Emergency Medical Service Teams Research Articles

Simulation based CPR Training of EMS Staff and its Utility in Managing Remote Patients at Tertiary Care Hospital of Central India

Abstract Introduction: AVBRH is 1500-bedded tertiary care hospital that caters to patients from areas within more than a 50 km radius. Emergency medical services (EMS) are established and frequently on the run. The EMS team has 10 basic life support (BLS) ambulances with 20 drivers and 20 paramedical staff. Daily, 3–5 highly critical patients who are in need of cardiopulmonary resuscitation (CPR) are transferred to the AVBRH hospital. The optimal medical care while transferring the patient to AVBRH hospital was unmonitored and without any benchmark. A low-risk simulation-based environment to practice can be valuable to maintain a wide array of skills. Effective and prompt delivery of expert instruction and guidance by a telesimulation is approved to be a beneficial approach in this setting. Training of EMS staff helps to improve patient care and satisfaction. Hence, we decided to undertake the simulation-based CPR training of the staff and correlate the outcome with existing mortality data of Medical record department (MRD). Objective: To optimize health care while transferring the patient to a tertiary hospital by BLS training and teleassisting. To see the impact of teaching and assisting on overall patient outcomes at the emergency department. Methodology: Forty EMS participants were enrolled and trained for 2 days. On day 1, they were trained in BLS, while on day 2, training in working as a team through simulation at school of virtual learning was done. They were trained to work as a team through simulated case scenarios with effective telecommunication while transferring the patient to the hospital. After training, these EMS staff were monitored and assisted according to the protocol of BLS by the emergency medicine department through telecommunication on the field for the next 3 months and reassessed again after the completion of 3 months. The following tabulated assessment format is used for EMS staff attending to the patient on the field. The prefield assessment on the same day of training and on postfield assessment after 3 months at school of virtual learning-simulation lab (SVL) was conducted. The data were gathered, tabulated, and analyzed for the percentage. Conclusion and Recommendation: Simulation-based teaching by a facilitator along with effective telesimulation creates an important link and gaps in the bridge between knowledge and technical skills. It has been found that overall patient care and performance of EMS staff was significantly improved; hence, recommendations for continuous assistance while transferring the patients are given. Training of the newly appointed EMS crew and the other available EMS services from the district should be aligned with assisted telecommunication services of AVBRH. Regular audit for quality improvement in EMS performance to be imparted.

Video support for prehospital stroke consultation: implications for system design and clinical implementation from prehospital simulations

BackgroundVideo consultations between hospital-based neurologists and Emergency Medical Services (EMS) have potential to increase precision of decisions regarding stroke patient assessment, management and transport. In this study we explored the use of real-time video streaming for neurologist–EMS consultation from the ambulance, using highly realistic full-scale prehospital simulations including role-play between on-scene EMS teams, simulated patients (actors), and neurologists specialized in stroke and reperfusion located at the remote regional stroke center.MethodsVideo streams from three angles were used for collaborative assessment of stroke using the National Institutes of Health Stroke Scale (NIHSS) to assess symptoms affecting patient’s legs, arms, language, and facial expressions. The aim of the assessment was to determine appropriate management and transport destination based on the combination of geographical location and severity of stroke symptoms. Two realistic patient scenarios were created, with severe and moderate stroke symptoms, respectively. Each scenario was simulated using a neurologist acting as stroke patient and an ambulance team performing patient assessment. Four ambulance teams with two nurses each all performed both scenarios, for a total of eight cases. All scenarios were video recorded using handheld and fixed cameras. The audio from the video consultations was transcribed. Each team participated in a semi-structured interview, and neurologists and actors were also interviewed. Interviews were audio recorded and transcribed.ResultsAnalysis of video-recordings and post-interviews (n = 7) show a more thorough prehospital patient assessment, but longer total on-scene time, compared to a baseline scenario not using video consultation. Both ambulance nurses and neurologists deem that video consultation has potential to provide improved precision of assessment of stroke patients. Interviews verify the system design effectiveness and suggest minor modifications.ConclusionsThe results indicate potential patient benefit based on a more effective assessment of the patient’s condition, which could lead to increased precision in decisions and more patients receiving optimal care. The findings outline requirements for pilot implementation and future clinical tests.

