Emergency Medical Services Response Research Articles

Impact of COVID-19 pandemic on emergency medical service response to emergency calls — a retrospective analysis of data from Emergency Medical Service station in Bydgoszcz

Introduction: Emergency medical systems, as the first line of management of infectious patients, were affected by the 2019 coronavirus acute respiratory disease (COVID-19) pandemic. The aim of the study was to analyze the impact of the COVID-19 pandemic on the Emergency Medical Service (EMS) with emphasis on response time. Material and methods: Retrospective analysis of dispatch card from EMS in Bydgoszcz between January 2018 and December 2020. The differences regarding the EMS response were analyzed between the pre-pandemic (2018–2019) and the pandemic (2020) period in three time-points: from call to Emergency Medical Team (EMT) departure (T1), from departure to arrival at the scene (T2), and from arrival to reaching the emergency department (T3). Results: There were 47783 EMT departures in 2018, 47113 in 2019 and 40835 in 2020. In 2020 mean (SD) monthly number of interventions was significantly lower [3403 (349) vs. 3954 (182), p < 0.001) compared to the 2018–2019 period. During the pandemic period the mean T1 [0.9 (1.49) vs. 0.63 (1.12) min, p < 0.001], T2 [9.91 (6.33) vs. 8.25 (5.07) min, p < 0.001], and T3 interval [40.45 (19.84) vs. 36.56 (14.63) min, p < 0.001] were prolonged in comparison to the pre-pandemic period. The differences in response time were the largest in October–December. Conclusions: During the first year of the pandemic, the number of EMT interventions decreased and the response time was prolonged compared to the pre-pandemic period. The largest differences were observed at the end of the year, which overlapped with the peak of the second wave of COVID-19 infections in Poland.

Evaluating the effects of heat vulnerability on heat-related emergency medical service incidents: Lessons from Austin, Texas

Extreme heat exposure and sensitivity have been a growing concern in urban regions as the effects of extreme heat pose a threat to public health, the water supply, and the infrastructure. Heat-related illnesses demand an immediate Emergency Medical Service (EMS) response since they might result in death or serious disability if not treated quickly. Despite increased concerns about urban heat waves and relevant health issues, a limited amount of research has investigated the effects of heat vulnerability on heat-related illnesses. This study explores the geographical distribution of heat vulnerability in the city of Austin and Travis County areas of Texas and identifies neighborhoods with a high degree of heat vulnerability and restricted EMS accessibility. We conducted negative binomial regressions to investigate the effects of heat vulnerability on heat-related EMS incidents. Heat-related EMS calls have increased in neighborhoods with more impervious surfaces, Hispanics, those receiving social benefits, people living alone, and the elderly. Higher urban capacity, including efficient road networks, water areas, and green spaces, is likely to reduce heat-related EMS incidents. This study provides data-driven evidence to help planners prioritize vulnerable locations and concentrate local efforts on addressing heat-related health concerns.

Hispanic Farmers Experience Shorter EMS Response Times but Longer Emergency Department Length of Stay Following Occupational Injuries.

Agriculture has the highest rate of fatal injuries by sector. Hispanic workers also experience more fatal work injuries than every other minority group combined. Pre-hospital and initial trauma evaluation represent an important marker to understand the impact of a trauma system. We sought to investigate whether Hispanic agricultural workers in the United States (US) experience disparities following traumatic occupational injuries in terms of pre-hospital and emergency department care. We retrospectively analyzed the National Trauma Data Bank from 2012-2016 to understand differences between Hispanic and non-Hispanic farmers in Emergency Medical Services (EMS) response and transport times (minutes), transport mode, transfer rates, presentation to University or Level I trauma hospitals, Injury Severity Scores (ISS), length of stay (LOS) in the emergency department (ED, minutes) or hospital (days), need for the operating room (OR), admittance to the Intensive Care Unit (ICU), and mortality. A total of 6,161 farmers were included in our analyses (median age 47years, females 7.0%). Multivariable analyses indicate differences regarding EMS response, EMS transport, and LOS in the ED. Rates of admission to the ICU, surgical operations, days on a ventilator, discharge from the hospital with supportive care, and mortality did not differ between groups. Non-Hispanic patients have longer median EMS response and total transport times. Hispanic patients have longer median LOS in the ED. However, the lack of significant differences in management variables other than EMS times and ED LOS indicate an equitable delivery of trauma care once patients were transferred from the ED.

