Emergency Medical Services Response Research Articles

Helicopter emergency medical services (HEMS) response to out-of-hospital cardiac arrest (OHCA) in the United States

IntroductionHelicopter emergency medical services (HEMS) are used in the United States and globally to respond to patients with critical illness and victims of traumatic injury. Relatively limited research has examined their role in responding to out-of-hospital cardiac arrests (OHCA) in the United States. In this study, we compared OHCA treated by HEMS units with cardiac arrests treated by ground ambulances. MethodsWe queried a large national-level database of emergency medical services (EMS) activations in the United States (NEMSIS). Inclusion criteria were OHCA activations between January 1, 2022 and December 31, 2022 treated by either HEMS or ground ambulance. Key arrest data from both groups were then compared. Interfacility transfers and cardiac arrests after EMS arrival were excluded. ResultsA total of 1,233 cardiac arrests treated by HEMS and 341,096 cardiac arrests treated by ground ambulances met inclusion criteria. Comparing the two groups, cardiac arrests with HEMS response were more likely to be male (66.7% vs. 62.8%, p < 0.01), White (50.2% vs. 45.7%, p < 0.01), under 18 years old (10.9% vs. 2.7%, p < 0.001), associated with traumatic injury (19.1% vs. 5.7%, p < 0.001), witnessed (72.7% vs. 37.3%, p < 0.001), and initially-shockable (24.7% vs. 11.1%, p < 0.001). ConclusionOur comparison of cardiac arrests treated by HEMS with cardiac arrests treated by ground ambulance reveals significant differences between the two groups. Further research is needed to better characterize HEMS’ ideal role in the response to OHCA as new prehospital resuscitative techniques for non-traumatic and traumatic cardiac arrest are developed.

Dispatch Categories as Indicators of Out-of-Hospital Time Critical Interventions and Associated Emergency Department Outcomes

Objectives Emergency medical services (EMS) systems increasingly grapple with rising call volumes and workforce shortages, forcing systems to decide which responses may be delayed. Limited research has linked dispatch codes, on-scene findings, and emergency department (ED) outcomes. This study evaluated the association between dispatch categorizations and time-critical EMS responses defined by prehospital interventions and ED outcomes. Secondarily, we proposed a framework for identifying dispatch categorizations that are safe or unsafe to hold in queue. Methods This retrospective, multi-center analysis encompassed all 9-1-1 responses from 8 accredited EMS systems between 1/1/2021 and 06/30/2023, utilizing the Medical Priority Dispatch System (MPDS). Independent variables included MPDS Protocol numbers and Determinant levels. EMS treatments and ED diagnoses/dispositions were categorized as time-critical using a multi-round consensus survey. The primary outcome was the proportion of EMS responses categorized as time-critical. A non-parametric test for trend was used to assess the proportion of time-critical responses Determinant levels. Based on group consensus, Protocol/Determinant level combinations with at least 120 responses (∼1 per week) were further categorized as safe to hold in queue (<1% time-critical intervention by EMS and <5% time-critical ED outcome) or unsafe to hold in queue (>10% time-critical intervention by EMS or >10% time-critical ED outcome). Results Of 1,715,612 EMS incidents, 6% (109,250) involved a time-critical EMS intervention. Among EMS transports with linked outcome data (543,883), 12% had time-critical ED outcomes. The proportion of time-critical EMS interventions increased with Determinant level (OMEGA: 1%, ECHO: 38%, p-trend < 0.01) as did time-critical ED outcomes (OMEGA: 3%, ECHO: 31%, p-trend < 0.01). Of 162 unique Protocols/Determinants with at least 120 uses, 30 met criteria for safe to hold in queue, accounting for 8% (142,067) of incidents. Meanwhile, 72 Protocols/Determinants met criteria for unsafe to hold, accounting for 52% (883,683) of incidents. Seven of 32 ALPHA level Protocols and 3/17 OMEGA level Protocols met the proposed criteria for unsafe to hold in queue. Conclusions In general, Determinant levels aligned with time-critical responses; however, a notable minority of lower acuity Determinant level Protocols met criteria for unsafe to hold. This suggests a more nuanced approach to dispatch prioritization, considering both Protocol and Determinant level factors.

Exploring paramedic perspectives on emergency medical service (EMS) delivery in Alberta: a qualitative study.

