Emergency Medical Stations Research Articles

Optimizing locations of emergency medical stations for rural areas: A case study in Iran

Given the dearth of emergency medical services in rural areas, offering these services is among the most important things that should be done right to save the lives of people who have suffered severe injuries. Rapid access to EMSs, which includes a shorter response time and the availability of all intensive care services, including the ICU, CCU, NICU, and PICU, is crucial in this regard. In this regard, a GIS-based ACO-QAP model is proposed for rural areas to optimize locations for EMS stations. This model takes into account the standards of EMS in rural areas, and the standards of out-of-city roads, reducing the response times from EMS stations to the scene of damage and from the damage scene to the closest hospital that offers the required intensive care services. Additionally, to increase the availability of intensive care services and to optimal use of available resources, the model determines which types of intensive care services should be provided in the EMS stations. As a result of the integration for setting up the out-of-city EMS, 614 optimized locations were identified. The identified EMS stations should provide single or multiple intensive care services. There were identified as 544 (88.6%) multiservice stations and 70 (11.4%) single service stations. Among the multiservice stations, 113 (20.8%) stations were identified as two-service, 150 (27.5%) as three-service, and 281 (51.7%), as four-service stations. This model generates a chain of EMS stations that improves spatial accessibility and emergency medical availability while reducing resource usage.

A Wasserstein distributionally robust chance constrained programming approach for emergency medical system planning problem

This paper proposes a distributionally robust chance constrained programming model for an emergency medical system location problem with uncertain demands. By minimising the total expected cost, the location of emergency medical stations, the allocation of the ambulances and demand assignments of system are optimised. The Wasserstein-metric is employed to construct the ambiguity set centred at an empirical distribution with a proper radius, which contains all the probability distributions of the uncertainties. We introduce a big-M technique to reformulate distributionally robust chance constrained programming into a corresponding mixed integer programm, which can be inner and outer approximated by Value-at-Risk (VaR) and Conditional-Value-at-Risk (CVaR). Numerical experiments are illustrated to demonstrate the effectiveness of the formulations.

Quantity and Quality of Healthcare Professionals, Transfer Delay and In-hospital Mortality Among ST-Segment Elevation Myocardial Infarction: A Mixed-Method Cross-Sectional Study of 89 Emergency Medical Stations in China.

BackgroundTransfer delay provokes prolongation of prehospital time, which contributes to treatment delay that endangers patients with ST-segment elevation myocardial infarction (STEMI). A key constraint in reducing transfer delay is the shortage of emergency healthcare workers. This study was to explore the influence of the quality and quantity of healthcare professionals at emergency medical stations on transfer delay and in-hospital mortality among STEMI patients.MethodsA cross-sectional study using mixed methods was conducted at 89 emergency stations in 9 districts in China's Shenzhen province. Based on a sample of 31 hospitals, 1,255 healthcare professionals, and 3,131 patients with STEMI, a generalized linear model was used to explore the associations between the quality and quantity of healthcare professionals and transfer delay and in-hospital mortality among STEMI patients. Qualitative data were collected and analyzed to explore the reasons for the lack of qualified healthcare professionals at emergency medical stations.ResultsThe analysis of the quantity of healthcare professionals showed that an increase of one physician per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 5.087 min (95% CI −6.722, −3.452; P < 0.001). An increase of one nurse per 100,000 individuals was associated with decreased transfer delay by 1.471 min (95% CI −2.943, 0.002; P=0.050). Analysis of the quality of healthcare professionals showed that an increase of one physician with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay for patients with STEMI by 8.508 min (95% CI −10.457, −6.558; P < 0.001). An increase of one nurse with an undergraduate degree per 100,000 individuals was associated with decreased transfer delay by 6.645 min (95% CI −8.218, −5.072; P < 0.001). Qualitative analysis illustrated that the main reasons for low satisfaction of healthcare professionals at emergency medical stations included low income, limited promotion opportunities, and poor working environment.ConclusionsThe quantity and quality of emergency healthcare professionals are key factors influencing transfer delay in STEMI patients. The government should increase the quantity of healthcare professionals at emergency medical stations, strengthen the training, and improve their performance by linking with clinical pathways to enhance job enthusiasm among emergency healthcare professionals.

