Emergency Medical Services Operations Research Articles

Paramedics’ experiences and observations: work-related emotions and well-being resources during the initial months of the COVID-19 pandemic—a qualitative study

BackgroundAs first responders, paramedics are an extremely important part of the care chain. COVID-19 significantly impacted their working circumstances. We examined, according to the experiences and observations of paramedics, (1) what kinds of emotions the Emergency Medical Service (EMS) personnel experienced in their new working circumstances, and (2) what work-related factors became resources for the well-being of EMS personnel during the initial months of the COVID-19 pandemic.MethodsThis qualitative study utilized reflective essay material written by experienced, advanced-level Finnish paramedics (n = 30). The essays used in this study were written during the fall of 2020 and reflected the period when Finland had declared a state of emergency (on 17.3.2020) and the Emergency Powers Act was implemented. The data was analyzed using an inductive thematic analysis.ResultsThe emotions experienced by the EMS personnel in their new working circumstances formed three themes: (1) New concerns arose that were constantly present; (2) Surviving without proper guidance; and (3) Rapidly approaching breaking point. Three themes were formed from work-related factors that were identified as resources for the well-being of the EMS personnel. These were: (1) A high level of organizational efficiency was achieved; (2) Adaptable EMS operations; and (3) Encouraging atmosphere.ConclusionsCrisis management practices should be more attentive to personnel needs, ensuring that managerial and psychological support is readily available in crisis situations. Preparedness that ensures effective organizational adaptation also supports personnel well-being during sudden changes in working circumstances.

Emergency medical services infrastructure development and operations in low- and middle-income countries: Community first responder–driven (Tier-1) emergency medical services systems

Low- and middle-income countries face unique challenges in delivering prehospital emergency care, often requiring context-appropriate emergency medical services development focused on community-driven solutions (tier 1 systems). Replicating high-income country tier 2 systems in low- and middle-income countries is not financially feasible in resource-limited settings. Instead, tier 1 systems composed of trained layperson first responders use locally available vehicles and involve local communities and stakeholders in their design and implementation to address specific local needs and emergencies. Community engagement is crucial for establishing sustainable and inclusive emergency medical services systems. This article focuses on the development and operation of tier 1 systems in low- and middle-income countries, covering technology integration, local appropriateness and co-operation, training curricula, trainee recruitment and selection, volunteer incentivization, monitoring and evaluation, and coordination with tier 2 systems. Layperson first responder programs are essential to address the global injury burden that disproportionately affects low- and middle-income countries and to evolve into, or coordinate with, tier 2 systems in resource-limited settings, but this requires community involvement to increase local ownership, drive sustainable solutions, and respect local values and cultures.

Constrained path planning for manned–unmanned rotorcraft teaming in emergency medical service missions

This paper investigates the path-planning problem applied to an innovative Unmanned Air Vehicle teaming with a helicopter to increase safety during Helicopter Emergency Medical Services operations. The unmanned vehicle, a drone that optionally can be launched from the helicopter, has the mission to explore the area of operation to determine the meteorological and environmental conditions and to detect physical obstacles. It is initially found that the combination of probabilistically optimal Rapidly-exploring Random Tree (RRT∗\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{*}$$\\end{document}) as the global planner and of Bidirectional Rapidly-exploring Random Tree (BiRRT) as the local planner provides a nearly optimal global path and a rapid replanning in case new obstacles are detected. Adopting a Savitzky–Golay filter in an optional post-processing phase enables trajectory smoothing, thus improving its practicability. The feasibility of the identified trajectory for a rigid-body helicopter model is assessed by computing a first estimate of attitude, forces, control inputs, and rotor power from the trajectory points and curvature. This assessment shows that the RRT∗\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^{*}$$\\end{document} used as a local planner provides replanned trajectories more feasible than BiRRT with comparable computational times.

