Emergency Medical Services Crews Research Articles

Experiences and challenges of emergency medical services in Incheon, South Korea: Implications for disaster risk reduction

Emergency Medical Services (EMS) in South Korea were formally established in 1982 meaning that they are relatively young in comparison to western counterparts. The handling of the 1988 Seoul Olympics earned widespread global support. Recent disasters have, however, brought the nation's preparedness into question. EMS provides life-critical pre-hospital emergency care. In South Korea, services are free at point-of-use, and, like several other countries, they are experiencing ever higher levels of stress. Budget cuts, personnel shortages, and increasing operational tempo are known stressors that cause individual and organizational harm which compromises disaster preparedness. Interestingly, EMS in South Korea suffer from poor social acknowledgement within a rank-based society that venerates firefighting and specialist rescue units. EMS are deemed less prestigious; this constrains their organizational voice, minimizes leadership representation, and reduces morale. Recent visceral disaster experience and the limited research focused expressly on the socio-cultural context of EMS provision in South Korea constitute a pertinent research gap. Accordingly, this study critically evaluated perceptions of the experiences and challenges faced by EMS crews in Incheon, South Korea.Constructivist grounded theory, semi-structured interviewing, and induction underpin 24 interviews that address the experiences and challenges faced by EMS. The resultant 24 codes, eight categories, and three themes drawn from 253 quotations are presented within a comprehensive network diagram that provides the building blocks of a new tentative theory. The posited EMS organizational efficiency model is, therefore, grounded within empirical data and is designed to mitigate chronic stressors and enhance disaster preparedness.

A Multi-Objective Facility Coverage Location Problem for Emergency Medical Service Decisions in Hajj

This paper proposes a multi-objective facility model of coverage location problem to determine the number, locations, and redeployments of Emergency Medical Services (EMS) system. The EMS runs with two types of ambulances, Basic Life Support (BLS) and Advance Life Support (ALS). The suggested Multi-objective Coverage Location model (MO-CL) considers a bi-objective function, which is minimizing the EMS costs and the fatigue of EMS crew members. This can be managed by reducing the number of redeployments for both types of ambulances while still providing the required coverage levels. The MO-CL model is based on the approximation hypercube model that eliminates the assumptions of autonomous ambulance operation and system-wide busy probability. It can be solved by applying a modified MO-CL search algorithm. The model and solution method have been applied for a case study based on real data collected from the Al Noor Specialist Hospital in Makkah, Saudi Arabia during the period of fifteen days of Hajj pilgrimage. The results showed that, to achieve the 95% coverage threshold of critical and non-critical demand, the MO-CL model needs at least 64 ambulances (29 ALS, 12 for BLS backups, and 23 for BLS) and 19 redeployments for every day (9 for ALS, 2 for BLS backup, and 8 for BLS).

Abstract 15775: Prehospital Scene Delays in the Prehospital Care of ST-Segment Myocardial Infarction (STEMI)

Introduction: Emergency medical services (EMS) are an important link in the chain of care for patients experiencing time-sensitive cardiovascular emergencies, including ST-segment elevation myocardial infarction (STEMI). Recent quality initiatives have focused on reducing delays in STEMI care in both the prehospital and in-hospital environments. For instance, “door-to-balloon times” are tracked to ensure minimal delays from the time a STEMI patient enters a hospital to revascularization. In the prehospital realm, comparably less research has investigated factors contributing to delays in care for STEMI patients. Prolonged “scene times” - the time spent with a patient prior to transport - represents one area where focus is needed. Methods: As part of an ongoing initiative, EMS providers are encouraged to limit scene times to under 20 minutes for STEMI patients. We queried data from the Minnesota State Emergency Medical Services Regulatory Bureau (EMSRB) to ascertain what percentage of EMS encounters involving STEMI patients within the state’s MNSTAR EMS database between 2018 and 2021 had a scene time of greater than 20 minutes. Encounters involving helicopter emergency medical services (HEMS) were excluded. Results: Between 2018 and 2021, there were a total of 5178 STEMI patient encounters meeting eligibility criteria. Approximately 67.6% (n~3501) of patient encounters involved a scene time less than or equal to 20 minutes. Rural communities were associated with prolonged scene times when compared with metropolitan communities. Conclusions: Our preliminary analysis of EMS data from Minnesota shows one-third of STEMI encounters had scene times greater than 20 minutes. Thus, reducing prehospital scene times by EMS may be one method to streamline the care for STEMI patients. Further research should investigate what factors influence EMS crews to spend more than 20 minutes on scene with STEMI patients.

