Emergency Medical Services Crews Research Articles

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.

Characteristics of Emergency Medical Services Utilized by Elderly Residents in Nursing Homes

This study aims to analyze the characteristics of emergency medical services (EMS) utilization among elderly patients divided into two groups depending on place of living: nursing homes and places other than nursing homes. The data includes patients aged 65 years old and over for whom ambulances were requested by the 119 Dispatch Center in Gyeonggi Province from January 1st to December 31st, 2018. Statistical analysis was performed using IBM SPSS Statistics 21.0. The findings showed that EMS ambulances were requested more frequently for female patients in nursing homes than males in other places. Brain disease was the most common medical history of the EMS users at nursing homes (P=0.000). Also, critical medical conditions, such as cardiac arrest (5.4%), altered mental status (16.4%), difficulty breathing (18.6%), and fever (19.2%), were found more than twofold higher among the EMS patients in nursing homes, which were classified as emergency by EMS crews. This study suggests a review and amendment of the legal standards regarding support for emergency medical providers and allocation of ambulances.

Self-reported incidence of verbal and physical violence against emergency medical services (EMS) personnel in Singapore

BackgroundWestern studies have highlighted alarmingly high rates of work-related violence experienced by emergency medical services (EMS) staff. As there is a paucity of Asian studies, we aimed to investigate the incidence of physical and verbal violence against the EMS crew in the Singapore Civil Defence Force (SCDF). MethodsThis was a cross-sectional study, utilising an online survey made available to all active paramedics in the SCDF. Paramedics with at least one year of work experience were eligible to participate. All responses were kept anonymous. ResultsThe response rate was 50.9% (n = 246), out of 483 paramedics in service at the time of the study. The respondents consisted of 144 males (58.5%) and 102 females (41.5%). They were between 18 and 55 years old; 160 (65.0%) of them had worked in EMS for less than 6 years. The paramedics experienced high levels of verbal and physical violence, but there was reticence in reporting these incidents. The main risk factor for violence appeared to be alcohol intoxication. ConclusionsParamedics may benefit from security escort for clients with history of alcohol intoxication or violence and more teaching on self-defence and soft restraints. Current training and protocols should be revised to meet these needs.

Making Them Pay? Patient Ability to Pay and Care Disparities in Emergency Medical Services

We investigate how patient ability to pay through insurance influences the equity of care given by Emergency Medical Service (EMS) crews following 9-1-1 calls. EMS agencies are often underfunded and rely on self-generated revenues to carry out their health mission. Revenues depend on insurance reimbursement rates that typically decrease in the following order: private insurance, Medicare, and Medicaid. Reimbursement rate differences provide strong organizational-level incentives to treat patients differently based on ability to pay, but it is unclear if such differences might impact individual-level behaviors in the absence of direct incentives. Using data from 31 states reported to the US National Emergency Medical Services Information System, 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. These differences reduce with call urgency but increase on busy days. Differences manifest across all agency types but particularly in larger agencies and agencies with fewer private insurance calls in the recent past. While EMS crews do not benefit directly from patient payments, our results suggest they do respond to indirect organization-level incentives when making care decisions.

LUCAS II Device for Cardiopulmonary Resuscitation in a Nonselective Out-of-Hospital Cardiac Arrest Population Leads to Worse 30-Day Survival Rate Than Manual Chest Compressions.

The LUCAS (Lund University Cardiopulmonary Assist System; Physio-Control Inc./Jolife AB, Lund, Sweden) was developed for automatic chest compressions during cardiopulmonary resuscitation (CPR). Evidence on the use of this device in out-of-hospital cardiac arrest (OHCA) suggests that it should not be used routinely because it has no superior effects. The aim of this study was to compare the effect of CPR for OHCA with and without LUCAS via a regional nonurban emergency medical service (EMS) physician-present prehospital medical system. We analyzed a prospective registry of all consecutive OHCA patients in four EMS stations. Two of them used a LUCAS device in all CPR, and the EMS crews in the other two stations used manual CPR. Individuals with contraindication to LUCAS or with EMS-witnessed arrest were excluded. Data from 278 patients were included in the analysis, 144 with LUCAS and 134 with manual CPR. There were more witnessed arrests in the LUCAS group (79.17% vs. 64.18%; p=0.0074) and patients in the LUCAS group were older (p = 0.03). We found no significant difference in return of spontaneous circulation (30.6% in non-LUCAS vs. 25% in LUCAS; p=0.35). In the LUCAS group, we observed significantly more conversions from nonshockable to shockable rhythm (20.7% vs. 10.10%; p=0.04). The 30-day survival rate was significantly lower in the LUCAS group (5.07% vs. 16.31% in the non-LUCAS group; p=0.044). At 180-day follow-up, we observed no significant difference (5.45% in non-LUCAS vs. 9.42% in LUCAS; p=0.25). Use of the LUCAS system decreased survival rate in OHCA patients. Significantly higher 30-day mortality was seen in LUCAS-treated patients.