Emergency medical services (EMS) infrastructure development and operations in low- and middle-income countries: Formal, professional-driven (Tier-2) systems

The World Health Organization recognized timely healthcare as a human right and called for the expansion of two-tiered prehospital and out-of-hospital emergency care systems in low- and middle-income countries. Tier-1 systems involve community-based first responder care, and Tier-2 systems involve more formalized emergency medical services designed as a sustainable system of services, including dedicated ambulances, personnel, and equipment. Tier-2 systems can play a crucial role in reducing mortality and disability due to emergency medical and surgical conditions worldwide. However, the implementation and operation of robust Tier-2 systems in low- and middle-income countries face significant challenges. This article examines the current state, challenges, and opportunities of Tier-2 system development and operations in low- and middle-income countries, highlighting the limited coverage and resourcing of existing systems.The challenges faced in developing Tier-2 systems in low- and middle-income countries include a lack of global awareness, financial constraints, regulatory and planning issues, cultural appropriateness, and workforce shortages. Additionally, the availability and maintenance of equipment, technology, transportation, facilities, and interfacility transfers pose significant hurdles. Localized adaptation of emergency medical services models to suit the diverse contexts of different low- and middle-income countries is critical, as are community partnerships in navigating the complexities of specific communities.Furthermore, Tier-2 systems in low- and middle-income countries should prioritize alignment with national policies and integration into their broader healthcare systems. There is also a need for innovative financial sustainability approaches, such as private-public partnerships and cost-sharing schemes, to overcome the upfront costs of establishing Tier-2 system infrastructure.Additionally, strategies for strengthening the emergency medical services workforce, including targeted recruitment and training, are explored. By addressing these challenges and opportunities, Tier-2 systems in low- and middle-income countries can better operate within their available resources and potentially contribute to improved healthcare outcomes. The sharing of best practices and collaborative networks between systems in low- and middle-income countries will also be critical for the development of Tier-2 system infrastructure in these areas.

Addressing Challenges in EMS Department Operations: A Comprehensive Analysis of Key Issues and Solution

Background: Emergency medical services (EMS) are essential in providing timely medical attention and transportation to people in need during times of crisis. Effective EMS operations are crucial for delivering prompt and effective healthcare. However, the landscape of EMS operations is constantly evolving, posing a number of challenges that require rigorous research and innovative solutions. Objectives: To highlight the key challenges facing EMS departments in their daily operations and discuss potential solutions. Methods: A narrative literature review was conducted. Relevant studies were identified by searching electronic databases, such as PubMed, MEDLINE, CINAHL, and Google Scholar. Results: The main challenges facing EMS departments include an increasing demand for services, limited resources, aging infrastructure, technological advancements, and regulatory compliance. Operational-level solutions that can be used to address these challenges include investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations. Conclusion: EMS departments today face a variety of challenges. However, there are a number of approaches that can be taken to address these challenges. By investing in technology, cross-training personnel, developing contingency plans, and partnering with other organizations, EMS departments can improve their operations and provide the best possible care to patients.

"Smart Emergency Call Point" Enhancing Emergency Medical Services on University Campuses.

The "Smart Emergency Call Point" is a device designed for requesting assistance and facilitating rapid responses to emergencies. The functionality of smart emergency call points has evolved to include features as real-time photo transmission and communication capabilities for both staff and emergency personnel. These devices are being used to request Emergency Medical Services (EMS) on university campuses. Despite these developments, there has been a lack of previous studies demonstrating significant advantages of integrating smart emergency call points into EMS systems. The primary goal of this study was to compare the response times of EMS between traditional phone calls and the utilization of smart emergency call points located on university campuses. Additionally, the study aimed to provide insights into the characteristics of smart emergency call points as a secondary objective. This retrospective database analysis made use of information acquired from Thailand's EMS at Srinagarind Hospital. The data were gathered over a period of four years, specifically from January 2019 through January 2022. The study included two groups: the first group used the phone number 1669 to request EMS assistance, while the second group utilized the smart emergency call point. The primary focus was on the response times. Additionally, the study documented the characteristics of the smart emergency call points that were used in the study. Among the 184 EMS operations included in this study, 60.9% (N = 56) involved females in the smart emergency call point group. Notably, the smart emergency call point group showed a higher frequency of operations between the hours of 6:00am and 6:00pm when compared to the 1669 call group (P = .020). In dispatch triage, the majority of emergency call points were categorized as non-urgent, in contrast to the phone group for 1669 which were primarily cases categorized as urgent (P = .010). The average response time for the smart emergency call point group was significantly shorter, at 6.01 minutes, compared to the phone number 1669 group, which had an average response time of 9.14 minutes (P <.001). In the context of calling for EMS on a university campus, the smart emergency call points demonstrate a significantly faster response time than phone number 1669 in Thailand. Furthermore, the system also offers the capability to request emergency assistance.

Impact of Smart Glasses on Patient Care Time in Emergency Medical Services Ambulance.