Understanding the role of faster emergency medical service response in the survival time of pedestrians

Fatalities and severe injuries among vulnerable road users, particularly pedestrians, are rising. In addition to the loss of life, about 6,000 annual pedestrian deaths in the U.S. cost society about $6 billion. Contrary to the assumption that all fatal pedestrian-involved crashes are similar, instantaneous death is substantially more severe than death that occurs several days after the crash. Instead of homogenizing all fatal pedestrian crashes, this study takes into account the severity of fatal injury crashes as a timeline based on the survival time of pedestrians. This study extracts valuable information from fatal crashes by examining pedestrians' survival time ranging from early death to death within 30 days of the crash. The Fatality Analysis Reporting System dataset is utilized from 2015 to 2018. The emergency medical service (EMS) response time is the key post-crash measure, while controlling for pedestrian, driver, roadway, and environmental characteristics. Notably, the response time and survival time can cause endogeneity, i.e., the response times may be shorter for more severe crashes. Due to the spatial and temporal nature of traffic crashes, to extract the association of different variables with pedestrians' survival time, a geographically and temporally weighted truncated regression with a two-stage residual inclusion treatment (local model) is estimated. The local model can overcome the endogeneity limitation (between EMS response time and survival time) and uncover the potentially spatially and temporally varying correlates of pedestrians’ survival time with associated factors to account for unobserved heterogeneity. Moreover, to verify the variations are noticeable, a truncated regression with the two-stage residual inclusion treatment is developed (global model). The modeling results indicate that while capturing the unobserved heterogeneity, the local model outperformed the global model. The empirical results show that EMS response time, speeding, and some pedestrian behaviors are the most important factors that affect pedestrians’ survival time in fatal injury crashes. However, the effect of factors on pedestrians’ survival time is noticeably varied spatially and temporally. The results and their implications are discussed in detail in the paper.

The Correlation between COVID-19 Hospitalizations and Emergency Medical Services Responses for Time-Sensitive Emergencies during the COVID-19 Pandemic

Objective COVID-19 has had significant secondary effects on health care systems, including effects on emergency medical services (EMS) responses for time-sensitive emergencies. We evaluated the correlation between COVID-19 hospitalizations and EMS responses for time-sensitive emergencies in a large EMS system. Methods This was a retrospective study using data from the Los Angeles County EMS Agency. We abstracted data on EMS encounters for stroke, ST-elevation myocardial infarction (STEMI), out-of-hospital cardiac arrest (OHCA), and trauma from April 5, 2020 to March 6, 2021 and for the same time period in the preceding year. We also abstracted daily hospital admissions and censuses (total and intensive care unit [ICU]) for COVID-19 patients. We designated November 29, 2020 to February 27, 2021 as the period of surge. We calculated Spearman’s correlations between the weekly averages of daily hospital admissions and census and EMS responses overall and for stroke, STEMI, OHCA, and trauma. Results During the study period, there were 70,616 patients admitted for confirmed COVID-19, including 12,467 (17.7%) patients admitted to the ICU. EMS responded to 899,794 calls, including 9,944 (1.1%) responses for stroke, 3,325 (0.4%) for STEMI, 11,207 (1.2%) for OHCA, and 114,846 (12.8%) for trauma. There was a significant correlation between total hospital COVID-19 positive patient admissions and EMS responses for all time-sensitive emergencies, including a positive correlation with stroke (0.41), STEMI (0.37), OHCA (0.78), and overall EMS responses (0.37); and a negative correlation with EMS responses for trauma (-0.48). ICU COVID-19 positive patient admissions also correlated with increases in EMS responses for stroke (0.39), STEMI (0.39), and OHCA (0.81); and decreased for trauma (-0.53). Similar though slightly weaker correlations were found when evaluating inpatient census. During the period of surge, the correlation with overall EMS responses increased substantially (0.88) and was very strong with OHCA (0.95). Conclusion We found significant correlation between COVID-19 hospitalizations and the frequency of EMS responses for time-sensitive emergencies in this regional EMS system. EMS systems should consider the potential effects of this and future pandemics on EMS responses and prepare to meet non-pandemic resource needs during periods of surge, particularly for time-sensitive conditions.

