outcome Scale. Conclusions: In the overall study population, no difference was found in 30-day mortality between patients with severe TBI treated during day or night in the multivariable model. Patients with isolated severe TBI had lower mortality rates at 30 days when treated at nighttime.

Technology commitment of emergency medical service practitioners and dispatchers

Background: Digitalisation and artificial intelligence (AI) have entered the emergency medical service (EMS). Successful use of them depends on employees' personal attitudes towards modern technology and its use. Aims: This study explored the technology commitment of EMS professionals, dispatchers and emergency physicians, including towards AI systems. Methods: To assess attitudes in the context of AI systems in EMS, employees were asked to answer an online questionnaire between October 2021 and March 2022. Findings: A total of 510 participants, including 184 EMS professionals, 199 dispatchers and 68 emergency physicians, participated. These professionals had moderate to high technology commitment values with minor differences. Technology commitment correlated negatively with age. Gender had no effect. Conclusion: The EMS provides fertile ground for AI systems. It is important to keep in mind that people with uncertainties and reservations need support. The scales in the questionnaire proved to be reliable and validt.

Compression-Only or Standard Cardiopulmonary Resuscitation for Trained Laypersons in Out-of-Hospital Cardiac Arrest: A Nationwide Randomized Trial in Sweden.

The ongoing TANGO2 (Telephone Assisted CPR. AN evaluation of efficacy amonGst cOmpression only and standard CPR) trial is designed to evaluate whether compression-only cardiopulmonary resuscitation (CPR) by trained laypersons is noninferior to standard CPR in adult out-of-hospital cardiac arrest. This pilot study assesses feasibility, safety, and intermediate clinical outcomes as part of the larger TANGO2 survival trial. Emergency medical dispatch calls of suspected out-of-hospital cardiac arrest were screened for inclusion at 18 dispatch centers in Sweden between January 1, 2017, and March 12, 2020. Inclusion criteria were witnessed event, bystander on the scene with previous CPR training, age above 18 years of age, and no signs of trauma, pregnancy, or intoxication. Cases were randomized 1:1 at the dispatch center to either instructions to perform compression-only CPR (intervention) or instructions to perform standard CPR (control). Feasibility included evaluation of inclusion, randomization, and adherence to protocol. Safety measures were time to emergency medical service dispatch CPR instructions, and to start of CPR, intermediate clinical outcome was defined as 1-day survival. Of 11 838 calls of suspected out-of-hospital cardiac arrest screened for inclusion, 2168 were randomized and 1250 (57.7%) were out-of-hospital cardiac arrests treated by the emergency medical service. Of these, 640 were assigned to intervention and 610 to control. Crossover from intervention to control occurred in 16.3% and from control to intervention in 18.5%. The median time from emergency call to ambulance dispatch was 1 minute and 36 s (interquartile range, 1.1-2.2) in the intervention group and 1 minute and 30 s (interquartile range, 1.1-2.2) in the control group. Survival to 1 day was 28.6% versus 28.4% (P=0.984) for intervention and control, respectively. In this national randomized pilot trial, compression-only CPR versus standard CPR by trained laypersons was feasible. No differences in safety measures or short-term survival were found between the 2 strategies. Efforts to reduce crossover are important and may strengthen the ongoing main trial that will assess differences in long-term survival. URL: https://www.clinicaltrials.gov; Unique identifier: NCT02401633.

EMS during disaster: A case study on Syria Arab Red Crescent (SARC) EMS response during February 2023 earthquake