The smart glasses were implemented as an innovative communication tool to enhance effectiveness in the field. The traditional mode of communication for Emergency Medical Services (EMS) was radio, which had significant restrictions, primarily that they were unable to transmit any visual data. To enhance efficiency, the smart glasses were used for a more accurate assessment of the condition of patients during transportation. At this time, however, no prior study has shown significant benefits of employing smart glasses into EMS. The primary objective of this study is to compare the duration of patient care in an ambulance between the use and non-use of smart glasses. The secondary objective is to identify the characteristics of data communication between the ambulance and the hospital. This retrospective study utilized data gathered from closed-circuit television (CCTV) in ambulances at Srinagarind Hospital, Thailand. The data were collected over a six-month period, specifically from July through December 2021. The study included two groups: the smart glasses group and no smart glasses groups, both used during EMS operations. The primary data collected focused on the duration of patient care in the ambulance. Additionally, the type and characteristics of data transfers via smart glasses during EMS operations were also recorded. Out of the 256 EMS operations included in this study, 53.1% (N = 68) of the participants in the smart glasses group were male. The majority of operations were performed during the afternoon shift in both groups. The average patient care time in the smart glasses group was 10.07 minutes, while it was 5.10 minutes in the no smart glasses group (P <.001), indicating a significant difference. Visual data communication between the ambulance and the hospital via smart glasses predominantly involved vital signs (100.0%), physical examination (56.3%), and neurological examination (42.2%). The use of audio data from the hospital to the ambulance primarily included taking additional patient history (26.6%) and performing physical examinations (19.5%). The implementation of smart glasses in EMS operations resulted in an increase in patient care time in the ambulance. Furthermore, the use of smart glasses facilitated an effective channel of real-time two-way communication between the ambulance and the hospital.

Social Determinants of Health in EMS Records: A Mixed-methods Analysis Using Natural Language Processing and Qualitative Content Analysis.

Introduction: Social determinants of health (SDoH) are known to impact the health and well-being of patients. However, information regarding them is not always collected in healthcare interactions, and healthcare professionals are not always well-trained or equipped to address them. Emergency medical services (EMS) professionals are uniquely positioned to observe and attend to SDoH because of their presence in patients' environments; however, the transmission of that information may be lost during transitions of care. Documentation of SDoH in EMS records may be helpful in identifying and addressing patients' insecurities and improving their health outcomes. Our objective in this study was to determine the presence of SDoH information in adult EMS records and understand how such information is referenced, appraised, and linked to other determinants by EMS personnel. Methods: Using EMS records for adult patients in the 2019 ESO Data Collaborative public-use research dataset using a natural language processing (NLP) algorithm, we identified free-text narratives containing documentation of at least one SDoH from categories associated with food, housing, employment, insurance, financial, and social support insecurities. From the NLP corpus, we randomly selected 100 records from each of the SDoH categories for qualitative content analysis using grounded theory. Results: Of the 5,665,229 records analyzed by the NLP algorithm, 175,378 (3.1%) were identified as containing at least one reference to SDoH. References to those SDoH were centered around the social topics of accessibility, mental health, physical health, and substance use. There were infrequent explicit references to other SDoH in the EMS records, but some relationships between categories could be inferred from contexts. Appraisals of patients' employment, food, and housing insecurities were mostly negative. Narratives including social support and financial insecurities were less negatively appraised, while those regarding insurance insecurities were mostly neutral and related to EMS operations and procedures. Conclusion: The social determinants of health are infrequently documented in EMS records. When they are included, they are infrequently explicitly linked to other SDoH categories and are often negatively appraised by EMS professionals. Given their unique position to observe and share patients' SDoH information, EMS professionals should be trained to understand, document, and address SDoH in their practice.

Emergency medical services operations during civil unrest: Best practices from lessons learned.

During periods of civil unrest, emergency medical services (EMSs) clinicians will be called upon to provide care to those impacted, including those who are actively instigating violence. Working during periods of civil unrest poses significant operational and security challenges to EMS leadership and clinicians. This review provides best practices for EMS operating during periods of civil unrest through analysis of after action reports from Baltimore, Maryland; Charlottesville, North Carolina; Minneapolis, Minnesota; and Washington, DC.

Twenty Years After the EMS Research Agenda: Trends in Emergency Medical Services Publications and Research Funding.