Emergency Medical Services (EMS) in Alberta are facing critical challenges. This qualitative study aims to describe and understand the frontline perspective regarding system level issues and propose provider-informed policy recommendations. 19 semi-structured one-on- one interviews were conducted with Primary or Advanced Care Paramedics (PCP/ACP) across Alberta. Participants were asked to share their perspectives, experiences and recommendations in relation to EMS response times and the working environment. Interviews were analyzed using thematic analysis to identify themes and subthemes. Two core themes were identified as areas of concern: poor response times and the EMS working environment, which each influence and impact the other. Within response times, paramedics highlighted specific difficulties with ED offloading, a lack of resources, low-acuity calls, and rural challenges. In terms of the EMS working environment, four subthemes were apparent including attrition, unhealthy culture, organizational barriers and the need for paramedic empowerment. Providers made many recommendations including creating and expanding emergency mobile integrated health (MIH) branches, sharing 811 and 911 responses, and enforcing ED target offload times amongst other suggestions. While response times are a key and highly visible problem, there are many critical factors like the EMS working environment that degrade patient care and cause concern amongst frontline practitioners. Multifaceted policy changes are to be explored to reduce disfunction within EMS services, enhance the well-being of the workforce and deliver improved patient care. Specific EMS-oriented policies are important for moving forward to reduce transfers to EDs, but the broader health system which is over capacity is causing downstream effects into EMS must be addressed by government and health administrators.

Differences in Out-of-Hospital Cardiac Arrest Outcomes Among 5 Racial/Ethnic Groups

Objective Out-of-hospital cardiac arrest (OHCA) is a major health problem and one of the leading causes of death in adults older than 40. Multiple prior studies have demonstrated survival disparities based on race/ethnicity, but most of these focus on a single racial/ethnic group. This study evaluated OHCA variables and outcomes among on 5 racial/ethnic groups. Methods This is a retrospective review of data for adult patients in the Cardiac Arrest Registry to Enhance Survival (CARES) from 3 racially diverse urban counties in the San Francisco Bay Area from May 2009 to October 2021. Stratifying by 5 racial/ethnic groups, we evaluated patient survival outcomes based on patient demographics, emergency medical services response location, cardiac arrest characteristics, and hospital interventions. Adjusted risk ratios were calculated for survival to hospital discharge, controlling for sex, age, response locations, median income of response location, arrest witness, shockable rhythm, and bystander cardiopulmonary resuscitation as well as clustering by census tract. Results There were 10,757 patient entries analyzed: 42% White, 24% Black, 18% Asian, 9.3% Hispanic, 6.0% Pacific Islander, 0.7% American Indian/Alaska Native, and 0.1% multiple races selected; however, only the first 5 racial/ethnic groups had sufficient numbers for comparison. The adjusted risk ratio for survival to hospital discharge was lower among the 4 racial/ethnic groups compared with the White reference group: Black (0.79, p = 0.003), Asian (0.78 p = 0.004), Hispanic (0.79, p = 0.018), and Pacific Islander (0.78, p = 0.041) groups. The risk difference for positive neurologic outcome was also lower among all 4 racial/ethnic groups compared with the White reference group. Conclusions The Black, Asian, Hispanic, and Pacific Islander groups were less likely to survive to hospital discharge from OHCA when compared with the White reference group. No variables were associated with decreased survival across any of these 4 groups.

Emergency Medical Service Attendances for Adults with Repeat Falls in Western Australia: A State-Wide Retrospective Cohort Study

