Emergency Medical Services System Research Articles

Influence of the COVID-19 Outbreak in Vulnerable Patients (Pediatric Patients, Pregnant Women, and Elderly Patients) on an Emergency Medical Service System: A Pre- and Post-COVID-19 Pandemic Comparative Study Using the Population-Based ORION Registry.

Background and Objective: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread all over the world. To assess the influence of the COVID-19 pandemic on emergency medical services (EMS) for vulnerable patients transported by ambulance. Materials and Methods: This study was a retrospective, descriptive study with a study period from 1 January 2019 to 31 December 2021 using the Osaka Emergency Information Research Intelligent Operation Network (ORION) system. We included all pediatric patients, pregnant women, and elderly patients ≥ 65 years of age transported by ambulance in Osaka Prefecture. The main outcome of this study was difficult-to-transport cases. We calculated the rate of difficult-to-transport cases under several conditions. Results: For the two year-long periods of 1 January 2019 to 31 December 2019 and 1 January 2021 to 31 December 2021, a total of 887,647 patients were transported to hospital by ambulance in Osaka Prefecture. The total number of vulnerable patients was 579,815 (304,882 in 2019 and 274,933 in 2021). Multivariate logistic regression analysis showed that difficult-to-transport cases were significantly more frequent in 2021 than in 2019. Difficult-to-transport cases were significantly less frequent in the vulnerable population than in the non-vulnerable population (adjusted odds ratio 0.81, 95% confidence interval 0.80-0.83; p < 0.001). Conclusion: During the pandemic (2021), difficult-to-transport cases were more frequent compared to before the pandemic (2019); however, vulnerable patients were not the cause of difficulties in obtaining hospital acceptance for transport.

The effect of power stretchers on occupational injury rates in an urban emergency medical services system.

To examine occupational injury rates in a dual-response emergency medical services(EMS) system before and after implementation of a power-lift stretcher system. The seasonally-adjusted occupational injury rate was estimated relative to medical call volume (per 1000 calls) and workers (per 100 FTEs) from 2009 to 2019, and stratified by severity (lost-time, healthcare only), role (EMS, FIRE) and type (patient-handling). Power-lift stretchers were adopted between 2013 and 2015. Preinjury versus postinjury rates were compared using binomial tests. Interrupted time series (ITS) analysis was used to estimate the trend and change in injuries related to patient-handling, with occupational illnesses serving as control. Binomial tests revealed varied results, with reductions in the injury rate per 1000 calls (-14.0%) and increases in the rate per 100 FTEs (+14.1%); rates also differed by EMS role and injury severity. ITS analysis demonstrated substantial reductions in patient-handling injuries following implementation of power-lift stretchers, both in the injury rate per 1000 calls (-50.4%) and per 100 FTEs (-46.6%), specifically among individuals deployed on the ambulance. Injury rates were slightly elevated during the winter months (+0.8 per 100 FTEs) and lower during spring (-0.5 per 100 FTEs). These results support the implementation of power-lift stretchers for injury prevention in EMS systems and demonstrate advantages of ITS analysis when data span long preintervention and postintervention periods.

Implementation of a Thrombectomy Stroke Center Triage Program in New York City Emergency Medical Services

Background Due to the increased morbidity and mortality associated with acute cerebral ischemia caused by large vessel occlusions, the New York City (NYC) 9‐1‐1 Emergency Medical Services system implemented the NYC Stroke Triage Protocol with the intention of improving access to endovascular therapy for patients with suspected severe stroke. Methods Successful collaboration between multiple stakeholders enabled the NYC region to develop and implement a new stroke system of care for patients treated by Emergency Medical Services. Descriptive statistics including medians (interquartile range) and proportions were used as appropriate. Continuous data were compared using Mann–Whitney tests for medians and categorical data were compared by using Pearson chi‐square test. Results Between April 1, 2019 and March 31, 2022, 1337 (83.5%) patients directly transported under the NYC Stroke Triage Protocol by the NYC 9‐1‐1 Emergency Medical Services system to a Thrombectomy Stroke Center had a stroke diagnosis. Patients transported to a more distant Thrombectomy Stroke Center traveled an average of 5.7 minutes longer compared with those who were delivered to the closest Primary Stroke Center but the overall time between first patient contact and first pass at a Thrombectomy Stroke Center was an estimated 98.2 minutes shorter. Approximately 24% of directly transported patients with a stroke diagnosis underwent a thrombectomy. Conclusions The NYC Stroke Triage Protocol increased access to advanced interventional stroke care for eligible patients by decreasing time to treatment through prehospital identification of patients with severe stroke and directly transporting them to a stroke center capable of providing endovascular therapy.

