Emergency Medical Services Personnel Research Articles

Experiences of emergency medical services personnel about barriers and facilitators in prehospital childbirth missions in Iran: a qualitative study

Objective: In Iran, the majority of emergency medical services (EMS) personnel are male; hence, one of their distinct and crucial missions is the prehospital childbirth mission, which might be significantly challenging for both personnel and patients. To obtain in-depth and authentic data, the present study was conducted to elucidate the barriers and facilitators of prehospital childbirth missions based on the experiences of EMS personnel. Methods: A qualitative study employing conventional content analysis was conducted in 2023. Participants were selected through purposive sampling from EMS personnel willing to participate in the study and who have experiences with missions leading to childbirth. Data saturation was reached through in-depth semi-structured interviews with 14 participants. Data accuracy and credibility were confirmed using the Lincoln & Guba criteria. Results: The results included two main themes including barriers and facilitators. Barriers were categorized into "gender-related barriers" and "personnel barriers." While "appropriate communication" and "efforts to preserve privacy" were the primary facilitator themes. Conclusion: The findings revealed that EMS personnel face considerable barriers in the process of these missions. Therefore, for optimal performance quality in this prominent mission, it is recommended that clinical and educational policymakers consider actively recruiting female personnel, focusing on enhancing communication and practical skills and securing the patient's privacy. These approaches can result in childbirth missions with lower stress levels for patients, families, and personnel who provide the service.

The prevalence of post-traumatic stress disorder among emergency medical services personnel in Saudi Red Crescent Authority, Riyadh, Saudi Arabia.

Determining the prevalence of PTSD and contributing variables among (EMS) specialists was the goal of the current investigation. Furthermore, limited evidence exists regarding the application of PCL-5 for EMT practitioners, and the incidence of PTSD among different age groups and genders in Saudi Arabia. This cross-sectional descriptive study includes 211 prehospital care providers of the Saudi Red Crescent Authority stations in Riyadh. The randomization was done using Google Forms into subgroups according to participants' gender, years of experience, occupations, and average working hours. The presence and severity of PTSD symptoms were evaluated using the 20-item PTSD Checklist for DSM-5 (PCL-5) self-report questionnaire. Data were analyzed using Pearson Chi-Square, Mann-Whitney and Kruskal-Wallis tests. The reliability statistics were calculated using Cronbach's Alpha for the 20-survey questionnaire. The comparison of PCL-5 total scores indicated more PTSD symptomatology among females (1.61 + 0.799) as compared to male workers (1.13 + 0.642). The total score of PTSD demonstrated no statistically significant (P=0.79) differences between our age group classifications. In terms of the participants' city (Riyadh), the total PTSD score was less than the cutoff point which is 31. PTSD total score may not be affected by working experience as indicated by the non-significant difference in prevalence among EMT practitioners having <5 years, 5-10 years and above 10 years of working experience (P=0.215 with X2 = 3.076). PTSD incidence is affected by the type of occupation as statistically significant differences between groups (P=0.001) were recorded depending on the position and responsibilities of EMS practitioners. PTSD is also affected by average working hours per week, and there were statistically significant differences between groups (P=0.001). The total score of PTSD in the case of emergency service practitioners was found to be 33.7% among all the research participants, which may be regarded as a high prevalence when compared to the general population. Our investigations would contribute to a better understanding of the underlying factors of mental stress in EMS specialists in Saudi Arabia and to the development of adequate mental health practices.

Telehealth Intervention with Emergency Medical Services Personnel for Fall Assessment

Telehealth Intervention with Emergency Medical Services Personnel for Fall Assessment

Effect of timing of advanced life support on out-of-hospital cardiac arrests at home in Japan