Privacy-Preserving Prediction of Victim’s Mortality and Their Need for Transportation to Health Facilities

Emergency medical services (EMS) provide crucial prehospital care, such as in the case of cardiac arrest, where the victim requires immediate first-aid. For this reason, it is vital to improving EMS response time. This article proposes a novel methodology based on machine learning (ML) techniques to predict both the victims’ mortality and their need for transportation to health facilities using data gathered from the start of the emergency call until the Departmental Fire and Rescue Service of the Doubs (SDIS25) is notified. We first analyzed SDIS25 calls to find out associations between the call processing times and victims’ mortality, and to measure the variables’ importance. Next, we validated our proposed ML-based methodology, where mortality could be predicted with accuracy and area under the receiver operating characteristic curve (AUC) scores of 96.44% and 96.04%, respectively, while the need for transportation achieved an accuracy and AUC scores of 73.62% and 78.91%, respectively. What is more, we found out that it was still possible to predict both targets perturbating the input data by applying <italic xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">k</i> -anonymity and differential privacy techniques. In conclusion, the results showed the potential of ML for EMS, which can be used as a decision-support tool to early identify mortality and the use of resources (transportation) and, thus, help EMS to save more lives and avoid service disruptions.

The Crowd Crush at Mount Meron: Emergency Medical Services Response to a Silent Mass Casualty Incident.

On April 30, 2021, a total of 45 died and 112 were injured in a crowd crush at a religious festival on Mount Meron, Israel. Unlike a bomb blast, building collapse, mass shooting, or stampede, the incident lacked a dramatic, noticeable trigger and may be termed a "silent mass casualty incident (MCI)." This may have resulted in a slight delay in response. Magen David Adom (MDA)-Israel's National Emergency Medical Services Organization-was the main prehospital response to the MCI. MDA's intense planning, organization of medical infrastructure, and on-site MCI drill before the event allowed for the rapid, coordinated treatment and evacuation of casualties by ambulance and helicopter. The use of volunteers facilitated an effective response to the event. A "rolling reinforcement" system of ambulances helped treat and transport those at the scene while placing staff at stations throughout the country to serve routine emergency calls.

Prevalence and correlates of incarceration following emergency medical services response to overdose

BackgroundTo describe the prevalence of incarceration among survivors of non-fatal overdose addressed through an emergency medical services (EMS) response, and compare incarceration by whether the emergency was for opioid-involved or stimulant-involved overdose. MethodsAdministrative records on 192,113 EMS incidents and 70,409 jail booking events occurring between January 1, 2019 and December 31, 2020 in Indianapolis, Indiana were record-linked at the event level. Incarceration taking place within 6-hours of an EMS incident was associated with that incident. Logistic regression was used to calculate adjusted odds ratios (AOR) of incarceration after an overdose. ResultsAmong all EMS incidents, 2.6% were followed by incarceration. For overdose EMS incidents, the prevalence of incarceration was 10.0%. Overdose incidents had higher odds than non-overdose incidents of leading to a charge of felony, booked on a warrant, and transferred to another law enforcement agency upon release. Prevalence of incarceration following a stimulant-involved overdose was 21.3%, compared to 9.3% for opioid-involved overdose survivors. Compared to persons from other EMS incidents, overdose survivors had greater odds of incarceration (AOR=3.48, 95% confidence interval (CI)= 3.22, 3.75, p < .001), with opioid-involved overdoses (AOR=3.03, 95% CI=2.76, 3.33, p < .001) and stimulant-involved overdoses (AOR=6.70, 95% CI=5.26, 8.55, p < .001) leading to higher odds of incarceration. ConclusionIncarceration in county jail followed one in ten overdose-involved EMS responses. As illicit drug consumption increasingly involves stimulants, the frequency of incarceration following these events is likely to increase. Policy changes and interventions are needed to reduce incarceration after overdose emergencies.