Background: On February 6, a magnitude 7.8 earthquake struck southern Turkey near the Syrian border. This was followed almost nine hours later by a magnitude 7.5 earthquake situated approximately 59 miles (95 kilometers) to the southwest. The earthquake had enormous effects on the cities of Aleppo, Latakia, Hama, and Idlib, causing significant destruction and the collapse of numerous structures as well as the devastation of water supplies. United Nations estimates that about 6 million people in government-controlled areas are affected. 200,000 people in the area around Aleppo alone have been made homeless. Overall, 170 sub-districts in 43 districts in ten governorates have been impacted by the earthquake. After more than 7,000 deaths and 10,400 injuries as a result of the earthquakes' effect, humanitarian operations in Syria have become much more challenging in the context of the region's ongoing civil conflict. The Syrian Arab Red Crescent (SARC) has a long history and high capacity in providing various health services. Before the earthquake, SARC was and remains the primary provider of humanitarian assistance and offers ongoing services across most of the country in the areas of ambulance services, disaster management, water and sanitation, health and medical services, including mental health, primary and secondary services, livelihoods, and early recovery, while also incorporating an inclusive approach to community services including psychological and protection support. In 2021, SARC signed a Memorandum of Understanding with the Ministry of Health (MoH) granting it a unique position to become the lead emergency medical service (EMS) provider across all of Syria. Methods: A case study of the SARC EMS response during the February 2023 earthquake was developed utilizing following data resources • Document review: SARC operation reports, situation reports on International federation of Red Cross & Red Crescent IFRC GO platform, lesson learned workshop report, SARC operation review workshop report • Key informant interview: SARC EMS director and EMS response team leaders Description: SARC EMS dispatch in Latakia, Aleppo, and Hama received the first calls at 4.20 a.m. on the 6th of February. EMS dispatch sent ambulances and activated forward assessment commanders, and within 10 minutes, a total of 22 ambulance cars were deployed to provide prehospital medical service and general assessment in the three governorates of Hama, Aleppo, and Latakia. During the first 24 hours, the assessment and services provided were challenged by the amount of destruction and the rabble. Some extractions were delayed due to a lack of appropriate search and rescue equipment. EMS centers in the affected governorate have been activating emergency status to provide 24/7 prehospital services to the affected population. Ambulance surge support was mobilized from Tartous to Latakia (5 ambulances) and from Homs to Hama. During the first week, SARC EMS was able to respond to 406 disaster-related requests in the three governorates: 111 critically ill patients were transferred to medical facilities, 41 patients were treated on site, and that was in addition to the non-disaster-related requests. By the end of the first month, EMS had provided prehospital service to 1034 beneficiaries, 1013 injured patients, 254 dead bodies transferred, and 45 patients treated without transfer. The earthquake-affected areas have shown a significant increase, doubling in Lattakia, 43% in Aleppo, and 15% in Hama, in the demand for EMS services up to 4 months after the earthquake. Until 15th of August SARC EMS has provided prehospital services to 5,029 cases in the affected areas, 2,387 injuries transferred and 2,388 cases treated at the place without transfer. SARC EMS service has conducted 36 community-based first aid training sessions for people in the affected areas, trained more than 780 lay people. Also, SARC has fostered the capacity of SARC EMS volunt