Objectives The risk of falls increases with age and often requires an emergency medical service (EMS) response. We compared the characteristics of patients attended by EMS in response to repeat falls within 30 days and 12 months of their first EMS-attended fall; and explored the number of days between the index fall and the subsequent fall(s). Methods This retrospective cohort study included all adults (> =18 years of age) who experienced their first EMS-attended fall between 1 January 2016 and 31 December 2020, followed up until 31 December 2021. Patients who experienced > =1 subsequent fall, following their first recorded fall, were defined as experiencing repeat falls. Multivariable logistic regression was used to identify the factors associated with repeat falls; and Kaplan-Meier analysis was used to estimate the time (in days) between consecutive EMS-attended falls. Results A total of 128,588 EMS-attended fall-related incidents occurred involving 77,087 individual patients. Most patients, 54,554 (71%) were attended only once for a fall-related incident (30,280 females; median age 73 years, inter-quartile range (IQR): 55–84). A total of 22,533 (29%) patients experienced repeat EMS-attended falls (13,248 females; median age 83 years, IQR: 74–89, at first call). These 22,533 patients accounted for 58% (74,034 attendances) of all EMS-attendances to fall-related incidents. Time between EMS-attended falls decreased significantly the more falls a patient sustained. Among the 22,533 patients who experienced repeat falls, 13,363 (59%) of repeat falls occurred within 12 months: 3,103 (14%) of patients sustained their second fall within 30 days of their index fall, and 10,260 (46%) between 31 days to 12 months. Patients who were transported to the hospital, via any urgency, at their first EMS-attended fall, had a reduced odds of sustaining a second EMS-attended fall within both 30 days and 31 days to 12 months, compared to non-transported patients. Conclusion Nearly 30% of all patients attended by EMS for a fall, sustained repeat falls, which collectively accounted for nearly 60% of all EMS-attendances to fall-related incidents. Further exploration of the role EMS clinicians play in identifying and referring patients who sustain repeat falls into alternative pathways is needed.

Advancing Emergency Medical Services’ (EMS) Response Capability for Behavioral Health Emergencies: Los Angeles County’s Performance Improvement Initiative

Introduction Behavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency’s Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders. Methods A Behavioral Health Initiative Committee was assembled with broad representation from EMS, LE, health agencies, and the public. Committee objectives included: 1) produce a process map of the BHE response from the time of a 9-1-1 call to patient arrival at transport destination, 2) identify and describe the different agencies that respond, 3) describe the critical decision points in the EMS and LE field responses, 4) acquire data that quantitatively and/or qualitatively describe the services available, and 5) recommend interventions for system performance improvement. Results The committee generated comprehensive process maps for the prehospital response to BHEs, articulated principles for evaluation, and described key observations of the current system including: 9-1-1 dispatch criteria are variable and often defaults to a LE response, the LE response inadvertently criminalizes BHEs, EMS field treatment protocols for BHEs (and especially agitated patients) are limited, substance use disorder treatment lacks integration, destination options differ by transporting agency, and receiving facilities’ capabilities to address BHEs are variable. Recommendations for performance improvement interventions and initial implementation steps included: standardize dispatch protocols, shift away from a LE primary response, augment EMS treatment protocols for BHEs and the management of agitation, develop alternate destination for EMS transport. Conclusion This paper describes a comprehensive performance improvement initiative in LAC-EMSA’s 9-1-1 response to BHEs. The initiative included a thorough current state analysis, followed by future state mapping and the implementation of interventions to reduce LE as the primary responder when an EMS response is often warranted, and to improve EMS protocols and access to resources for BHEs.

Socioeconomic disadvantage and long-term survival duration in out-of-hospital cardiac arrest patients: A population-based cohort study

BackgroundSocioeconomic status (SES) is a well-established determinant of cardiovascular health. However, the relationship between SES and clinical outcomes in long-term out-of-hospital cardiac arrest (OHCA) is less well-understood. The Singapore Housing Index (SHI) is a validated building-level SES indicator. We investigated whether SES as measured by SHI is associated with long-term OHCA survival in Singapore. MethodsWe conducted an open cohort study with linked data from the Singapore Pan-Asian Resuscitation Outcomes Study (PAROS), and the Singapore Registry of Births and Deaths (SRBD) from 2010 to 2020. We fitted generalized structural equation models, calculating hazard ratios (HRs) using a Weibull model. We constructed Kaplan–Meier survival curves and calculated the predicted marginal probability for each SHI category. ResultsWe included 659 cases. In both univariable and multivariable analyses, SHI did not have a significant association with survival. Indirect pathways of SHI mediated through covariates such as Emergency Medical Services (EMS) response time (HR of low-medium, high-medium and high SHI when compared to low SHI: 0.98 (0.88–1.10), 1.01 (0.93–1.11), 1.02 (0.93–1.12) respectively), and age of arrest (HR of low-medium, high-medium and high SHI when compared to low SHI: 1.02 (0.75–1.38), 1.08 (0.84–1.38), 1.18 (0.91–1.54) respectively) had no significant association with OHCA survival. There was no clear trend in the predicted marginal probability of survival among the different SHI categories. ConclusionsWe did not find a significant association between SES and OHCA survival outcomes in residential areas in Singapore. Among other reasons, this could be due to affordable healthcare across different socioeconomic classes.