Computer simulation of spatial placement of emergency medical stations in urban agglomeration

The provision of first aid and saving the lives of victims in an emergency situation are the main tasks of the ambulance service. Since the time of arrival of the ambulance team to the call is one of the key factors affecting the outcome of treatment in emergency cases, the question of the location and number of ambulance stations is relevant. The article proposes a solution to one of the tasks of the strategic level of planning the logistics of emergency medical care in a large urban agglomeration - determining the best location of the required number of emergency medical care points to cover the service region, provided that the time to reach the ambulance brigade to any point will be minimal. To build a model of the optimal spatial location of emergency departments, the capabilities of the K-Medoid clustering algorithm are used. The implementation of the proposed model was carried out using the Statistic Toolbox tool of the MATLAB application software package based on geographical data of Yekaterinburg. A comparative analysis of the current and model time indicators show a noticeable reduction in the arrival time of the ambulance team to the call.

Outbreaks of COVID-19 in Medical organizations

Relevance. Prevention of the outbreak of a new coronavirus infection in medical organizations (MO) is one of the tasks facing the Rospotrebnadzor service and practical health care. Analysis of the causes and conditions of the spread of SARS-CoV-2 in the MO allows us to determine the most effective measures to contain the infection and prevent the occurrence of subsequent diseases in the focus.The aim is to characterize the epidemiological features of a new coronavirus infection during its nosocomial spread in medical organizations based on the analysis of outbreak incidence.Materials and methods. The data of the reporting forms «General information on patients with positive COVID-19», «General information on patients with community-acquired pneumonia with positive COVID-19» (138 pieces of information), copies of «Acts of epidemiological investigation of foci of infectious (parasitic) diseases with the establishment of a causal relationship» (57 pieces of information), copies of extraordinary reports on an emergency of a sanitary and epidemiological nature (57 pieces of information) were analyzed. The work uses epidemiological and statistical methods of research.Results. When analyzing 57 COVID-19 outbreaks in 30 medical organizations, it was found that the outbreak incidence was more often registered in multidisciplinary hospitals – 70.2% compared to 12.3% in specialized organizations of noninfectious profile, 10.5% of outbreaks were in polyclinics, 1.8% at emergency medical stations. The total number of people affected by the spread of the infection was 961, with a small proportion of children (15 people or 1.7%). Among those who fell ill with the spread of infection in the foci, the share of employees of medical organizations was 62.6%, including doctors – 16.6%, middle and junior medical workers-50.6% and 11.3%, respectively, and other categories – 21.5%. In nosocomial outbreaks of COVID-19, the focality index corresponded to 16.9, and the average duration of the focus was 32.4 days. The construction of the so-called «combined» outbreak diagram in the course of the epidanalysis allowed us to establish its total duration, which was 71 days, with the peaks of morbidity within the outbreak at intervals of 3–7 days, the greatest number of cases in the 1st and 8th days, and the gradual «extinction» of its activity in dynamics.Conclusions. The outbreak of COVID-19 in medical organizations usually occurred when there was an epidemic problem with COVID-19 in the territory. The peculiarity of nosocomial outbreaks was a significant proportion of adults (98.3%), mainly employees of medical organizations, who were often active sources of infection, as well as the involvement of structural units and hospitals for adults in the epidemic process, a high frequency of etiological interpretation of outbreaks (95.9%), a significant proportion of asymptomatic forms of infection and carrier, and the complexity of differential diagnosis of cases of out – of-hospital and nosocomial infection. The patterns of occurrence and spread of morbidity in medical organizations can be used in practical anti-epidemic work.