EMS Potentials in MENA region

Background Emergency Medical Services (EMS) have been always considered as a vital service provided by of many Red Cross and Red Crescent (RCRC) national societies worldwide and in Middle East and North Africa (MENA) region in particular during emergency and non-emergency contexts. The role to supporting the national wide health system in prehospital stage has got special attention during COVID 19 due to overwhelming health care facilities. The national societies have played a key role in mitigating the impact of the COVID 19 on the healthcare facilities by activating and growing their EMS capacities and expanding their scope of services in the prehospital stage. To define capacities and areas for improvement in RCRC national societies, we've developed a tool to survey different aspects of EMS. Methodology A questionnaire was designed by the IFRC MENA health team based on Prehospital emergency management system PEMS conceptual framework for assessment. 67 questions were grouped into 5 domains: governance and dispatch, Human Resources (H.R.) & Logistics, EMS Education, EMS operation and quality , and EMS disaster preparedness. Two open-ended questions were added to define areas of improvement and what national societies can offer to enhance capacities for other national societies in the region… The questionnaire was piloted with EMS leaders at Lebanese Red Cross. Between the period of April 2022 and August 2022, the online questionnaire was sent to four national society EMS managements, Lebanese Red Cross LRC , Palestine Red Crescent Society PRCS , Saudi Red Crescent Authority SRCA and Syria Arab Red Crescent SARC. The answers were collected using SurveyMonkey platform and validation workshops were held with all four EMS managements. For the qualitative questions of the perceived weaknesses and strengths, interviews with EMS managements were recorded and transcript. Analysis tools of SurveyMonkey was utilized for quantitative data analysis, and qualitative data was explored manually using thematic analysis methodology. Results The input from the four national societies revealed variation in governance, structure, and scope of services of EMS among them. We can highlight the main outcomes under each domain EMS Governance and Dispatch The four NSs are considering scoop and run operational model. The percentage of acute to cold cases in day to day practice is varying with predominance of cold cases among all. SRCA, PRCS in West Bank, and LRCS central dispatch center are using fully automated dispatch system, while LRC is using semi-automated in the regional dispatch centers, and SARC and PRCS branches in Gaza and Jerusalem are using manual (paper based) dispatch system. EMS H.R. & Logistics LRC, PRCS and SARC are mainly relying on volunteers to run EMS daily operations while SRCA depends on 6000 full time employees to operate 24/7 EMS services. SRCA EMS fleet is considered the largest among the four NSs with around 1,400 vehicles, LRC came next with 390 vehicles, then PRCS with 180, and lastly SARC with 112. EMS Education Both LRC and SRCA are running international accredited emergency courses including Basic Life Support (BLS), Advanced Life Support, Prehospital Trauma Life Support (PTLS), Advanced Trauma Life Support, and other relevant courses. On the other hand, PRCS and SARC are considering academic and locally customized training courses to train their EMS staff and volunteers. EMS Operation and Quality The service coverage of the four EMS in urban areas ranges between 80 – 100% while coverage decreases in rural areas to reach under 50% in some regions. Quality assurance and regular monitoring are areas that need to be standardized and systematized in most cases. EMS Disaster Preparedness Specialized training program for Mass Causality Incidences (MCI) is conducted in LRC, PRCS and SRCA. LRC, SARC, and SRCA possess a standardized approach for major incidence management as part of their disaster management

Predictive Dispatch of Volunteer First Responders: Algorithm Development and Validation.

Smartphone-based emergency response apps are increasingly being used to identify and dispatch volunteer first responders (VFRs) to medical emergencies to provide faster first aid, which is associated with better prognoses. Volunteers' availability and willingness to respond are uncertain, leading in recent studies to response rates of 17% to 47%. Dispatch algorithms that select volunteers based on their estimated time of arrival (ETA) without considering the likelihood of response may be suboptimal due to a large percentage of alerts wasted on VFRs with shorter ETA but a low likelihood of response, resulting in delays until a volunteer who will actually respond can be dispatched. This study aims to improve the decision-making process of human emergency medical services dispatchers and autonomous dispatch algorithms by presenting a novel approach for predicting whether a VFR will respond to or ignore a given alert. We developed and compared 4 analytical models to predict VFRs' response behaviors based on emergency event characteristics, volunteers' demographic data and previous experience, and condition-specific parameters. We tested these 4 models using 4 different algorithms applied on actual demographic and response data from a 12-month study of 112 VFRs who received 993 alerts to respond to 188 opioid overdose emergencies. Model 4 used an additional dynamically updated synthetic dichotomous variable, frequent responder, which reflects the responder's previous behavior. The highest accuracy (260/329, 79.1%) of prediction that a VFR will ignore an alert was achieved by 2 models that used events data, VFRs' demographic data, and their previous response experience, with slightly better overall accuracy (248/329, 75.4%) for model 4, which used the frequent responder indicator. Another model that used events data and VFRs' previous experience but did not use demographic data provided a high-accuracy prediction (277/329, 84.2%) of ignored alerts but a low-accuracy prediction (153/329, 46.5%) of responded alerts. The accuracy of the model that used events data only was unacceptably low. The J48 decision tree algorithm provided the best accuracy. VFR dispatch has evolved in the last decades, thanks to technological advances and a better understanding of VFR management. The dispatch of substitute responders is a common approach in VFR systems. Predicting the response behavior of candidate responders in advance of dispatch can allow any VFR system to choose the best possible response candidates based not only on ETA but also on the probability of actual response. The integration of the probability to respond into the dispatch algorithm constitutes a new generation of individual dispatch, making this one of the first studies to harness the power of predictive analytics for VFR dispatch. Our findings can help VFR network administrators in their continual efforts to improve the response times of their networks and to save lives.