Measures of patient acuity among children encountered by emergency medical services by the Child Opportunity Index

ABSTRACT Background. Children have differing utilization of emergency medical services (EMS) by socioeconomic status. We evaluated differences in prehospital care among children by the Child Opportunity Index (COI), the agreement between a child’s COI at the scene and at home, and in-hospital outcomes for children by COI. Methods. We performed a retrospective study of pediatric (<18 years) scene encounters from approximately 2,000 United States EMS agencies from the 2021-2022 ESO Data Collaborative. We evaluated socioeconomic status using the multi-dimensional COI v2.0 at the scene. We described EMS interventions and in-hospital outcomes by COI categories using ordinal regression. We evaluated the agreement between the home and scene COI. Results. Data were available for 99.8% of pediatric scene runs, with 936,940 included EMS responses. Children from lower COI areas more frequently had a response occurring at home (62.9% in Very Low COI areas; 47.1% in Very High COI areas). Children from higher COI areas were more frequently not transported to the hospital (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.86-0.87). Children in lower COI areas had lower use of physical (OR 1.23, 95% CI 1.13-1.33) and chemical (OR 1.41, 95% CI 1.29-1.55) restraints for behavioral health problems. Among injured children with elevated pain scores (≥7), analgesia was provided more frequently to children in higher COI areas (OR 1.73, 95% CI 1.65-1.81). The proportion of children in cardiac arrest was lowest from higher COI areas. Among 107,114 encounters with in-hospital data, the proportion hospitalized was higher among children from higher COI areas (OR 1.14, 95% CI 1.11-1.18) and the proportion with in-hospital mortality lower (OR 0.75, 95% CI 0.65-0.85). Home and scene COI had strong agreement (Kendall’s W = 0.81). Conclusion. Patterns of EMS utilization among children with prehospital emergencies differ by COI. Some measures, such as for in-hospital mortality, occurred more frequently among children transported from Very Low COI areas, whereas others, such as admission, occurred more frequently among children from Very High COI areas. These findings have implications in EMS planning and in alternative out-of-hospital care models, including in regional placement of ambulance stations.

Emergency medical service response for cases of stroke-suspected seizure: A population-based study

ObjectivesWe evaluated the on-scene time of emergency medical services (EMS) for cases where discrimination between acute stroke and epileptic seizures at the initial examination was difficult and identified factors linked to delays in such scenarios. Materials and MethodsA retrospective review of cases with suspected seizure using the EMS database of fire departments across six Japanese cities between 2016 and 2021 was conducted. Patient classification was based on transport codes. We defined cases with stroke-suspected seizure as those in whom epileptic seizure was difficult to differentiate from stroke and evaluated their EMS on-scene time compared to those with epileptic seizures. ResultsAmong 30,439 cases with any seizures, 292 cases of stroke-suspected seizure and 8,737 cases of epileptic seizure were included. EMS on-scene time in cases of stroke-suspected seizure was shorter than in those with epileptic seizure after propensity score matching (15.1±7.2 min vs. 17.0±9.0 min; p = 0.007). Factors associated with delays included transport during nighttime (odds ratio [OR], 1.73, 95 % confidence interval [CI] 1.02–2.93, p = 0.041) and transport during the 2020–2021 pandemic (OR, 1.77, 95 % CI 1.08–2.90, p = 0.022). ConclusionThis study highlighted the difference between the characteristics in EMS for stroke and epileptic seizure by evaluating the response to cases with stroke-suspected seizure. Facilitating prompt and smooth transfers of such cases to an appropriate medical facility after admission could optimize the operation of specialized medical resources.

Abstract WMP36: Quality Improvement for Improved Ischemic Stroke Large Vessel Occlusion Door-In-Door-Out Times at an Urban Primary Stroke Center Integrated Health System