AimIn cases of out-of-hospital cardiac arrests (OHCA) occurring at home, Japanese emergency medical services personnel decide whether to provide treatment on the scene or during transport based on their judgment. This study aimed to evaluate the association between the timing of advanced life support (ALS) (i.e., endotracheal intubation [ETI] or adrenaline administration) for OHCA at home and prognosis. MethodThis retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital ETI (n = 6806) and received adrenaline (n = 22,636) between 2016 and 2019. The timing of ETI or adrenaline administration was determined as “on the scene” or “in the ambulance.” Multiple logistic regression analysis was used to estimate the association among the timing of ALS implementation, pre-hospital return of spontaneous circulation (ROSC), and survival at 1 month. ResultETI on the scene was significantly positively associated with pre-hospital ROSC (adjusted odds ratio [AOR], 1.81; 95% confidence interval [CI], 1.57–2.09) and survival at 1 month (AOR, 1.81; 95% CI, 1.47–2.23). Adrenaline administration on the scene was significantly positively associated with pre-hospital ROSC (AOR, 2.51; 95% CI, 2.33–2.70) and survival at 1 month (AOR, 2.13; 95% CI, 1.89–2.40). ConclusionOur analysis suggests performing ALS on the scene was associated with pre-hospital ROSC and survival at 1 month. Further efforts are needed to increase the rate of ALS implementation on the scene by emergency life-saving technicians.

Academic qualifications for emergency medical services personnel— does it make sense?

Academic qualifications for emergency medical services personnel— does it make sense?

Longitudinal Assessment of Emergency Responders' Attitudes Toward People Who Overdose and Naloxone Following an Overdose Education Training.

In addition to teaching overdose recognition and response, overdose education and naloxone distribution (OEND) trainings for emergency responders aim to improve trainee attitudes toward people who use drugs and toward naloxone. This study examines the training effectiveness long term, as well as the extent to which improvements are dependent on profession type or recent experience administering naloxone. A total of 774 emergency responders, consisting of law enforcement officers (LEOs) (n = 624, 81%) and emergency medical service (EMS) personnel (n = 150, 19%), attended OEND trainings and completed surveys immediately prior to ("pre") and following ("post") the training, as well as 6 months later ("follow-up"). Survey items assessed attitudes toward people who have overdosed, naloxone-related risk compensation (ie, "enabling") beliefs, and whether participants had administered naloxone since attending the training. Multiple regression and estimated marginal means were used to evaluate changes in scores. Emergency responders showed improved attitudes (pre = 2.60, follow-up = 2.45, P < .001) and risk compensation beliefs (pre = 2.97, follow-up = 2.67, P < .001) 6 months following the training. Follow-up scores differed by profession, with LEOs endorsing worse attitudes (difference = 0.55, P = .013) and more risk compensation beliefs (difference = 0.67, P = .014) than EMS. In addition, having recently administered naloxone predicted more negative attitudes (EMS: difference = 0.55, P = .01; LEO: difference = 0.54, P = .004) and risk compensation beliefs (EMS = 0.73, P = .006; LEO = 0.69, P = .002) at follow-up. Six months after an OEND training, emergency responders' attitudes toward people who overdose, and their risk compensation beliefs remained improved. However, LEOs had more negative follow-up attitudes and beliefs compared to EMS. Emergency responders who had administered naloxone had worse attitudes and beliefs at follow-up than those who had not. Of note, our sample evidenced sizable attrition between pre and follow-up assessments, leaving room for selection bias. Future studies should investigate how to mitigate negative effects of administering naloxone on attitudes toward those who overdose, and belief that naloxone is "enabling."

Assessing the Accuracy of ECG Chest Electrode Placement by EMS and Clinical Personnel Using Two Evaluation Methods

Background and purpose: A valid 12-lead electrocardiogram (ECG) depends on correct acquisition technique, particularly on the accurate location of precordial (chest) electrodes. The emergency medical services (EMS) segment of the care continuum is under-represented in previous clinically oriented studies of electrode placement. This study sought to assess the accuracy of chest electrode placement by EMS and clinical personnel in one geographic area, to identify patterns of misplacement to inform future training and continuing education, and to compare two methods of assessing electrode placement. Methods: This prospective observational study recruited a convenience sample of EMS and clinical personnel. Participants placed simulated electrodes on a CPR-style manikin and completed a questionnaire about their training and experience. A subset also marked electrode locations on a printed diagram of the ribcage. Digitized placement data and questionnaire responses were analysed statistically. Results: Findings from 149 participants showed misplacement patterns consistent with prior studies, with 41.6% rated as “acceptable” and 34.2% placing £ 3 electrodes acceptably. Correctness of electrode placement was comparable between EMS and clinical participants. More correct electrode placement correlated with classroom vs. on-the-job training, frequent vs. infrequent practice, and greater self-confidence. The diagram data collection method proved not equivalent to, and probably less reliable than, the hands-on manikin method for assessing placement skills. Conclusions: Significant variation in ECG chest electrode placement by EMS personnel was comparable to that previously reported for clinical personnel, suggesting that existing concerns about placement errors by clinical personnel may apply equally to EMS personnel. More frequent practice and classroom-based initial ECG training were associated with significantly greater placement accuracy. Participants used diverse strategies to identify electrode locations. Further research is warranted to clarify optimal strategies for placing chest electrodes, especially on diverse body types. Sound initial ECG training and continuing education are necessary to reinforce high-quality ECG skills.

