Emergency Medical Services Providers Research Articles

Comparison of Law Enforcement Officer versus Emergency Medical Services Placed Tourniquets.

Tourniquet (TQ) use for hemorrhage control is a core skill for many law enforcement officers (LEO) and all emergency medical services (EMS) providers. However, LEO TQ training is not as intensive as EMS. Overuse of TQ can result in over triage. We hypothesize that LEO are more liberal than EMS with TQ placement. A seven-year retrospective, single center study of adult patients who had a TQ placed in the field was conducted. Data were stratified by provider who placed the TQ. Patient demographics, body location where the TQ was placed, hospital location where the TQ was removed, incidence of recurrent bleeding and need for operative control of bleeding, and name of injured vessel were recorded. Data were analyzed using student t-test and Chi-square tests. 192 patients had 197 TQ placed (LEO 77 (40%) and EMS 120 (63%). Most TQ were placed on the thigh. There was no difference in body mass index but the EMS cohort had a higher injury severity score (9.4 v 6.5, p = 0.03) and extremity abbreviated injury severity score (2.4 v 1.9, p = 0.007). LEO placed TQ were more commonly removed in the trauma bay (83% v 73%, p = 0.03). EMS placed TQ were more likely to require operative control of bleeding (23% v 6%, p = 0.003). There were no complications related to TQ use in either arm. LEO are more likely than EMS to place tourniquets without injury to a named vessel or the presence of severe bleeding. LEO need better training to determine when a TQ is needed. EMS should be allowed to remove TQ if appropriate. Studies on the impact of over triage based on TQ use are needed. Therapeutic/Care Management, Level III.

Use of a SimBox, a Video-Augmented, Newborn Resuscitation Simulation for Prehospital Providers to Measure Clinical Performance and Educational Experience.

Few studies have described the current clinical practices, adherence to guidelines, and outcomes of newborn resuscitations attended by emergency medical services (EMS). SimBox, a novel, video-augmented simulation, was used to describe the adherence of prehospital providers to Neonatal Resuscitation Program guidelines, to measure satisfaction with the simulation intervention, and to describe the self-reported improvement in knowledge, skills, and attitudes after the simulation. A prospective observational cohort study of EMS providers was designed and conducted using SimBox, an open-access simulation platform, and facilitated by EMS educators. Clinical performance measures were collected using a five-item checklist. Simulation satisfaction measures were collected through net promoter scores. Learners' demographics, and self-reported knowledge, skills, and attitudes were measured using a retrospective survey of 25 questions. In total, 33 facilitator and 55 learner surveys were collected across Connecticut, Colorado, and Alaska between July 2021 and September 2022. At least one deviation from clinical guidelines occurred in 22/30 (73.3%) of the sessions, with 10/30 (33.3%) teams inappropriately performing chest compressions, 5/31 (16.1%) teams not warming, drying, stimulating, and suctioning the newborn, and 7/31 (22.6%) teams not performing positive pressure ventilation correctly. Lastly, 10/30 (33.3%) teams administered an incorrect dose of dextrose-containing fluids. Very high levels of satisfaction were reported with net promoter scores of 97 and 82 out of 100 for the facilitator and learner surveys, respectively. Finally, all 55/55 (100%) of the learners strongly or somewhat agreed that the simulation improved their knowledge, teamwork, communication, and psychomotor skills. In this cohort of prehospital providers, clinical management decisions during a newborn resuscitation simulation often deviated from the gold-standard, newborn resuscitation guidelines. Free, online, open-access simulation resources like SimBox can be used to identify and measure practice deviations from standardized resuscitation protocols in the prehospital setting.

Inequalities in birth before arrival at hospital in South West England: a multimethods study of neonatal hypothermia and emergency medical services call-handler advice

ObjectivesTo examine inequalities in birth before arrival (BBA) at hospitals in South West England, understand which groups are most likely to experience BBA and how this relates to hypothermia and...

Pre-hospital emergency medicine: a spectrum of imaging findings.

