Emergency Medical Service Teams Research Articles

The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment

Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.

Abstract WP497: And the Golden Lobe Award for Best Stroke Patient Outcomes Goes To

Background and Purpose: This process improvement project was conducted to improve the emergency department (ED) door to needle time (DTN) for intravenous (IV) alteplase times for stroke patients arriving both by local emergency medical services (EMS) and by private owned vehicles (POV). Ultimate goal was to meet American Heart Association (AHA) and American Stroke Association (ASA) Get With the Guidelines (GWTG) Target Stroke Honor Roll Elite Plus. Methods: A two-year nurse led multidisciplinary collaborative process improvement (PI) plan was designed to include local EMS, emergency department (ED) and radiology personnel. The patient workflow was streamlined allowing EMS Stroke Alert patients, as well as patients arriving in the ED in POV, with stroke symptoms, to go straight to the radiology department for immediate computed tomography (CT) scans. The PI plan was based on Six Sigma methodology and included a 90-day pilot data analysis led by Registered Nurse (RN) Directors, Neurologists, ED Physicians, Medical Imaging, Quality Improvement, and RN Stroke Coordinator. As part of the project design a recognition award was given to team mates with the best patient outcomes. The “Golden Lobe” award was awarded to EMS and ED team members for their significant improvement in stroke patient outcomes. Results: January 2016 to July 2018, a total of 79 were included. Average DTN times for EMS patients decreased 5.4 minutes, from 40.7 to 35.3. Average DTN times for POV patients decreased 17.8 minutes, from 51.8 to 34. Additional improvements were noted on transferring large vessel occlusion, drip and ship cases 81 minutes faster, from 196 to 115. Complication rates associated with IV alteplase decreased by 2.9% and stroke mimic rate reduced by 6.1%. Conclusion: In conclusion, nurse led multi-disciplinary collaborative PI project was successful in reducing DTN time for patients exhibiting stroke symptoms regardless if they arrived EMS or POV. Not only did the ED team improve DTN time, they also decreased IV alteplase complication rates, stroke mimic rates and stroke interventional transfer times.

Adverse events in prehospital emergency care: a trigger tool study

BackgroundPrehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care.MethodsWe used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria.ResultsThe reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9–5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1–0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew.ConclusionsThere were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid.

An unperformed autopsy does not exclude the possibility of proving a physician´s error

Introduction/Objective. Clarifying cases involving suspicious natural death and all forensic problems connected to such cases is possible only with the aid of a timely and adequately performed autopsy. The objective of this paper, however, is to point out the fact that it is possible to prove the existence of a physician?s error, even when an autopsy had not been performed. Case report. The Emergency Medical Service (EMS) team had been dispatched to respond to a call for help by a 53-year-old woman, complaining of chest pain, shortness of breath, and dizziness. The pain was located in the center of her chest and would increase in response to palpation, change of body position, and deep breathing. The physical examination was normal. The EMS physician concluded that it was not necessary to perform electrocardiography (ECG). Forty minutes later, the EMS team was dispatched to see the same patient again, this time for suspected cardiac arrest. Protocol-based cardiopulmonary resuscitation (CPR) for asystole was performed, without success. After 30 minutes, CPR was discontinued and the patient was declared deceased. Although the patient?s relatives did not allow an autopsy to be performed, they did send a claim to the Health Inspector at the Ministry of Health of Serbia, demanding an internal review of the physician?s professional work. It was concluded that the physician should have performed ECG, but that the true cause of death could only have been determined through a timely and adequately performed autopsy. Conclusion. An unperformed autopsy does not exclude the possibility of proving a physician?s error.

Modeling variation of clinical team processes with multiple sequence alignment.

Our objective was to model process variation of Emergency Medical Service teams responding to simulated pediatric emergencies and determine if sequence alignment distinguishes performance quality. We performed a retrospective process analysis by watching and coding activities in videos from standardized simulations of 42 Emergency Medical Service teams. Teams were classified into high- or low-performing groups based on the Clinical Teamwork Scale™. Activities were coded according to resuscitation tasks, performer, and times. We used ClustalG to align task sequences within and between groups, and measured similarity. Teams within and between performance levels had an average sequence similarity of 52 ± 7% and 50 ± 7%. Teams performed clinically appropriate tasks that varied in prioritization, for example, performing compressions or connecting the EKG monitor early. There was no statistical difference in gross similarity between groups but specific differences in prioritization may have had clinically meaningful implications. Alignment could improve by accounting for task duration and concurrency.