Two teams, one mission: A study using EMS units in hospital triage during active-shooter and other mass-casualty events.

Recent mass-casualty events have exposed errors with common assumptions about response proc-esses, notably triage and transport of patients. Response planners generally assume that the majority of patients from a mass-casualty event will have received some level of field triage and transport from the scene to the hospital will have been coordinated through on-scene incident command. When this is not the case, emergency response at the hospital is hampered as staff must be pulled to handle the influx of untriaged patients. Determine whether the use of emergency medical service (EMS) field resources in hospital triage could enhance the overall response to active-shooter and other mass-casualty events. A proof of concept study was planned in conjunction with a regularly scheduled mass-casualty hospital ex-ercise conducted by an urban level II trauma center in Utah. This was a cross-over study with triage initially performed by hospital staff, and at the midpoint of the exercise, triage was transferred to EMS field units. General performance was judged by exercise planners with limited additional data collection. EMS crews at the hospital significantly enhanced the efficiency and efficacy of the triage operation in both qualitative and quantitative assessment. Hospital planners deemed the proof of concept exercise a success and are now experimenting with implementation of this alternate approach to triage. However, much additional work remains to fully implement this change in processes.

Challenges in the development and implementation of a healthcare system based extracorporeal cardiopulmonary resuscitation (ECPR) program for the treatment of out of hospital cardiac arrest

IntroductionExtracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapies. Many institutions are interested in developing their own ECPR program. However, there may be challenges in logistics and implementation. AimsThe aim of our protocol was to demonstrate that an ECPR team was feasible within our healthcare system and that the identification of UPMC Presbyterian as a receiving center allowed for successful treatment within 30 min from EMS dispatch. MethodsWe developed out of hospital cardiac arrest (OHCA) ECPR protocols for Emergency Medical Services (EMS), EMS communications, and our in-hospital ECPR team. Inclusion criteria indentified patients with a potentially reversible arrest etiology and high probability of recoverable brain injury using a simple checklist: witnessed collapse, layperson CPR, initial shockable rhythm, and age 18–60 years. We trained local EMS crews to screen patients and reviewed the criteria with a Medic Command Physician prior to transport to our hospital. ResultsFrom October 2015 to March 31st 2018, EMS treated 1165 EMS OHCA cases, transported 664 (57%) to a local hospital, and transported 120 (10%) to our institution. Of these, five (4.1%) patients underwent ECPR. Among excluded cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. For ECPR cases, median pre-hospital CPR duration was 26 [IQR 25–40] min. Four patients (80%) received mechanical CPR. Interval from arrest to arrival on scene was 5 [IQR 4–6] min and interval from radio call to activation of ECPR was 13 [IQR 7–21] min. Interval from EMS dispatch to departure from scene was 20 [IQR 19–21] min. Time from EMS dispatch to initiation of ECPR was 63 [IQR 59–69] min. ConclusionsECPR is an infrequent occurrence in EMS practice. Most apparently eligible patients did not get ECPR, highlighting the need for ongoing programmatic development, provider education, and qualitative work exploring barriers to implementation.

163 Nitrous Oxide Exposure in Emergency Medical Services Providers: A Novel Direct Measurement Approach With Concerning Preliminary Findings

