Emergency Medical Services Time Research Articles

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

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

EuReCa_Srbija 2014-2021 - epidemiološka analiza vanbolničkog srčanog zastoja - uticaj reaktivnog vremena na uspešnost resuscitacije

The aim of this study is to analyze the basic epidemiological data related to OHCA and the impact of time intervals during the care of OHCA patients on their survival. Materials and Methods: Epidemiological data, data related to time intervals during the response and care process of OHCA patients, as well as outcome data for these patients, were analyzed in seven municipalities in Serbia. Data were collected as part of the EuReCa_Srbija program during the period from October 1, 2014, to December 31, 2021. Results: The overall annual incidence of recorded OHCA in the studied area was 137.43/100,000 inhabitants, while the annual incidence of initiating CPR measures was 50.16/100,000. In the group of patients with initiated CPR measures, a bystander initiated CPR in 16.98% of cases (annual incidence 8.52/100,000). Return of spontaneous circulation (ROSC) at the scene was recorded in 18.71% of cases with an annual incidence of 9.38/100,000, while in the same group, 15.49% of patients with ROSC were admitted to the hospital (annual incidence 7.77/100,000). The median response time of emergency medical services was 9.0 (IQR 5.0-17.0) minutes, the time from achieving ROSC to hospital arrival was 17.0 (IQR 12.0-27.0) minutes, and the time from departure from the cardiac arrest scene to hospital arrival was 9.5 (IQR 5.0-17.0) minutes. The cumulative proportion of ROSC was 50% after 5.6 kilometers traveled, or 5 minutes from the emergency call. ROSC at the scene was not recorded after 20 minutes from the emergency call, or after 11.2 kilometers traveled from the call reception to the scene. Conclusion: The incidence of OHCA in Serbia is comparable to that in other countries, with room for improvement in terms of greater layperson involvement in initiating CPR measures. The time intervals during the EMS response and care process for OHCA patients are longer compared to reports from other countries, indicating the need to modify factors that directly or indirectly affect these intervals.

25 Interaction effects between survival outcomes of out-of-hospital cardiac arrest patients receiving intravenous fluid resuscitation and emergency medical service time interval

25 Interaction effects between survival outcomes of out-of-hospital cardiac arrest patients receiving intravenous fluid resuscitation and emergency medical service time interval

On-scene time delays for epileptic seizures in emergencies during a social pandemic: A population-based study

ObjectivesThe on-scene time of Emergency Medical Services (EMS), including time for hospital selection, is critical for people in an emergency. However, the outbreak of the novel coronavirus disease 2019 (COVID-19) led to longer delays in providing immediate care for individuals with non-COVID-19-related emergencies, such as epileptic seizures. This study aimed to examine factors associated with on-scene time delays for people with epilepsy (PWE) with seizures needing immediate amelioration. Materials & MethodsWe conducted a population-based retrospective cohort study for PWE transported by EMS between 2016 and 2021. We used data from the Hiroshima City Fire Service Bureau database, divided into three study periods: “Pre period”, the period before the COVID pandemic (2016–2019); “Early period”, the early period of the COVID pandemic (2020); and “Middle period”, the middle period of the COVID pandemic (2021). We performed linear regression modeling to identify factors associated with changes in EMS on-scene time for PWE during each period. In addition, we estimated the rate of total EMS call volume required to maintain the same on-scene time for PWE transported by EMS during the pandemic expansion. ResultsAmong 2,205 PWE transported by EMS, significant differences in mean age and prevalence of impaired consciousness were found between pandemic periods. Total EMS call volume per month for all causes during the same month <5,000 (−0.55 min, 95% confidence interval [CI] −1.02 – −0.08, p = 0.022) and transport during the Early period (−1.88 min, 95%CI −2.75 – −1.00, p < 0.001) decreased on-scene time, whereas transport during the Middle period (1.58 min, 95%CI 0.70 – 2.46, p < 0.001) increased on-scene time for PWE transported by EMS. The rate of total EMS call volume was estimated as 0.81 (95%CI −0.04 – 1.07) during the expansion phase of the pandemic to maintain the same degree of on-scene time for PWE transported by EMS before the pandemic. ConclusionsOn-scene time delays on PWE in critical care settings were observed during the Middle period. When the pandemic expanded, the EMS system required resource allocation to maintain EMS for time-sensitive illnesses such as epileptic seizures. Timely system changes are critical to meet dramatic social changes.

Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea.