Emergency medical team interventions in Poland during out-of-hospital deliveries: A retrospective analysis.

Emergency medical teams are a crucial component of healthcare systems, routinely providing essential care to pregnant patients in various situations. To evaluate the rate and outcomes of out-of-hospital deliveries attended by Emergency Medical Services (EMS) in Poland and identify areas for improvement in the care provided by emergency medical teams. This retrospective study was based on 41,335 EMS emergency calls to women in advanced pregnancy, of which 879 births were delivered directly by medical teams between January 2018 and December 2022. Data were obtained from the Polish National Monitoring Center for Emergency Medical Services, encompassing all EMS interventions in Poland. The study involved 879 EMS team interventions for pregnant women, with an average patient age of 29.87 years. Most patients were in their 2nd pregnancy (28.26%) and delivering for the 2nd time (25.77%). The postnatal condition of newborns, assessed using the Apgar score, was missing in 408 cases (46.52%) due to incorrect completion of documentation. Emergency Medical Services teams, predominantly P-type (basic) teams, handled 69.78% of deliveries, while S-type (specialist) teams were involved in 30.22% of cases. Medical procedures often performed during childbirth included manual assistance in spontaneous delivery, pulse oximetry, physical examination, examination of systemic blood pressure, obtaining peripheral intravenous access, and gynecological examination. Given the rate of encountered cases and the gaps identified in medical documentation, there is merit in potentially implementing a dedicated form to be completed by medical teams when caring for a pregnant patient. Ongoing training and enhancements in the range of assistance provided to the mother and newborn are imperative for ensuring appropriate care.

Ambulance Crew Waiting Time: Causes, Impacts and Solutions- A Review

Ambulance crew waiting time, defined as the duration spent by emergency medical services (EMS) teams at hospitals before transferring a patient to hospital care, is a critical concern globally. This delay impacts patient outcomes, leads to operational inefficiencies, and increases healthcare costs. Various factors contribute to this issue, including hospital overcrowding, increased demand for emergency services, and poor communication between hospitals and EMS teams. This paper explores the causes and impacts of ambulance crew waiting time and reviews potential solutions for mitigating these delays, emphasizing the need for systemic improvements and technological innovations.

Emergency medical services experience in King Saud University Medical City

Objective: This study aimed to assess the response time of the emergency medical services (EMS) at King Saud University Medical City (KSUMC), Riyadh, Saudi Arabia. Methods: This cross-sectional study was conducted at KSUMC emergency department. The study included all records of emergency calls that required ambulance dispatch during the study period. Data on the times they received the call, dispatched the ambulance, arrived at the scene, left the scene, and arrived at the hospital were collected. Each call was examined to assess if it took place during normal working hours (08:00-16:00) or within 30 minutes of shift changes (08:00, 16:00, and 00:00). Results: Of all the calls received, 288 (61.7%) were made during regular working hours (08:00-16:00), while 47 (10.1%) were made during the turning shifts (30 minutes before or after the shift). The median time from receiving the call to dispatch, from receiving the call to arrival at the scene, from dispatch to hospital arrival, and the scene time was 1 minute, 7 minutes, 24 minutes, and 10 minutes, respectively. The response and transportation times for emergency responders were consistent whether the calls were received during shift changes or at other times. The differences in mean rank were not statistically significant (P-values = 0.404 and 0.262, respectively). Conclusion: The EMS team at KSUMC in Riyadh, Saudi Arabia, responded quickly. The median times between receiving a call and arriving at the scene, as well as the median scene time, were found to be adequate.

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.