The use of inhaled nitrous oxide (N2O) as a pain control agent by emergency medical services (EMS) has notably increased nationwide in recent years. N2O offers numerous benefits as a out-of-hospital analgesic but is also exhaled unmetabolized by patients and accumulates in confined areas, with potential for chronic health implications or acute intoxication at high levels. While there is a wealth of literature addressing occupational N2O exposure in hospital and outpatient settings, the literature on out-of-hospital provider exposure is outdated and inadequate. This ongoing study is the first to measure levels of EMS provider exposure to N2O during actual (non-simulated) patient encounters. The primary study objective is to obtain an average value of ambient N2O concentration during a typical EMS patient encounter in which N2O is used, and to compare this sample mean to national standards for safe exposure limits. Ambient N2O concentrations were directly sampled via externally validated dosimeter badges (Kem Medical Products Corp.) worn in the breathing zone of EMS providers while caring for patients who met clinical criteria for (and were subsequently given) N2O, on-scene and/or during transport, as dictated by existing statewide EMS protocols for pain control. The primary provider of participating EMS crews unsealed and donned a dosimeter badge when N2O was started and wore the badge until care was transferred at the hospital. The delivery system (Nitronox) provided N2O with oxygen in a fixed 50/50 mix; patients self-administered ad libitum via a hand-held mouthpiece, with flow regulated via a demand valve. Per state protocol, crews were always required to open a patient compartment window and utilize the exhaust fan during N2O administration. Used badges were immediately re-sealed and later shipped for lab analysis by the supplier. Additional data including total exposure time were gathered for each call. Enrollment was started on a continuous basis at three 911 agencies within a single EMS district containing both urban and rural service areas in late March 2019. At the time of abstract submission, lab analysis was complete for three dosimeters, with a fourth pending. The average ambient N2O concentration over the three corresponding patient encounters was calculated to be 275 parts per million (ppm) as a time-weighted average (TWA). This preliminary sample mean exceeds the National Institute of Occupational Safety and Health (NIOSH) Recommended Exposure Limit (REL) of 25 ppm as a TWA, as well as the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) of 50 ppm as a TWA. Of note, during the only patient encounter in which N2O was used as the exclusive pain control agent for the duration of transport, ambient concentrations exceeded the validated limit of the dosimeter (N2O >700 ppm as a TWA). Preliminary findings suggest EMS providers in the study area may be unintentionally exposed to ambient N2O concentrations in excess of the NIOSH REL and ACGIH TLV during administration for out-of-hospital analgesia; however, no conclusions may be drawn yet given the current n of 3. Data collection was ongoing at the time of submission; if further data suggests excessive exposure, it may prompt early study termination and reassessment of EMS N2O protocols or delivery systems.

Opportunities for achieving resuscitation goals during the inter-emergency department transfer of severe sepsis patients by emergency medical services: A case series

PurposeThis study aimed to describe the care provide by Emergency Medical Services (EMS) to severe sepsis patients being transferred between acute care hospitals and identify how that care contributes to sepsis care goals. MethodsThis was a single-center retrospective cohort study conducted at a 60,000-visit Midwestern academic emergency department, using run reports from 13 ambulance services transferring from 9 hospitals. Results39 patients were included in the final cohort, transferred by 13 ambulance services from 9 hospitals. Included patients were adults with severe sepsis transferred by ambulance between 2009 and 2014. Thirty-nine patients were included in this cohort. 41% (n = 12) of patients received an adequate fluid bolus of 30 mL/kg (median 42.9 mL/kg crystalloid fluid, IQR 8.0 mL/kg) prior to tertiary care arrival. Seventeen percent (n = 2) of patients completed the adequate bolus during transfer time. Broad-spectrum antibiotics were initiated during transfer in 2 patients. ConclusionsEMS sepsis care during transfer was limited. EMS crews primarily continued treatments previously initiated and did not take additional steps toward resuscitation targets. Data suggests the inter-emergency department transfer period may provide an opportunity to continue working toward treatment targets, though the time is currently underutilized.

Students’ views on the need for hostile environment awareness training for South African emergency medical care students

Background. South Africans experience high levels of contact crime, including assault, robbery and hijacking. Emergency medical services (EMS) are frequently called to the scene of such incidents. Their presence in these potentially hostile environments increases the risk of South African (SA) paramedics and paramedic students becoming victims of crime and violence. A 2015 study showed that ~66% of SA EMS staff reported being assaulted while on duty. During a 10-month period in 2016, Western Cape Province recorded >40 incidents of physical violence against their EMS personnel. Questions are being asked about how well prepared EMS staff are to operate in potentially hostile environments. Objectives. To explore emergency medical care (EMC) students’ experiences of violence and crime and their views on the need for hostile environment awareness training (HEAT) as part of their undergraduate degree programmes. Methods. A self-designed, non-validated, cross-sectional online survey questionnaire was used to document the experiences, views and opinions of 113 undergraduate EMC students from 4 SA universities. The questionnaire consisted of 24 closed-ended questions with pre-set Likert scale options focusing on documenting participants’ experiences, views and opinions regarding hostile environments and the need for HEAT. Results. A high percentage of participants (92%) indicated feeling unsafe while engaging in clinical learning shifts; 63% specified that they had personally witnessed violence against EMS crews, and 32% indicated that they had been assaulted while on duty. Unsurprisingly, 81% of the respondents felt that there is a need for inclusion of HEAT in the undergraduate curriculum. Conclusions. Participation in clinical learning shifts in the current SA prehospital EMS environment increases the risk of exposure to potentially hostile environments. Consequently, students feel unsafe and support the inclusion of HEAT as part of their undergraduate degree programmes.

