Medical Rescue Services Research Articles

Midazolam for Post-Arrest Sedation in Pre-Hospital Emergency Care.

An out-of-hospital cardiac arrest (OHCA) with return of spontaneous circulation (ROSC) may need to be treated with airway management, emergency ventilation, invasive interventions, and post-arrest sedation. We investigated the influence of the use of midazolam for post-arrest sedation on achieving postresuscitation care targets and the associated risk of hemodynamic complications. All emergency rescue missions of the Dresden, Gütersloh, and Lippe medical rescue services in the years 2019-2021 were reviewed to identify adult patients who had OHCA, unconsciousness, and sustained ROSC with spontaneous circulation until arrival at the hospital; the findings were supplemented with data from the German Resuscitation Registry. Patients who received midazolam (alone or in combination with other anesthetic agents) for post-arrest sedation were compared with those who did not. The endpoints were the regaining of a systolic blood pressure ≥ 100 mmHg, end-tidal pCO2 35-45 mmHg, and oxygen saturation (SpO2) 94-98%. A propensity score analysis was used to adjust for age, sex, and variables potentially affecting hemodynamic status or the targets for oxygenation and ventilation. There were 2335 cases of OHCA among 391 305 emer - gency rescue missions. 571 patients had ROSC before arrival in the hospital (24.5%; female, 33.6%; age, 68 ± 14 years). Of the 395 among them (69.2%) who were treated with postarrest sedation, 249 (63.0%) received midazolam. Patients who received midazolam reached the guideline- recommended targets for oxygenation, ventilation, and blood pressure more frequently than those who were not sedated: the respective odds ratios and 95% confidence intervals were 2.00 [1.20; 3.34], 1.57 [0.99; 2.48], and 1.41 [0.89; 2.21]. The pre-hospital administration of midazolam leads to more frequent pre-hospital attainment of the oxygenation and ventilation targets in post-resuscitation care, without any evidence of an elevated risk of hemodynamic complications.

Türkiye's Health Diplomacy Activities: A Qualitative Research

Health diplomacy is a field that facilitates the implementation and governance of global health policies. Assisting, such as transferring expertise, experience, and human and medical equipment to different countries, constitutes the content of health diplomacy. The main argument of this study is that Türkiye provides official development assistance abroad, establishes and operates health enterprises, and provides medical rescue and emergency health services in disasters and emergencies. For this reason, it has been tried to reveal Türkiye's perception of health diplomacy, how the health service process is carried out across the border, and the possible contributions of these services. A case study design was used to examine Türkiye's health diplomacy process. In this context, interviews were conducted with the public (n=1) and non-governmental organization personnel (n=8). The research findings were evaluated within the framework of four main themes: perception of health diplomacy, difficulties experienced in the health diplomacy process, solutions to the difficulties encountered in the health diplomacy process, and contributions of health diplomacy. The perception of health diplomacy is fieldwork, experience transfer, support, joint action, foreign policy, soft power, and health priority. In the process of health service delivery, it has been determined that there are difficulties in terms of medical equipment, service delivery, personnel, and politics, and these difficulties are tried to be solved through cooperation, communication, and other means. It has been concluded that health diplomacy contributes to the health of the recipient country or region and supports employment with newly opened health institutions. In addition, it was determined that Turkish health personnel gained experience, sympathy for Türkiye developed, and prejudices were broken.

INCREASED RISK OF CHEMICAL TERROR ATTACKS

The risk of using highly toxic chemicals in a terrorist attack is resurfacing. Over the last fewdecades, terrorists have proven that they can source, develop and produce their own toxicchemicals. These substances are particularly dangerous for civilians who do not have access tothe protective equipment to be used in the event of contamination. It is impossible to guaranteefull public security in relation to the threats of chemical terrorism. Only trained, functioningand cooperating elements of state crisis response systems (mainly: medical rescue services,fire brigades, the police and the army) are capable of minimising the negative effects of theseattacks on the civilian population. This problem is becoming particularly important in view of theongoing Russian-Ukrainian war and the potential use of chemical weapons by the Russian army.An important problem impacting the extent of poisoning after a chemical attack is secondarycontamination of people and emergency equipment. The authors, through a detailed descriptionof the sources of secondary pollution, propose a number of solutions aimed at minimizing the riskof poisoning in people who are not directly exposed to chemical hazardous agents as a result ofsecondary contamination. The proposed solutions are based on the experience of chemical troopsin the elimination of chemical contamination of a large number of people, as well as the experienceof the authors related to the implementation of research and development projects regarding theprotection and operating procedures of rescue services in CBRN contamination zones.