Strategi Dalam Meningkatkan Survival Rate Pada Penderita Henti Jantung Di Luar Rumah Sakit Out- Hospital Cardiac Arrest

The incidence of out-hospital cardiac arrest (OHCA) continues to increase. The survival rates of out hospital cardiac arrest decrease by 7-10% every minute. Therefore, Emergency medical services (EMS) as a part of the chain of survival needs to implement paramount strategies in order to increase survival rates. Socialization and discussion to strengthen the strategy has been conducted on December 2023 which involved pre-hospital team of Manambai Abdulkadir hospital (8 nurses, 1 doctor). It was followed by developing action plans. The pre-hospital team has chosen 2 of 10 action plans (rapid dispatch and community CPR) as main strategy to improve survival rates of out-hospital cardiac arrest patients. The Manambai Hospital are recommended to improve their support to develop human resources, medical equipment and funding to EMS team in order to improving survival rates of OHCA patients

Zoonotic Health Hazards in the Practice of Emergency Medical Service Teams – a Three-Year Observation

Zoonotic Health Hazards in the Practice of Emergency Medical Service Teams – a Three-Year Observation

A simulation-based randomized trial of ABCDE style cognitive aid for emergency medical services CHecklist In Prehospital Settings: the CHIPS-study

BackgroundChecklists are a powerful tool for reduction of mortality and morbidity. Checklists structure complex processes in a reproducible manner, optimize team interaction, and prevent errors related to human factors. Despite wide dissemination of the checklist, effects of checklist use in the prehospital emergency medicine are currently unclear. The aim of the study was to demonstrate that participants achieve higher adherence to guideline-recommended actions, manage the scenario more time-efficient, and thirdly demonstrate better adherence to the ABCDE-compliant workflow in a simulated ROSC situation.MethodsCHIPS was a prospective randomized case–control study. Professional emergency medical service teams were asked to perform cardiopulmonary resuscitation on an adult high-fidelity patient simulator achieving ROSC. The intervention group used a checklist which transferred the ERC guideline statements of ROSC into the structure of the ‘ABCDE’ mnemonic. Guideline adherence (performance score, PS), utilization of process time (items/minute) and workflow were measured by analyzing continuous A/V recordings of the simulation. Pre- and post-questionnaires addressing demographics and relevance of the checklist were recorded. Effect sizes were determined by calculating Cohen’s d. The level of significance was defined at p < 0.05.ResultsTwenty scenarios in the intervention group (INT) and twenty-one in the control group (CON) were evaluated. The average time of use of the checklist (CU) in the INT was 6.32 min (2.39–9.18 min; SD = 2.08 min). Mean PS of INT was significantly higher than CON, with a strong effect size (p = 0.001, d = 0.935). In the INT, significantly more items were completed per minute of scenario duration (INT, 1.48 items/min; CON, 1.15 items/min, difference: 0.33/min (25%), p = 0.001), showing a large effect size (d = 1.11). The workflow did not significantly differ between the groups (p = 0.079), although a medium effect size was shown (d = 0.563) with the tendency of the CON group deviating stronger from the ABCDE than the INT.ConclusionChecklists can have positive effects on outcome in the prehospital setting by significantly facilitates adherence to guidelines. Checklist use may be time-effective in the prehospital setting. Checklists based on the ‘ABCDE’ mnemonic can be used according to the ‘do verify’ approach. Team Time Outs are recommended to start and finish checklists.