Investigating the Relationship Between Moral Distress and Ethical Climate Among Emergency Medical Services Personnel

Investigating the Relationship Between Moral Distress and Ethical Climate Among Emergency Medical Services Personnel

Changes in neurologic status after traumatic brain injury in the Resuscitation Outcomes Consortium Hypertonic Saline trial.

Traumatic brain injury (TBI) is an important public health problem resulting in significant death and disability. Emergency medical services (EMS) personnel often provide initial treatment for TBI, but only limited data describe the long-term course and outcomes of this care. We sought to characterize changes in neurologic status among adults with TBI patients enrolled in the Resuscitation Outcomes Consortium Hypertonic Saline (ROC-HS) trial. We used data from the TBI cohort of the ROC-HS trial. The trial included adults with TBI, with Glasgow Coma Scale (GCS) ≤8, and excluded those with shock (systolic blood pressure [SBP] ≤70 or SBP 71-90 with a heart rate [HR] ≥108). The primary outcome was Glasgow Outcome Scale-Extended (GOS-E; 1=dead, 8=no disability) determined at (a) hospital discharge and (b) 6-month follow-up. We assessed changes in GOS-E between hospital discharge and 6-month follow-up using descriptive statistics and Sankey graphs. Among 1279 TBI included in the analysis, GOS-E categories at hospital discharge were as follows: favorable (GOS-E 5-8) 220 (17.2%), unfavorable (GOS-E 2-4) 664 (51.9%), dead (GOS-E 1) 321 (25.1%), and missing 74 (5.8%). GOS-E categories at 6-month follow-up were as follows: favorable 459 (35.9%), unfavorable 279 (21.8%), dead 346 (27.1%), and missing 195 (15.2%). Among initial TBI survivors with complete GOS-E,>96% followed one of three neurologic recovery patterns: (1) favorable to favorable (20.0%), (2) unfavorable to favorable (40.3%), and (3) unfavorable to unfavorable (36.0%). Few patients deteriorated from favorable to unfavorable neurologic status, and there were few additional deaths. Among TBI receiving initial prehospital care in the ROC-HS trial, changes in 6-month neurologic status followed distinct patterns. Among TBI with unfavorable neurologic status at hospital discharge, almost half improved to favorable neurologic status at 6 months. Among those with favorable neurologic status at discharge, very few worsened or died at 6 months. These findings have important implications for TBI clinical care, research, and trial design.

Foreign body airway obstruction resulting in out-of-hospital cardiac arrest in Denmark – Incidence, survival and interventions

BackgroundForeign body airway obstruction (FBAO) stands as an important contributor to accidental fatalities, yet prompt bystander interventions have been shown to improve survival. This study aimed to evaluate the incidence, interventions, and survival outcomes of patients with out-of-hospital cardiac arrest (OHCA) related to FBAO in comparison to patients with non-FBAO OHCA. MethodsIn this population-based cohort study, we included all OHCAs in Denmark from 2016 to 2022. Cases related to FBAO were identified and linked to the patient register. Descriptive and multivariable analyses were performed to evaluate prognostic factors potentially influencing survival. ResultsA total of 30,926 OHCA patients were included. The incidence rate of FBAO-related OHCA was 0.78 per 100,000 person-years. Among FBAO cases, 24% presented with return of spontaneous circulation upon arrival of the emergency medical services. The 30-day survival rate was higher in FBAO patients (30%) compared to non-FBAO patients (14%). Bystander interventions were recorded in 26% of FBAO cases. However, no statistically significant association between bystander interventions or EMS personnels’ use of Magill forceps and survival was shown, aOR 1.47 (95 % CI 0.6–3.6) and aOR 0.88 (95% CI 0.3–2.1). ConclusionFBAO-related OHCA was rare but has a higher initial survival rate than non-FBAO related OHCA, with a considerable proportion of patients achieving return of spontaneous circulation upon arrival of the emergency medical service personnel. No definitive associations were established between survival and specific interventions performed by bystanders or EMS personnel. These findings highlight the need for further research in this area.