Coverage versus response time objectives in ambulance location

BackgroundThis paper deals with the location of emergency medical stations where ambulances waiting to be dispatched are parked. The literature reports a lot of mathematical programming models used to optimize station locations. Most studies evaluate the models only analytically applying the same simplifying assumptions that were used in the modelling phase. In addition, they concentrate on systems operating one type of emergency units in homogeneous urban areas. The goal of our study is to identify which optimization criterion the emergency medical service (EMS) outcomes benefit from the most and which model should be used to design tiered systems in large urban–rural areas.MethodsA bi-criteria mathematical programming model is proposed. The criteria include the accessibility of high-priority patients within a short time limit and average response time to all patients. This model is being compared to the p-median model with a single response time objective and to a hierarchical pq-median model that considers two different vehicle types. A detailed computer simulation model is used to evaluate the solutions. The methodology is verified in the conditions of the Slovak Republic using real historical data on 149,474 ambulance trips performed in 2015.ResultsAll mathematical models improve EMS performance by relocating some stations compared to the current distribution. The best results are achieved by the hierarchical median-type model. The average response time is reduced by 58 s, the number of calls responded to within 15 min is increased by 5% and the number of high-priority calls responded to within 8 min by 6%.ConclusionsThe EMS systems operating in heterogeneous areas should be designed to minimize response times, and not to maximize the number of calls served within a given time limit.

Model and principles of organizing emergency specialized medical care for children at the stage of medical evacuation

Relevance. The problem of organizing specialized medical care in emergency forms for children is caused by three groups of reasons: the presence at the junction of several adult and pediatric medical specialties, the medical and geographical features of the country and the lack of a unified regulatory framework.Intention. To increase the availability of medical services and reduce regional inequality in their distribution. A model of organizing a single operational service of specialized medical care for children and the basic principles of its functioning on the territory of the Russian Federation are proposed.Methodology. Statistical data, features of legislation, ways of solving the problem in certain regions and the achievements of initiative groups of specialists are analyzed.Results and Discussion. Since 2000, the number of hospital beds for children, the number of emergency medical stations has decreased, and the number of diseases and conditions requiring specialized emergency care for children has increased. Infant mortality rates in remote and hard-to-reach regions exceed the national average by 1.5–2.6 times. At the same time, the current statistics of medical evacuations of children are not accurately reflected in any of the official sources. The regulatory framework for medical evacuation of children includes three “ Procedures for providing medical care “in the profile “ambulance”, “neonatology” and “obstetrics and gynecology” and Federal Law N 323. The law implies the presence of mobile teams in hospitals and departments of different profiles that are not related to each other, but there is no structure that unites them and analyzes the results of work at the federal level.Conclusion. To solve the problem, it is necessary to create a federal operational service and a “hotline” that can be contacted by any resident of the country, to form a federal medical register of critical conditions in children, to develop and implement common principles of diagnosis and treatment. The presented model and principles contribute to the development of a three-level system of emergency medical care and correspond to the goals and objectives of the Ministry of Health of the Russian Federation set out in Letter N 14-3/n/2-2339 of 20.03.2019.

FEATURES OF THE ORGANIZATION AND PROVISION OF EMERGENCY MEDICAL CARE IN POLTAVA REGION

The aim: Is to study and analyze the dynamics of the indicators of the emergency medical service of the Ukrainian and the Poltava region in the context of the reforms of the healthcare system in Ukraine. Materials and methods: In this work, the indicators of development of the emergency medical service of the Ukrainian and the Poltava region were studied and analyzed. Conclusions: The provision of emergency medical care in the Poltava region is provided by the Poltava Regional Center for Emergency Medicine and Disaster Medicine. The structure of the center includes 4 emergency medical stations, which are located in cities such as Poltava, Kremenchuk, Lubny, Mirgorod. А modern telemedicine center was built іn 2018 for emergency counseling on-line in new directions was carried out: ultrasound and endoscopic diagnostics, radiology, counseling during surgical interventions, laboratory diagnostics, etc. Emergencymedical care reform Poltava Regional should be aimed at increasing the efficiency of the use of resources; provision of the EMC system by the relevant vehicles; qualitative training of doctors in emergency medicine; informatization of the EMC system.

Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response...

Outsourcing of transport services at emergency medical stations in the regions of the Russian Federation: negative consequences of the introduction

The article is devoted to the consideration and analysis of such a phenomenon as outsourcing at ambulance stations in the Russian Federation. Experiments on the introduction of ambulance outsourcing in different regions of Russia have been conducted for almost 10 years. The analysis of social and labor conflicts shows that the cases when these attempts were made without conflicts are isolated exceptions. This threatens the reliability of the organization of emergency medical care to the population and worsens the situation of ambulance workers.