Improving outcomes from paediatric cardiac arrest in low resource setting

Abstract Introduction Both out of (OHCA) and in hospital (IHCA) pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. This is further magnified by resuscitation protocols are typically articulated from the perspective of ideal resource environment without consideration of applicability in district hospitals or non-tertiary centres. Purpose To determine clinical outcomes from both paediatric OHCA and IHCA in low-resource setting and to identify shortcomings in relation to resuscitation in these areas, possible solutions and to suggest future research priorities. Methods This was a multicenter retrospective study in a middle sized city (estimated population 390000) served by a single Emergency Medical Services (EMS) system. All records of OHCA and IHCA under 16 years old were reviewed from the Cardiac Arrest Registry from 2017 to 2022. Data collected included demographic profiles, etiology of cardiac arrest, initial cardiac rhythm, time of initiation of cardiopulmonary resuscitation (CPR) and adrenaline administration by EMS team and duration of CPR. Outcomes of interest included return of spontaneous circulation (ROSC) and survival to hospital discharge (STHD). Results From the 5-year study period, 68 children (mean age of 5.8±1.2 yrs) were included in this study. 22 (32.4%) were infants (&amp;lt;1 year old) and 7 (10.3%) were neonates (&amp;lt;28 days old). Total mortality was observed at 63.2% (n=43). Return of spontaneous circulation (ROSC) was achieved in 40 (58.8%) patients and 33.8% (n=23) survived to hospital discharge. OHCA was witnessed in 52 (83.8%) children from total OHCA and bystander CPR was delivered only in 19 (30.6%) cases. All IHCA were witnessed. Asystole was the most common (n=39) initial rhythm. A delay in initiating cardiopulmonary resuscitation (CPR) and adrenaline administration was observed in 49 cases of OHCA and 1 in IHCA. The median time from emergency call to CPR and from CPR to first adrenaline administration was 20.9±1.2 min and 2.9±1.3 min for OHCA and 0.4±0.2 min and 1.5±0.7min for IHCA [Table 1]. Longer time to CPR and adrenaline administration was associated with lower chance of achieving ROSC and STHD. Using multivariate analyses, fewer adrenaline doses (p&amp;lt;0.05), witnessed cardiac arrest (p=0.001), initial rhythm of ventricular fibrillation (p&amp;lt;0.05) and shorter CPR duration (p=0.007) were good prognostic factors for ROSC and STHD. Conclusion Outcomes from OHCA and IHCA in low resource settings are poor. Unwitnessed arrest, delays in initiation of CPR and adrenaline administration were associated with poor survival. Recognition and identification of at-risk patients, early high-quality CPR and adrenaline administration are imperative to improve mortality. Early recognition and effective resuscitation protocols for children in the community and encouraging bystander CPR should be developed collaboratively with local experts and the EMS team.

Fatigue risk assessment of a Helicopter Emergency Medical Service crew working a 24/7 shift pattern: results of a prospective service evaluation

BackgroundThe work of Helicopter Emergency Medical Services (HEMS) teams crosses the boundaries of several high-risk occupations including medicine, aviation, and transport. Working conditions can be challenging and operational demands requires a 24-h rota, resulting in disruption of the normal circadian rhythm. HEMS crews are therefore prone to both mental and physical fatigue. As fatigue in medical providers is linked to poor cognitive performance, degradation of psychomotor skills and error, this study aimed to explore the existence of predictable patterns of crew-fatigue in a HEMS service.MethodsHEMS medical crew members working a 3-on 3-off forward rotating rota with a 5-week shift cycle were asked to do psychomotor vigilance tests (PVT) as an objective measure of fatigue. PVT testing was undertaken at the start, mid- and at the end of every shift during a full 5-week shift cycle. In addition, they were asked to score subjective tiredness with the Samn-Perelli Fatigue Scale (SPFS), and to keep a Transport Fatigue Assessment shift log, wherein they noted shift characteristics potentially related to fatigue. Primary outcome of interest was defined as the change in PVT and SPFS scores over time.ResultsMean baseline resting PVT in milliseconds at the start of the study period was 427 [390–464]. There was an overall trend towards higher PVT-scores with shift progression mean [95% CI] PVT at the start of shifts 447 [433–460]; halfway through the shift 452 [440–463]; end of the shift 459 [444–475], p = 0.10), whereas SPFS scores remained constant. Within a 5 week forward-rotating cycle, an overall trend towards a gradual increase in both average PVT (from 436 [238–454] to 460 [371–527, p = 0.68] ms;) and SPFS (from 2.9 [2.6–3.2] to 3.6 [3.1–4.0], p = 0.38) was observed, although significant interindividual variation was present. Reported SPFS scores ≥ 4 (moderate fatigue) were mainly related to workload (number of jobs) and transport mode (car-based shifts).ConclusionAn overall trend towards a decline in psychomotor vigilance and an increase in self-reported tiredness was found for HEMS crew over a 5-week shift cycle. Using a bespoke predictive fatigue tool on a day-to-day basis could increase fatigue awareness and provide a framework to which relevant mitigating options can be applied.