Adverse Effects After Prehospital Administration of Naloxone by Bystanders: A Preliminary Study.

Opioid use disorder is a cause of significant morbidity and mortality. In order to reverse opioid overdose as quickly as possible, many institutions and municipalities have encouraged people with no professional medical training to carry and administer naloxone. This study sought to provide preliminary data for research into the rates of adverse effects of naloxone when administered by bystanders compared to Emergency Medical Services (EMS) personnel, since this question has not been studied previously. This was a retrospective cohort study performed at an urban, tertiary, academic medical center that operates its own EMS service. A consecutive sample of patients presenting to EMS with opioid overdose requiring naloxone was separated into two groups based on whether naloxone was administered by bystanders or by EMS personnel. Each group was analyzed to determine the incidence of four pre-specified adverse events. There was no significant difference in the rate of adverse events between the bystander (19%) and EMS (16%) groups (OR = 1.23; 95% CI, 0.63 - 2.32; P = .499) in this small sample. Based on these initial results, a study would need a sample size of 6,188 in order to reach this conclusion with 80% power. Similarly, there were no significant differences in the rates of any of the individual adverse events. Secondary analysis of patients' demographics showed differences between the two groups which generate hypotheses for further investigation of disparities in naloxone administration. This preliminary study provides foundational data for further investigation of naloxone administration by bystanders. Adverse events after the prehospital administration of naloxone are rare, and future studies will require large sample sizes. These preliminary data did not demonstrate a statistically significant difference in adverse event rates when comparing naloxone administration by bystanders and EMS clinicians. This study provides data that will be useful for conducting further research on multiple facets of this topic.

Comparison of Palliative Knowledge and Self-Efficacy Expectation of German Paramedics Between a Rural and an Urban Structured Emergency Medical Service Area.

Differences in the German emergency medical service (EMS) can be seen in the countryside in contrast to the city with regard to travel distances to hospitals and in the access routes of EMS-physicians. In order to investigate the success of establishment of palliative crisis cards associated with training and the rural and urban EMS structures, two urban and two rural EMS areas were compared using the Paramedic Palliative Care Test (PARPACT). Methods: The PARPACT includes test items on palliative knowledge (PK, maximum score: 15 points) and palliative self-efficacy expectations (PSE, maximum score: 18 points), as well as items on palliative attitudes in dealing with palliative care patients. We used a 4-point Likert-type scale. For data analysis, nonparametric tests (χ-test and Mann-Whitney U test) were used in addition to descriptive analysis (frequencies, means, medians, standard deviations, and ranges). Results: In total, 291 out of 750 ambulance or EMS personnel participated in the voluntary survey. Rural ambulance or EMS personnel answered the PK-questions correctly more often on average (mean: 11.19, SD: 1.85) than urban ambulance or EMS personnel (mean: 9.18, SD: 2.39; Mann-Whitney U test: U=5040.000, P=.001). In addition, ambulance or EMS personnel with the highest level of training (3-year-trained paramedics) performed better in PK (mean: 10.38, SD: 2.31) than less intensively training ambulance or EMS personnel (mean: 9.58, SD: 2.43; Mann-Whitney U-test: U=8446.500, P=.004). In terms of PSE, rural ambulance or EMS personnel also achieved higher mean PSE-scores (mean: 12.55, SD: 2.60) than urban ambulance or EMS personnel (mean: 9.77, SD: 3.41; Mann-Whitney U-test: U=5148.500, P=.001). Conclusions: Better training in the EMS is associated with improved PK compared to less qualified nonphysician EMS staff. The establishment of palliative crisis cards and the structures in the city alone do not lead to improved knowledge and PSE.