Fatigue risk assessment of a Helicopter Emergency Medical Service crew working a 24/7 shift pattern: results of a prospective service evaluation

BackgroundThe work of Helicopter Emergency Medical Services (HEMS) teams crosses the boundaries of several high-risk occupations including medicine, aviation, and transport. Working conditions can be challenging and operational demands requires a 24-h rota, resulting in disruption of the normal circadian rhythm. HEMS crews are therefore prone to both mental and physical fatigue. As fatigue in medical providers is linked to poor cognitive performance, degradation of psychomotor skills and error, this study aimed to explore the existence of predictable patterns of crew-fatigue in a HEMS service.MethodsHEMS medical crew members working a 3-on 3-off forward rotating rota with a 5-week shift cycle were asked to do psychomotor vigilance tests (PVT) as an objective measure of fatigue. PVT testing was undertaken at the start, mid- and at the end of every shift during a full 5-week shift cycle. In addition, they were asked to score subjective tiredness with the Samn-Perelli Fatigue Scale (SPFS), and to keep a Transport Fatigue Assessment shift log, wherein they noted shift characteristics potentially related to fatigue. Primary outcome of interest was defined as the change in PVT and SPFS scores over time.ResultsMean baseline resting PVT in milliseconds at the start of the study period was 427 [390–464]. There was an overall trend towards higher PVT-scores with shift progression mean [95% CI] PVT at the start of shifts 447 [433–460]; halfway through the shift 452 [440–463]; end of the shift 459 [444–475], p = 0.10), whereas SPFS scores remained constant. Within a 5 week forward-rotating cycle, an overall trend towards a gradual increase in both average PVT (from 436 [238–454] to 460 [371–527, p = 0.68] ms;) and SPFS (from 2.9 [2.6–3.2] to 3.6 [3.1–4.0], p = 0.38) was observed, although significant interindividual variation was present. Reported SPFS scores ≥ 4 (moderate fatigue) were mainly related to workload (number of jobs) and transport mode (car-based shifts).ConclusionAn overall trend towards a decline in psychomotor vigilance and an increase in self-reported tiredness was found for HEMS crew over a 5-week shift cycle. Using a bespoke predictive fatigue tool on a day-to-day basis could increase fatigue awareness and provide a framework to which relevant mitigating options can be applied.

Multi-criteria assignment problems for optimising the emergency medical services (EMS), considering non-homogeneous speciality of the emergency departments and EMS crews

Dispatching of the EMS crews (ambulances) to awaiting patients and then directing the patients, that are already onboard, to appropriate Emergency Departments (ED), is a nontrivial decision problem. In many emergency medical systems it is handled by the Medical Dispatcher using various strategies—sometimes preferring the closest unit. However, applying a wrong strategy may result in transferring acute-state patients, who require very specialised medical aid, to low-speciality EDs with insufficient treatment capabilities. Then, they would need to be re-transferred to referential units, prolonging substantially the time to receive treatment. In some cases such a delay might make the treatment less effective or even impossible. In this work we propose two multi-criteria mathematical optimisation problems—the first one allows us to calculate the ambulance-to-patient assignment, the second one—to establish the patient-to-hospital assignment. These problems not only take the time-to-support criterion into consideration but also optimise for the speciality of care received by each patient. The ED dispatching problem proposed allows both for direct transfers of patients to referential units and for re-transferring them from non-referential EDs. The performance of the proposed approach is tested in simulations with real-life emergency cases from the NEMSIS data set and compared with classic assignment strategies. The tests showed the proposed approach is able to produce better and more fit-for-purpose dispatching results than other strategies tested. Additionally, we propose a framework for embedding the proposed optimisation problems in the current EMS/ED dispatching process.