Opinion of specialists of emergency medical services on the practice of distance counseling on first aid: results of the interregional survey

Introduction. Wide implementation of distance counseling of incident witnesses on first aid (DCFA) over the telephone by dispatchers of emergency medical services (EMS) can significantly increase the rate of provision of first aid (FA) by the bystanders and contribute to reduction of mortality from the life-threatening conditions. The purpose of this study was to investigate personal experience and opinions of the specialists of EMS of the Russian Federation regarding the practice of DCFA, that is important for planning and determining priority areas for the development of a unified domestic program on DCFA.Methods. In September–October 2022, an anonymous interregional survey of the EMS specialists was conducted. EMS dispatchers constituted the target group of the survey. Participation of specialists without experience of dispatching was also allowed. The survey was carried out online using a pre-tested questionnaire that included 17 questions to assess, inter alia, personal experience of DCFA, self-confidence of the specialists when giving instructions on FA over the telephone, opinion on the importance of DCFA, level of the specialists’ knowledge on FA, experience of prior training on the methods of DCFA, as well as to identify factors that prevent or hinder real practice of DCFA. To analyze the results, nonparametric statistics was used.Results. The final sample consisted of 965 EMS specialists from 58 constituent entities of the Russian Federation, of which 77.4% (n=747) were feldshers and nurses for receiving and transmitting EMS calls. 73.3% (n=707) of the respondents reported that they had experience of DCFA. The average number of cases of DCFA in the past year reported by one specialist was 97 (median=10). 87.6% (n=619) of respondents with experience of DCFA have highly rated the importance of this practice for saving human health and life. However, only 47.8% (n=338) of the specialists with experience of DCFA reported that they felt themselves completely confident when giving the instructions to bystanders. Despite the fact that the level of confidence was characterized by a positive correlation with the specialists’ assessment of their knowledge on FA (p<0.001) , only 46.4% (n=328) of the respondents with experience of DCFA have rated their knowledge as very good, and 15.7% (n=111) have ever learned the principles of DCFA. From the perspective of the respondents with experience of DCFA, main barriers to this practice include unreadiness of bystanders to follow instructions on FA, fears of dispatchers regarding possible egal liability, a lack of dispatchers and/or their overburden with receiving and transmitting calls, and a lack of clear algorithms/protocols for instructing witnesses.Conclusion. EMS dispatchers generally highly rate the importance of DCFA, but feel themselves uncertain when counseling the bystanders, and have a lack of knowledge on FA. The vast majority of the specialists have never been trained in the methods of DCFA. Priority measures aimed at implementation a unified domestic practice of DCFA include the development of a universal program for training EMS specialists on the principles and skills of DCFA, creation and testing of standardized dispatch algorithms/protocols on DCFA for various health disorders, organization of effective legal regulation for the practice of DCFA, and solution of the problem of shortage of EMS specialists who operate as dispatchers.

Quantifying Pediatric Gun Violence by Location, Time of Day, and Day of Week

BackgroundFirearm injuries are the leading cause of pediatric deaths. The objective of this study was to describe the location and timing of pediatric firearm injuries and to determine the proportion of these injuries that occur within schools in the United States. MethodsIn this retrospective cohort study, we used national emergency medical services (EMS) data from 2019 to evaluate dispatches to firearm injuries involving school-aged children (age 5–18). We extracted incident location type, patient demographics, number of patients on scene, and injury intent. ResultsWe identified 4764 EMS dispatches for firearm injuries in school-aged children during 2019. Assault was the most common cause of injury (53.9 %), followed by unintentional shootings (12.1 %) and self-inflicted injuries (6.1 %). Most incidents involved a single patient (91.4 %). Private residence (51.5 %) was the most common location, followed by street/road (23.8 %). 81 firearm injuries (1.7 %) occurred in a school. Private residence was the most common location of injury across all injury intents. During school hours, most firearm injuries occurred in a private residence (51.6 %) or on a street/road (19.9 %). A total of 63 dispatches (1.3 %) were considered a mass casualty incident, of which 9 (14 %) occurred in a school. ConclusionsRegardless of injury intent or time of day, the most common location for pediatric firearm injuries was a private home. Firearm injuries within schools were far less frequent. In designing prevention strategies, our data calls for renewed focus on preventing children from accessing firearms in the home and instituting comprehensive, community-based after school programs. Type of StudyRetrospective cohort. Level of EvidenceIII.