The goal of emergency medical services (EMS) is to provide urgent medical care and stabilization prior to patient transport to a healthcare facility for definitive treatment. The number and variety of interventions performed in the field by EMS providers continues to grow as early management of severe injuries and critical illness in the pre-hospital setting has been shown to improve patient outcomes. The sequela of many field interventions, including those associated with airway management, emergent vascular access, cardiopulmonary resuscitation (CPR), patient immobilization, and hemorrhage control may be appreciated on emergency department admission imaging. Attention to these imaging findings is important for the emergency radiologist, who may be the first to identify a malpositioned device or an iatrogenic complication arising from pre-hospital treatment. Recognition of these findings may allow for earlier corrective action to be taken in the acute care setting. This review describes common EMS interventions and their imaging findings.

Touchless Interaction for Smart Glasses in Emergency Medical Services: User Needs and Experiences

The application of smart glasses in healthcare, particularly for providers engaged in hands-on patient care tasks, presents unique design challenges. This study combines participatory design and usability testing to assess the user experiences of touchless interaction methods for smart glasses in the context of Emergency Medical Services (EMS). The participatory design workshops with 16 EMS providers reveal a preference for touchless interaction methods such as voice commands and pinch hand gestures, driven by the need to keep hands free and minimize cross-contamination risk. Despite this preference, the laboratory-based usability testing with 16 EMS providers indicates that both voice commands and hand gestures fall short in task performance compared to the default tangible buttons on smart glasses, primarily due to software limitations and EMS providers’ unfamiliarity with touchless techniques. Our findings reveal specific issues associated with using different interaction methods when operating smart glasses. Building on these insights, we discuss design implications for smart glasses to better align with the dynamic and unique characteristics of fast-paced medical work.

Redesign of Military Patient Handoff Training for Emergency Medical Services

We conducted a qualitative research inquiry to facilitate the redesign of a military patient handoff training program for a new population of civilian Emergency Medical Services (EMS) learners. Emergency Medical Service providers provided insights about the organizational and interpersonal factors that contribute to patient handoffs, which were used to tailor the existing military patient handoff training for a civilian population. Results revealed four key phases in the patient handoff journey and three topics regarding improvements to the EMS handoff process: importance of interpersonal communication, dedicated time for handoffs, and standardized communication.

Trends in presumed drug overdose out-of-hospital cardiac arrests in San Francisco, 2015–2023

IntroductionEstimates of the prevalence of drug-related out of hospital cardiac arrest (OHCA) vary, ranging from 1.8% to 10.0% of medical OHCA. However, studies conducted prior to the recent wave of fentanyl deaths likely underestimate the current prevalence of drug-related OHCA. We evaluated recent trends in drug-related OHCA, hypothesizing that the proportion of presumed drug-related OHCA treated by emergency medical services (EMS) has increased since 2015. MethodsWe conducted a retrospective analysis of OHCA patients treated by EMS providers in San Francisco, California between 2015 and 2023. Participants included OHCA cases in which resuscitation was attempted by EMS. The study exposure was the year of arrest. Our primary outcome was the occurrence of drug-related OHCA, defined as the EMS impression of OHCA caused by a presumed or known overdose of medication(s) or drug(s). ResultsFrom 2015 to 2023, 5044 OHCA resuscitations attended by EMS (average 561 per year) met inclusion criteria. The median age was 65 (IQR 50–79); 3508 (69.6%) were male. The EMS impression of arrest etiology was drug-related in 446/5044 (8.8%) of OHCA. The prevalence of presumed drug-related OHCA increased significantly each year from 1% in 2015 to 17.6% in 2023 (p-value for trend = 0.0001). After adjustment, presumed drug-related OHCA increased by 30% each year from 2015-2023. ConclusionDrug-related OHCA is an increasingly common etiology of OHCA. In 2023, one in six OHCA was presumed to be drug related. Among participants less than 60 years old, one in three OHCA was presumed to be drug related.