Since its publication in 2001, the National EMS Research Agenda has brought attention to a relative paucity of emergency medical services (EMS)-specific research and has called for an increase in funding and infrastructure to support EMS research. We investigated the trends in EMS-specific publications and National Institutes of Health (NIH)-funded research grants in the 20 years since this landmark publication. We performed a structured PubMed search of English-language citations from 2001 to 2020 to identify publications with populations, settings, or topics related to EMS care, education, or operations. Publications in trade journals and studies not involving humans were excluded. We also queried NIH Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) using a similar structured search. Titles, keywords, and abstracts were reviewed. Descriptive statistics were calculated, and nonlinear trends were described using segmented regression models. A total of 183,307 references met the search criteria in PubMed, and 4,281 grants were identified in NIH RePORTER. After removing duplicates, 152,408 titles were screened, with 17,314 (11.5%) included. EMS-related publications increased from 419 in 2001 to 1,788 in 2020, a 327% increase, compared with a 197% increase in total PubMed publications. There was a statistically significant nonlinear (J-shaped) increase in EMS publications after 2007. There were 1,166 funded EMS-related NIH grants, with a 469% increase from 2001 to 2020 compared with an 18% increase in overall NIH awards. Although total publications have doubled in the United States over the past 20 years, EMS-specific research has more than tripled and the number of funded EMS research grants has increased nearly 5-fold. Future evaluation should examine the quality of this research and its application to clinical practice.

The Impact of Hurricane Ida on Emergency Medical Services Operations in New Orleans

Introduction:On August 29, 2021 Hurricane Ida struck New Orleans with Category 4 winds. While the most severe weather occurred during a 24-hr period on August 29, the city suffered significant damage to telecommunication systems, medical facilities, and infrastructure for several weeks afterward. At the height of the storm, multiple events affected routine deployment of EMS, including damage to transmission lines causing interruption of the 911 system, and suspension of ambulance travel for safety when the winds exceeded 50 mph. These factors, as well as pre-storm preparations, affected utilization of EMS by residents and thus a “peri-hurricane” period was examined to determine the overall effect of Hurricane Ida on New Orleans EMS operations.Method:Run sheets for calls to NOEMS between August 26-September 9, 2021 were analyzed to assess the most frequently reported medical complaint just prior to and after the hurricane. Run sheets were also evaluated to determine average time from call to arrival on scene, time to arrival at patient (“response time”), and time from leaving scene to arrival at destination (“transport time”). To account for the atypical period during which EMS response was suspended due to wind, both mean and median times were calculated. Data was compared to a control period of Aug 26-Sept 9, 2022.Results:During the study period, 1,971 calls were received, with trauma and respiratory the most common complaints. The mean call-to-arrival time was one hour, although the median time was 15 minutes. Response time was 34 minutes compared to 21 minutes in 2022, and median response time was comparable to the control period. Transport time mean and median were 12.3 and 11.3 minutes, also similar to 2022.Conclusion:Despite citywide infrastructure failures and suspension of operations for over 12 hours during landfall, multiple mitigation strategies enabled NOEMS to quickly resume operations and minimize impact on patient care times.

Ambulance response time in a Brazilian emergency medical service

Research efforts on ambulance response times for Emergency Medical Services (EMS) calls have been made for decades, especially in developed countries, using different techniques and with varying objectives. In Brazil, a developing country, the scarce scientific production on this vital indicator prioritizes scenarios for EMS in cities with more than one million inhabitants. This shows the importance of extending research to the reality of small and medium-sized cities. This paper presents SAMU, the Brazilian EMS that follows the Franco-German emergency medicine model, compiling numbers related to service at the national level. The use of quantile regression allows the identification of the RT for the EMS and helps to explain the effects of factors at the system level, at the patient level, and specific factors on response time intervals of Southwest Paraná SAMU. This specific EMS, characterized as an inter-municipal consortium of prehospital services, is responsible for prehospital emergency care for an approximate population of 635,000 inhabitants in 42 small towns in the State of Paraná in southern Brazil. From the analysis of the records of 12,050 ambulance dispatches, it was possible to identify the average ambulance response time of 14 min and 25 s. The regression model was able to explain the influence of the independent variables at the system level (presumed severity of the emergency, ambulance dispatch time, and ambulance travel time), at the patient level (age, gender, and characteristic of the emergency) and specific variables of the emergency (day of the week and time of day) on the dependent variable response time over the quantiles, showing that the dispatch time, travel time, time of day, service to male patients and critical cases influence the ambulance response time. This work contributes to deepening the understanding of the management of EMS operations in a developing country, allows the comparison of the RT identified in relation to other countries, and identifies factors that impact the RT for other actors directly or indirectly involved. The practical implications are also presented, as well as how the study impacts the decision-making and management process of the EMS in the short, medium and long term.