Out of hospital cardiac arrest: when to resuscitate.

IntroductionThis study explores why resuscitation is withheld when mobile emergency medical team arrive at the scene of a cardiac arrest.MethodsWe conducted a prospective, observational study in pre hospital emergency services. We included adults' patients, with a suspicion of non-traumatic cardiac arrest (CA) in an out of hospital environment, who received or not cardiopulmonary resuscitation (CPR) by our mobile emergency medical service teams. An analytic study was conducted in order to identify independent factors that could influence the decision to resuscitate OHCA.ResultsDuring study, 228 patients were enrolled, the mean age was 64 +/- 14 years and 59% were men. Eighteen patients (8%) received bystander CPR by witnesses. The median time elapsed to arrive at the scene was 13 [8-25] min. The median “noflow” was 22 [10-34] min. The resuscitation decision was taken by the mobile EMS staff for 106 patients (46.5%). For other patients, the decision not to resuscitate was motivated solely by the finding of a confirmed state of death in an elderly patient (p = 0.045). The predictive decision factor for resuscitation was the no flow time less than 18.5 min, Odds Ratio adjusted with 95% confidence interval to: 1.38 (1.24 - 3.55) (p <0.001). Overall out of hospital survival rate was 17% of resuscitated patients.ConclusionThe decision to resuscitate a cardiac arrest outside of the hospital depends more on the “no flow” time than on the presumed etiologies.

Analysis of the factors limiting reperfusion therapy in patients with ischemic strokes

Introduction. Systemic thrombolytic therapy with recombinant tissue plasminogen activator is the only reperfusion method available to most primary vascular units which allows significantly improving the functional prognosis of patients with ischemic stroke. Objective. To analyze the main determinants limiting reperfusion therapy administration in a subsidized region with demographic aging of the population, and to develop and scientifically justify the ways of their elimination. Materials and methods. We analyzed the data of the ambulance station in Smolensk electronic archive accounting for 17,143 phone requests for medical aid for patients with strokes, the data from the annual report of the neurological department for patients with acute cerebrovascular accident of the Clinical emergency care hospital, and 200 clinical records of patients diagnosed with acute stroke that were delivered to the in-patient facility by emergency medical service (EMS) teams in the period of the therapeutic window and who did not receive reperfusion therapy. The operative work of the dispatcher service, the efficiency of the mobile teams work, the structure of time losses during the call service, and the distribution of patients by the time period before the admission to a hospital depending on the way of admission and the remoteness of the zone of responsibility from the primary vascular surgery department were assessed. Results. It was found that statistically significant differences in time period before admission to a hospital of patients with ischemic strokes depend on the admission way and, in the case of arrival by the EMC, do not depend on the distance of the delivery area. The low efficiency of the mobile teams is due to the imperfection of call processing by dispatchers and the lack of a systematic approach and a single algorithm aimed for diagnosing and providing emergency assistance to the medical personnel of EMS teams. The main non-regulating factors for abandoning systemic administration of the recombinant tissue plasminogen activator in patients with ischemic strokes delivered to the hospital in the period of the therapeutic window are mild neurological symptoms, the age over 80 years and poly-morbidity of patients. Conclusion. It is necessary to adopt a series of measures aimed at advancing the efficiency of the EMS teams and rising awareness within the general public in order to reduce mortality of patients with ischemic strokes through increasing frequency of reperfusion therapy administration.

Improvement of out-of-hospital cardiac arrest survival rate after implementation of the 2010 resuscitation guidelines.

ObjectiveThe implementation of cardiopulmonary resuscitation guidelines, updated every five years, appears to improve patient survival rates after Out-Of-Hospital Cardiac Arrest (OHCA). The aim of this study is: 1) to measure the level of improvement in the prognosis of OHCA patient survival rates for the years 2009 and 2010 and the following two years 2011 and 2012; and 2) correlate the improvement in prognosis with the updated 2010 Advanced Cardiovascular Life Support (ACLS) Guidelines.MethodWe performed a retrospective observational study based on Geneva’s OHCA register that includes data from January 1, 2009 to December 31, 2012. We compared the evolution of prognostic factors that influenced survival at hospital discharge between the periods before and after the implementation of the 2010 guidelines. We then compared the survival rates between each period. Finally, we adjusted the effects on survival in the second period to prognostic factors not linked with the care provided by Emergency Medical Services (EMS) teams, using a multivariable logistic regression model. Changes in advanced resuscitation treatment provided by EMS personnel were also examined.Results795 OHCA were resuscitated between 1st January, 2009 and 31st December, 2012. The prognosis of patient survival at the time of hospital discharge rose from 10.33% in 2009–2010 to 17.01% in 2011–2012 (p = 0.007). After making adjustments for the effect of improved survival rates on the second period with factors not related to care provided by EMS teams, the odds ratio (OR) remains comparable (OR = 1.87, 95% CI [1.08–3.22]). Measured changes in treatment provided by EMS personnel were minor.ConclusionsSurvival rate for OHCA patients improved significantly in 2011–2012. This study suggests that it was probably the improvement in the quality of care provided during CPR and post-cardiac arrest care that have contributed to the increase in survival rates at the time of hospital discharge.