Sustainable Urban Drone Operations: FF2020 view

Experts worldwide agree that development of operations of Unmanned Aircraft Systems (UAS, commonly known as drones) above populated areas, to remain socially acceptable, must satisfy a set of crucial criteria: safety, security, environmental sustainability (including noise and pollution reduction) and compliance with legal requirements (encompassing liability, privacy and alignment with urban land use regulations). However, for both commercial organisations and entities carrying flights in the public interest, these operations need to also be economically sustainable. This article considers two illustrative scenarios: (1) the urgent transport of medical equipment (e.g., defibrillators) on an ad-hoc basis, precisely when and where required, rather than on a routine schedule; (2) security or plant safety applications, where a drone remains on standby, recharging its batteries in a designated ‘nest,’ ready to take-off for capturing imagery or sensory data when triggered by security personnel or by automatic alerts (e.g., a camera detecting an individual penetrating a perimeter). Deploying one remote pilot for each ‘sleeping’ drone 24/7 would lead to enormous service costs, difficult to be sustained by any organisation. The drone hence needs to be completely autonomous, meaning that a remote pilot would no longer be necessary. The concept, often referred to as ‘Drones in the Box,’ is technically feasible and currently exists. Organisation of the operations, however, goes beyond technical feasibility. According to the Automation Concept by the Joint Authorities for Rulemaking on Unmanned Systems (JARUS), this falls under level 5 of automation. In this highest level, there is neither involvement of a remote pilot in aircraft flight functions, both on the ground and in the air, nor any human awareness of dynamic operational parameters. In essence, to ensure economic sustainability, the 24/7 operations must entirely eliminate the need for remote pilots. Nonetheless, a UAS operator would still exist as the legal entity responsible for organising and overseeing operations, securing necessary approvals and being accountable for the process. Therefore, a professional job profile would still be necessary, to possibly trigger the flight, receive the collected information and act upon or activate the Emergency Response Plan (ERP) when required. This professional would neither need to be trained nor licenced as Remote Pilot but the position should be 24/7. In scenarios such as the two mentioned examples, security personnel may already be on duty 24/7 to safeguard certain facilities (e.g., hospitals) or provide emergency medical services (e.g., 118 in Italy). These operations could thus become economically viable if these personnel were trained by the operator for this on-demand duty. The Flying Forward 2020 (FF2020) project has coined this role as the ‘Fleet Manager’ and intends to standardise it through ISO (International Organisation for Standardisation), for global harmonisation.

The impact of the education program based on dimensions of quality of work life among emergency medical services providers

BackgroundQuality of work life is a vital factor for health care providers. This study aimed to determine the impact of the education program based on dimensions of quality of work life among emergency medical services employees.MethodsThe quasi-experimental study was conducted on 100 emergency medical services employees in Tehran, Iran, who were chosen using a convenience sampling method (50 in the intervention group and 50 in the control group). The information was gathered using a Demographic Questionnaire and a Walton Quality of Work Life Questionnaire with eight dimensions. The research was carried out in three stages: design, implementation, and evaluation of the education program. During the design phase, the educational needs of the participants were determined in terms of the dimensions of the quality of work life and work and total living space. The education program on work-life quality was implemented in four virtual group sessions, emphasizing the educational needs identified through uploading educational content to the WhatsApp application. The evaluation was conducted in two stages: before the education program and three months after the program. With a significance level of 0.05, the data was analyzed using SPSS version 24 software.ResultsThe results revealed that an education program on the quality of work life and its dimensions, emphasizing strategies to improve work and total living space, can improve the score of this dimension in the intra-group comparison of both the intervention and control groups (p = 0.046), as well as in the inter-group comparison, at the three-month post-intervention stage, there is a significant difference and a significant increase (p = 0.030), but it does not have a significant effect on the quality of work life and its other dimensions.ConclusionIt is recommended that emergency medical services managers plan to improve the quality of working life of their employees, particularly in terms of work and total living space.

Prevalence of Low-Acuity Pediatric Emergency Medical Services Transports to a Pediatric Emergency Department in an Urban Area.