In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19. This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient's EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports. The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ² test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19. A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 (P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021. After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported. However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

Community socioeconomic and urban-rural differences in emergency medical services times for suspected stroke in North Carolina

ObjectiveOur objectives were to describe time intervals of EMS encounters for suspected stroke patients in North Carolina (NC) and evaluate differences in EMS time intervals by community socioeconomic status (SES) and rurality. MethodsThis cross-sectional study used statewide data on EMS encounters of suspected stroke in NC in 2019. Eligible patients were adults requiring EMS transport to a hospital following a 9–1-1 call for stroke-like symptoms. Incident street addresses were geocoded to census tracts and linked to American Community Survey SES data and to rural-urban commuting area (RUCA) codes. Community SES was defined as high, medium, or low based on tertiles of an SES index. Urban, suburban, and rural tracts were defined by RUCA codes 1, 2–6, and 7–10, respectively. Multivariable quantile regression was used to estimate how the median and 90th percentile of EMS time intervals varied by community SES and rurality, adjusting for each other; patient age, gender, and race/ethnicity; and incident characteristics. ResultsWe identified 17,117 eligible EMS encounters of suspected stroke from 2028 census tracts. The population was 65% 65+ years old; 55% female; and 69% Non-Hispanic White. Median response, scene, and transport times were 8 (interquartile range, IQR 6–11) min, 16 (IQR 12–20) min, and 14 (IQR 9–22) minutes, respectively. In quantile regression adjusted for patient demographics, minimal differences were observed for median response and scene times by community SES and rurality. The largest median differences were observed for transport times in rural (6.7 min, 95% CI 5.8, 7.6) and suburban (4.7 min, 95% CI 4.2, 5.1) tracts compared to urban tracts. Adjusted rural-urban differences in 90th percentile transport times were substantially greater (16.0 min, 95% CI 14.5, 17.5). Low SES was modesty associated with shorter median (−3.3 min, 95% CI −3.8, −2.9) and 90th percentile (−3.0 min, 95% CI −4.0, −2.0) transport times compared to high SES tracts. ConclusionsWhile community-level factors were not strongly associated with EMS response and scene times for stroke, transport times were significantly longer rural tracts and modestly shorter in low SES tracts, accounting for patient demographics. Further research is needed on the role of community socioeconomic deprivation and rurality in contributing to delays in prehospital stroke care.

Continuum of Care: A Multiagency Approach to Seamless Warmed Prehospital Whole Blood Resuscitation of a Patient with Noncompressible Truncal Hemorrhage

Background Prehospital transfusion capabilities vary widely in the United States. Here we describe a case of prehospital resuscitation using warmed, whole blood in a patient with penetrating torso trauma and associated hemorrhagic shock. Case Report A 68-year-old man sustained a single gunshot wound to the left chest and was found to have a shock index of 1.5 at the time of emergency medical services (EMS) arrival. Rapid peripheral intravenous and central venous access enabled the infusion of warmed low-titer O-positive whole blood. The EMS crew intentionally resuscitated the patient before managing the airway by means of rapid sequence intubation. An air medical services helicopter crew assumed patient care from the ground EMS crew and continued the warmed, whole blood transfusion during the flight to a regional Level I trauma center. The patient went directly to the operating room from the helipad, underwent definitive operative management, and was ultimately discharged home on hospital day nine. Conclusion Early recognition of hemorrhagic shock, implementation of prehospital transfusion protocols that emphasize transfusion of warmed blood without interruption, and an organized, regional approach to trauma care are critical for improving patient survival.

Variation in on-scene time of emergency medical services and the extent of the difference of on-scene time between genders: a retrospective population-based registry study in Riyadh Province, Saudi Arabia

ObjectivesTo identify the intergender variation of on-scene time (OST) for highly urgent emergency cases conveyed by emergency medical services (EMS) in Saudi Arabia and to assess other predictors of OST...

Emergency Medical Service Time Intervals for Patients With Suspected Stroke in the United States.