Evaluation of Telephone Cardiopulmonary Resuscitation Performance in Current Practice in Saudi Arabia.

Out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system. A retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR. A total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively. T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers' locations could improve T-CPR performance.

Telephone Assessment of Suicidal Risk at Prehospital Emergency Medical Services: A Direct Comparison with Face-to-Face Evaluation at Psychiatric Emergency Service

Objective Assessment of suicidal risk is one of the most challenging tasks faced by health professionals, notably in emergency care. We compared telephone suicide risk assessment at prehospital Emergency Medical Services Dispatch Center (EMS-DC), with subsequent face-to-face evaluation at Psychiatric Emergency Service (PES), using French national Risk-Urgency-Danger standards (RUD). Method Data were collected for all suicidal adult patients (N = 80) who were addressed by EMS-DC to PES between December 2018 and August 2019 and benefited from RUD assessment at both services. Suicidal risk was given a score of 1, 2, 3 or 4, in order of severity. Results Mean of the differences between the RUD score at EMS-DC and PES was −0.825 (SD = 1.19), and was found to be significant (p < 0.01). The average time between RUD assessments was 420 min (SD = 448) and was negatively correlated with the difference in the RUD score (r = −0.295, p = 0.008). Associated suicide attempt increased the odds of a decrease in the RUD score (OR = 2.989; 95% CI = 1.141–8.069; p < 0.05). Conclusions Telephone evaluation of suicidal risk using RUD at EMS-DC yielded moderately higher scores than those obtained by a subsequent face-to face evaluation at PES, with this difference partially explained by the time between assessments, and by clinical and contextual factors.

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

IntroductionPrompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. MethodsIn-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants’ perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. ResultsStakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. ConclusionDespite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.

Comparison of outcomes of out-of-hospital cardiac arrest patients: Emergency calls placed from mobile phones vs. landline phones

BackgroundUntil recently, calls to the emergency medical service (EMS) from landline phones, which display the caller’s exact location at the dispatch center, had been common. Since the use of mobile phones has become widespread, many emergency calls are now made from mobile phones. Differences in outcomes of out-of-hospital cardiac arrest (OHCA) patients for whom EMS was called from mobile versus landline phones has not yet been fully elucidated. MethodsWe performed a retrospective, population-based analysis in Kobe, Japan to examine whether EMS calls from mobiles improved the prognosis of OHCA patients over EMS calls placed from landlines. The primary outcome was favorable neurological outcome, defined as Cerebral Performance Category (CPC) scores of 1 or 2 at discharge. Secondary outcomes were survival at one-month, survival at discharge, and time durations between call and EMS activities. ResultsOf 4,231 OHCA cases, 2,194 cases (706 landline cases vs. 1,488 mobile cases) were included in this study. The percentages of favorable neurological outcomes were 0.7% (5/706) in the landline group and 3.8% (56/1,488) in the mobile group. Adjusted multivariable logistic regression revealed that favorable neurological outcomes (odds ratio [OR] 3.03, 95% confidence interval [CI] 1.12–8.17, p = 0.03) were better in the mobile group, while one-month survival (OR 1.30, 95% CI 0.80–2.14, p = 0.29) was not significantly different. Bystander CPR was more frequently administered in the mobile group (landlines 61.3% vs. mobiles 68.4%, p < 0.01). Time durations between call to EMS dispatch (184.5 [IQR 157–220 s] vs. 205 [IQR 174–248 s], p < 0.01) and EMS arrival (476.5 [IQR 377–599 s] vs. 491 [IQR 407.5–611.5 s], p < 0.01) were shorter in the landline group. ConclusionsAlthough the landline caller location display system seems effective for shorter times between EMS call and EMS arrival, mobile phone use was associated with better neurological outcomes.