Many patients transported by Emergency Medical Services (EMS) do not have emergent resource needs. Estimates for the proportion of pediatric EMS calls for low-acuity complaints, and thus potential candidates for alternative dispositions, vary widely and are often based on physician judgment. A more accurate reference standard should include patient assessments, interventions, and dispositions. The objective of this study was to describe the prevalence and characteristics of low-acuity pediatric EMS calls in an urban area. This is a prospective observational study of children transported by EMS to a tertiary care pediatric emergency department. Patient acuity was defined using a novel composite measure that included physiologic assessments, resources used, and disposition. Bivariable and multivariable logistic regression were conducted to assess for factors associated with low-acuity status. A total of 996 patients were enrolled, of whom 32.9% (95% confidence interval, 30.0-36.0) were low acuity. Most of the sample was Black, non-Hispanic with a mean age of 7 years. When compared with adolescents, children younger than 1 year were more likely to be low acuity (adjusted odds ratio, 3.1 [1.9-5.1]). Patients in a motor vehicle crash were also more likely to be low acuity (adjusted odds ratio, 2.4 [1.2-4.6]). All other variables, including race, insurance status, chief complaint, and dispatch time, were not associated with low-acuity status. One third of pediatric patients transported to the pediatric emergency department by EMS in this urban area are for low-acuity complaints. Further research is needed to determine low-acuity rates in other jurisdictions and whether EMS providers can accurately identify low-acuity patients to develop alternative EMS disposition programs for children.

Use of cognitive aids in paediatric out-of-hospital cardiac arrest

Background: Paediatric cardiac arrest resuscitation is a high-stakes, rare event that can cause high stress levels in emergency medical services (EMS) practitioners. The demands of this work could raise cognitive load on practitioners, which may contribute to adverse safety events. Methods: An EMS agency survey was developed as part of a larger study into organisation-level factors that affect paediatric out-of-hospital cardiac arrest care. Questions focused on the types and numbers of cognitive aids, and whether a paediatric emergency care coordinator (PECC) was present. The number and frequency of these aids were analysed, and statistical significance assessed. The number and type of aids were stratified according to the presence of a PECC and paediatric call volumes. Results: The number of available resources ranged from 0 to 4, with a mean of 2.6 and a median of 3; the average number used was 2.0. These figures are higher than for adults. The most commonly available resources were local protocols, followed by local medication/equipment guides and Broselow tape. The least commonly available were paediatric advanced life support cards. No significant differences were found between the number of resources and the presence of a PECC or call volume. Conclusion: There is wide variability of resources to support EMS providers in the resuscitation of infants and children in out-of-hospital cardiac arrest.

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.

Abstract WP78: Large Vessel Occlusion Triage and Routing Utilized for Long-Distance Stroke Transports by Emergency Medical Services (LVO TRUST EMS)

Introduction: Endovascular treatment (EVT) is the most effective therapy in acute ischemic stroke (AIS) with large vessel occlusion (LVO) but its practice is limited to comprehensive stroke centers (CSC). Previous studies have suggested that trained Emergency Medical Services (EMS) professionals can successfully detect LVO cases using a validated screening tool. For these cases, direct transfer to CSC bypassing community hospitals could lead to better outcomes. Methods: This is a retrospective cohort study from 01/01/2018-12/31/2022 of patients with suspected stroke transported by EMS providers from 14 community agencies (primarily fire paramedics) in Southeastern Massachusetts (EMS Region V). When stroke was suspected, EMS providers applied the Field Assessment Stroke Triage for Emergency Destination (FAST-ED) score to assess severity. Bypass of local community hospitals for direct transport to CSC was generally considered for patients with FAST-ED ≥4 and approval of the Region V EMS Medical Director, with the goal of early intervention for severe strokes. In addition to standard education on the use of the FAST-ED score, the EMS agencies received annual aggregate performance feedback and individual case feedback (when requested) from the CSC. Data were collected from the Electronic Health Record (EHR) on demographics, comorbidities, final diagnoses, FAST-ED scores, NIHSS and acute treatments. Descriptive statistics were performed to describe the accuracy of diagnosis and rates of treatment. Results: Among 166 triaged patients to go directly to CSC, 57.6% (95/166) were diagnosed with AIS, and 61.1% (58/95) of them were found to have LVO. There was a higher proportion of AIS or intracranial hemorrhage (ICH) in cases with higher FAST-ED scores. Only 23.4% (39/166) of the cases were diagnosed with stroke mimics, primarily related to lower FAST-ED scores. In total, 36.9% of patients with AIS received EVT: thrombectomy with standard window tPA (21.1%) or late presenter tPA (LKW ≥ 4.5 h, 1.1%), and without tPA (14.7%). Conclusions: A diverse group of community-based EMS services in Southeastern Massachusetts using a prehospital tool can identify patients with severe stroke, i.e. AIS due to LVO or ICH, with acceptable diagnostic accuracy.