Spatial clustering of heroin-related overdose incidents: a case study in Cincinnati, Ohio

BackgroundDrug overdose is one of the top leading causes of accidental death in the U.S., largely due to the opioid epidemic. Although the opioid epidemic is a nationwide issue, it has not affected the nation uniformly.MethodsWe combined multiple data sources, including emergency medical service response, American Community Survey data, and health facilities datasets to analyze distributions of heroin-related overdose incidents in Cincinnati, Ohio at the census block group level. The Ripley’s K function and the local Moran’s I statistics were performed to examine geographic variation patterns in heroin-related overdose incidents within the study area. Then, conditional cluster maps were plotted to examine a relationship between heroin-related incident rates and sociodemographic characteristics of areas as well as the resources for opioid use disorder treatment.ResultsThe global spatial analysis indicated that there was a clustered pattern of heroin-related overdose incident rates at every distance across the study area. The univariate local spatial analysis identified 7 hot spot clusters, 27 cold spot clusters, and 1 outlier cluster. Conditional cluster maps showed characteristics of neighborhoods with high heroin overdose rates, such as a higher crime rate, a high percentage of the male, a high poverty level, a lower education level, and a lower income level. The hot spots in the Southwest areas of Cincinnati had longer distances to opioid treatment programs and buprenorphine prescribing physicians than the median, while the hot spots in the South-Central areas of the city had shorter distances to those health resources.ConclusionsOur study showed that the opioid epidemic disproportionately affected Cincinnati. Multi-phased spatial clustering models based on various data sources can be useful to identify areas that require more policy attention and targeted interventions to alleviate high heroin-related overdose rates.

Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan

BackgroundThe impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient...

Variation in Out-of-Hospital Cardiac Arrest Survival Across Emergency Medical Service Agencies.

Although studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by geographic location, little is known about variation in OHCA survival at the level of emergency medical service (EMS) agencies-which may have modifiable practices, unlike counties and regions. We quantified the variation in OHCA survival across EMS agencies and explored whether variation in 2 specific EMS resuscitation practices were associated with survival to hospital admission. Within the Cardiac Arrest Registry to Enhance Survival, a prospective registry representing ≈51% of the US population, we identified 258 342 OHCAs from 764 EMS agencies with >10 OHCA cases annually during 2015 to 2019. Using hierarchical logistic regression, risk-standardized rates of survival to hospital admission were computed for each EMS agency. We quantified inter-agency variation in survival with median odds ratios and assessed the association of 2 resuscitation practices (EMS response time and the proportion of OHCAs with termination of resuscitation without meeting futility criteria) with EMS agency survival rates to hospital admission. Across 764 EMS agencies comprising 258 342 OHCAs, the median risk-standardized rate of survival to hospital admission was 27.3% (interquartile range, 24.5%-30.1%; range: 16.0%-45.6%). The adjusted median odds ratio was 1.35 (95% CI, 1.32-1.39), denoting that the odds of survival of 2 patients with identical covariates varied by 35% at 2 randomly selected EMS agencies. EMS agencies in the lowest quartile of risk-standardized survival had longer EMS response times when compared with the highest quartile (12.0±3.4 versus 9.0±2.6 minutes; P<0.001), and a higher proportion of OHCAs with termination of resuscitation without meeting futility criteria (27.9±16.1% versus 18.9±11.4%; P<0.001). Survival after OHCA varies widely across EMS agencies. EMS response times and termination of resuscitation practices were associated with agency-level rates of survival to hospital admission, suggesting potentially modifiable practices which can improve OHCA survival.