Optimal care for patients with stroke relies on timely recognition and rapid transport to appropriate treatment, often by emergency medical services (EMS). Our primary objective was to describe EMS time intervals for patients with suspected stroke in the United States. We also sought to quantify the variation in EMS time intervals by geographic location and urbanicity. We conducted a cross-sectional evaluation of EMS 9-1-1 activations (ie, calls for service) included in the 2018 and 2019 National EMS Information System datasets. We included ground or air EMS activations for a 9-1-1 scene response where a patient aged ≥18 years with suspected stroke was treated and transported by EMS. Time intervals for dispatch, response, scene, transport, and total prehospital time (ie, from dispatch to hospital arrival) were calculated, stratified by ground and air transport type. A total of 410 187 activations for suspected stroke were included, of which 98% were a ground transport. The median total prehospital time for ground transports was 35 minutes (interquartile range, 27-45, 90th percentile 58). Median total prehospital time for air transports was substantially longer at 56 minutes (interquartile range, 43-70, 90th percentile 86). Times varied by Census division and urbanicity with the shortest ground total prehospital times in the East North Central division and urban areas and longest times in the East South Central and rural and frontier areas. Timely EMS response and transport is critical for optimizing care of patients with suspected stroke. Using a large, national dataset of EMS activations, we found variations by geographic location and urbanicity in total prehospital time for ground and air EMS activations for patients with stroke.

Abstract TP47: Emergency Medical Services Time Intervals For Suspected Stroke Patients In The United States

Introduction: Prehospital recognition and rapid transport of stroke patients by emergency medical services (EMS) is critical to optimize access to time-sensitive care. We aimed to describe EMS time intervals for suspected stroke patients in the U.S. and to quantify variation in EMS time intervals by geographic location and urbanicity. Methods: We conducted a cross-sectional evaluation of EMS 9-1-1 activations (i.e., calls for service) included in the 2018 and 2019 National EMS Information System. We included ground and air EMS activations for a scene response where a patient aged ≥18 years old with suspected stroke (EMS impression of I60-I63 or G45) was treated and transported by EMS. Time intervals for dispatch, response, scene, transport, and total prehospital time were calculated, stratified by ground and air transport type. Results: A total of 415,342 activations for suspected stroke were included, of which 98% were a ground transport. The overall median total prehospital time for ground transports was 35 minutes (IQR 27-45, 90 th percentile 58; Table). Median total prehospital time for air transports was substantially longer at 56 minutes (IQR 43-70, 90 th percentile 86). Times varied by census division and urbanicity with the shortest median total prehospital time of ground transports in the East North Central division (31 min, IQR 25-40) and urban areas (34 min, IQR 27-43) and longest times in the East South Central (39 min, IQR 30-52), rural (40 min, IQR 28-56), and frontier (44 min, IQR 29-63) areas. Conclusions: With ongoing focus on optimizing time-to-treatment for acute stroke interventions, prehospital transport can be targeted for quality improvement. While some variation is expected due to geographical constraints, we found substantial variation in prehospital transport times for suspected stroke that may present opportunities for future improvement. These findings may inform health services research and policy efforts to improve stroke care access.

Effects of different crash data variables on EMS response time for a rural county in alabama.

Response time of Emergency Medical Services (EMS) is an important factor related to preventable deaths in road crash incidents. This study focuses on analyzing the effects of different independent variables on the EMS Response Time (ERT). Independent variables considered for this investigation are travel time, day of the week, crash severity, weather, time of the day, and lighting condition. Understanding outcomes resulting from variations of the considered parameters on ERT is crucial to minimize the possibility of adverse outcomes which are tied to different types of injuries, and vital to limit the prospect of fatalities. Crash data used for this study is from a rural county in Alabama where only one EMS control location is available. Results from the analysis indicate that ERT becomes larger as travel time increases. ERT is also larger on weekends than on weekdays. ERT is larger in the evening and night when compared with morning. When the weather is clear or cloudy, the ERT parameter is shorter. But when the weather is extreme, with mist, fog, or rain, the parameter is longer. When roads are dark, ERT is long. When daylight is present, the ERT is shorter. If the crash is fatal, the parameter is longer compared with situations when crash injuries are non-severe.

Abstract 10319: Community Socioeconomic and Urban-Rural Differences in Emergency Medical Services Time Intervals for Suspected Stroke Patients in North Carolina