Background: Stroke patients who present to an Emergency Department (ED) with an acute ischemic stroke (AIS) due to a large vessel occlusion (LVO) and are eligible for endovascular stroke therapy (EST) require rapid transfer to a facility capable of EST. Nationwide data for 2022 suggest that 19% of LVO patients are transferred for EST within 90 minutes. Our practice center is a large urban community-based Primary Stroke Center, part of a spoke and hub integrated system. In 2022, we had a median door-in-door-out (DIDO) time of 98 min with 33% percent of cases under 90 min (n = 12). Purpose: Knowing the importance of early reperfusion, we implemented a quality improvement project using a pre-post design to improve our DIDO times for patients with AIS due to LVO, with a goal of achieving a median DIDO time of 75 min or less. Methods: Our approach was multidisciplinary. We completed comprehensive chart reviews focusing on critical time points and reviewed recent literature (2022 - 2023) for best practices. We created an ED interdisciplinary DIDO workgroup which developed and implemented a DIDO checklist after education and socialization. In March 2023, we created a dedicated regional neuro transfer hub to address changes with EMS notification and response to expedite LVO transfers. Other DIDO literature recommendations were already in place, including the use of a regionalized telestroke program. Best practices identified but not implemented focused on Emergency Medical Services (EMS), such as holding a rig while completing imaging, providing enroute reports, and conducting joint drills post-COVID. Results: After the implementation of the DIDO checklist, DIDO times decreased to 82 minutes from August 2022 to July 2023 (a decrease of 16 min), with 44% of cases under 75 mins (n = 9). Our median time for 2023 (January - July) is 68 min (n = 2). Conclusion: Transfer of LVO patients is a low-volume, high-risk event, but one where every minute matters for optimal patient outcomes. The DIDO checklist was a helpful aid for staff to ensure key steps were completed timely, leading to a decrease in DIDO times.

Description of the Public Safety Medical Response and Patient Encounters Within and During the Indianapolis (USA) Spring 2020 Civil Unrest.

This study describes the local Emergency Medical Services (EMS) response and patient encounters corresponding to the civil unrest occurring over a four-day period in Spring 2020 in Indianapolis, Indiana (USA). This study describes the non-conventional EMS response to civil unrest. The study included patients encountered by EMS in the area of the civil unrest occurring in Indianapolis, Indiana from May 29 through June 1, 2020. The area of civil unrest defined by Indianapolis Metropolitan Police Department covered 15 blocks by 12 blocks (roughly 4.0 square miles) and included central Indianapolis. The study analyzed records and collected demographics, scene times, interventions, dispositions, EMS clinician narratives, transport destinations, and hospital course with outcomes from receiving hospitals for patients extracted from the area of civil unrest by EMS. Twenty-nine patients were included with ages ranging from two to sixty-eight years. In total, EMS transported 72.4% (21 of 29) of the patients, with the remainder declining transport. Ballistic injuries from gun violence accounted for 10.3% (3 of 29) of injuries. Two additional fatalities from penetrating trauma occurred among patients without EMS contact within and during the civil unrest. Conditions not involving trauma occurred in 37.9% (11 of 29). Among transported patients, 33.3% (7 of 21) were admitted to the hospital and there was one fatality. While most EMS transports did not result in hospitalization, it is important to note that the majority of EMS calls did result in a transport. There was a substantial amount of non-traumatic patient encounters. Trauma in many of the encounters was relatively severe, and the findings imply the need for rapid extraction methods from dangerous areas to facilitate timely in-hospital stabilization.

Promoting Emergency Medical Service Infrastructure Equality to Reduce Road Crash Fatalities

Timely emergency medical service (EMS) is critical to mitigate outcomes of severe traffic crashes, especially in rural areas. The urban–rural inequality of the EMS infrastructure has been one of the factors contributing to a higher death rate for patients in rural road crashes. To address the spatial imbalance of EMS infrastructure, this study aimed to provide a methodological framework for evaluating the existing EMS infrastructure by taking South Korea’s EMS infrastructure expansion plans as the case study. Specifically, this study developed a road crash data-driven methodology to promote spatial balance and economical expansion of EMS infrastructure of all types, including EMS stations, hospitals, the helicopter fleet, and landing spots. Geographically weighted binary logit regression and spatial analysis identified strategic locations for prioritizing the EMS infrastructure expansion using crash victim data and road networks to close the gap between urban and rural areas. The analysis of access to existing EMS infrastructure showed that the 16 to 20 min EMS response time, including on-scene time and transport time ranging from 11 to 15 min, are significantly associated with higher crash fatalities. The results also suggested that EMS stations and heliports are inadequate to meet the EMS time thresholds in the central province of Korea. The findings of this research could inform policymakers as they are working toward expanding the EMS infrastructure and creating a more equitable EMS response when it comes to transporting rural road crash patients.