Description of the 2020 NEMSIS Public-Release Research Dataset

Background The National Emergency Medical Services Information System (NEMSIS) is a federally funded program designed to standardize Emergency Medical Services (EMS) patient care reporting and facilitate state and national data repositories for the assessment and improvement of EMS systems of care. This manuscript characterizes the 2020 submissions to the National EMS Database, detailing the strengths and limitations associated with use of these data for public health surveillance, improving prehospital patient care, critical resource allocation, clinician safety, system quality assurance and research purposes. Methodology Using the 2020 NEMSIS Public-Release Research Dataset (NEMSIS dataset), we evaluated the dataset completeness (i.e., presence of missing/null values), dataset content and assessed data generalizability. The analysis focused on 9-1-1 EMS activations resulting in the treatment and transport of a patient, except for out-of-hospital cardiac arrests for which all patients were included regardless of transport status. Results In 2020, 43,488,767 EMS activations were reported to the National EMS Database by 12,319 agencies serving 50 states and territories. Of the 19,533,036 9-1-1 EMS activations reportedly treating and transporting a patient, the majority were attended by “non-volunteer” clinicians (77%) working in a fire-based EMS agency (35%) certified to offer Advanced Life Support (ALS) Paramedic service (80%) and located in an urban area (82%). 9-1-1 call centers most often dispatched EMS for “sick person” (20%), while EMS clinicians most likely reported asthenia (7%) as the patient’s primary symptom as well as the clinician’s primary impression (6%), and documented “fall on same level, slip, or trip” as the most common cause of injury (37%). The NEMSIS dataset demonstrates some “missingness” and element inconsistencies, but methods may be employed to mitigate these data limitations. Conclusions The National EMS Database is a free and publicly available resource for evaluating EMS system utilization, response, and prehospital patient care. Understanding the characteristics of the underlying dataset and known data limitations will help ensure proper analysis and reporting of research and quality metrics based on nationally standardized NEMSIS data.

Observational study on implications of the COVID-19-pandemic for cardiopulmonary resuscitation in out-of-hospital cardiac arrest: qualitative and quantitative insights from a model region in Germany

BackgroundThe city of Freiburg has been among the most affected regions by the COVID-19 pandemic in Germany. In out of hospital cardiac arrest (OHCA) care, all parts of the rescue system were exposed to profound infrastructural changes. We aimed to provide a comprehensive overview of these changes in the resuscitation landscape in the Freiburg region.MethodsUtstein-style quantitative data on OHCA with CPR initiated, occurring in the first pandemic wave between February 27th, 2020 and April 30th, 2020 were compared to the same time periods between 2016 and 2019.Additionally, qualitative changes in the entire rescue system were analyzed and described.ResultsIncidence of OHCA with attempted CPR did not significantly increase during the pandemic period (11.1/100.000 inhabitants/63 days vs 10.4/100.000 inhabitants/63 days, p = 1.000). In witnessed cases, bystander-CPR decreased significantly from 57.7% (30/52) to 25% (4/16) (p = 0.043). A severe pre-existing condition (PEC) was documented more often, 66.7% (16/24) vs 38.2% (39/102) there were longer emergency medical services (EMS) response times, more resuscitation attempts terminated on scene, 62.5% (15/24) vs. 34.3% (35/102) and less patients transported to hospital (p = 0.019). Public basic life support courses, an app-based first-responder alarm system, Kids Save Lives activities and a prehospital extracorporeal CPR (eCPR) service were paused during the peak of the pandemic.ConclusionIn our region, bystander CPR in witnessed OHCA cases as well as the number of patients transported to hospital significantly decreased during the first pandemic wave. Several important parts of the resuscitation landscape were paused. The COVID-19 pandemic impedes OHCA care, which leads to additional casualties. Countermeasures should be taken.

Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats.

BackgroundClimate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring.ObjectiveThe objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26°C.MethodsWe used secondary data—indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non–air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018.ResultsThere were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non–heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non–air conditioned houses.ConclusionsOur findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses.