A case of pediatric out-of-hospital cardiac arrest due to fulminant myocarditis requiring extracorporeal cardiopulmonary resuscitation

A 7-year-old girl presented with a 2-day history of fever and chest pain that led her to collapse, prompting her father to call the emergency medical services (EMS). Both an EMS ambulance and a physician-staffed ambulance were dispatched to the scene. Upon arrival, the EMS crew discovered that the patient was in cardiac arrest, with ventricular fibrillation (VF) as the initial heart rhythm. Due to the patient’s refractory VF, the physician requested the receiving hospital to prepare for extracorporeal cardiopulmonary resuscitation (ECPR), which was successfully initiated 105 minutes after the patient’s collapse. The patient was admitted to the intensive care unit, where her cardiac function gradually improved. On the eighth day, she was successfully weaned off extracorporeal membrane oxygenation and discharged from the hospital on the thirty-third day without any neurological complications. The presumed cause of the cardiac arrest was fulminant myocarditis, based on the patient’s clinical history and findings from cardiac magnetic resonance imaging. Overall, early mechanical cardiopulmonary support is crucial for patients with fulminant myocarditis. However, cases resulting in out-of-hospital cardiac arrest generally have poor outcomes, even with ECPR. This particular case demonstrated that optimal resuscitation, spanning from the prehospital phase to the intensive care unit, utilizing ECPR, played a vital role in achieving a favorable neurological outcome.

The number and level of first-contact emergency medical services crew and clinical outcomes in out-of-hospital cardiac arrest with dual dispatch response.

This study aimed to evaluate the association between the number and level of emergency medical technicians (EMTs) in the first-contact emergency medical services (EMS) unit and the clinical outcomes of out-of-hospital cardiac arrest (OHCA) with a dual dispatch response. Adult nontraumatic EMS-treated OHCAs between 2015 and 2018 in a nationwide database, were enrolled. The main exposure was the number and certification level of first-contact EMS crew: three versus two members, proportion of EMT intermediate level (EMT-I) over 50% versus under or equal to 50%. Good neurologic recovery was selected as the primary outcome. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios and confidence intervals. A total of 26,867 patients were enrolled and analyzed. Good neurologic recovery was different across the study groups: 5.4% in the two-member crews, 7.2% in the three-member crews, 5.9% in the low EMT-I proportion crews, and 6.8% in the high EMT-I proportion crews. In the main analysis, statistically significant differences for favorable outcomes were found between the three-member and two-member crews, and the high EMT-I proportion and low EMT-I proportion crews; for good neurologic recovery, adjusted odds ratios (95% confidence interval) were 1.23 (1.06-1.43) for three-member crews, and 1.28 (1.17-1.40) for a high EMT-I proportion. The higher number and level of first-contact EMS crew was associated with better neurologic recovery in adult nontraumatic OHCA with a dual-dispatched EMS response.

Treatment of Presumed Hyperkalemia in the Prehospital Setting.

Hyperkalemia (HK) is common and potentially a life-threatening condition. If untreated, HK can progress to ventricular arrhythmia and cardiac arrest. Early treatment reduces mortality in HK. This study evaluates a novel protocol for identification and empiric management of presumed HK in the prehospital setting. This was a retrospective, observational chart review of a single, large, suburban Emergency Medical Services (EMS) system. Patients treated for presumed HK, with both a clinical concern for HK and electrocardiogram (ECG) changes consistent with HK, from February 2018 through February 2021 were eligible for inclusion. Patients were excluded if found to be in cardiac arrest on EMS arrival. Empiric treatment of HK included administration of calcium, sodium bicarbonate, and albuterol. Post-treatment, patients were placed on cardiac monitoring and adverse events recorded enroute to receiving hospital. Protocol compliance was assessed by two independent reviewers. Serum potassium (K) level was obtained from hospital medical records. A total of 582 patients were treated for HK, of which 533 patients were excluded due to cardiac arrest prior to EMS arrival. The remaining 48 patients included in the analysis had a mean age of 56 (SD = 20) years and were 60.4% (n = 29) male with 77.1% (n = 37) Caucasian, 10.4% (n = 5) African American, and 12.5% (n = 6) Hispanic. Initial blood draw at the receiving facilities showed K >5.0mEq/L in 22 (45.8%), K of 3.5-5.0mEq/L in 23 (47.9%), and K <3.5mEq/L in three patients (6.3%). Independent review of the EMS ECG found the presence of hyperkalemic-related change in 43 (89.6%) cases, and five (10.4%) patients did not meet criteria for treatment due to lack of either appropriate ECG findings or clinical suspicion. No episodes of unstable tachyarrhythmia or cardiac arrest occurred during EMS treatment or transport. The study evaluated a novel protocol for detecting and managing HK in the prehospital setting. It is feasible for EMS crews to administer this protocol, although a larger study is needed to make the results generalizable.