Standard vs. targeted oxygen therapy prehospitally for chronic obstructive pulmonary disease (STOP-COPD): study protocol for a randomised controlled trial

BackgroundA high concentration of inspired supplemental oxygen may possibly cause hypercapnia and acidosis and increase mortality in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). Even so, patients with AECOPD are being treated with high oxygen flow rates when receiving inhalation drugs in the prehospital setting. A cluster-randomised controlled trial found that reduced oxygen delivery by titrated treatment reduced mortality—a result supported by observational studies—but the results have never been reproduced. In the STOP-COPD trial, we investigate the effect of titrated oxygen delivery compared with usual care consisting of high flow oxygen delivery in patients with AECOPD in the prehospital setting.MethodsIn this randomised controlled trial, patients will be blinded to allocation. Patients with suspected AECOPD (n = 1888) attended by the emergency medical service (EMS) and aged > 40 years will be allocated randomly to either standard treatment or titrated oxygen, targeting a blood oxygen saturation of 88–92% during inhalation therapy. The trial will be conducted in the Central Denmark Region and include all ambulance units. The power to detect a 3% 30-day mortality risk difference is 80%. The trial is approved as an emergency trial. Hence, EMS providers will include patients without prior consent.DiscussionThe results will provide evidence on whether titrated oxygen delivery outperforms standard high flow oxygen when used to nebulise inhaled bronchodilators in AECOPD treatment. The trial is designed to ensure unselected inclusion of patients with AECOPD needing nebulised bronchodilators—a group of patients that receives high oxygen fractions when treated in the prehospital setting where the only compressed gas is generally pure oxygen. Conducting this trial, we aim to improve treatment for people with AECOPD while reducing their 30-day mortality.Trial registrationEuropean Union Clinical Trials (EUCT) number: 2022-502003-30-00 (authorised 06/12/2022), ClinicalTrials.gov number: NCT05703919 (released 02/02/2023), Universal trial number: U1111-1278-2162.

Geospatial Agricultural Incident Analysis for the State of Indiana

Highlights 29 recent agricultural-related fatalities or injuries occurring throughout the state of Indiana were analyzed using geospatial incident analysis. Proximity of each incident to nearby cellular towers was found through 5 and 10-mile spatial joins by their relationship with cellular towers, with no towers most likely to be found within 5 miles of a given incident and only one tower to be found within 10 miles of a given incident. Proximity of each incident to emergency services and the nearest hospital was performed through 5 and 10-mile spatial joins, with only one service provider most likely to be within the five-mile range of a given incident. Abstract. A total of 29 recent agricultural-related injuries and fatalities throughout the state of Indiana were identified and analyzed for their proximity to cellular towers and emergency medical services (EMS). The objective of this research was to identify relationships between selected agricultural incidents and the ability of the victim to successfully contact emergency services. The geographic information system (GIS) software ArcGIS Pro and ArcGIS Online were utilized for trend identification and analysis. Findings from this analysis showed that only one EMS provider was most likely to be found within five miles of a given incident location. This frequency increased to seven EMS providers when the proximity range was increased to ten miles of a given incident location. The analysis also showed that only one cellular tower was most likely to be within a 10-mile radius of a given incident. There were frequently no accessible towers within five miles of a given incident. In addition, identified incidents were overlaid on a digital elevation map (DEM) of Indiana for analysis on the relationship between elevation and the number of accessible cell towers in the area. Studies have confirmed that victims of serious agricultural-related injuries, especially while working alone, face significant barriers in alerting EMS of their need for assistance. Geospatial analysis techniques performed in this study can be utilized by other states to assess access to EMS and for larger-scale, agricultural incident analysis. These tools have the potential to improve detail in agricultural incident reporting. Keywords: Emergency, Emergency communication, Emergency response, Farm injury, Incident response GIS, Working alone.