The Field’s mass shooting: emergency medical services response

BackgroundMajor incidents (MI) happen infrequently in Scandinavia and mass shootings are even less frequently occurring. Case reports and research are called for, as literature is scarce. On 3rd July 2022, a mass shooting took place at the shopping mall Field’s in Copenhagen, Denmark. Three people were killed and seven injured by a gunman, firing a rifle inside the mall. A further 21 people suffered minor injuries during the evacuation of the mall. In this case report, we describe the emergency medical services (EMS) incident response and evaluate the EMS´ adherence to the MI management guidelines to identify possible areas of improvement.Case presentationForty-eight EMS units including five Tactical Emergency Medical Service teams were dispatched to the incident. Four critically injured patients were taken to two trauma hospitals. The deceased patients were declared dead at the scene and remained there for the sake of the investigation. A total of 24 patients with less severe and minor injuries were treated at four different hospitals in connection with the attack. The ambulance resources were inherently limited in the initial phase of the MI, mandating improvisation in medical incident command. Though challenged, Command and Control, Safety, Communication, Assessment, Triage, Treatment, Transport (CSCATTT) principles were followed.ConclusionsThe EMS response generally adhered to national guidelines for MI. The activation of EMS and the hospital preparedness program was relevant. Important findings were communication shortcomings; inherent lack of readily available ambulance resources in the initial critical phase; uncertainty regarding the number of perpetrators; uncertainty regarding number of casualties and social media rumors that unnecessarily hampered and prolonged the response. The incident command had to use non-standard measures to mitigate potential challenges.

Implementation and evaluation of a palliative care training unit for EMS providers.

The prevalence of children with life-limiting conditions (LLCs) is rising. It is characteristic for these children to require 24/7 care. In emergencies, families must decide to call the emergency medical service (EMS) or a palliative care team (PCT)-if available. For EMS teams, an emergency in a child with an LLC is a rare event. Therefore, EMS providers asked for a training unit (TU) to improve their knowledge and skills in pediatric palliative care. The questions were as follows: whether a TU is feasible, whether its integration into the EMS training program was accepted, and whether an improvement of knowledge can be achieved. We designed and implemented a brief TU based on findings of a previous study that included 1,005 EMS providers. The topics covered were: (1) basics in palliative home care, (2) theoretical aspects, and (3) practical aspects. After participating in the TU, the participants were given a questionnaire to re-evaluate their learning gains and self-confidence in dealing with emergencies in pediatric patients with LLC. 782 (77.8%) of 1,005 participants of the previous study responded to the questionnaire. The average age was 34.9 years (±10.7 years SD), and 75.3% were male. The average work experience was 11.4 years (±9.5 years SD), and 15.2% were medical doctors. We found an increase in theoretical knowledge and enhanced self-confidence in dealing with emergencies in patients with LLC (confidence: before training: 3.3 ± 2.0 SD; after training: 5.7 ± 2.1 SD; min.: 1; max.: 10; p < 0.001). The participants changed their approaches to a fictitious case report from more invasive to less invasive treatment. Most participants wanted to communicate directly with PCTs and demanded a standard operating procedure (SOP) for treating patients with LLC. We discussed a proposal for an SOP with the participants. EMS providers want to be prepared for emergencies in children with LLCs. A brief TU can improve their knowledge and confidence to handle these situations adequately. This TU is the first step to improve collaboration between PCTs and EMS teams.

Effect of the pandemic on prehospital management of patients with mental and behavioral disorders: a retrospective cohort study.

The novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection and the accompanying coronavirus disease (Covid-19) have shifted the priority of human and technical resources toward their handling, thus affecting the usual standards of care for populations diagnosed with other clinical entities. The phenomenon becomes even more apparent in patients with presenting symptoms of mental and behavioral disorders, a category already vulnerable and underrepresented in regard to its prehospital approach and management. For the purposes of the current retrospective cohort study, we used records of the Polish National Emergency Medical Service Command Support System for the time period between April 1, 2019 and April 30, 2021, the official register of medical interventions delivered in Poland by Emergency Medical Services (EMS). We aimed to examine the potential impact of the COVID-19 pandemic across the Masovian Voivodeship on individuals seeking medical care for mental and behavioral disorders pertaining in the "F" category of the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). We examined the individuals' baseline characteristics, prehospital vital parameters and EMS processing times in a population of 59,651 adult patients (04/2019-03/2020, 28,089 patients, 04/2020-03/2021, 31,562 patients) handled by EMS teams. Compared to pre-COVID-19, EMS personnel handled fewer patients, but more patients required mental and behavioral care. Throughout the duration of the pandemic, all prehospital time periods were significantly delayed due to the increased time needed to prepare crew, vehicles, and technical equipment to ensure COVID-19 prevention and overcrowding in Emergency Departments (EDs).