The Utilization of Handheld Ultrasound Devices in a Prehospital Setting.

Prehospital ultrasounds can be considered a new form of diagnostic tool when taking into account their small structure and due to the fact that nowadays, they are used in the care of emergency patients. However, at present, there is no study regarding the advantage of ultrasound usage in prehospital settings in Thailand. This study aims to determine the sonographic characteristics recorded by handheld ultrasounds used in prehospital care and the diagnostic accuracy of ultrasounds for prehospital patients. A cross-sectional study was conducted on prehospital patients who underwent point-of-care ultrasound (POCUS) examination on Emergency Medical Service (EMS) operations at Srinagarind Hospital, Thailand from January 2021 through December 2021. The ultrasound images, the electronic emergency department medical records, and the EMS database were recorded and reviewed by a team of emergency physicians. The quality of prehospital ultrasound examinations was assessed by comparing the diagnoses at the scene with those taken at the hospital. One hundred sixty-nine prehospital patients who received POCUS examinations were examined over a one-year period. All (100.0%) of the scans were for medical cases. No ultrasound protocol was used in the prehospital care. Two hundred eight POCUS examinations were performed in this study. The most common POCUS indication was dyspnea (45.6%), followed by hypotension/shock (30.1%), and finally syncope (8.2%). The most common area where POCUS was performed was on the lung (37.0%), followed by the inferior vena cava (30.8%), and finally for cardiac cases (26.4%). This study found that 34.9% of sonographic findings could be considered abnormal. The diagnoses of prehospital patients were confirmed by using POCUS in 66 cases (39.1%) with the accuracy of prehospital diagnosis reaching a peak of 75.8%. This study shows POCUS examinations can be effectively used in prehospital care. The prehospital diagnosis given by physicians administering treatment who used POCUS examinations correlated with the in-hospital diagnosis.

Standardised data collection in prehospital critical care: a comparison of medical problem categories and discharge diagnoses

BackgroundPrehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking. This study aimed to describe the in-hospital diagnoses, patient characteristics and medical interventions in different categories of medical problems.MethodsThis retrospective, observational registry study examined the 10 most common in-hospital International Statistical Classification of Disease (ICD-10) diagnoseswithin different prehospital medical problem categories, defined by the HEMS physician/paramedic immediately after the mission was completed. Data were gathered from a national HEMS quality registry and a national hospital discharge registry. Patient characteristics and medical interventions related to different medical problem categories are also described.ResultsA total of 33,844 patients were included in the analyses. All the medical problem categories included a broad spectrum of ICD-10 diagnoses (the number of diagnosis classes per medical problem category ranged from 73 to 403). The most frequent diagnoses were mainly consistent with the reported medical problems. Overlapping of ICD-10 diagnoses was mostly seen in two medical problem categories: stroke and acute neurology excluding stroke. Additionally, typical patient characteristics and disturbances in vital signs were related to adequate medical problem categories.ConclusionsMedical problems reported by HEMS personnel have adequate correspondence to hospital discharge diagnoses. However, the classification of cerebrovascular accidents remains challenging.

An analysis of cost and time for non-emergency calls: A retrospective study on the Emergency Medical Services resources management

Background: Non-transported calls refer to calls received by dispatchers, ambulances dispatched, and the patient not being transported to any health facility. There is a need to analyze and scrutinize the number of such calls and the monetary cost associated with them as it will help to build an effective system to prevent wastage of money and time. Objective: The main objective of this study is to determine the cost and time lost due to the use of resources higher than required in non-emergency situations, and then a comparison is being made to determine the acceptable cost if the appropriate resources are used for such cases. Incidence of non-transported Emergency Medical Services (EMS) calls and the financial and time burdens in Jubail, classified non-urgent from 2017 to 2019, have wasted EMS resources. This information can be useful to improve EMS operations and allocate resources to control inappropriate usage. Methodology: A retrospective cross-sectional study was conducted to assess non-emergency EMS calls in Jubail, Saudi Arabia. Study data were obtained from the Royal Commission Health Services Program- Jubail (RCHSP-J) key performance indicator (KPIs) system from 2017 to 2019. Descriptive statistical measures (sum, mean, and percentage), and comparison methods were obtained. Results: The cost from 2017 to 2019 for the non-emergency calls by using the advanced life support ambulance (ALS) was 2,051,651 USD while the cost of emergency calls was 546,037 USD only. On the other hand, the time for the non-emergency calls was 6870 hours (78%) and the emergency calls were only 1769 hours (22%). Conclusion: In systems with limited resources and poor regulation; the non-emergency calls having higher costs and time more than emergency calls from 2017 to 2019, might have caused a delay in providing care for the more serious cases. This involves a significant financial waste that could have been planned to make the system work more efficiently avoiding massive waste of resources.