The A to E (ABCDE) Pit Crew Model: A Novel Approach to Team Based Care of Critical Patients in the Prehospital Setting.

This study aimed to evaluate the effectiveness of a Pit Crew intervention to improve team dynamics and time to performance of critical actions in a prehospital critical care scenario. The primary outcome was successful completion of critical actions and time to completion of these critical actions. Secondary outcomes included effectiveness of communication and overall team functioning. The study was conducted with a fire-based Emergency Medical Services (EMS) system with 233 paramedics and 115 Emergency Medical Technicians (EMT). Eight EMS crews comprised of five members each were randomly selected and assigned to either the intervention or the control group. The intervention group (n=20) watched a thirty-minute video prior to the training describing the "Pit Crew Approach;" the control group (n=20) did not watch the video. Each crew was given the same simulation scenario of a pediatric patient that had overdosed on a beta-blocker. Completion of predetermined critical tasks were noted and timestamped. A survey was administered to the participants following the training to assess team dynamics and level of confidence. Three outcomes were statistically significant between the two arms: The interventional group felt they themselves had a more defined role in the resuscitation in comparison to the non-interventional group (p= 0.021). The interventional group also felt that their team members had a clearer and more defined role than the nonintervention group (p= 0.018). The interventional group also felt more confident managing a beta blocker overdose than the nonintervention group (p.007). The only statistically significant secondary outcome finding was in scene departure decision: the interventional arm spent more time on-scene (p=0.031). Of note, the non-intervention group missed performing tasks more often than the interventional group and team leaders of these groups often performed task(s) while also directing the patient care. The Pit Crew model was developed to optimize communication and team function. Our data identified that a formal instruction of the pit crew approach to a critical care scenario improved comfort in patient care. Future studies are needed evaluate other methods of training and the effects of continued formal pit-crew training over time.

Continuum of Care: A Multiagency Approach to Seamless Warmed Prehospital Whole Blood Resuscitation of a Patient with Noncompressible Truncal Hemorrhage

Background Prehospital transfusion capabilities vary widely in the United States. Here we describe a case of prehospital resuscitation using warmed, whole blood in a patient with penetrating torso trauma and associated hemorrhagic shock. Case Report A 68-year-old man sustained a single gunshot wound to the left chest and was found to have a shock index of 1.5 at the time of emergency medical services (EMS) arrival. Rapid peripheral intravenous and central venous access enabled the infusion of warmed low-titer O-positive whole blood. The EMS crew intentionally resuscitated the patient before managing the airway by means of rapid sequence intubation. An air medical services helicopter crew assumed patient care from the ground EMS crew and continued the warmed, whole blood transfusion during the flight to a regional Level I trauma center. The patient went directly to the operating room from the helipad, underwent definitive operative management, and was ultimately discharged home on hospital day nine. Conclusion Early recognition of hemorrhagic shock, implementation of prehospital transfusion protocols that emphasize transfusion of warmed blood without interruption, and an organized, regional approach to trauma care are critical for improving patient survival.