Comparison of chest compression quality between the overlapping hands and interlocking hands techniques: A randomised cross-over trial

BackgroundPerforming quality chest compressions is fundamental to the management of cardiopulmonary arrest. The aim of this study was to compare the efficacy of two hand positions: overlapping versus interlocking for performing chest compressions during cardiopulmonary arrest. MethodsThe HP2C (for Hands Position and Chest Compression) was a prospective, randomised, open-label, cross-over, single-centre study. Participants were recruited from the Emergency Medical Service (EMS) teams and the prehospital firefighter teams. They were randomised to start chest compressions either with overlapping or interlocking hands and then performed the other technique after a washout period. The judgement criteria were the overall chest compressions success score generated by software in accordance with ILCOR recommendations, the quality of compression, release, rate and subjective intensity measured with the Borg scale. ResultsA total of 100 participants were included in the study. The mean age of the caregivers was 38 ± 9.3 years. The median CPR score was 79.5% IQR [48.5–94.0] in the overlapping hands group and 71% IQR [38.0–92.8] in the interlocking hands group (p-value = 0.37). There was no significant difference for the other criteria, especially no difference in term of intensity of effort. However, there was a trend towards better results with overlapping hands. ConclusionsThis study failed to demonstrate a difference in effectiveness between overlapping and interlocking hand chest compressions during cardiopulmonary resuscitation.

The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls – A descriptive retrospective register-based study

BackgroundMedical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls. MethodsDescriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed. ResultsIn total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required. ConclusionsHospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs.

Psychiatric conditions in the practice of National Emergency Medical Services teams in eastern Poland during the SARS-CoV2 pandemic.

To assess the impact of the COVID-19 epidemic in Poland on the number of visits by National Medical Rescue teams to patients with mental disorders. The study included a retrospective analysis of EMT departures from the Łuków district (northern part of the Lublin province) in the two-year period 3.2019-2.2021 (one year before epidemic -period I, the year of the epidemic -period II). The material consisted of Departure Request Cards and Medical Rescue Cards. In 2-year period were 862 events that met the criteria for inclusion in the analysis, 442- period I and 420- period II, respectively. In both periods, men were analyzed more often (68.7% Pre-Pan; 71.1% Pan). Interventions were more frequent in cities (60.3% Pre-Pan; 60.7% Pan). The share of alcohol and psychoactive substances as a cause of EMS interventions in psychiatric conditions was higher in pandemic. 1. The COVID-19 pandemic did not have a significant impact on the number of EMS interventions related to mental disorders in the area covered by the analysis 2. The average duration of EMS interventions to psychiatric conditions slightly increased during the epidemic period 3. Both in the period before and during the pandemic, in the interventions covered by the analysis, men were much more likely to be EMT patients 4. The age of the patients included in the analysis did not change significantly before and during the pandemic 5. Events caused by alcohol abuse and exacerbations of schizophrenia symptoms both before and during the pandemic have the largest share in the analysis.

Development of a Pilot Introductory Advanced Cardiovascular Resuscitation Course for Senior Medical Students in Switzerland: Student-Driven Implementation Study.

Cardiac arrest is the most time-critical emergency medical students and junior physicians may face in their personal or professional life. However, many studies have shown that most of them lack the necessary knowledge and skills to efficiently perform resuscitation. This could be related to the fact that advanced cardiovascular resuscitation courses are not always part of the undergraduate medical curriculum. The aim of this study was to describe the development, pilot implementation, and assessment of an advanced cardiovascular resuscitation course designed to enable senior medical students to manage the initial resuscitation phase in case of cardiac arrest. An introductory advanced cardiovascular resuscitation course was developed on the initiative of fifth-year medical students, in collaboration with the prehospital emergency medical service team of the Geneva University Hospitals. The 60 slots available to the 157 members of the fifth-year promotion of the University of Geneva Faculty of Medicine were filled in less than 8 hours. This unexpected success prompted the creation of a first questionnaire, which was sent to all fifth-year students to determine the overall proportion of students interested in attending an advanced cardiovascular resuscitation course. This questionnaire was also used to assess basic life support education and experience among course participants. A postcourse questionnaire was used to gather feedback regarding the course and to assess student confidence regarding the resuscitation skills they had been taught. Out of 157 fifth-year medical students, 73 (46%) completed the first questionnaire. Most thought that the current curriculum did not provide them with enough knowledge and skills regarding resuscitation and 85% (62/73) wished to attend an introductory advanced cardiovascular resuscitation course. All the participants who would have wanted to follow the full Advanced Cardiovascular Life Support course before graduating were set back by its cost (10/10, 100%). Of the 60 students who had registered for the training sessions, 56 (93%) actually attended. The postcourse questionnaire was completed by 42 (87%) students (out of 48 who had registered on the platform). They unanimously answered that an advanced cardiovascular resuscitation course should be part of the standard curriculum. This study demonstrates the interest of senior medical students in an advanced cardiovascular resuscitation course and their willingness to see such a course integrated as a part of their regular curriculum.