Prehospital clinical presentation in patients with acute coronary syndrome complicated by cardiogenic shock: A single center study

BackgroundThe development of cardiogenic shock remains the most important factor affecting the prognosis of patients with acute coronary syndrome. Despite significant advances in treatment, achieved in the last two decades, the mortality rate is still very high. The development of knowledge about the pathophysiology of cardiogenic shock, necessitates a thorough and comprehensive assessment of its progress at all stages of medical care. ObjectivesThe aim of the study was to assess the prehospital clinical presentation in patients with acute coronary syndrome complicated by cardiogenic shock. MethodsThe population of our study consisted of 40 patients with acute coronary syndrome complicated by cardiogenic shock who were transported to the Intensive Cardiac Therapy Clinic by ambulances directly from place of the event in order to implement primary coronary intervention. The control group was selected among age, gender and infarct location-matched patients with acute coronary syndrome uncomplicated by shock. The clinical presentation in investigated patients was assessed on the basis of the data contained in the medical records of Emergency Medical Services teams. ResultsIn univariate logistic regression analysis eight prehospital clinical symptoms proved to be statistically significant predictors of the development of cardiogenic shock: fainting and/or impaired consciousness, pale skin, cold skin, clammy skin, dyspnea, pulmonary congestion, peripheral cyanosis and hyperglycemia >11,1 mmol/l. In the multivariate model significant predictors of cardiogenic shock development were: pale skin and hyperglycemia >11.1 mmol/l. A risk prediction model was constructed. It proved to differentiate patients from study and control group highly significantly (p < 0.001). ConclusionsPatients with acute coronary syndrome who develop cardiogenic shock, present a different clinical symptoms at the moment of the first medical contact. The proposed 4S Scale can be used for quick assessment of risk in patients with acute coronary syndrome before the development of a fully-blown cardiogenic shock with severe, long-lasting hypotonia.

Determinants of occupational burnout among employees of the Emergency Medical Services in Poland.

Occupational burnout is a multifaceted phenomenon and a problem often encountered among medical personnel. An example of such a group are workers of the Emergency Medical Services (EMS). The aim of the present study was to make an attempt to assess the level of job burnout among professionally active employees of the EMS and to compare the different occupational groups (paramedics, nurses of the system, doctors of the system) according to four analyzed factors. A cross-sectional study was performed using an on-line questionnaire. Four factors impacting the level of burnout were analyzed: 1) attitude to work; 2) workload; 3) contact with the patient; 4) attitude to stress). The minimum possible result on the scale is 36 points and the maximum - 252. Data were analysed by means of the Cronbach's alpha coefficient, the Spearman correlation, the Ramsey RESET test, the Chow test, VIF statistics. The average score for occupational burnout was 131.0 points (SD ± 31.47). The tool's reliability measured by means of Cronbach's alpha was 0.910). Both nurses and doctors obtained higher results throughout the scale (βstand.0.147 and 0.215). Significant differences were shown between the group working only in the Helicopter Emergency Medical Service (HEMS) teams and the other services (land EMS, emergency rooms, etc.) at the level of p < 0.000. EMS employees encounter varying degrees of threat by occupational burnout. Doctors working in the system are shown to have the highest level of burnout, while paramedics the lowest. Among all the jobs analyzed, the lowest level of occupational burnout has been demonstrated by employees of HEMS.

TerraXcube: A new hi-tech training facility for EMS teams

Purpose of the study: Training of emergency medical services (EMS) teams in mountain rescue focuses mainly on proficiency in technical or medical skills as independent components. However, the quality of resuscitation manoeuvres rapidly declines at high altitude and other manual tasks can be slowed by cold temperatures and other environmental factors. In order to lessen the decline and to improve the performance of EMS teams, a new facility has been realised.