A Case Report of Cardiac Arrest Following Intentional Ingestion of Liquid Nicotine for Electronic Cigarette

Acute nicotine poisoning by liquid nicotine for electronic cigarettes is becoming an increasing problem worldwide. On the other hand, there are no regulations regarding its concentration, container or labelling in Korea. This is the first case of a cardiac arrest after liquid nicotine ingestion that was confirmed by plasma nicotine detection in Korea. A 34-year-old male was found with a cardiac arrest at home by the emergency medical services crew, and had a return of spontaneous circulation after 27 minutes of cardio-pulmonary resuscitation. The cause of his cardiac arrest was suspected to be acute nicotine poisoning by the ingestion of liquid nicotine. Toxicology analysis of the National Forensic Service confirmed plasma nicotine, and the pharmacokinetic estimated average concentration of plasma nicotine at the time of the cardiac arrest was 29.7 mg/L, a lethal dose. He was hospitalized for further treatment, but was discharged after 20 days without any improvement. Considering the strong toxicity of nicotine, appropriate policy decisions are required for sales and distribution.

Abstract 170: Challenges in Implementing an ECPR Program for Out of Hospital Cardiac Arrest

Introduction: Extracorporeal cardiopulmonary resuscitation (ECPR) can treat cardiac arrest refractory to conventional therapy. Many institutions are interested in developing their own ECPR program. However, there are challenges in logistics and implementation. Hypothesis: Development of an ECPR team and identification of UPMC Presbyterian as a receiving center will increase recognition of potential ECPR candidates. Methods: We developed an infrastructure of Emergency Medical Services (EMS), Medic Command, and an in-hospital ECPR team. We identified inclusion criteria for patients with an out of hospital cardiac arrest (OHCA) likely to have a reversible arrest etiology and developed them into a simple checklist. These criteria were: witnessed arrest with bystander CPR, shockable rhythm, and ages 18 to 60. We trained local EMS crews to screen patients and review the checklist with a Command Physician prior to transport to our hospital. Results: From October 2015 to March 31 st 2018, there were 1165 dispatches for OHCA, of which 664 (57%) were treated and transported to the hospital and 120 to our institution. Of these, five patients underwent ECPR. Of the remaining cases, 64 (53%) had nonshockable rhythms, 48 (40%) were unwitnessed arrests, 50 (42%) were over age 60 and the remaining 20 (17%) had no documented reasons for exclusion. Prehospital CPR duration was 26 [IQR 25-40] min. Four patients (80%) underwent mechanical CPR with LUCAS device. Time from arrest to arrive on scene was 5 [IQR 4-6] min and time call MD command was 13 [IQR 7-21] min. Time to transport was 20 [IQR 19-21] min. Time from arrest to initiation of ECMO was 63 [IQR 59-69] min. Conclusions: ECPR is a relatively infrequent occurrence. Implementation challenges include prompt identification of patients with reversible OHCA causes, preferential transport to an ECPR capable facility and changing the focus of EMS in these select patients from a “stay and play” to a “load and go” mentality.

Hot Off the Press: Prehospital Advanced Cardiac Life Support for Out-of-hospital Cardiac Arrest.

This retrospective cohort study examined the rate of survival to hospital discharge among adult patients with out-of-hospital cardiac arrest, comparing patients who received care only from basic cardiac life support (BCLS)-trained emergency medical service (EMS) crews to patients who had an advanced cardiac life support (ACLS)-trained EMS crew on scene at some point during the resuscitation. There was no difference in the primary outcome of rate of survival to hospital discharge (10.9% with ACLS care and 10.6% with BCLS care, p=0.67).

Real-time ambulance relocation: Assessing real-time redeployment strategies for ambulance relocation

Providers of Emergency Medical Services (EMS) are typically concerned with keeping response times short. A powerful means to ensure this, is to dynamically redistribute the ambulances over the region, depending on the current state of the system. In this paper, we provide new insight into how to optimally (re)distribute ambulances. We study the impact of (1) the frequency of redeployment decision moments, (2) the inclusion of busy ambulances in the state description of the system, and (3) the performance criterion on the quality of the distribution strategy. In addition, we consider the influence of the EMS crew workload, such as (4) chain relocations and (5) time bounds, on the execution of an ambulance relocation. To this end, we use trace-driven simulations based on a real dataset from ambulance providers in the Netherlands. In doing so, we differentiate between rural and urban regions, which typically face different challenges when it comes to EMS. Our results show that: (1) taking the classical 0–1 performance criterion for assessing the fraction of late arrivals only differs slightly from related response time criteria for evaluating the performance as a function of the response time, (2) adding more relocation decision moments is highly beneficial, particularly for rural areas, (3) considering ambulances involved in dropping off patients available for newly coming incidents reduces relocation times only slightly, and (4) simulation experiments for assessing move-up policies are highly preferable to simple mathematical models.