Impact of the COVID-19 pandemic on prehospital and in-hospital treatment and outcomes of patients after out-of-hospital cardiac arrest: a Japanese multicenter cohort study

BackgroundIn the chain of survival for Out-of-hospital cardiac arrest (OHCA), each component of care contributes to improve the prognosis of the patient with OHCA. The SARS-CoV-2 (COVID-19) pandemic potentially affected each part of care in the chain of survival. The aim of this study was to compare prehospital care, in-hospital treatment, and outcomes among OHCA patients before and after the COVID-19 pandemic.MethodsWe analyzed data from a multicenter prospective study in Kanto area, Japan, named SOS-KANTO 2017. We enrolled patients who registered during the pre-pandemic period (September 2019 to December 2019) and the post-pandemic period (June 2020 to March 2021). The main outcome measures were 30-day mortality and the proportion of favorable outcomes at 1 month, and secondary outcome measures were changes in prehospital and in-hospital treatments between the pre- and post-pandemic periods.ResultsThere were 2015 patients in the pre-pandemic group, and 5023 in the post-pandemic group. The proportion of advanced airway management by emergency medical service (EMS) increased (p < 0.01), and EMS call-to-hospital time was prolonged (p < 0.01) in the post- versus pre-pandemic group. There were no differences between the groups in defibrillation, extracorporeal membrane oxygenation, or temperature control therapy (p = 0.43, p = 0.14, and p = 0.16, respectively). Survival rate at 1 month and favorable outcome rate at 1 month were lower (p = 0.01 and p < 0.01, respectively) in the post- versus pre-pandemic group.ConclusionSurvival rate and favorable outcome rate 1 month after return of spontaneous circulation of OHCA worsened, EMS response time was prolonged, and advanced airway management by EMS increased in the post- versus pre-pandemic group; however, most prehospital and in-hospital management did not change between pre- and post-COVID-19 pandemic.

Software-defined traffic light preemption for faster emergency medical service response in smart cities

Proper management of rescue operations following an accident is one of the most fundamental challenges faced by today's smart cities. Taking advantage of vehicular communications, in this paper we propose novel mechanisms for the acceleration of the rescue operation resulting in a reduction in fatalities in accidents. We propose a Software-Defined Traffic Light Preemption (SD-TLP) mechanism that enables Emergency Medical Vehicles (EMVs) to travel along the rescue route with minimal interruptions. The SD-TLP makes preemption decisions based on global knowledge of the traffic conditions in the city. We also propose mechanisms for the selection of the nearest emergency center and fast discharge of the route of EMVs. Furthermore, depending on the dynamic traffic conditions on the streets at the time of the accident, an appropriate rescue route is selected for the EMV before its departure. The proposed approach is evaluated using the OMNET++ and SUMO tools over part of the Megacity of Tabriz, Iran. The simulation results demonstrate that the method can reduce the average rescue time significantly. The proposed approach keeps the resulting disruption in city traffic acceptably low while trying to shorten the rescue time as much as possible.

Association Between Emergency Medical Service Agency Intubation Rate and Intubation Success

Airway management is a crucial part of out-of-hospital care. It is not known if the rate of overall agency intubation attempts is associated with intubation success. We sought to evaluate the association between agency intubation attempt rate and intubation success using a national out-of-hospital database. We conducted a retrospective secondary analysis of the ESO Data Collaborative from 2018 to 2019, and included all adult cases with an endotracheal intubation attempt. We calculated the number of intubations attempted per 100 responses, advanced life support responses, and transports for each agency. We excluded cases originating at health care facilities and outliers. We used multivariable logistic regression to evaluate the association between agency intubation attempt rate and 1) intubation success and 2) first-pass success. We adjusted for confounders. We included 1,005 agencies attempting 58,509 intubations. Overall, the intubation success rate was 78.8%, and the first-pass success rate was 68.5%. Per agency, the median rate of intubation attempts per 100 emergency medical service responses was 0.8 (interquartile range 0.6 to 1.1). Rates of intubation attempts per 100 responses (adjusted odds ratio [aOR] 1.7; 95% confidence interval [CI] 1.6 to 1.8), advanced life support responses (aOR 1.18; 95% CI 1.16 to 1.20), and transports (aOR 1.21; 95% CI 1.18 to 1.22) were all associated with intubation success. These relationships were similar for first-pass success but with smaller effect sizes. Higher agency rates of intubation attempts were associated with increased rates of intubation success and first-pass success.