Informing Utstein-style reporting guidelines for prehospital thrombolysis: A scoping review

BackgroundRural Australians with acute myocardial infarction (AMI) face higher mortality rates due to limited access to specialised cardiac services. Paramedic-administered prehospital thrombolysis (PHT) has emerged as an alternative to primary percutaneous intervention (pPCI) for patients facing barriers or delays to cardiac care. There is variability in PHT practices among Australian ambulance services, lacking standardised definitions and outcome measures. The aim of this scoping review was to identify quality indicators and influencing factors associated with outcomes for patients receiving PHT. MethodsA systematic search of literature in SCOPUS and Academic Search Complete, CINAHL and Health Source: Nursing/Academic Edition databases via EBSCO (Health) was conducted following the Joanna Briggs Institute methodology. Peer-reviewed studies from the past decade were screened using search criteria relevant to prehospital thrombolysis and quality indicators. Data extraction was performed and themed using five domains from the Utstein-style template commonly known for standardised prehospital cardiac arrest reporting. ResultsAfter removing duplicates, the search yielded 3596 articles with 28 empirical studies meeting inclusion criteria for the review. These were primarily retrospective cohort studies performed in Australia, Canada and the United States. The scoping review identified 24 clinical quality indicators and factors related to Emergency Medical Service (EMS) systems, AMI recognition and ambulance dispatch, patient variables, PHT processes and patient outcomes. These findings correlate to the Donabedian structure-process-outcome quality of care model and have utility to inform future PHT reporting guidelines for jurisdictional ambulance services. ConclusionsGiven the variability in prehospital practice across Australian ambulance services, standardised reporting on quality indicators for PHT is needed. The Utstein-style template used to report data on pre-hospital cardiac arrest, trauma and airway management could be used for quality improvement in PHT. This review presents 24 quality indicators representing system, recognition and response, patient, process, and outcomes related to PHT. These results could be used to inform a future Delphi study and Utstein-like reporting guideline for prehospital thrombolysis.

Decision support framework for tactical emergency medical service location planning

A well-designed emergency medical services (EMS) system is essential to provide the best possible quality of care to patients in emergencies. Exogenous effects, such as demographic change or extreme weather conditions, lead to a continuous increase in emergency calls. On the other hand, emergency vehicles and qualified personnel are limited. Consequently, there is a continuous need to improve the existing EMS systems in order to optimize the use of the available resources. To assist decision makers in this complex task, we provide a decision support framework at the tactical site planning level. First, we analyze the given historical data to find suitable periods that have similar structures in terms of the number of calls and the time of day. We follow this approach to account for fluctuating demand and time-dependent travel times. A new stochastic, time-dependent, mixed-integer extension of the maximum expected coverage location problem (MEXCLP) is developed that accounts for ambulance site interdependencies. We conduct computational experiments for an existing EMS network structure to optimally locate sites and allocate ambulances. Furthermore, we analyze the benefit of additional ambulances and flexible waiting sites. A discrete-event simulation (DES) is used to evaluate the model solutions and to provide further insights into the trade-off between quality and cost of care for the given model solutions. Results based on anonymized real-world EMS data indicate that flexible waiting sites provide considerable potential savings in the use of ambulances while maintaining a high level of coverage.