Stroke Coordinator Developmental Needs Around the Globe: An MT - ANVC International Survey

Background Stroke Coordinators (SC) should be commonly utilized in Stroke Centers to ensure provision of evidence-based services, oversee quality improvement, and support interdisciplinary and community education. Mission Thrombectomy (MT) partnered with the Association of Neurovascular Clinicians (ANVC) to understand how SCs are utilized outside the US and to compare developmental needs for this role across the world. Methods A brief survey was constructed to capture information about the use of SCs and their duties, including personnel utilized to execute the role and areas deemed important for role development. The survey was disseminated through the MT and ANVC membership rosters; returned data were assembled in SPSS (version 25) and analyzed using descriptive and X2statistical tests.Results A total of 74 surveys were returned from 17 countries (63% USA). Survey responders were SCs (41%), physicians (39%), program managers (19%) and advanced practice providers (APPs) (1%); 47% were from thrombectomy centers. The SC role was filled at 92% of centers; MDs more commonly assumed the SC role outside the USA (63%), versus registered nurses in the USA (95%; X2=25.2, p&lt;0.001). Of the 70% of respondents interested in receiving assistance from MT and ANVC for SC development resources, the functions deemed most important were “quality improvement” and “emergency medical service personnel education” for USA respondents (36%), whereas “development of stroke systems of care” (60%) and “government policy change” (40%) were ranked highest outside the USA. Conclusions Non-USA Stroke Centers have significant SC development needs that differ markedly from those within the USA. MT provides an important platform to engage international programs and the MT/ANVC partnership is well positioned to further stroke nursing care and SC development globally.

Abstract TP102: Pre-Hospital Obtention of Vital Information for Decision Enforcement in Cerebrovascular Emergencies: The PROVIDENCE Study

Background: Difficulties determining an acute ischemic stroke patient's eligibility for intravenous thrombolysis (IVT) treatment is a frequent cause of delays. Objective: To assess the effectiveness of the "PROVIDENCE" datasheet, a pre-assessment of contraindications for IVT use applied by emergency medical services personnel in the field. Methods: This is a quasi-experimental study to evaluate the efficacy of the PROVIDENCE datasheet used by first responders. Participants were eligible if they were over 18 years old and presented to our center from the field with stroke-like symptoms with onset within 4.5 h. Results: We identified 465 records and included 166 records in our final analysis (54 in the study group and 112 in the control group). Eighty-five of the 166 patients received IVT (30 in the study group patients and 55 in the control group). The PROVIDENCE datasheet showed a noticeable median improvement in corrected time by five minutes from the patient's initial presentation at the emergency department to the final decision regarding IVT eligibility (p = 0.032). Additionally, the time between the first encounter with a neurology provider and the decision regarding IVT administration saw a median improvement of six minutes (p = 0.002) for the entire sample. In the subgroup that received IVT, the PROVIDENCE datasheet decreased by seven minutes (p = 0.044) the median time between the first encounter by the neurology provider and the decision regarding the administration of IVT. All other comparisons were not significant. However, the PROVIDENCE datasheet decreased the door-to-needle time by 6.5 minutes compared to the control group. Conclusion: Using the PROVIDENCE datasheet, first responders can quickly identify potential contraindications for IVT treatment in patients with stroke-like symptoms. This tool expedited decision-making and led to faster IVT administration process at a comprehensive stroke center.

Abstract WP37: Way Beyond the Call: An Extended Collaborative Feedback Project With EMS

Background/Purpose: Emergency Medical Services (EMS) providers assess, treat and transport patients to destinations that provide the most appropriate emergency care. EMS provides the first crucial link in the chain of survival for patients suffering from life-threatening conditions. Stroke is a time-sensitive emergent condition which requires urgent evaluation, treatment, and expeditious transport to stroke-specialty centers. We noticed that EMS was not providing us with important information that could impact our initial stroke care. Our 21-month collaborative feedback project was created to provide EMS personnel who frequent our Emergency Department (ED) the tools necessary to administer high-quality, expeditious care. Our goal was to improve information provided to the stroke team and ED upon patient arrival by improving and sustaining three metrics by 20% within a 21-month period, by providing feedback to EMS, which include last known well time (LKWT), caregiver contact information (CCI), and mLAPSS documented (mLAPSS). Methods/Implementation: We collaborated with the Beverly Hills Fire Department (BHFD) educators from July of 2021 through March of 2023, providing a continual feedback loop for all EMS runs with an adjudication of stroke and TIA. Our feedback tool included quality metrics with benchmarks determined by the Los Angeles County EMS Agency, in conjunction with the BHFD educators and our team. We performed chart reviews and extracted data pertinent to each run. We summarized the hospital course and disposition for each patient and the feedback tool was distributed to the EMS providers for review. Data was collected and analyzed over seven quarters (Q3 and Q4 of 2021, Q1-Q4 of 2022, and Q1 of 2023, respectively). Results/Conclusions: Sustained improvements were noted in documentation. We achieved 20% improvement in LKWT (from 78% in Q3-Q4 2021, 98% in Q1-4 2022, 98% in Q1 2023), CCI collected (from 29% in Q3-Q4 2021, 75% in Q1-4 2022, 100% in Q1 2023), and mLAPSS completion was 8% improvement (from 89% in Q3-Q4 2021, 97% in Q1-4 2022, 100% in Q1 2023). An unanticipated result of this project was a halo effect of improved destination decisions from EMS. We will continue to track and trend these metrics and work closely with our colleagues in EMS.