Accuracy of emergency medical service telephone triage of need for an ambulance response in suspected COVID-19: an observational cohort study

ObjectiveTo assess accuracy of emergency medical service (EMS) telephone triage in identifying patients who need an EMS response and identify factors which affect triage accuracy.DesignObservational cohort study.SettingEmergency telephone triage provided...

Emergency Medical Services Prehospital Response to the COVID-19 Pandemic in the US: A Brief Literature Review.

This study aimed to analyze prehospital Emergency Medical Services (EMS) response to the COVID-19 pandemic in the US through a brief systematic review of available literature in context with international prehospital counterparts. An exploration of the NCBI repository was performed using a search string of relevant keywords which returned n=5128 results; articles that met the inclusion criteria (n=77) were reviewed and analyzed in accordance with PRISMA and PROSPERO recommendations. Methodical quality was assessed using critical appraisal tools, and the Egger’s test was used for risk of bias reduction upon linear regression analysis of a funnel plot. Sources of heterogeneity as defined by P < 0.10 or I^2 > 50% were interrogated. Findings were considered within ten domains: structural/systemic; clinical outcomes; clinical assessment; treatment; special populations; dispatch/activation; education; mental health; perspectives/experiences; and transport. Findings suggest, EMS clinicians have likely made significant and unmeasured contributions to care during the pandemic via nontraditional roles, ie, COVID-19 testing and vaccine deployment. EMS plays a critical role in counteracting the COVID-19 pandemic in addition to the worsening opioid epidemic, both of which disproportionately impact patients of color. As such, being uniquely influential on clinical outcomes, these providers may benefit from standardized education on care and access disparities such as racial identity. Access to distance learning continuing education opportunities may increase rates of provider recertification. Additionally, there is a high prevalence of vaccine hesitancy among surveyed nationally registered EMS providers. Continued rigorous investigation on the impact of COVID-19 on EMS systems and personnel is warranted to ensure informed preparation for future pandemic and infectious disease responses.

Ambulance dispatching and relocation problem considering overcrowding of emergency departments

An important issue in emergency medical services (EMS) is ambulance dispatching and relocation. EMS response time is usually measured by the response time of an ambulance (RTA), the time between receiving a call and the ambulance's arrival at the scene. EMS's success also depends on response time to the patient (RTP), the time between receiving a call and starting the service to the patient in a hospital. This study aims to use RTP to decide about ambulance dispatching and relocation. RTP is affected by the distance of the patient to the chosen hospital and the crowding in the hospital. Thus, this study integrates ambulance dispatching and relocation with hospital selection to better provide both RTA and RTP along with coverage while considering an overcrowded emergency department (ED). A mixed-integer linear programming model is developed to solve the proposed problem. The model's performance and the impact of the ED overcrowding factor have been examined in the context of a real case study from Utrecht, Netherlands. Findings reveal that considering RTP in joint ambulance dispatching and relocation has a 39% positive impact on the patient's average response time. Further, considering ED crowding with RTP results in 91% and 9% improvement in RTP and RTA with the same demand coverage, compared to typical ambulance dispatching and relocation problems, respectively.

Unrecognized cardiac arrests: A one-year review of audio from emergency medical dispatch calls.

Immediate recognition of out-of-hospital cardiac arrest (OHCA) by Emergency Medical Dispatch (EMD) operators is crucial to facilitate timely initiation of telephone cardiopulmonary resuscitation (T-CPR) and to enable the appropriate level of Emergency Medical Services (EMS) response. The goal of this study was to identify patterns that can increase EMD-level recognition of cardiac arrests prior to EMS arrival. The Combined Communications Center in Alachua County, Florida provided audio recordings of all emergency calls from January 1, 2018 to November 16, 2018 dispatched as a chief complaint other than OHCA, but later identified as cardiac arrest. A multi-disciplinary medical team transcribed and analyzed the calls to determine common themes and trends. Out of an initial 81 calls meeting inclusion criteria, 69 were immediately recognized as OHCA by EMDs, leaving 12 calls of unrecognized OHCA. In 11 of 12 calls respiratory issues were described to EMD. In 10 of 12 calls the subject was described as unconscious, and in the other 2 calls, the subject lost consciousness during the call. Lack of recognition of OHCA by EMD occurred in most calls due to difficulty communicating the subject's respiratory status. Further emphasis should be placed on identifying non-viable respirations in unconscious patients in EMD training and algorithms to increase recognition of OHCA and initiation of T-CPR. A multi-year review of a comparable dataset from geographically and socioeconomically diverse regions in the United States can validate and expand these preliminary trends.