Outcome of emergency patients transported by ambulance during the COVID-19 pandemic in Osaka Prefecture, Japan: a population-based descriptive study.

The novel corona virus (COVID-19) pandemic occurred worldwide. Although an excessive burden was placed on emergency medical institutions treating urgent and severe patients, its impact on patient outcome remains unknown. This study aimed to assess the impact of the COVID-19 pandemic in 2021 on the emergency medical services (EMS) system and patient outcomes in Osaka Prefecture, Japan. This was a retrospective descriptive study with a study period from January 1, 2019 to December 31, 2021. We included patients who were transported by ambulance and had cleaned data that was recorded in the ORION system. The study endpoints were the number of patients transported by ambulance and the number of deaths among these patients in each month. To assess the impact of the COVID-19 pandemic on the EMS system, the incidence rate ratio (IRR) and 95% confidence interval (CI) were calculated using 2019 as the reference year. Mortalities were evaluated based on deaths in the emergency department and deaths at 21 days after hospitalization. The numbers of patients transported by ambulance were 500,194 in 2019, 443,321 in 2020 (IRR: 0.88, 95% CI: 0.87-0.88), and 448,054 in 2021 (IRR: 0.90, 95% CI: 0.89-0.90). In 2019, the number of patients transported by ambulance and who died in the emergency departments was 4,980, compared to 5,485 in 2020 (IRR: 1.10, 95% CI; 1.06-1.44) and 5,925 in 2021 (IRR: 1.19, 95% CI: 1.15-1.24). In 2019, the number of patients who died within 21 days after hospitalization was 11,931, compared to 11,913 in 2020 (IRR; 1.00, 95% CI; 0.98-1.03) and 13,376 in 2021 (IRR; 1.12, 95% CI; 1.09-1.15). The COVID-19 pandemic decreased the number of ambulance requests and worsened mortality of patients transported by ambulance in Osaka Prefecture during 2021.

Changes in Transport Mode for Pediatric Trauma Patients Before and After the COVID-19 Pandemic

Background: The Emergency Medical Services (EMS) system has faced significant stress due to the COVID-19 pandemic and now workforce issues. This study was performed to evaluate potential changes in pediatric trauma patient transport over that time period. We hypothesized that more trauma patients would use private transportation/personal vehicles to arrive at the ED in the post-pandemic time frame when compared pre-pandemic. &#x0D; Methods: This was a retrospective cohort study of patients that were admitted to the Emergency Department of Riley Hospital for Children between 01/01/2017 to 12/31/2022. Patients were excluded if they were transferred from another hospital or had mechanisms of injury including burns, suffocations, drownings, hangings, medical, and ingestions. Pre- and post-COVID patients were defined as admission to the ED before or after March 25, 2020, the day after a stay at home orders were implemented in Indiana. Univariate and multivariate analyses were performed. &#x0D; Results: A total of 4,116 patients matching the criteria were identified with 52% arriving after the start of the COVID-19 shut down orders. 30.6% of patients arrived by private operated vehicles (POV) during pre-covid times and 30.3% in the post-covid years (p=0;39). A logistic regression analysis was performed for mortality which demonstrated that transport mode (ground ambulance vs helicopter vs POV) was not statistically associated with mortality rate (OR 0.36, 95% CI 0.12 – 1.10, p=0.07), when controlling for important clinical variables associated with injury severity. &#x0D; Conclusion: There was no statistical difference in arrival by POV before and after the COVID-19 pandemic in our cohort. Additionally, there was no significant data to suggest that transport mode was associated with mortality. Further research should be done to assess potential barriers to transport to pediatric trauma centers, particularly considering ongoing EMS workforce strains.

Impact of Prehospital Exsanguinating Airway-Breathing-Circulation Resuscitation Sequence on Patients with Severe Hemorrhage.