Introduction: Rapid emergency medical services (EMS) response, care, and transport of acute stroke patients increases the likelihood of receiving time-sensitive treatment. There is limited research on the relationship of community factors with prehospital delays in EMS management of stroke. We compared EMS prehospital time intervals for suspected stroke patients by community socioeconomic status (SES) and urban-rural status in North Carolina (NC). Methods: We analyzed 2019 NC EMS encounter data collected in the National EMS Information System Version 3 standard. Eligible patients were adults requiring a 911 call response by EMS for stroke-like symptoms and transport to the hospital. Incident street addresses were geocoded to census tracts using ArcGIS Pro and linked to SES data from the American Community Survey and rural-urban commuting area (RUCA) codes. Community SES was defined as high, medium, or low based on tertiles of the AHRQ SES index. Urban, suburban, and rural tracts were defined by RUCA codes 1, 2-6, and 7-10, respectively. Differences in mean times by community SES and urban-rural status were evaluated using Kruskal Wallis tests. Results: We identified 17,117 eligible EMS encounters of suspected stroke (65% (11,121 of 17,117) 65+ years old; 55% (9,330 of 17,117) female; 70% (11,839 of 17,117) White) from 2,028 tracts. Median response, scene, and transport times were 8 (interquartile range, IQR 6-11) min, 16 (IQR 12-20) min, and 14 (IQR 9-22) min, respectively. Mean transport times were shorter in low SES (16 min) than in medium and high SES communities (17 min, p&lt;.0001). Mean transport times were longer in rural (21 min) and suburban (19 min) than in urban tracts (14 min, p&lt;.0001). Conclusions: EMS transport times were on average longer for suspected stroke patients in rural but not in low SES tracts. Further research is needed on the role of community socioeconomic deprivation and rurality in contributing to delays in prehospital stroke care.

Do EMS times associate with injury severity?

In this study, emergency medical services times, along with other crash-related explanatory variables, have been used to investigate influential factors on injury severity. To overcome the complexity of emergency medical services times impact on crash outcome, the interaction effects of EMS times and injury location on the body were also investigated in a separate model. This study utilized the linked data of police-reported crash data and emergency medical services runs, including 2192 crash injuries that transferred to hospital. A random-effects ordered probit approach was implemented to identify effective factors on crash injury severity. Three models of (1) crash-related variables, (2) crash-related and emergency medical services times and (3) crash-related, emergency medical services times and interaction effects of EMS times and injury location on the body were developed. Although the outcome could not find the impact of faster emergency medical services times on injury severity in the second model, in the third model, faster response time and slower on-scene time were associated with decreasing the severity of entire-body injuries. We discuss why this may be the case.

心肺停止傷病者に対して救急救命士が実施する特定行為の包括的指示化に関する研究(Effect of protocol modification from medical control orders to standing orders for paramedics in prehospital advanced life support for patients with out–of–hospital cardiac arrest)

要旨【目的】院外心肺停止傷病者（OHCA）に対し救急救命士が実施する特定行為の中で包括的指示化（包括化）可能な処置を抽出し，包括化が救急活動時間に与える影響を明らかにする。【対象】北海道内9消防本部が対応したOHCA症例。［調査1］2年間の事後検証票を解析し，救急救命士が提示した具体的指示要請に対してMC指示医師が修正を指示した割合を医師介入率として算出した。［調査2］プロトコル改訂により初回アドレナリン投与（薬投）までに必要な具体的指示が2回から1回に減少した前後各1年間における指示要請時の通話時間，初回薬投，救急活動時間，病院到着前の心拍再開率および1か月後の神経学的予後を比較した。［調査3］プロトコル改訂前後条件下におけるOHCA事例への対応模擬訓練を動画撮影し，初回薬投時間，搬出開始時間を計測比較した。【結果】［調査1］声門上器具気道確保，静脈路確保，初回薬投の3つは医師介入率が1%未満であった。［調査2］具体的指示要請回数の減少により指示要請時通話時間は31秒短縮，初回薬投は30秒短縮でいずれも有意差を認めた。救急車内収容時間，心拍再開率，神経学的予後は有意差を認めなかった。［調査3］模擬訓練では包括化による初回薬投までの短縮時間は32秒，現場搬出開始までの短縮時間は39秒であった。【結語】声門上器具気道確保，静脈路確保，初回薬投の3つの特定行為は包括化を検討すべきである。

Time to Return of Spontaneous Circulation and Survival: When to Transport in out-of-Hospital Cardiac Arrest?