EMS during disaster: A case study on Syria Arab Red Crescent (SARC) EMS response during February 2023 earthquake

Background: On February 6, a magnitude 7.8 earthquake struck southern Turkey near the Syrian border. This was followed almost nine hours later by a magnitude 7.5 earthquake situated approximately 59 miles (95 kilometers) to the southwest. The earthquake had enormous effects on the cities of Aleppo, Latakia, Hama, and Idlib, causing significant destruction and the collapse of numerous structures as well as the devastation of water supplies. United Nations estimates that about 6 million people in government-controlled areas are affected. 200,000 people in the area around Aleppo alone have been made homeless. Overall, 170 sub-districts in 43 districts in ten governorates have been impacted by the earthquake. After more than 7,000 deaths and 10,400 injuries as a result of the earthquakes&amp;apos; effect, humanitarian operations in Syria have become much more challenging in the context of the region&amp;apos;s ongoing civil conflict. The Syrian Arab Red Crescent (SARC) has a long history and high capacity in providing various health services. Before the earthquake, SARC was and remains the primary provider of humanitarian assistance and offers ongoing services across most of the country in the areas of ambulance services, disaster management, water and sanitation, health and medical services, including mental health, primary and secondary services, livelihoods, and early recovery, while also incorporating an inclusive approach to community services including psychological and protection support. In 2021, SARC signed a Memorandum of Understanding with the Ministry of Health (MoH) granting it a unique position to become the lead emergency medical service (EMS) provider across all of Syria. Methods: A case study of the SARC EMS response during the February 2023 earthquake was developed utilizing following data resources • Document review: SARC operation reports, situation reports on International federation of Red Cross &amp; Red Crescent IFRC GO platform, lesson learned workshop report, SARC operation review workshop report • Key informant interview: SARC EMS director and EMS response team leaders Description: SARC EMS dispatch in Latakia, Aleppo, and Hama received the first calls at 4.20 a.m. on the 6th of February. EMS dispatch sent ambulances and activated forward assessment commanders, and within 10 minutes, a total of 22 ambulance cars were deployed to provide prehospital medical service and general assessment in the three governorates of Hama, Aleppo, and Latakia. During the first 24 hours, the assessment and services provided were challenged by the amount of destruction and the rabble. Some extractions were delayed due to a lack of appropriate search and rescue equipment. EMS centers in the affected governorate have been activating emergency status to provide 24/7 prehospital services to the affected population. Ambulance surge support was mobilized from Tartous to Latakia (5 ambulances) and from Homs to Hama. During the first week, SARC EMS was able to respond to 406 disaster-related requests in the three governorates: 111 critically ill patients were transferred to medical facilities, 41 patients were treated on site, and that was in addition to the non-disaster-related requests. By the end of the first month, EMS had provided prehospital service to 1034 beneficiaries, 1013 injured patients, 254 dead bodies transferred, and 45 patients treated without transfer. The earthquake-affected areas have shown a significant increase, doubling in Lattakia, 43% in Aleppo, and 15% in Hama, in the demand for EMS services up to 4 months after the earthquake. Until 15th of August SARC EMS has provided prehospital services to 5,029 cases in the affected areas, 2,387 injuries transferred and 2,388 cases treated at the place without transfer. SARC EMS service has conducted 36 community-based first aid training sessions for people in the affected areas, trained more than 780 lay people. Also, SARC has fostered the capacity of SARC EMS volunt

Effect of emergency medical service response time on fatality risk of freeway crashes: Bayesian random parameters spatial logistic approach.

Emergency medical service (EMS) serves as a pivotal role in linking injured road users to hospitals via offering first aid measures and transportation. This paper aims to investigate the effect of emergency medical service (EMS) response time on the fatality risk of freeway crashes. Crash injury severity data from Kaiyang Freeway, China in 2014 and 2015 are employed for the empirical investigation. A Bayesian random parameters spatial logistic model is developed for analyzing crash severity. Bayesian inference of the random parameters spatial logistic model demonstrates the importance of reducing EMS response time on minimizing the fatality risk of freeway crashes. Fatality odds would increase by 2.6% for 1 min increase in EMS response time. Additionally, vehicle type, crash type, time of day, horizontal curvature, vertical grade, and precipitation are also found to have significant effects on the fatality probability of freeway crashes. It is crucial to reduce EMS response time to decrease the fatality likelihood of freeway crashes. Some countermeasures have been proposed to shorten EMS response time.