At the 2023 ATLS symposium, the priority of circulation was emphasized through the "x-airway-breathing-circulation (ABC)" sequence, where "x" stands for exsanguinating hemorrhage control. With growing evidence from military and civilian studies supporting an x-ABC approach to trauma care, a prehospital advanced resuscitative care (ARC) bundle emphasizing early transfusion was developed in our emergency medical services (EMS) system. We hypothesized that prioritization of prehospital x-ABC through ARC would reduce in-hospital mortality. This was a single-year prospective analysis of patients with severe hemorrhage. These patients were combined with our institution's historic controls before prehospital blood implementation. Included were patients with systolic blood pressure (SBP) less than 90 mmHg. Excluded were patients with penetrating head trauma or prehospital cardiac arrest. Two-to-one propensity matching for x-ABC to ABC groups was conducted, and the primary outcome, in-hospital mortality, was compared between groups. A total of 93 patients (x-ABC = 62, ABC = 31) met the inclusion criteria. There was no difference in patient age, sex, initial SBP, initial Glasgow Coma Score, and initial shock index between groups. When compared with the ABC group, x-ABC patients had significant improvement in vitals at emergency department admission. Overall mortality was lower in the x-ABC group (13% vs 47%, p < 0.001). Multivariable regression revealed that prehospital circulation-first prioritization was independently associated with decreased in-hospital mortality (odds ratio 0.15, 95% CI 0.04 to 0.54, p = 0.004). This is the first analysis to demonstrate a prehospital survival benefit of x-ABC in this subset of patient with severe injury and hemorrhagic shock. Standardization of prehospital x-ABC management in this patient population warrants special consideration.

The Obstacles that Face Emergency Medical Services System when Dealing with Critical Care Cases in Saudi Arabia

Introduction The Emergency Medical Services system is the first system that responds to people who need immediate emergency care. In prehospital, EMS workers deal with various cases. This study focuses on the challenges and weaknesses of the EMS system in dealing with life- threatening critical issues to identify and compare the obstacles that affect the outcomes of the EMS system when exposed to critical care cases by measuring these aspects: patient care, workforce, policy, education, and equipment. Methodology In this research, the sampling technique was Random sampling technique. The study area is the Saudi Red Crescent Authority in Saudi Arabia. The inclusion criteria include field paramedics and EMTs in the Saudi Red Crescent Authority. The sample size is 385. The researchers gathered data by using an online questionnaire. The data were analyzed using SPSS Inc. Categorical data were presented as frequencies and percentages. Results In total of 674, the results were that most of the respondents fell within the 31–40 age range (61.4%). The majority of respondents were EMTs (83.7%). The study revealed that 80.0% of respondents responded to over 20 critical cases. The majority of females were in the central area. Paramedic specialists were more likely to work in the western area in critical cases. 69.1% believing four members were satisfactory. The older respondents had the highest proportion (54.5%) of those who believed that two squad members were enough to handle one critical case. Additionally, 80.7% reported shortages of tools or drugs, with drugs being the most commonly missing material (45.7%). 77.5% agree to change the policy to enhance their dealings with critical cases. The study found the participants agreed that they need more practice to deal with critical cases, with a percentage of 62.2%. Also, 74.3% believe the curriculum needs adjustment. Finally, to improve patient outcomes, the Saudi EMS system requires updated protocols, further training sessions, and better workforce distribution. A multifaceted strategy is required to address these issues, including better resource management, gender diversity, and the balance of regional resources.

Social mass gathering events influence emergency medical services call volume.