The Role of Doctors in Ambulance Management of Stroke Patients in Emergency Medical Services

BACKGROUND: Strokes are one of the most common of all neurological diseases and can be found in all genders and ages. Emergency medical services (EMS) are the first line of care with access to stroke patients from on the scene assessment to initial treatment. However, currently there are no studies regarding the role doctors play in initial ambulance contact to assess stroke patients.&#x0D; AIM: To analyze the role of doctors in ambulances managing stroke patients in EMS.&#x0D; METHODS: This was a retrospective study over a five-year period (2017-2021) at Srinagarind Hospital EMS units. The information from the EMS database was transferred completely into the data record form and imported into the computer system for further data analysis.&#x0D; RESULTS: A total of 10,329 EMS operations were examined. The mean age of the patients was 52.10 ± 10.24 years. A total of 64.4% (n = 6650) of them were male. The afternoon shift was the most common time for EMS operations with doctors in the stroke group (42.9%) and non-stroke group (59.3%). The distance from hospital to the scene in the stroke group was 12.6 ± 3.2 km. The average response time for stroke group and non-stroke group were 7.05 minutes and 9.50 minutes, respectively&#x0D; CONCLUSIONS: The role of doctors in the ambulance to manage stroke patients in EMS directly resulted in a decrease in time in arriving at the scene to diagnose, arriving at the laboratory, and arriving at the scene to activate the special team.

State emergency medical services guidance and protocol changes in response to the COVID-19 pandemic: A national investigation.

ObjectivesThe COVID‐19 pandemic has had an impact on emergency medical services (EMS) and its guidelines, which aid in patient care. This study characterizes state and territory EMS office recommendations to EMS statewide operational and clinical guidelines and describes the mechanisms of distribution and implementation during the COVID‐19 pandemic.MethodsA mixed‐methods study was conducted in 2 phases. In phase 1, changes and development of COVID‐19 guidance and protocols for EMS clinical management and operations were identified among 50 states, the District of Columbia, and 5 territories in publicly available online documents and information. In phase 2, structured interviews were conducted with state/territory EMS officials to confirm the protocol changes or guidance and assess dissemination and implementation strategies for COVID‐19.ResultsIn phase 1, publicly available online documents for 52 states/territories regarding EMS protocols and COVID‐19 guidance were identified and reviewed. Of 52 (33/52) states/territories, 33 had either formal protocol changes or specific guidance for the pandemic. In phase 2, 2 state and territory EMS officials were interviewed regarding their protocols or guidance for COVID‐19 and the dissemination and implementation practices they used to reach EMS agencies (response rate = 65%). Of the 34 state/territory officials interviewed, 22 had publicly available online COVID‐19 protocols or guidance. Of the 22 officials with online COVID‐19 protocols, all reported providing operational direction, and 19 of 22 officials reported providing clinical direction.ConclusionsMost states provided guidance to EMS agencies and/or updated protocols in response to the COVID‐19 pandemic.

A simulation and optimisation package for emergency medical services

Emergency Medical Service (EMS) providers make decisions such as selecting ambulance station locations and ambulance dispatch policies; these decisions can be made effectively with the aid of optimisation and simulation models. We have developed JEMSS – a Julia (programming language) package for Emergency Medical Services Simulation – to allow for performance evaluation and optimisation of decisions or policies for problems arising in EMS operations and strategic planning. To the best of our knowledge this is the first free and open-source EMS simulation and optimisation package, which incorporates integer programming optimisation, heuristic local search, and simulation capabilities. The decision protocols used for ambulance dispatch and dynamic redeployment during a simulation run are flexible and easy to customize. Analytical optimisation models relevant to EMS decision-making are included, such as for station location and ambulance deployment problems. The simulations run quickly, requiring less than a second to simulate 100 days for a realistic city model. Data to simulate Auckland, New Zealand is included in the package and other cities will be added to enable researchers to conduct a more varied and fair comparison of newly developed EMS strategies. The JEMSS package includes a visualisation tool to view the simulation as it is running. The simulation model has been validated by comparing the simulation trace and output of existing EMS simulation and analysis software BartSim. This paper details the JEMSS design and presents a case study showing how to apply integer programming, local search, and simulation optimisation using JEMSS.