Nutrient and Dietary Intake Status and Its Perspectives of Firefighters and Emergency Medical Service Crews

Nutrient and Dietary Intake Status and Its Perspectives of Firefighters and Emergency Medical Service Crews

776 Quality Improvement in Prehospital Burn Care

IntroductionBurn center implemented a new quality improvement program with emergency medical services (EMS) that examined patient care prior to arrival. Inconsistencies were noted with key interventions that would improve patient’s overall health. These included oxygen administration, fluid resuscitation, pain management, and the application of sterile dressings. There was also improvement in the transfer of care from EMS to receiving hospital.MethodsPatient care reports were examined to see the quality of care that was being given in the prehospital setting. Based on these results, education in the form of a lecture and prior cases are presented routinely to different emergency medical services. To improve transfer of care at bed side from EMS, “burn page” was created. This is a page sent directly to charge nurse of burn unit, emergency department, attending physicians of burn unit, outreach coordinator, and prehospital care coordinator. This allows for improved preparation to receive burn patient from EMS. After the patient is received from EMS, a patient follow up is provided by the prehospital care coordinator to EMS within 24 hours. The patient care report from EMS is reviewed along with the care currently being provided by the burn unit. A case review is scheduled with EMS to examine the care provided and see where improvement can be made with both EMS care and the transition of care at the bed side. This case review also allows the EMS crew to see how the patient is doing a few weeks later.ResultsThe burn center has noticed drastic improvement of care in the prehospital setting. This includes hitting critical bench marks as described in the introduction. This improvement is seen at the transition of care at bedside and in patient care reports done by EMS. These EMS providers also express the improvement of how patients are transferred to the burn center and a sense of trust that the patient will have excellent burn care. They also express that creating the patient follow ups and case reviews helps close the loop in patient care resulting in better burn care being provided in the prehospital setting.ConclusionsWith noticing what critical bench marks that were not being met regarding burn care in the prehospital setting, corrective actions can be created that will establish a closed loop that drastically improves care. From the point of injury to the end of stay in the burn unit, patient care has been drastically improved.

Clinical Validation of Cardiac Arrest Hospital Prognosis (CAHP) Score and MIRACLE2 Score to Predict Neurologic Outcomes after Out-of-Hospital Cardiac Arrest.

Background. Out-of-hospital cardiac arrest (OHCA) remains a challenge for emergency physicians, given the poor prognosis. In 2020, MIRACLE2, a new and easier to apply score, was established to predict the neurological outcome of OHCA. Objective. The aim of this study is to compare the discrimination of MIRACLE2 score with cardiac arrest hospital prognosis (CAHP) score for OHCA neurologic outcomes. Methods. This retrospective cohort study was conducted between January 2015 and December 2019. Adult patients (>17 years) with cardiac arrest who were brought to the hospital by an emergency medical service crew were included. Deaths due to trauma, burn, drowning, resuscitation not initiated due to pre-ordered “do not resuscitate” orders, and patients who did not achieve return of spontaneous circulation were excluded. Receiver operating characteristic curve analysis with Youden Index was performed to calculate optimal cut-off values for both scores. Results. Overall, 200 adult OHCA cases were analyzed. The threshold of the MIRACLE2 score for favorable neurologic outcomes was 5.5, with an area under the curve (AUC) value of 0.70 (0.61–0.80, p < 0.001); the threshold of the CAHP score was 223.4, with an AUC of 0.77 (0.68–0.86, p < 0.001). On setting the MIRACLE2 score cut-off value, we documented 64.7% sensitivity (95% confidence interval [CI], 56.9–71.9%), 66.7.0% specificity (95% CI, 48.2–82.0%), 90.8% positive predictive value (PPV; 95% CI, 85.6–94.2%), and 27.2% negative predictive value (NPV; 95% CI, 21.4–33.9%). On establishing a CAHP cut-off value, we observed 68.2% sensitivity (95% CI, 60.2–75.5%), 80.6% specificity (95% CI, 62.5–92.6%), 94.6% PPV (95% CI, 88.6%–98.0%), and 33.8% NPV (95% CI, 23.2–45.7%) for unfavorable neurologic outcomes. Conclusions. The CAHP score demonstrated better discrimination than the MIRACLE2 score, affording superior sensitivity, specificity, PPV, and NPV; however, the CAHP score remains relatively difficult to apply. Further studies are warranted to establish scores with better discrimination and ease of application.