Prior literature suggests that mass gathering events pose challenges to an emergency medical services (EMS) system. We aimed to investigate whether events influence EMS call rates. This study is a retrospective review of all primary response ambulance calls in Rhode Island (US) between January 1st, 2018 and August 31st, 2022. The number of EMS calls per day was taken from the state's EMS registry. Event data was collected using a Google (Google LLC, Mountain View, CA) search. We used separate Poisson regression models with the number of ambulance calls as the dependent and the social event categories sports, agricultural, music events, and public exhibitions as independent variables. All models controlled for the population at risk and the period of the COVID-19 pandemic. Results are presented as increases or decreases in calls per 100,000 inhabitants from the mean over the study period. The mean number of daily EMS calls was 38 ± 4 per 100,000 inhabitants. EMS encountered significantly more missions on days with music events (+3, 95% CI [2; 3]) and public exhibitions (+2, 95% CI [1; 2]). In contrast, days with agricultural events were associated with fewer calls (-1, 95% CI [-1; 0]). We did not find any effect of sports events on call rates. Increased ambulance call volumes are observed on days with music events and public exhibitions. Days with agricultural events are associated with fewer EMS calls.

A semi-Markov decision model for the optimal control of an emergency medical service system

A semi-Markov decision model for the optimal control of an emergency medical service system

An Insight on Prehospital Delay and Ambulance Usage in Acute Myocardial Infarction

In acute myocardial infarction (AMI), the time elapsed between the onset of symptoms and definitive care plays a crucial role in the mortality and morbidity of a victim. The symptom onset to reperfusion therapy comprises prehospital time and hospital time. There are evidence-based international guidelines to minimize hospital time. However, reducing prehospital time and developing strategies to prevent the delay necessitate a thorough understanding of the underlying causes. In the event of an emergency, calling an ambulance can assist cut down on transportation delays, which cuts down on prehospital time and its effects. Aim of this review is to analyze the relationship between ambulance service utilization and prehospital delay in AMI patients. Studies that reported prehospital delay and ambulance usage were collected with a search on the expression “prehospital delay in AMI” in combination with “ambulance usage.” These studies were from around 15 countries on six continents and were analyzed and summarized in this review. The extracted data expressed under six headings: emergency medical service (EMS) as a first medical contact, ambulance disuse, shorter prehospital delay, no or poor EMS system, predictors of ambulance use in AMI, and efforts to reduce prehospital delay. In AMI, using an ambulance is advisable for early diagnosis and swift transport to a definitive care center. However, ambulance services are frequently unavailable or underutilized.

The quality of chest compressions performedby the staff employed in selected units cooperatingwith the state emergency medical services system

The quality of chest compressions performedby the staff employed in selected units cooperatingwith the state emergency medical services system

National emergency medical teleconsultation: A novel system applied during the COVID-19 pandemic in Taiwan.

Telemedicine can facilitate social distancing during an infectious disease pandemic and reduce the burden on health-care resources. Moreover, telemedicine can be utilized for medical care in remote island regions, in home health care, and during isolated major disasters such as regional earthquakes. However, the effectiveness of telemedicine for emergency consultation remains unclear. This study introduced and analyzed the national emergency medical teleconsultation (NEMTC) established in Taiwan in 2022 during the COVID-19 pandemic. In response to the COVID-19 pandemic, Taiwan's Centers for Disease Control established a temporary 24-h NEMTC contingency system. Patient information was collected from consultations through the NEMTC from April 28 to June 28, 2022. After successful consultation, physicians made recommendations for home observation, emergency department (ED) visit, or outpatient follow-up. ED visits were divided into two categories, namely self-transport and transport, by the emergency medical service system (EMSS). During the aforementioned period, 20,902 consultation requests were made through the NEMTC, and 11,804 consultations (56.5% of 20,902) were successful. Consultation success rates were significantly higher for those who had a consultation between 08:00 and 16:00, had a waiting time of less than 10 min, and were not aged between 18 and 45 years. Moreover, 8.2% of the analyzed patients were advised to visit the ED, and only 0.4% required ambulance transportation. Children and older individuals and patients with cardiovascular symptoms, shortness of breath, or neurological or abdominal symptoms had a significantly higher chance of being referred to the ED than did other individuals. The NEMTC response system can enhance the efficiency of the EMSS and can reduce the burden of patients with mild conditions overloading the EMSS and EDs. The NEMTC could serve as an effective rapid response system during future pandemics.