A user-centered evaluation of automated chest compression devices for prehospital cardiac arrest care

Objective: This study aimed to compare the various factors of LUCAS and AutoPulse devices used for patients struggling with cardiac arrest. Methods: A randomized crossover study with 24 emergency medical service (EMS) providers were recruited for this research. Such studies performed CPR with both devices on a manikin in a simulated ambulance. Results: The results showed that the AutoPulse device provides a faster response and is easy to apply with less user interaction than LUCAS. Moreover, the AutoPulse device also resulted in minimized workload, higher satisfaction, and maximum situation awareness compared with LUCAS. However, proper information must be presented between the two devices according to the chest compression quality, hemodynamic parameters, and ventilation quality. Conclusion: AutoPulse had gained a clear advantage over LUCAS regarding workload, user performance, situation awareness, and satisfaction of the EMS providers.

The Impact of the COVID-19 Pandemic on Pre-Hospital Emergency Medical Services: The impact of the Covid-19 pandemic on pre-hospital services.

The novel coronavirus (COVID-19) disease outbreak started in China and went on to affect the entire world. Healthcare providers were among the communities that faced severe challenges during the pandemic, and this was especially true of Pre-Hospital Emergency Medical Services (PHEMS) providers. This study aims to investigate the effect of the COVID-19 pandemic on service requests submitted to PHEMS providers via calls made to emergency hotlines. Data were obtained on calls made to 112 (the emergency hotline) during March - August 2020 (i.e., during the pandemic) and the same period the previous year (i.e., the pre-pandemic period). These 2 data sets were analyzed and compared using the SPSS 26 software package (IBM Corp., Armonk, New York, USA). The results of the analysis indicated that the total number of emergency calls received during the pandemic period (11 745) increased compared to the pre-pandemic period (10 747), whereas there was a decrease in the proportion of trauma-related emergency calls during the pandemic period (5.3%) compared to the pre-pandemic period (6.8%). Furthermore, there was a higher proportion of extended service times among ambulances serving in PHEMS during the pandemic period (ambulance movements longer than 90 seconds: 15.6%) compared to the pre-pandemic period (ambulance movements longer than 90 seconds: 8.6%). Non-emergency ambulance usage rate was 44.90% in the pre-pandemic period and 38.90% in the pandemic period. As the study's results show that there was an increase in the number of calls to PHEMS during the pandemic period, especially given that a significant portion of these calls consisted of non-emergency calls, it is recommended that measures be taken to reduce the excessive load on PHEMS during a pandemic.

The effect of ambulance response time on patient and transfer to hospital

This study investigates the critical relationship between ambulance response time and its impact on patient outcomes during the transfer to the hospital. Timely and efficient ambulance responses are fundamental in emergency medical services, significantly influencing patient morbidity and mortality rates. The research employs a retrospective analysis of ambulance response times and patient transfer data collected over a specific period. Key variables include response time intervals, patient demographics, medical conditions, and outcomes during hospital transfer. Statistical analyses, including regression modeling, are utilized to assess the correlation between response times and patient outcomes, considering potential confounding factors. Preliminary findings indicate a noteworthy association between extended ambulance response times and adverse patient outcomes, emphasizing the urgency of swift emergency medical interventions. This research contributes valuable insights to emergency medical service providers, policymakers, and healthcare professionals, aiming to enhance pre-hospital care strategies and improve overall patient well-being. The implications of these findings extend beyond statistical correlations, emphasizing the imperative need for efficient emergency response systems to optimize patient care and outcomes. Keywords: Ambulance response time, Patient care, Emergency medical service, Hospital.