Artificial Intelligence Model Predicts Sudden Cardiac Arrest Manifesting With Pulseless Electric Activity Versus Ventricular Fibrillation.

There is no specific treatment for sudden cardiac arrest (SCA) manifesting as pulseless electric activity (PEA) and survival rates are low; unlike ventricular fibrillation (VF), which is treatable by defibrillation. Development of novel treatments requires fundamental clinical studies, but access to the true initial rhythm has been a limiting factor. Using demographics and detailed clinical variables, we trained and tested an AI model (extreme gradient boosting) to differentiate PEA-SCA versus VF-SCA in a novel setting that provided the true initial rhythm. A subgroup of SCAs are witnessed by emergency medical services personnel, and because the response time is zero, the true SCA initial rhythm is recorded. The internal cohort consisted of 421 emergency medical services-witnessed out-of-hospital SCAs with PEA or VF as the initial rhythm in the Portland, Oregon metropolitan area. External validation was performed in 220 emergency medical services-witnessed SCAs from Ventura, CA. In the internal cohort, the artificial intelligence model achieved an area under the receiver operating characteristic curve of 0.68 (95% CI, 0.61-0.76). Model performance was similar in the external cohort, achieving an area under the receiver operating characteristic curve of 0.72 (95% CI, 0.59-0.84). Anemia, older age, increased weight, and dyspnea as a warning symptom were the most important features of PEA-SCA; younger age, chest pain as a warning symptom and established coronary artery disease were important features associated with VF. The artificial intelligence model identified novel features of PEA-SCA, differentiated from VF-SCA and was successfully replicated in an external cohort. These findings enhance the mechanistic understanding of PEA-SCA with potential implications for developing novel management strategies.

Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest

Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival. To characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA. This population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019. Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023. Severe ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose). A total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months. At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more. Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]). In multivariable logistic regression, the only factor associated with severe ASEs was young age. Neonates with birth-related and non-birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non-birth-related: OR, 3.4; 95% CI, 1.2-9.6). In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.

Chemical Incident Preparedness Among Emergency Medical Service Personnel

Background: Hazardous chemicals are essential for modern society but the use and transportation of them bears the risk of major incidents. Past incidents have revealed the importance of preparation and training of emergency medical service (EMS) personnel when responding to these incidents. However, studies have shown the level of preparedness to be insufficient. There is a lack of knowledge as to how EMS personnel perceive their preparedness and response when facing chemical incidents.&#x0D; Aim: The aim of this study was to qualitative investigate working procedures regarding chemical incidents among a cohort of EMS personnel.&#x0D; Method: Seventeen ambulance nurses from rural and urban areas were individually interviewed using four different realistic scenarios (vignettes). The transcribed text from the interviews was analyzed using qualitative content analysis.&#x0D; Result: The results were derived into two categories with underlying sub-categories: a struggle to organize the onsite work situation (insufficient managerial support, limited resources, trust in rescue services, difficult decision making, stressful responsibilities); and decontamination—a demanding and risky situation (risk management, work in protective gear, aggravating circumstances). Participants often lack real life experience in facing a chemical incident and training that improves preparedness and the ability to respond adequately.&#x0D; Conclusion: Chemical incidents pose many challenges for EMS personnel, but with proper training efforts many of these challenges could be solved. This study has shown the need for more accessible chemical incident training targeting EMS personnel: especially focusing on risk assessment; managerial support; resource management; equipment; and decontamination, including stress management and decision-making. Research in the area of chemical incidents is sparse and there remains much to understand concerning work procedures during chemical incidents.