Форми симуляційного навчання лікарів-слухачів, лікарів-інтернів, середнього медичного персоналу та парамедиків

Поява сучасної апаратури, нових технологій при наданні допомоги на догоспітальному етапі, високий темп розвитку науково-технічного прогресу в медицині змінили вимоги до професійного рівня лікарів невідкладних станів та середнього медичного персоналу, а також парамедиків. Актуальним є питання підвищення рівня володіння практичними навичками під час надання невідкладної та екстреної допомоги. Особлива увага приділяється практичному відпрацюванню алгоритмів проведення серцево-легеневої реанімації, надання екстреної медичної допомоги при політравмі, бойовій травмі та інших невідкладних станах для медичних працівників бригад екстреної (швидкої) медичної допомоги. Симуляційна форма навчання бригад екстреної (швидкої) медичної допомоги, що передбачає навчання в спеціальному штучно створеному імітованому середовищі з використанням манекенів, є найбільш прийнятною. У ДЗ «ЗМАПО МОЗ України» впроваджені різні форми симуляційного навчання: бригадні заняття, спільне навчання, майстер-класи, семінари-тренінги, змагання, що мають свої особливості та переваги.

Job stressors and job satisfaction in emergency medical services crew members in Slovakia

Job stressors and job satisfaction in emergency medical services crew members in Slovakia

Polish Medical Air Rescue Interventions Concerning Pregnant Women in Poland: A 10-year Retrospective Analysis.

BackgroundEven in the normal course of pregnancy, alarming symptoms and obstetric complications can occur, necessitating appropriate care. Medical rescue and Helicopter Emergency Medical Services (HEMS) teams are responsible for responding to emergencies and performing medical emergency procedures on scene and during patient transport to hospital. The purpose of our study was to present the characteristics of HEMS and Emergency Medical Service (EMS) interventions concerning pregnant women in Poland.Material/MethodsThe study involved a retrospective analysis of missions by HEMS and EMS crews of the Polish Medical Air Rescue concerning pregnant women in Poland. The analysis included all HEMS and EMS flights to cases of accidents and other emergencies and air transport missions where medical assistance had been provided to pregnant women between January 2011 and December 2020.ResultsPolish Medical Air Rescue teams were most commonly dispatched to urban areas (79.46%) and for inter-hospital transport (75.85%). The mean patient age was 29.72 years, and the most common diagnosis, in accordance with the International Statistical Classification of Diseases and Related Health Problems (ICD-10), was premature labor (24.38%).ConclusionsPregnant patients aged 30 and older and those receiving HEMS and EMS assistance in urban areas were found to have a higher odds ratio for premature labor. A correlation was identified between the diagnosis associated with the Polish Medical Air Rescue intervention and the pregnant woman’s age and location of call.

A Dispatch Screening Tool to Identify Patients at High Risk for COVID-19 in the Prehospital Setting.

IntroductionEmergency medical services (EMS) dispatchers have made efforts to determine whether patients are high risk for coronavirus disease 2019 (COVID-19) so that appropriate personal protective equipment (PPE) can be donned. A screening tool is valuable as the healthcare community balances protection of medical personnel and conservation of PPE. There is little existing literature on the efficacy of prehospital COVID-19 screening tools. The objective of this study was to determine the positive and negative predictive value of an emergency infectious disease surveillance tool for detecting COVID-19 patients and the impact of positive screening on PPE usage.MethodsThis study was a retrospective chart review of prehospital care reports and hospital electronic health records. We abstracted records for all 911 calls to an urban EMS from March 1–July 31, 2020 that had a documented positive screen for COVID-19 and/or had a positive COVID-19 test. The dispatch screen solicited information regarding travel, sick contacts, and high-risk symptoms. We reviewed charts to determine dispatch-screening results, the outcome of patients’ COVID-19 testing, and documentation of crew fidelity to PPE guidelines.ResultsThe sample size was 263. The rate of positive COVID-19 tests for all-comers in the state of Massachusetts was 2.0%. The dispatch screen had a sensitivity of 74.9% (confidence interval [CI], 69.21–80.03) and a specificity of 67.7% (CI, 66.91–68.50). The positive predictive value was 4.5% (CI, 4.17–4.80), and the negative predictive value was 99.3% (CI, 99.09–99.40). The most common symptom that triggered a positive screen was shortness of breath (51.5% of calls). The most common high-risk population identified was skilled nursing facility patients (19.5%), but most positive tests did not belong to a high-risk population (58.1%). The EMS personnel were documented as wearing full PPE for the patient in 55.7% of encounters, not wearing PPE in 8.0% of encounters, and not documented in 27.9% of encounters.ConclusionThis dispatch-screening questionnaire has a high negative predictive value but moderate sensitivity and therefore should be used with some caution to guide EMS crews in their PPE usage. Clinical judgment is still essential and may supersede screening status.