The Location Problem of Medical Drone Vertiports for Emergency Cardiac Arrest Needs

The implementation of medical drones can quickly and efficiently expand the coverage range of an area, allowing for a faster response to incidences of out-of-hospital cardiac arrest and improving the subsequent survival rate of such incidences, while promoting sustainable health development goals under the configuration standards for automatic external defibrillators in China. In response to the problem of the selection of locations for medical drone vertiports (for take-off and landing) that are equipped with automatic external defibrillation facilities, a survival function was introduced to establish a model for site selection, with the primary optimization objective of maximizing the average survival rate of patients and taking the operating costs of a system into account. At the same time, considering the constraints of drone phase operation time, energy consumption, coverage range, etc., a medical drone vertiport site selection model was established for emergency cardiac arrest needs. An improved immune algorithm was applied to the model’s calculations and the analysis of the results, using the Jinnan District in Tianjin as an example. The results show that the proposed model and algorithm are feasible and applicable. The Jinnan District in the city of Tianjin requires a total of 24 medical drone vertiports in order to achieve full coverage of an area under the “golden 4-minute” rescue time. When the average survival rate of patients is 0.9, the operation results are deemed optimal, and the average survival rate of patients is 64.06%. Compared to ground ambulances currently used in hospitals, the implementation of medical drones could significantly shorten response time, improve the average survival rate of patients by 41.96%, and effectively improve the existing low survival rate and the accessibility of medical services. The results of this study can provide decision-making support for the planning of automatic external defibrillators in public places and the construction of sustainable and efficient emergency medical service systems.

Perception, attitudes and expectations among people toward emergency medical services system in Samut Songkhram Province, Thailand

The emergency medical service system is a pre-hospital medical service that effectively helps reduce the severity of emergencies and mortality rates before transferring patients to the hospital. This cross-sectional study investigated people's perceptions, attitudes, and expectations toward the emergency medical services system and aimed to find the relationship between the perceptions, attitudes, and expectations toward the emergency medical services system in Samut Songkhram province, Thailand. The samples consisted of 491 individuals who were selected using a multi-stage sampling method. Data were collected through a self-administered questionnaire and analyzed using linear regression analysis to identify correlations. Results revealed that most participants demonstrated a good overall perception of the use of the emergency medical service system (M = 2.46, SD = 0.27), a good attitude towards the emergency medical service system (M = 2.40, SD = 0.23), and a high level of expectation towards the emergency medical service system (M = 2.85, SD = 0.25). Perception of the use of emergency medical services and attitude towards the emergency medical service system showed positive correlation with expectation towards the emergency medical service system, with R2 = 0.23 (p-value &lt; 0.05). These findings can be used to plan and develop strategies for improving the utilization of emergency medical services, ensuring that the public is informed, understands, and accesses the emergency medical service system correctly and effectively.

Shortening Emergency Medical Response Time with Joint Operations of Uncrewed Aerial Vehicles with Ambulances

Problem definition: Uncrewed aerial vehicles (UAVs) are transforming emergency service logistics applications across sectors, offering easy deployment and rapid response. In the context of emergency medical services (EMS), UAVs have the potential to augment ambulances by leveraging bystander assistance, thereby reducing response times for delivering urgent medical interventions and improving EMS outcomes. Notably, the use of UAVs for opioid overdose cases is particularly promising as it addresses the challenges faced by ambulances in delivering timely medication. This study aims to optimize the integration of UAVs and bystanders into EMS in order to minimize average response times for overdose interventions. Methodology/results: We formulate the joint operation of UAVs with ambulances through a Markov decision process that captures random emergency vehicle travel times and bystander availability. We apply an approximate dynamic programming approach to mitigate the solution challenges from high-dimensional state variables and complex decisions through a neural network-based approximation of the value functions (NN-API). To design the approximation, we construct a set of basis functions based on queueing and geographic properties of the UAV-augmented EMS system. Managerial implications: The simulation results suggest that our NN-API policy tends to outperform several noteworthy rule- and optimization-based benchmark policies in terms of accumulated rewards, particularly for situations that are primarily characterized by high request arrival rates and a limited number of available ambulances and UAVs. The results also demonstrate the benefits of incorporating UAVs into the EMS system and the effectiveness of an intelligent real-time operations strategy in addressing capacity shortages, which are often a problem in rural areas of the United States. Additionally, the results provide insights into specific contributions of each dispatching or redeployment strategy to overall performance improvement. Funding: This work was supported by the National Science [Grant 1761022]. Supplemental Material: The online appendix is available at https://doi.org/10.1287/msom.2022.0166

"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.