Perception and Satisfaction of Patients' Relatives Regarding Emergency Medical Service Response Times: A Cross-Sectional Study.

PurposeDelays in emergency medical service (EMS) directly affect life-threatening emergencies. Delays also indirectly affect the perception and satisfaction of patients and their relatives, which are important qualitative EMS indicators.Patients and MethodsFor this cross-sectional study, data was collected from May 1 to July 31, 2021, through questionnaires developed by the authors. The study sample consisted of relatives of EMS patients. The primary objective was the perceived EMS response time, which was compared to the actual EMS response time. The secondary objective was the relatives’ perceptions and feelings regarding the waiting time.ResultsDuring study period, the sample was 165 relatives of patients managed by EMS. The mean perceived EMS response time of 18.28 ± 8.10 min was significantly longer than the mean actual response time of 14.44 ± 4.86 min (p < 0.001). The positive correlation between the perceived and actual times was low but statistically significant (p < 0.001) with a correlation coefficient of 0.315 (95% CI 0.170–0.446). The overall satisfaction level was high (noverline {rm{x}} ,{rm{ = }},{rm{4}}{rm{.47}}n, standard deviation 0.63). The mean perceived EMS response time compares with the high-to-highest satisfaction levels of relatives was significantly lower than the mean perceived EMS response time compares with the lowest-to-middle satisfaction levels of relatives (17.83 ± 8.05 and 22.50 ± 7.47 min, respectively; p = 0.028).ConclusionThe perceived EMS response time was longer than the actual response time, with a low correlation. However, the relatives’ overall satisfaction level was high.

Association between Mode of Transport and Patient Outcomes in the Emergency Department following Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Study

Background Out-of-hospital cardiac arrest (OHCA) remains a health problem worldwide, carrying a high mortality rate. Comparison of emergency department (ED) return of spontaneous circulation (ROSC) after OHCA in relation to emergency medical services (EMS) and non-EMS modes of transportation to the hospital was conducted to assess the impact points of the EMS system in Thailand. Methods This retrospective observational study enrolled all OHCA patients who visited the ED of Ramathibodi Hospital, a tertiary university hospital in Bangkok, between January 1, 2008, and May 31, 2020. Patients were differentiated into EMS and non-EMS groups according to mode of transportation to the ED. Patients’ characteristics and comorbidities, witnessed arrests, bystander chest compression, initial rhythm, and resuscitation treatment were documented. ED-sustained ROSC, ED survival, 30-day survival, and 30-day survival with good cerebral performance category (CPC) scores were monitored and recorded. Multivariate logistic analyses were performed to assess factors influencing clinical outcomes. Results A total of 339 patients were enrolled, 117 (34.51%) of whom were in the EMS transport group. There were no differences between the EMS and non-EMS groups in ED-sustained ROSC (adjusted odds ratio [aOR], 0.99; 95% confidence interval [CI], 0.58–1.70; P = 0.98), or ED survival (aOR, 0.99; 95% CI, 0.57–1.71; P = 0.97). There were also no differences in 30-day survival or 30-day survival with good CPC score between the two groups. Conclusions In our cohort data of OHCA, ED-sustained ROSC and ED survival outcomes were not superior in the EMS transportation group. Evidence to show that EMS transportation affected 30-day survival and 30-day good CPC score was also lacking. Thus, public promotion of Thailand’s EMS system is advocated with a simultaneous improvement of EMS response to enhance OHCA outcomes.