Videographic Assessment of the Quality of EMS to ED Handoff Communication During Pediatric Resuscitations

Background: The National Association of Emergency Medical Services (EMS) Physicians emphasizes the importance of high quality communication between EMS providers and emergency department (ED) staff for providing safe, effective care. The Joint Commission has identified ineffective handoff communication as a contributing factor in 80% of serious medical errors. The quality of handoff communication from EMS to ED teams for critically ill pediatric patients needs further exploration.Objective: This study assessed the quality of handoff communication between EMS and ED staff during pediatric medical resuscitations.Methods/Design: We conducted a retrospective review of video recordings of pediatric patients who required critical care (“resuscitation”) in the ED between January 2014 and February 2016 at a Level 1 pediatric trauma center. Handoff quality between EMS and emergency department teams was assessed for completeness, timeliness, and efficiency. Institutional review board approval was obtained.Results: Sixty-eight resuscitations were reviewed; 28% presented in cardiac arrest, requiring cardiopulmonary resuscitation (CPR). Completeness of information communicated was variable and included chief complaint (88%), prehospital interventions (81%), physical exam findings (63%), medical history (59%), age (56%), and weight (20%). Completeness of specific vital sign reporting included: respiratory rate (53%), heart rate (43%), oxygen saturation (39%), and blood pressure (31%). Timeliness of communication included median patient handoff and report times of 50 seconds [IQR 30,74] and 108 seconds [IQR 62,252], respectively. Inefficient communication occurred in 87% of handoffs, including interruptions by ED staff (51%), questions from the ED physician team leader asking for information already communicated (40%), and questions by ED physician team leader requesting information not yet communicated (65%). When comparing non-CPR to CPR cases, only timeliness of patient handoff was significantly different for those patients receiving prehospital CPR.Conclusion: Handoff communication between EMS and ED teams during pediatric resuscitation was frequently incomplete and inefficient. Future educational and quality improvement interventions could aim to improve the quality of handoff communication for this patient population.

Overview of doctor-staffed ambulance use in Japan: a nationwide survey and 1-week study.

AimIn Japan, standard prehospital care is provided by emergency medical services teams. Doctor‐staffed ambulances play a role in facilitating the immediate treatment of critically ill patients to increase the survival rates. However, little is known about their activities. We revealed the present situation of doctor‐staffed ambulances in Japan.MethodsFirst, we surveyed all the fire departments in Japan and determined whether a doctor‐staffed ambulance was present within their district boundary. Second, we surveyed hospitals that operate doctor‐staffed ambulances in their system to list their activities during a 1‐week period.ResultsOf 133 hospitals that operated a doctor‐staffed ambulance, 73 (55%) replied to our questionnaire. Only 26 (36%) of them provided 24‐h ambulance deployment. Additionally, 51 (70%) of hospitals bore the operational costs of ambulances. Within 1 week, 345 doctor‐staffed ambulances were dispatched, but 97 (28%) were cancelled. In total, 62 patients (28%) were diagnosed with cardiac arrest, 48 (19%) with trauma or burns, 36 (15%) with stroke, and 22 (9%) with acute coronary syndrome; 159 (58%) were transferred to a tertiary emergency medical center.ConclusionsDoctor‐staffed ambulances have the advantage of deployment at night and in urban areas compared to doctor‐staffed helicopters. Among the 73 hospitals that responded to the questionnaire, doctor‐staffed ambulances were dispatched almost as frequently as doctor‐staffed helicopters. However, doctor‐staffed ambulances did not receive adequate funding. Future data collection is necessary to determine the efficacy of doctor‐staffed ambulances among hospitals that operate this service.

CARDIOPULMONARY RESUSCITATION AT THE PRE-HOSPITAL PERIOD: CRITERIA OF TERMINATING RESUSCITATION (A CLINICAL CASE ANALYSIS)

The clinical case analysis revealed the pressing need for enhanced emergency medical services, in particular, regarding the adequate performance of cardiopulmonary resuscitation in the pre-hospital setting. The analysis is focused on reasonable decision to terminate cardiopulmonary resuscitation. It is revealed that there are significant conflicts in the algorithms, protocols, clinical recommendations and the decree of the Government of the Russian Federation on determining the moment to terminate cardiopulmonary resuscitation with lasting pulseless electrical activity. The conflicting requirements create problems in practical activity of emergency medical services teams, build grounds for expert claims and make an important issue for a comprehensive study. The discussed subject seems to be highly relevant: in case of out-of-hospital deaths, emergency medical services are the only life-saving facility.