An optimization and simulation approach to emergency stations relocation

This paper suggests and compares three median-type location models to determine how to optimally relocate existing emergency medical stations. It also describes a detailed computer simulation model used to evaluate the locations proposed by each model in terms of several indicators of system performance. The simulation model was calibrated using real data from a health care provider in the Slovak Republic. The results of the computer simulation experiments suggest that the simple p-median model can significantly improve the accessibility of urgent health care to patients.

Present-day prehospital airway management in the former Eastern German state of Thuringia: equipment and education of emergency physicians

We describe the condition of education and equipment regarding prehospital airway management in the German federal state of Thuringia, representing a part of former Eastern Germany. In 2006 a postal survey of the 39 emergency medical stations (EMS) in Thuringia was carried out. The response rate was 100%. In 72% of the EMS, a device for extraglottic airway management and in all EMS a device for cricothyrotomy was available. A device to monitor end-tidal CO2 was available in 41%. Difficulties in airway management in the past two years were reported from 74% of the EMS. Ongoing training and education in airway management is provided in 82% of the emergency districts. This survey reveals wide variations in the equipment for airway management available to prehospital emergency physicians in Thuringia. Given the reported difficulties in airway management, availability of a more standardized set of airway management devices in Thuringia may be helpful.

Hyperleptinemia in subjects with persistent partial posttraumatic stress disorder after a major earthquake.

Leptin, a peptide hormone derived from adipose tissue, regulates food intake and controls weight. Serum leptin levels may be elevated in critically ill patients and in cases of physical stress. Our aim was to examine the relationship between postdisaster psychiatric symptoms and serum leptin levels. We recruited 92 subjects who visited emergency medical stations immediately after the giant earthquake seized middle Taiwan on September 21, 1999. Of these cases, 43 met the criteria for subsyndromal acute stress disorder. Eighteen months later, we measured serum leptin levels and performed in-depth psychiatric assessments using the posttraumatic stress disorder subset in the Mini International Neuropsychiatric Instrument and the Brief Symptom Rating Scale short form. After we adjusted for age, gender, and body mass index, serum leptin levels were significantly higher in the persistent subsyndromal group (N = 15; estimated marginal mean, 9.641; 95% confidence interval, 7.673-11.610) than in others (estimated marginal means, 4.775-6.368). A hyperaroused state predicted a higher adjusted leptin level. On the Brief Symptom Rating Scale, general severity index, paranoid tendency, anxiety symptoms, and depressive symptoms were positively correlated with adjusted leptin levels. We found a direct relationship between stress-related psychopathologic symptoms and serum leptin levels. Subjects with persistent subsyndromal posttraumatic stress disorder and hyperarousal had significantly higher serum leptin levels. Therefore, leptin may be a valid neuroendocrinologic marker for the hypervigilant state of vulnerable people who have faced tremendous danger and uncertainty. Further studies are needed to examine the correlation between leptin levels and hypothalamic-pituitary-adrenal axis function, particularly the inverted diurnal serum leptin levels in hyperaroused subjects.

The mosh pit experience: Emergency medical care for concert injuries

Effective planning is essential for medical personnel preparing to provide emergency care at mass gatherings. At large concerts where audience members participate in “moshing,” crowd surfing, and stage diving, there may be a potential for a dramatic increase in injuries requiring medical attention. Injuries seen at emergency medical stations at 3 concerts, all with large mosh pits, over 4 event days were recorded and evaluated. Each event day had over 60,000 attendees. A total of 1,542 medical incidents (82.9 per 10,000) were reported over the 4 event days. There were 37% (466 patients, 25.1 per 10,000) of incidents related to moshing activity. Hospital transport was required for 2.5% (39 patients, 2.1 per 10,000) of medical visits with 74% (29 patients, 1.5 per 10,000) of those transported being for mosh pit-related injuries. When planning emergency medical care for such concerts with mosh pits, the potential for an increase in the number of medical incidents and injuries requiring medical attention and hospital transport should be taken into account for efficient medical coverage.