Technology commitment of emergency medical service practitioners and dispatchers

Background Digitalization and artificial intelligence (AI) have entered the emergency medical service (EMS). Successful use of them depends on employees’ personal attitudes towards modern technology and its use. Aims This study explored the technology commitment of EMS professionals, dispatchers and emergency physicians, including towards AI systems. Methods To assess attitudes in the context of AI systems in EMS, employees were asked to answer an online questionnaire between October 2021 and March 2022. Findings A total of 510 participants, including 184 EMS professionals, 199 dispatchers and 68 emergency physicians, participated. These professionals had moderate to high technology commitment values with minor differences. Technology commitment correlated negatively with age. Gender had no effect. Conclusion The EMS provides fertile ground for AI systems. It is important to keep in mind that people with uncertainties and reservations need support. The scales in the questionnaire proved to be reliable and valid.

Foreign Body Airway Obstruction: Modern Principles and Approaches to First Aid and Dispatcher Assistance on First Aid

Foreign body airway obstruction (FBAO) is one of the most common causes of accidental death in adults and children. Probability of saving a life in severe FBAO depends on the ability of the bystander to quickly recognize the problem and correctly provide first aid (FA) to the victim. However, due to the lack of knowledge and skills of the FA, bystanders rarely attempt to give necessary help. Along with mass FA training, provision of instructions on the FA to untrained bystanders over the telephone by emergency medical services (EMS) dispatchers can facilitate active involvement of the population in the process of providing FA. In this study, a detailed analysis of the modern principles and approaches to the provision of the FA in FBAO was carried out and a draft of a universal Russian-language algorithm for remote dispatch support of the FA was developed. The developed algorithm can become a component of the domestic program for remotely instructing the population on provision of FA in life-threatening conditions and is proposed for further testing and implementation in the practice of EMS dispatchers.

Usefulness of Key Word Methods to Execute Early Requests for a Physician-Staffed Helicopter Emergency Medical Service Dispatch to Facilitate Early Medical Intervention by Physicians

ObjectiveA physician-staffed helicopter emergency medical service is called a doctor helicopter (DH) in Japan. We retrospectively investigated this service using a data bank provided by the Japan DH registry system. MethodsThe following details of the dispatch activity were collected: patient age and sex, vital signs (Japan Coma Scale [JCS], systolic blood pressure, heart rate, and respiratory rate) at the scene measured by emergency medical technicians (EMTs), dispatch of the DH before the EMTs made contact with patients (key words group) or after (control group), and the survival outcome at 1 month. ResultsDuring the investigation period, 28,357 patient records were analyzed (key words group, n = 13,861; control group, n = 14,496). The age, JCS, and respiratory rate were significantly smaller in the key words group than in the control group. The rates of male sex and survival in the key words group were significantly greater than those in the control group. In the multivariate analysis, dispatch of the DH after EMTs made contact with the patients (odds ratio [OR] = 0.72; 95% confidence interval [CI], 0.55-0.92), female sex (OR = 0.86; 95% CI, 0.75-0.98), older age (OR = 0.97; 95% CI, 0.96-0.97), elevated respiratory rate (OR = 0.97; 95% CI, 0.97-0.98), and high JCS (OR = 0.99; 95% CI, 0.99-0.99) were associated with a decreased 1-month survival (P > .0001). ConclusionThis is the first report to describe the key words method as a potential factor influencing optimal outcomes/potential survival rates in patients evacuated by the DH using the JDRS. Our study results suggest that the firefighting central command room should consider adopting the key words method when the helicopter emergency medical service is used.

The SEE-IT Trial: emergency medical services Streaming Enabled Evaluation In Trauma: study protocol for an interventional feasibility randomised controlled trial

IntroductionAccurate and timely dispatch of emergency medical services (EMS) is vital due to limited resources and patients’ risk of mortality and morbidity increasing with time. Currently, most UK emergency operations...