Background In out-of-hospital cardiac arrest (OHCA), 10–50% of patients have return of spontaneous circulation (ROSC) before hospital arrival. It is important to investigate the relation between time-to-ROSC and survival to determine the optimal timing of transport to the hospital in patients without ROSC. Methods: We analyzed data of OHCA patients with a presumed cardiac cause (excluding traumatic and other obvious non-cardiac causes) and ROSC before hospital arrival from the Amsterdam Resuscitation Study (ARREST) database. ROSC included those patients whose ROSC was persistent or transient before or during transport, lasting ≥1 min. Of these data, we analyzed the association between the time of emergency medical services (EMS) arrival until ROSC (time-to-ROSC) and 30-day survival. Results: Of 3632 OHCA patients with attempted resuscitation, 810 patients with prehospital ROSC were included. Of these, 332 (41%) survived 30 days. Survivors had a significant shorter time-to-ROSC compared to non-survivors of median 5 min (IQR 2,10) vs. median 12 min (IQR 9,17) (p < 0.001). Of the survivors, 90% achieved ROSC within 15 min compared to 22 min of non-survivors. In a multivariable model adjusted for known system determinants time-to-ROSC per minute was significantly associated with 30-day survival (OR 0.89; 95%CI 0.86–0.91). A ROC curve showed 8 min as the time-to-ROSC with the best test performance (sensitivity of 0.72 and specificity of 0.77). Conclusion: In OHCA patients with prehospital ROSC survival significantly decreases with increasing time-to-ROSC. Of all patients, 90% of survivors had achieved ROSC within the first 15 min of EMS resuscitation. The optimal time for the decision to transport is between 8 and 15 min after EMS arrival.

Emergency Medical Services Time Intervals for Acute Chest Pain in the United States, 2015–2016

Background: Chest pain is a leading complaint in emergency settings. Timely emergency medical services (EMS) responses can reduce delays to treatment and improve clinical outcomes for acute myocardial infarction patients and other medical emergencies. We investigated national-level EMS response, scene, and transport times for acute chest pain patients in the United States. Methods: A retrospective analysis was performed using 2015–2016 data from the National EMS Information System (NEMSIS). Eligible patients were identified as having a provider impression of chest pain or discomfort and not due to trauma or resulting in cardiac arrest during EMS care. Descriptive analyses of prehospital time intervals and patient-, response-, and system-level covariates were performed. Multivariable logistic regression was used to measure associations between meeting response and scene time benchmarks (8-min and 15-min, respectively) and covariates. Results: Our study identified 1,672,893 eligible EMS encounters of chest pain. Patients had a mean age of 63.1 years (SD = 14.8). The population was evenly distributed by sex (51% male; 49% female). Most encounters occurred in home or residence (58%) and had lights and sirens response to scene (84%). Most encounters were in urban areas (78%). The median (interquartile range, IQR) response time was 7 (5–10) minutes. The median (IQR) scene time was 16 (12–20) minutes. The median (IQR) transport time was 13 (8–20) minutes. Generally, median response and transport times were longer in rural and frontier areas compared to urban and suburban areas. Only 65% and 49% met the 8-min response and 15-min scene time benchmarks. Responding with lights and sirens was associated with greater compliance with EMS response time benchmark. EMS care of older age groups and females was less likely to meet the scene time benchmark. Conclusions: Substantial proportions of EMS encounters for chest pain did not meet response and scene time benchmarks. Regional and urban-rural differences were observed in adherence with the response time benchmark. Our findings also suggest age and gender disparities in on-scene delays by EMS. Our study contributes important evidence on timely EMS responses for cardiac chest pain and provides suggestions for EMS system benchmarking and quality improvement.

The Effect of All-Terrain Vehicle Crash Location on Emergency Medical Services Time Intervals

Over 100,000 all-terrain vehicle (ATV)-related injuries are evaluated in U.S. emergency departments each year. In this study, we analyzed the time intervals for emergency medical services (EMS) providers responding to ATV crashes in different location types. Data from the Iowa State Trauma Registry and a statewide ATV crash/injury database was matched with Iowa EMS Registry records from 2004–2014. Ground ambulance responses to 270 ATV crashes were identified, and response characteristics and time intervals were analyzed. Off-road crashes had a longer median patient access interval (p &lt; 0.001) and total on scene interval (p = 0.002) than roadway crashes. Crashes in remote locations had a longer median patient access interval (p &lt; 0.001) and total on scene interval (p &lt; 0.001), but also a longer median on scene with patient interval (p = 0.004) than crashes in accessible locations. Fifteen percent of remote patient access times were &gt;6 min as compared to 3% of accessible crashes (p = 0.0004). There were no differences in en route to scene or en route to hospital time. Comparisons by location type showed no differences in injury severity score or number of total procedures performed. We concluded that responding EMS providers had an increased length of time to get to the patient after arriving on scene for off-road and remote ATV crashes relative to roadway and accessible location crashes, respectively.