Are You Ready for Emergency Medical Services in Your Oral and Maxillofacial Surgery Office?

Efficient responses to emergencies in the oral and maxillofacial surgery office require preparation, communication, and thorough documentation of the event and response. The concept of team anesthesia is showcased with these efforts. Emergency medical services training and response times vary greatly. The oral and maxillofacial surgery office should be prepared to manage the patient for at least 15minutes after making the call to 911. Patient outcomes are optimized when providers work together to manage and transport the patient. Oral and maxillofacial surgery offices should develop and rehearse emergency plans and coordinate these protocols with local Emergency medical services teams.

Improvement of injury severity prediction (ISP) of AACN during on-site triage using vehicle deformation pattern for car-to-car (C2C) side impacts

ABSTRACTObjective: The Advanced Automatic Crash Notification (AACN) system needs to predict injury accurately, to provide appropriate treatment for seriously injured occupants involved in motor vehicle crashes. This study investigates the possibility of improving the accuracy of the AACN system, using vehicle deformation parameters in car-to-car (C2C) side impacts.Methods: This study was based on car-to-car (C2C) crash data from NASS-CDS, CY 2004–2014. Variables from Kononen's algorithm (published in 2011) were used to build a “base model” for this study. Two additional variables, intrusion magnitude and max deformation location, are added to Kononen's algorithm variables (age, belt usage, number of events, and delta-v) to build a “proposed model.” This proposed model operates in two stages: In the first stage, the AACN system uses Kononen's variables and predicts injury severity, based on which emergency medical services (EMS) is dispatched; in the second stage, the EMS team conveys deformation-related information, for accurate prediction of serious injury.Results: Logistic regression analysis reveals that the vehicle deformation location and intrusion magnitude are significant parameters in predicting the level of injury. The percentage of serious injury decreases as the deformation location shifts away from the driver sitting position. The proposed model can improve the sensitivity (serious injury correctly predicted as serious) from 50% to 63%, and overall prediction accuracy increased from 83.5% to 85.9%.Conclusion: The proposed method can improve the accuracy of injury prediction in side-impact collisions. Similar opportunities exist for other crash modes also.

A before-and-after observational study of a protocol for use of the C-MAC videolaryngoscope with a Frova introducer in pre-hospital rapid sequence intubation.

Results using videolaryngoscopy in pre-hospital rapid sequence intubation are mixed. A bougie is not commonly used with videolaryngoscopy. We hypothesised that using videolaryngoscopy and a bougie as core elements of a standardised protocol that includes a drugs and a laryngoscopy algorithm would result in a high first-pass tracheal intubation success rate. We employed videolaryngoscopy (C-MAC) combined with a bougie (Frova intubating introducer) in an anaesthetist-staffed helicopter emergency medical service. Data for adult tracheal intubation were collected prospectively as part of the airway registry of our unit for 22months after implementation of the protocol (n=543) and compared with controls (n=238) treated in the previous year before the implementation. The mean first-pass success rate (95%CI) was 98.2% (96.6-99.0%) in the study group and 85.7% (80.7-89.6%) in the control group, p<0.0001. Combining C-MAC videolaryngoscopy and bougie with a standardised rapid sequence induction protocol leads to a high first attempt intubation success rate when performed by an anaesthetist-led helicopter emergency medical service team.

Epidemiologija vanbolničkog srčanog zastoja u opštini Kanjiža - EuReCa Srbija

Objective: To analyze epidemiology of out-of-hospital cardiac arrest (OHCA) managed by emergency medical service (EMS) in the territory of Kanjiža municipality. Methodology: Information for this research was taken from the unique registry of out-of-hospital cardiac arrest, established by Resuscitation Council of Serbia through an online questionnaire. Head researcher entered the data after every OHCA managed by EMS team. SPSS program was used for statistical processing. Results: Through the observed period (October 1st, 2014 to December 31st , 2016) 22 cases of OHCA with initiated resuscitation measures were recorded. Gender distribution of OHCA shows the majority of male patients. The most common cause of OHCA was cardiovascular and the most common place of event was home of the patient. 17 patients suffered OHCA in front of a witness but only 4 times witness has started CPR before EMS arrived. Telephone assisted CPR was not used in any of the cases. Initially shockable rhythm, ventricular tachycardia without pulse or ventricular fibrillation (pulseless VT/ VF) was registered 4 times, and ROSC was achieved 2 times. None of the patients survived to be discharged from hospital. Conclusion: It is necessary to make a greater effort towards citizens' education and raising their awareness of the significance of starting the early basic life support measures, before EMS arrives. Another important task that is ahead of us is education of emergency dispatchers on providing telephone guided CPR, especially in cases of distant intervention locations, so that the EMS could literally buy time until arriving.