Emergency Medical Responses at US Immigration and Customs Enforcement Detention Centers in California

Knowledge of medical care in US Immigration and Customs Enforcement (ICE) detention centers is limited. Reviews show high rates of preventable deaths while in detention due to substandard medical care within detention centers. To describe characteristics of medical emergencies at ICE detention centers in California. This cross-sectional study analyzed emergency medical services (EMS)-reported medical emergencies activated through 911 from January 1, 2018, to December 31, 2022, at 3 of the 5 ICE detention centers in California: Adelanto ICE Processing Center, Imperial Regional Detention Facility, and Otay Mesa Detention Center. Medical services requiring 911 activation. Data included the number of EMS-reported medical emergencies; ICE-reported medical emergencies; patient age and sex; and medical data in the EMS report, including primary symptom, EMS provider (emergency medical technician or paramedic) impression, vital signs, and interventions performed, using descriptive statistics. In this analysis of 3 detention centers with a mean daily census of 775 (range, 504-1001) individuals per center, there was a median of 68 (IQR, 10-88) EMS-reported emergencies per center per year for a total of 1224 emergencies. The EMS-reported emergencies involved 881 males (72%) and 338 females (28%) with a median age of 39.0 (IQR 30.0-49.0) years. The ratios of female-to-male EMS-reported emergencies were 0.51 (95% CI, 0.31-0.87) at Adelanto, 0.86 (95% CI, 0.31-2.43) at Imperial, and 1.60 (95% CI, 1.40-1.83) at Otay Mesa. Pregnancy-related emergencies accounted for 12.4% (42 of 338) of emergencies in females. A total of 357 individuals (29.2%) had at least 1 abnormal vital sign during their EMS encounter. Psychiatric emergencies comprised 48 EMS responses (3.9%), despite higher rates of ICE-reported psychiatric-related complaints. The median number of monthly EMS-reported emergencies across all 3 centers was 3 (IQR, 0-9) vs 4 ICE-reported emergencies (IQR, 1-15). In this study of medical emergencies at 3 of 5 ICE detention facilities in California, there were discrepancies in EMS vs ICE reported emergencies. The data suggested that vulnerable populations, such as pregnant women, had an increased number of medical emergencies, while individuals with psychiatric emergencies accounted for fewer reported emergencies. Based on these findings, emergency medical care provision in ICE detention centers requires increased transparency to ensure appropriate delivery of care.

Prehospital Emergency Interventions for Idiopathic Spinal Cord Injury Prevention

Introduction: Despite the critical role of prehospital management, variations persist in global practices. Recent literature indicates that about 35% of emergency medical services (EMS) providers adhere to established guidelines for spinal immobilization in certain regions. This systematic review aimed to contribute to the ongoing dialogue surrounding the prehospital management of SCIs, ultimately improving outcomes for individuals affected by these traumatic injuries. Methods: A comprehensive literature review was conducted through a systematic search of electronic databases, employing refined search terms and Boolean operators to focus on prehospital management of spinal cord injuries from the inception of each database to July 2023. Inclusion criteria involved original research articles, systematic reviews, and meta-analyses, with a screening process led by two independent reviewers and subsequent data extraction to inform evidence synthesis, accounting for study limitations and bias assessments. Results: This systematic review summarizes findings from eight clinical interventional studies on preventing idiopathic spinal cord injury (SCI) during prehospital emergency aid for traumatized patients. The studies encompassed diverse populations and interventions, revealing variable effectiveness in reducing idiopathic SCI incidence. Notably, specialized protocols for pediatric spinal immobilization and modifications for geriatric patients demonstrated promising effectiveness, emphasizing the importance of age-specific considerations in prehospital care for SCI prevention. Conclusions: The systematic review findings underscore the nuanced nature of prehospital interventions for idiopathic spinal cord injury prevention, emphasizing the importance of age-specific considerations and cautioning against a one-size-fits-all approach, while also highlighting the need for ongoing research to refine protocols and improve patient outcomes given the lack of definitive evidence in favor of early versus delayed immobilization.