Employee Dilemmas From Competing Organizational Goals: Insights from Emergency Medical Services

The literature on multiple-goal organizations highlights the unique challenge of simultaneously meeting potentially conflicting profit and prosocial objectives. We study individual level performance effects on the delivery of a prosocial service in the presence of strong organization-level financial incentives. We examine these effects within the context of Emergency Medical Service (EMS) crews responding to 9-1-1 calls. Using data from 31 states reported to the US National Emergency Medical Services Information System, we find that even in the absence of direct individual benefits, EMS crews are responsive to the financial sustainability objective of their agencies by providing higher levels of service to patients with higher ability to pay. Specifically, we find that both private insurance and Medicare patients receive more procedures (4.6% and 1.5%) and have longer transport times (5.1% and 3.9%) than Medicaid patients controlling for time, call, patient, and condition characteristics. These differences reduce with call urgency and for agencies with a higher proportion of high ability to pay patients in the recent past but increase on busy days. The robustness of our findings derives from the quasi-random assignment of insurance across EMS units’ runs and the fixed effects specification in our models and is supported by several robustness checks including instrumental variable analyses.

Work-related factors, cognitive skills, unsafe behavior and safety incident involvement among emergency medical services crew members: relationships and indirect effects

Objectives. This study examines relationships between work-related factors – stress and fatigue, cognitive skills – situation awareness and cognitive flexibility, unsafe behavior and safety incident involvement among emergency medical services (EMS) crew members, and whether cognitive skills and unsafe behavior together indirectly affect the relationship between work-related factors and safety incident involvement. Methods. A sample of 131 EMS crew members working in ground ambulances (physicians, paramedics, ambulance drivers) completed self-report questionnaires. Results. The correlation analysis showed significant positive interrelationships between work-related factors, unsafe behavior and safety incident involvement, and that cognitive skills were significantly negatively related to these variables. The multiple indirect effects analysis revealed significant indirect effects of both work-related factors on safety incident involvement through situation awareness and unsafe behavior, but not through cognitive flexibility. Conclusion. In terms of reducing the number of EMS provider and patient safety incidents, the findings suggest the importance of reducing stress and fatigue in EMS crew members, improving their cognitive skills, in particular situation awareness, and supporting their safety compliance behavior.

The Safety and Utility of Ground Transport of Traumatic Cardiopulmonary Arrest Patients by Helicopter Emergency Medical Services Crews

Patients suffering from traumatic cardiopulmonary arrest (TCPA) typically demonstrate dismal survival rates. Some helicopter emergency medical services (HEMS) systems transport TCPA patients via ground with a referring agency when cardiopulmonary pulmonary resuscitation is in progress. With expanding research on the inherent risk of ground emergency medical services (GEMS) transport with the use of lights and sirens to both crew and the general public, the benefits may not outweigh the risks of transporting these patients by GEMS. The aim of this study was todetermine the number of TCPA patients transported by GEMS with HEMS crews on board who survived to hospital discharge. A retrospective chart review was performed of approximately 10 years of data from a regional Midwest HEMS service. Survival to hospital discharge was the primary outcome. Flight crews transported 54 patients via ambulance with GEMS crews; 31 patients met all inclusion and exclusion criteria. Of the 31 patients transported, 0 survived to hospital discharge. Based on our 0% survival rate and the inherent risk of injury and death to emergency medical services crews and the general public, the risk of transporting adult TCPA patients by GEMS using lights and sirens outweighs the benefit.