Usability Evaluation of a National Mobile-Based Automation System for Pre-Hospital Emergency Care (ASAYAR)

Introduction: Emergency Medical Services (EMS) is one of the vital links in the care chain, and its services need to be improved. These services can be available through mobile-based automation system, in which low usability level of these systems lead to decrease the acceptance, satisfaction, and confidence of users especially the emergency care team. The purpose of this study was the usability evaluation of a national mobile- based automation system among the pre-hospital emergency care team.Material and Methods: This cross-sectional study was conducted on pre-hospital emergency care team members in Semnan and Shahroud Universities of Medical Sciences in 2022. The usability evaluation of the mobile- based EMS automation system was done using the Software Usability Measurement Inventory (SUMI) questionnaire. Multiple logistic regression models were used to analyze data.Results: One hundred eighty-eight EMS team members from the 31 EMS centers in Semnan province participated in present study. The mean total usability score was 61.93±15.37, the highest mean score was related to the efficiency feature (67.19±19.85) and the lowest mean score was related to the learnability feature (48.21±29.29). There was a reverse and significant relationship between being a manager and the agreement with the usability (p=0.04, OR= -3.383, CI 95%=0.389-29549).Conclusion: This study showed that although an automation system may be widely used in a country, its usability could be at a low level. In order to improve the different function of these systems, it is suggested to participate various clinical experts include prehospital emergency care team in all stages of designing and developing these systems.

Challenges Locating the Scene of Emergency: A Qualitative Study of the EMS System in Rwanda

Background Timely prehospital emergency care significantly improves health outcomes. One substantial challenge delaying prehospital emergency care is in locating the patient requiring emergency services. The goal of this study was to describe challenges emergency medical services (EMS) teams in Rwanda face locating emergencies, and explore potential opportunities for improvement. Methods Between August 2021 and April 2022, we conducted 13 in-depth interviews with three stakeholder groups representing the EMS response system in Rwanda: ambulance dispatchers, ambulance field staff, and policymakers. Semi-structured interview guides covered three domains: 1) the process of locating an emergency, including challenges faced; 2) how challenges affect prehospital care; and 3) what opportunities exist for improvement. Interviews lasted approximately 60 min, and were audio recorded and transcribed. Applied thematic analysis was used to identify themes across the three domains. NVivo (version 12) was used to code and organize data. Results The current process of locating a patient experiencing a medical emergency in Kigali is hampered by a lack of adequate technology, a reliance on local knowledge of both the caller and response team to locate the emergency, and the necessity of multiple calls to share location details between parties (caller, dispatch, ambulance). Three themes emerged related to how challenges affect prehospital care: increased response interval, variability in response interval based on both the caller’s and dispatcher’s individual knowledge of the area, and inefficient communication between the caller, dispatch, and ambulance. Three themes emerged related to opportunities for processes and tools to improve the location of emergencies: technology to geolocate an emergency accurately and improve the response interval, improvements in communication to allow for real-time information sharing, and better location data from the public. Conclusion This study has identified challenges faced by the EMS system in Rwanda in locating emergencies and identified opportunities for intervention. Timely EMS response is essential for optimal clinical outcomes. As EMS systems develop and expand in low-resource settings, there is an urgent need to implement locally relevant solutions to improve the timely locating of emergencies.