Single-Legged Triple-Hop Propulsion Strategies in Females With and Those Without a History of Anterior Cruciate Ligament Reconstruction.

The single-legged triple hop is a commonly used functional task after anterior cruciate ligament reconstruction (ACLR). Recently, researchers have suggested that individuals may use a compensatory propulsion strategy to mask underlying quadriceps dysfunction and achieve symmetric hop performance. To evaluate the performance and propulsion strategies used by females with and those without ACLR during a single-legged triple hop. Cross-sectional study. Laboratory. A total of 38 females, 19 with ACLR (age = 19.21 ± 1.81 years, height = 1.64 ± 0.70 m, mass = 63.79 ± 7.59 kg) and 19 without ACLR (control group; age = 21.11 ± 3.28 years, height = 1.67 ± 0.73 m, mass = 67.28 ± 9.25 kg). Hop distance and limb symmetry index (LSI) were assessed during a single-legged triple hop for distance. Propulsion strategies were evaluated during the first and second hops of the single-legged triple hop. Separate 2-way analysis-of-variance models were used to examine the influence of ACLR, joint, and their interaction on mechanical joint work, moment impulse, and the relative joint contributions to total work and moment impulse in females with and those without a history of ACLR. Despite achieving a mean LSI of approximately 96%, the ACLR group produced less total work in the reconstructed than the uninvolved limb during single-legged triple-hop propulsion (first hop: t18 = -3.73, P = .002; second hop: t18 = -2.55, P = .02). During the first and second hops, the reconstructed knee generated 19.3% (t18 = -2.33, P = .03) and 27.3% (t18 = -4.47, P < .001) less work than the uninvolved knee. No differences were identified between the involved and uninvolved limbs of the ACLR group in moment impulse (first hop: t18 = -0.44, P = .67; second hop: t18 = -0.32; P = .76). Irrespective of limb or group, the ankle was the largest contributor to both work and moment during both the first and second hops (P < .001). Clinicians should exercise caution when using a single-legged triple hop as a surrogate for restored lower extremity function in females post-ACLR. This recommendation is driven by the compelling findings that knee-joint deficits persisted in the reconstructed limb despite an LSI of approximately 96% and, regardless of previous injury status, single-legged triple-hop propulsion was predominantly driven by the ankle.

TIME IS BRAIN: ASSESSING EMERGENCY HEALTHCARE WORKERS KNOWLEDGE OF EARLY RECOGNITION OF STROKE AND WARNING SIGNS

Background: A stroke, also known as a cerebrovascular accident (CVA), has a profound impact on the human brain. Early recognition and successful treatment of strokes not only enhance patients clinical outcomes but also play a crucial role in preventing fatalities. The knowledge of strokes is highly significant for Emergency Medical Services (EMS) and nurses. In order to evaluate the level of awareness, this audit was conducted in the Emergency Department (ED) of a prominent tertiary care center in Eastern India. Methodology: This study primarily involved EMS and ED nurses. A self-administered questionnaire consisting of three sections was employed to assess their level of awareness regarding stroke. The questionnaire covered various factors, which were then coded, and a basic analysis was conducted using Microsoft Excel. Results: A total of 52 participants, including nurses, EMS personnel, and students took part in the questionnaire-based audit. The mean age of 27.83 years (SD: 7.56), with a notable percentage holding a General Nurse Midwifery (GNM) degree. Around 75% (n: 37) of the participants had received BLS/ACLS training within the past 1-2 years. It was concerning to find that a significant number of nurses and EMS personnel who frequently attended ambulance calls provided incorrect responses to a question regarding the appropriate destination for suspected stroke patients. However, the majority demonstrated good awareness of warning signs, clinical manifestations, and diagnostic procedures related to acute stroke patients. Only a small fraction (one-tenth) of the participants accurately identified the time window for thrombolysis in stroke cases, and few could recognize patients who may require definitive airway intervention. Conclusion: The majority of participants showed insufficient knowledge regarding the appropriate disposition of stroke patients and correctly identifying the window period for thrombolysis. However, they demonstrated a strong understanding of warning signs, clinical manifestations, and diagnostic procedures associated with acute stroke patients.