A Novel Algorithm for Improving the Prehospital Diagnostic Accuracy of ST-Segment Elevation Myocardial Infarction.

Early detection of ST-segment elevation myocardial infarction (STEMI) on the prehospital electrocardiogram (ECG) improves patient outcomes. Current software algorithms optimize sensitivity but have a high false-positive rate. The authors propose an algorithm to improve the specificity of STEMI diagnosis in the prehospital setting. A dataset of prehospital ECGs with verified outcomes was used to validate an algorithm to identify true and false-positive software interpretations of STEMI. Four criteria implicated in prior research to differentiate STEMI true positives were applied: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. The test characteristics were calculated and regression analysis was used to examine the association between the number of criteria included and test characteristics. There were 44,611 cases available. Of these, 1,193 were identified as STEMI by the software interpretation. Applying all four criteria had the highest positive likelihood ratio of 353 (95% CI, 201-595) and specificity of 99.96% (95% CI, 99.93-99.98), but the lowest sensitivity (14%; 95% CI, 11-17) and worst negative likelihood ratio (0.86; 95% CI, 0.84-0.89). There was a strong correlation between increased positive likelihood ratio (r2 = 0.90) and specificity (r2 = 0.85) with increasing number of criteria. Prehospital ECGs with a high probability of true STEMI can be accurately identified using these four criteria: heart rate <130, QRS <100, verification of ST-segment elevation, and absence of artifact. Applying these criteria to prehospital ECGs with software interpretations of STEMI could decrease false-positive field activations, while also reducing the need to rely on transmission for physician over-read. This can have significant clinical and quality implications for Emergency Medical Services (EMS) systems.

Policy implementation strategies to address rural disparities in access to care for stroke patients.

Stroke systems of care (SSOC) promote access to stroke prevention, treatment, and rehabilitation and ensure patients receive evidence-based treatment. Stroke patients living in rural areas have disproportionately less access to emergency medical services (EMS). In the United States, rural counties have a 30% higher stroke mortality rate compared to urban counties. Many states have SSOC laws supported by evidence; however, there are knowledge gaps in how states implement these state laws to strengthen SSOC. This study identifies strategies and potential challenges to implementing state policy interventions that require or encourage evidence-supported pre-hospital interventions for stroke pre-notification, triage and transport, and inter-facility transfer of patients to the most appropriate stroke facility. Researchers interviewed representatives engaged in implementing SSOC across six states. Informants (n = 34) included state public health agency staff and other public health and clinical practitioners. This study examined implementation of pre-hospital SSOCs policies in terms of (1) development roles, processes, facilitators, and barriers; (2) implementation partners, challenges, and solutions; (3) EMS system structure, protocols, communication, and supervision; and (4) program improvement, outcomes, and sustainability. Challenges included unequal resource allocation and EMS and hospital services coverage, particularly in rural settings, lack of stroke registry usage, insufficient technologies, inconsistent use of standardized tools and protocols, collaboration gaps across SSOC, and lack of EMS stroke training. Strategies included addressing scarce resources, services, and facilities; disseminating, training on, and implementing standardized statewide SSOC protocols and tools; and utilizing SSOC quality and performance improvement systems and approaches. This paper identifies several strategies that can be incorporated to enhance the implementation of evidence-based stroke policies to improve access to timely stroke care for all patient populations, particularly those experiencing disparities in rural communities.