Childrens' and Parents' Willingness to Join a Smartphone-Based Emergency Response Community for Anaphylaxis: Survey.

BackgroundMedical emergencies such as anaphylaxis may require immediate use of emergency medication. Because of the low adherence of chronic patients (ie, carrying anti-anaphylactic medication) and the potentially long response time of emergency medical services (EMSs), alternative approaches to provide immediate first aid are required. A smartphone-based emergency response community (ERC) was established for patients with allergies to enable members to share their automatic adrenaline injector (AAI) with other patients who do not have their AAI at the onset of anaphylactic symptoms. The community is operated by a national EMS. In the first stage of the trial, children with food allergies and their parents were invited to join.ObjectiveThis study aimed to identify the factors that influence the willingness to join an ERC for a group of patients at risk of anaphylaxis.MethodsThe willingness to join an ERC was studied from different perspectives: the willingness of children with severe allergies to join an ERC, the willingness of their parents to join an ERC, the willingness of parents to enroll their children in an ERC, and the opinions of parents and children about the minimum age to join an ERC. Several types of independent variables were used: demographics, medical data, adherence, parenting style, and children's autonomy. A convenience sample of children and their parents who attended an annual meeting of a nonprofit organization for patients with food allergies was used. ResultsA total of 96 questionnaires, 73 by parents and 23 by children, were collected. Response rates were approximately 95%. Adherence was high: 22 out of 23 children (96%) and 22 out of 52 parents (42%) had their AAI when asked. Willingness to join the community was high among parents (95%) and among children (78%). Willingness of parents to enroll their children was 49% (36/73). The minimum age to join an ERC was 12.27 years (SD 3.02) in the parents’ opinion and 13.15 years (SD 3.44) in the children’s opinion.ConclusionsParents’ willingness to join an ERC was negatively correlated with parents’ age, child’s age, and parents’ adherence. This can be explained by the free-rider effect: parents who carried an AAI for their young child, but had low adherence, wanted to join the ERC to get an additional layer of emergency response. Children’s willingness to join the community was positively correlated with age and negatively correlated with the child’s emotional autonomy. Parents’ willingness to enroll their children in an ERC was positively correlated with child’s age and negatively correlated with parents’ adherence: again, this can be explained by the aforementioned free-rider effect. Parents’ and children’s opinions about the minimum age to join an ERC were negatively correlated with protective parenting style and positively correlated with monitoring parenting style.

DISPATCHER-ASSISTED CARDIOPULMONARY RESUSCITATION — AN EFFICIENT WAY FOR IMPROVING SURVIVAL AFTER OUT-OFHOSPITAL CARDIAC ARREST

Immediate witnesses of out-of-hospital cardiac arrest (OHCA) play the leading role in supporting human life. In cases when basic cardiopulmonary resuscitation (CPR) is not performed by the bystanders, precipitous hypoxia brings chances for recovery almost to zero by the time of emergency medical services (EMS) arrival. Carrying out CPR following the instructions given by EMS dispatcher over the telephone (T-CPR) is the fastest and most efficient way of increasing bystander CPR rates. Implementation of T-CPR programs is proved to increase survival from OHCA. Consequently, T-CPR is defined by the effective guidelines for resuscitation as an essential component of pre-hospital care. This review discusses the modern approaches to organizing and implementing T-CPR programs, as well as potential barriers and international experience of T-CPR implementation. The paper is meant for EMS directors and managers, EMS dispatchers and public health specialists.

Response time in the emergency services. Systematic review.

The growth of the urban population raises concern about municipal public managers in the sense of providing emergency medical services (EMS) that are aligned with the needs of prehospital emergency medical care demanded by the population. The literature review aims at presenting the response time of emergency medical services in several parts of the world and discussing some factors that interfere in the result of this indicator such as GDP (Gross Domestic Product) percentage spent on health and life expectancy of countries. The study will also show that in some of the consulted articles, authors suggest to EMS recommendations for decreasing the response time using simulations, heuristics and metaheuristics. Response time is a basic indicator of emergency medical services, in such a way that researchers use the descriptive statistics to evaluate this parameter. Europe and the USA outstand in the publication of studies that present this information. Some articles use stochastic and mathematical methods to suggest models that simulate scenarios of response time reduction and suggest such proposals to the local EMS. Countries in which the response time was identified have a high index of human development and life expectancy between 74.7 and 83.7 years.