Accuracy of Emergency Medical Services Dispatcher and Crew Diagnosis of Stroke in Clinical Practice.

Accurate recognition of stroke symptoms by Emergency Medical Services (EMS) is necessary for timely care of acute stroke patients. We assessed the accuracy of stroke diagnosis by EMS in clinical practice in a major US city. Philadelphia Fire Department data were merged with data from a single comprehensive stroke center to identify patients diagnosed with stroke or TIA from 9/2009 to 10/2012. Sensitivity and positive predictive value (PPV) were calculated. Multivariable logistic regression identified variables associated with correct EMS diagnosis. There were 709 total cases, with 400 having a discharge diagnosis of stroke or TIA. EMS crew sensitivity was 57.5% and PPV was 69.1%. EMS crew identified 80.2% of strokes with National Institutes of Health Stroke Scale (NIHSS) ≥5 and symptom duration <6 h. In a multivariable model, correct EMS crew diagnosis was positively associated with NIHSS (NIHSS 5-9, OR 2.62, 95% CI 1.41-4.89; NIHSS ≥10, OR 4.56, 95% CI 2.29-9.09) and weakness (OR 2.28, 95% CI 1.35-3.85), and negatively associated with symptom duration >270 min (OR 0.41, 95% CI 0.25-0.68). EMS dispatchers identified 90 stroke cases that the EMS crew missed. EMS dispatcher or crew identified stroke with sensitivity of 80% and PPV of 50.9%, and EMS dispatcher or crew identified 90.5% of patients with NIHSS ≥5 and symptom duration <6 h. Prehospital diagnosis of stroke has limited sensitivity, resulting in a high proportion of missed stroke cases. Dispatchers identified many strokes that EMS crews did not. Incorporating EMS dispatcher impression into regional protocols may maximize the effectiveness of hospital destination selection and pre-notification.

Helicopter Emergency Medical Service Simulation Training in the Extreme: Simulation-based Training in a Mountain Weather Chamber

Mountain rescue operations often confront crews with extreme weather conditions. Extremely cold temperatures make standard treatment sometimes difficult or even impossible. It is well-known that most manual tasks, including those involved in mountain rescue operations, are slowed by extremely cold weather. To lessen and improve the decrement in performance of emergency medical treatment caused by cold-induced manual impairment and inadequate medical equipment and supplies, simulation training in a weather chamber, which can produce wind and temperatures up to −22°C, was developed. It provides a promising tool to train the management of complex multidisciplinary settings, thus reducing the occurrence of fatal human and technical errors and increasing the safety for both the patient and the mountain emergency medical service crew.

Performance review of regional emergency medical service pre-arrival cardiopulmonary resuscitation with or without dispatcher instruction: a population-based observational study.

BackgroundTo investigate variations in emergency medical service (EMS) pre‐arrival cardiopulmonary resuscitation (CPR), including both bystander CPR without dispatch assistance and dispatch‐assisted CPR (DACPR).MethodsWe carried out an observational study by implementing EMS pre‐arrival CPR reports in three fire agencies. We included adult, non‐traumatic, and non‐EMS witnessed out‐of‐hospital cardiac arrests. This reporting system comprised the dispatch instruction process and bystander CPR quality based on evaluations by EMS crews who arrived on the scene. Bystander CPR was categorized as “ongoing CPR” if the bystander was performing CPR when the EMS reached the patient's side and “good‐quality CPR” if the CPR was performed proficiently. We compared the frequencies of ongoing and good‐quality CPR in the bystander CPR already started without dispatch assistance (CPR in progress) group and DACPR group.ResultsOf 688 out‐of‐hospital cardiac arrests, CPR was already started in 150 cases (CPR in progress group). Dispatcher CPR instruction was provided in 368 cases. Among these, callers started chest compressions in 162 cases (DACPR group). Ongoing CPR was performed in 220 cases and was more frequent in the DACPR group (128/162 [79.0%] versus 92/150 [61.3%], P < 0.001). Good‐quality CPR was more frequent in the CPR in progress group, but the difference was not statistically significant (36/92 [39.1%] versus 42/128 [29.0%], P = 0.888).ConclusionsOngoing CPR and good‐quality CPR were not frequent in EMS pre‐arrival CPR. Detailed analysis of dispatch instructions and bystander CPR can contribute to improvement in EMS pre‐arrival CPR.