Approaches for Enhancing Pre-hospital EMS Response during the COVID-19 Pandemic Machine Learning

Background: Coronavirus disease 2019 (COVID-19) caused an unprecedented healthcare crisis and warranted a need to use artificial intelligence (AI) and machine learning (ML) for enhancing caller screening and triage within pre-hospital Emergency Medical Services (EMS) specifically tailored to COVID-19 cases. This study aimed to analyze existing AI and ML models and assess their accuracy and precision. Methods: A comprehensive assessment of artificial intelligence (AI) applications used to improve EMS responses in the context of COVID-19 instances was done. The dataset produced by Mexican government was used. This dataset was assessed over different models encompassing logistic regression, random forest, gradient boosting, neural networks, k-nearest neighbors (KNN), Naive Bayes, and clustering (K-means). Results: Multiple models performance evaluation was done employing metrics such as accuracy, precision, recall, and F1-score to comprehensively assess the strengths and limitations of these models. Conclusion: The study\&amp;apos;s findings underline the complexities inherent in caller screening and triage for COVID-19 cases, showcasing diverse strengths and limitations within the deployed machine learning models. The discourse underscores the necessity for a multifaceted approach to effectively manage the intricate challenges associated with caller classification and triage, offering invaluable insights for future research endeavors and guiding the enhancement of emergency healthcare systems.

Associated Factors of Patients' Survival in Out of Hospital Cardiac Arrest; a Cross-sectional Study.

Chinese populations have an increasingly high prevalence of cardiac arrest. This study aimed to investigate the prehospital associated factors of survival to hospital admission and discharge among out-of-hospital cardiac arrest (OHCA) adult cases in Macao Special Administrative Region (SAR), China. Baseline characteristics as well as prehospital factors of OHCA patients were collected from publicly accessible medical records and Macao Fire Services Bureau, China. Demographic and other prehospital OHCA characteristics of patients who survived to hospital admission and discharge were analyzed using multivariate logistic regression analysis. A total of 904 cases with a mean age of 74.2±17.3 (range: 18-106) years were included (78%>65 years, 62% male). Initial shockable cardiac rhythm was the strongest predictor for survival to both hospital admission (OR=3.57, 95% CI: 2.26-5.63; p<0.001) and discharge (OR=12.40, 95% CI: 5.70-26.96; p<0.001). Being male (OR=1.63, 95% CI:1.08-2.46; p =0.021) and the lower emergency medical service (EMS) response time (OR=1.62, 95% CI: 1.12-2.34; p =0.010) were also associated with a 2-fold association with survival to hospital admission. In addition, access to prehospital defibrillation (OR=4.25, 95% CI: 1.78-10.12; p <0.001) had a 4-fold association with survival to hospital discharge. None of these associations substantively increased with age. The major OHCA predictors of survival were initial shockable cardiac rhythm, being male, lower EMS response time, and access to prehospital defibrillation. These findings indicate a need for increased public awareness and more education.

Increased number of dispatches in emergency medical services correlates to response time extension.

This study investigated the correlation between the number of emergency medical service (EMS) dispatches and response time extension. In addition, we conducted a simulation to assess the potential for reducing response times by relocating the ambulance based on the number of dispatches. This retrospective observational study analyzed data on patients treated with EMS between May 1 and June 25, 2021, in an urban area (Chiba City, Japan). Spearman's rank correlation tests were used to analyze the correlations among the number of dispatches, response time extension, and ambulance distance. We created a heat map to visualize the number of dispatches and distribution of emergency case occurrences, and simulated the relocation of the EMS team with the lowest number of dispatches to the closest EMS team with the highest number of dispatches. In total, 7915 emergency cases were included. The median response time across all dispatches was 9 min, whereas that for the response time extension cases was 12 min. There was a significant positive correlation between the increased number of dispatches, response time extension (r = 0.94, p < 0.0001), and ambulance distance (r = 0.95, p < 0.0001). The relocation simulation significantly shortened the average response time from 13 min and 30 s to 12 min and 11 s (9.9% decrease, p < 0.0001). An increased number of dispatches significantly increased the response time extension cases and ambulance distance. Our simulation suggests that EMS relocation can potentially shorten the response time. While increased dispatches influence the response time extension, optimal EMS allocation may improve response times.