Clinical, Operational, and Socioeconomic Analysis of EMS Bypass of the Closest Facility for Pediatric Asthma Patients

IntroductionPediatric hospital care is becoming increasingly regionalized, with fewer facilities providing inpatient care for common conditions such as asthma. That trend has major implications for emergency medical services (EMS) medical care and operations because EMS historically transports patients to the closest facility. This study describes EMS transport patterns of pediatric asthma patients in greater depth, including an analysis of facility bypass rates and the association of bypass with demographics and clinical outcomes.MethodsThis was a retrospective study of pediatric asthma patients ages 2–18 years transported by Lee County, FL EMS between March 1, 2018 – December 31, 2019. A priori, we defined bypass as greater than five minutes extra transport time. We performed geospatial analysis and mapping of EMS pediatric asthma encounters. We used the Pediatric Destination Tree (PDTree) project’s tiered approach to characterize receiving hospital facility pediatric capability. We analyzed incidence and characteristics of bypass, and bypass and non-bypass patient characteristics including demographics, emergency department (ED) clinical outcomes, and socioeconomic disadvantage (SED).ResultsFrom the study period, there were a total of 262 encounters meeting inclusion criteria, 254 (96.9%) of which could be geocoded to EMS incident and destination locations. Most encounters (72.8%) bypassed at least one facility, and the average number of facilities bypassed per encounter was 1.52. For all 185 bypass encounters, there was a median additional travel time of 13.5 minutes (interquartile range 7.5 – 17.5). Using the PDTree’s classification of pediatric capability of destination facilities, 172 of the 185 bypasses (93%) went to a Level I facility. Bypass incidence varied significantly by age, but not by minority status, asthma severity, or by the area deprivation index of the patient’s home address. Overall, the highest concentrations of EMS incidents tended to occur in areas of greater SED. With regard to ED outcomes, ED length of stay did not vary between bypass and non-bypass patients (P = 0.54), and neither did hospitalization (P = 0.80).ConclusionWe found high rates of bypass for pediatric EMS encounters for asthma exacerbations, and that bypass frequency was significantly higher in younger age groups. With national trends pointing toward increasing pediatric healthcare regionalization, bypass has significant implications for EMS operations.

Emergency Medical Services amid New Wave of Coronavirus Disease 2019 Outbreak in Khon Kaen, Thailand

BACKGROUND: COVID-19 outbreaks occurring in many countries around the world have had a significant impact on emergency medical services (EMS) in terms of the number of operations and procedures performed, including those on ambulances. However, the number of EMS amid the rising number of COVID-19 cases in Khon Kaen, Thailand has not been well studied.&#x0D; AIM: The aim of this study was to identify and analyze the relationship between the use of EMS and the outbreak of COVID-19.&#x0D; METHODS: A cross-sectional study was done in Srinagarind Hospital, Khon Kaen, Thailand with a single EMS centered. Data was collected between March 27, 2021 and April 9, 2021 and designated as (Day-7 to Day 7 of pandemic services) as well as normal services which collected data between March 27 and April 9, 2019 (Day-7 to Day 7 of normal services).&#x0D; RESULTS: Three hundred eight EMS operations were examined. A total of 77.9% (n = 95) of pandemic services were for males and the mean age of the patients was 32.1 ± 5.4 years. During the normal services in 2019, the average number of EMS operations was 13.3 ± 2.4 times per day over the two weeks of the study. In 2021, before the outbreak (Day-7 to Day 1), the average number of EMS operations was 13.2 ± 1.8 times/day. After Day 1, there was a drop in the number of EMS operations which was associated with an increase in COVID-19 infections (p &lt; 0.001).&#x0D; CONCLUSIONS: The number of EMS users during the COVID-19 outbreak decreased considerably compared to the pre-epidemic levels and normal service intervals, including the severity of the users, were more severe than normal.