Analiza epidemioloških podataka vanbolničkog srčanog zastoja kod žena u Vojvodini

Objective: analysis of epidemiological data of out of hospital cardiac arrest (OHCA) in women of Vojvodina in comparison to up to date published studies. Methods: In our study we used data from the OHCA register from region of Vojvodina from 01. 10. 2014 to 01. 08. 2017. Data were derived from common database of Serbian Resuscitation Council collected by main researchers from 13 centers. Analysis was performed using statistical program SPSS. Results: In observed period in Vojvodina region, 1240 cases of OHCA were confirmed by Emergency Medical Service (EMS) teams. Cardiopulmonary resuscitation (CPR) was attempted in 706 patients, 237 (33.56%) of women. Average age of women was 68.2 years. Youngest patient had less than 1 year and eldest was 94 years old. Considering etiology, cardiovascular cause is most common, in197 (83%) cases, respiratory in 15 (6.4%) and other non-cardiological causes in 23 (9.8%) in women. Trauma as the cause of OHCA was not found in our analysis was not registered. Dominant location of OHCA in woman is at home, in 187 (88.6%) cases, followed by public spaces-street in 12 (5%), Nursing Homes in 7 (3%) and public institutions in 3 (1.2%). No cases of OHCA in women were registered on sports fields. Bystander CPR before EMS arrival was registered in 44 (18.6%) of OHCA in women. Shockable rhythm was registered in 61 women (25.7%). Return of spontaneous circulation (ROSC) was achieved in 74 (31.2%) while 12 (5%) patients were released from hospital alive and 30 days survival was registered in 11 (4.6%). Conclusion: According to epidemiological analysis of OHCA database in woman in region of Vojvodina, we can notice that it is less present than in man. Also, average age of woman with OHCA is grater. OHCA in woman happened less in presence of bystander. Bystander CPR attempt in woman is slightly higher than in man, but presence of shockable rhythm, as well as ROSC and survival to hospital discharge is less. Detailed analysis of bystanders who start CPR in women OHCA might indicate the reason of their rather willingness to perform it. Still it is not enough to increase survival.

Project for the introduction of prehospital analgesia with fentanyl and morphine administered by specially trained paramedics in a rural service area in Germany.

BackgroundIn patients with serious illness or trauma, reduction of severe pain is a key therapeutic goal of emergency medical service (EMS) teams. In Germany, only physicians are allowed to use opioid analgesics. In the rural EMS area studied, the mean arrival time for paramedics is 8 minutes, 23 seconds, and for the rescue physician between 10 minutes, 30 seconds and 16 minutes, 59 seconds, depending on EMS site. In cases of parallel callouts, rescue-physician arrival times may be considerably longer.ObjectiveDuring this project, we assessed the administration of the opioid analgesics morphine and fentanyl by specially trained paramedics with regard to analgesia quality and patient safety.Materials and methodsDuring the 18-month study period, specially trained paramedics administered morphine or fentanyl to patients with severe pain if indicated and if a rescue physician was not available in time. Besides basic documentation, pain intensity (using a numeric rating scale) and oxygen saturation were measured initially and at hospital handover.ResultsDuring the 18 months, 4,285 emergency callouts were attended to by the 13 specially trained paramedics of the district (total callouts during this period 21,423). In 77 patients (1.8%), fentanyl (n=53/68.8%) or morphine (n=24/31.2%) was administered. Based on the measurements obtained with the numeric rating scale at the start of treatment (7.9) and upon hospital handover (3.3), pain reduction was 4.52 overall (41.5%, P<0.001): 4.64 with fentanyl (42.9%, P<0.001) and 4.25 with morphine (43.2%, P<0.001). None of the patients had an oxygen saturation <95% at the time of handover, and no patient developed opioid-induced respiratory depression requiring treatment.ConclusionThe results of this study indicate that the administration of opioid analgesics by specially trained and qualified paramedics is safe and effective.