Response times in rural areas for emergency medical services, fire and rescue services and voluntary first responders during out-of-hospital cardiac arrests

AimTo increase survival in out-of-hospital cardiac arrests (OHCA), great efforts are made to improve the number of voluntary first responders (VFR). However, evidence of the potential utility of such efforts is sparse, especially in rural areas. Therefore, the aim was to describe and compare response times for emergency medical services (EMS), fire and rescue services (FRS), and VFR during OHCA in relation to population density. MethodsThis observational and comparative study was based on data including positions and time stamps for VFR and response times for EMS and FRS in a region in southern Sweden. ResultsIn total, 285 OHCAs between 1 July 2020 and 31 December 2021 were analysed. VFR had the shortest median response time in comparison to EMS and FRS in all studied population densities. The overall median (Q1–Q3) time gain for VFR was 03:07 (01:39–05:41) minutes. A small proportion (19.2%) of alerted VFR accepted the assignments. This is most problematic in rural and sub-rural areas, where there were low numbers of alerted VFR. Also, FRS had shorter response time than EMS in all studied population densities except in urban areas. ConclusionThe differences found in median response times between rural and urban areas are worrisome from an equality perspective. More focus should be placed on recruiting VFR, especially in rural areas since VFR can potentially contribute to saving more lives. Also, since FRS has a shorter response time than EMS in rural, sub-rural, and sub-urban areas, FRS should be dispatched more frequently.

Health and medical rescue service supervision centre

The profession of firefighter working on the rescue and emergency care involves many skills and requirements. The Health Sub-Directorate's supervisory division oversees the activities of these agents in partnership with the Operations, Forecasting and Prevention Division. A firefighter nurse is present on the site and watches over the 250 to 350 daily interventions.

Interpersonal communication between medical rescue service employees and patients as perceived by patients

Interpersonal communication between medical rescue service employees and patients as perceived by patients

Construction of a 5G-based, three-dimensional, and efficiently connected emergency medical management system

BackgroundShenzhen is unique in its need for ad hoc responses to emergencies. The need for emergency medicine also demonstrates a trend of sustained growth. ObjectiveA three-dimensional and efficiently connected emergency medical management model using fifth generation mobile communication technology (5G) was established to improve the efficiency and level of management in emergency medicine. MethodA mixed-frequency band private network collaborative emergency treatment mode was built under daily emergency scenarios using 5G. The efficiency of a three-dimensional telemedicine treatment mode was tested using prehospital emergency medicine. Also, the feasibility of quickly establishing a temporary network information system using unmanned aerial vehicle (UAV) and/or high-throughput communication satellites under disaster-caused power outages and network interruptions was examined. A monitoring system was constructed for suspected cases using 5G amid public health emergencies, which raised the Emergency Department’s efficiency and security in responding to the pandemic. ResultsThe three-dimensional rescue system supported by 5G showed that the radius of the emergency medical rescue services expanded from 5 to 60 km, and the cross-district emergency reaction time reduced from 1 h to <20 min. Thus, it was feasible to construct a communication network expeditiously with devices carried by UAV under disastrous scenarios. The system developed based on 5G could be used in managing suspected cases of public emergencies. Among the 134 suspected cases in the early stage of the pandemic, no nosocomial infection was detected. ConclusionA three-dimensional, efficiently connected emergency medical management system based on 5G was constructed, following which the emergency rescue radius quickly expanded and the emergency response time reduced. Thus, with the aid of new technology, an emergency information network system was built expeditiously under specific scenarios, such as a natural disaster, and the level of management under public health emergencies advances. The confidentiality of patient information is a critical issue regarding the application of new technology.

Building “common knowledge” when responding to major road tunnel incidents: an inter-organisational focus group study

PurposeMajor incidents in tunnel environment will pose several challenges for the emergency service organisations in terms of heat, visibility and lack of experiences from working in confined environments. These aspects, in turn, could pose challenges to establish collaboration. This study aims to contribute to the field of collaborative tunnel responses by exploring how “common knowledge” (Edwards, 2011) is built by the emergency services organisations, that is, what the organisations consider important while working on a potentially common problem, and their motives for the interpretations and actions if a major tunnel incident occurs.Design/methodology/approachParticipants from the road traffic control centre, emergency dispatch centre, emergency medical service, rescue service and police were included in the study. Data from four focus group sessions was analysed using thematic analysis.FindingsThe study revealed that the tunnel environment presents specific aspects of how common knowledge was produced related to lifesaving and safety. The themes structuring mechanisms to reduce uncertainty, managing information for initial priorities, aligning responsibilities without hampering each other's work and adjusting actions to manage distance, illustrated how common knowledge was produced as crucial aspects to a collaborative response. Organising management sites, grasping and communicating risks, accessing the injury victims, was challenged by the confined environment, physical distances and imbalance in access to information and preparedness activities in tunnel environments.Originality/valueThis study offers new insights of common knowledge, by illustrating a motive perspective on collaborative responses in tunnel incidents. Creating interoperability calls not just for readiness for action and tunnel safety, but also training activities acknowledging different interpretations and motives to further develop tunnel responses.

Emergency Medical Rescue Services in Dhaka City, Bangladesh: A Situational Analysis and Needs Assessments

Deaths and disabilities due to the lack of proper Emergency Medical Rescue Services (EMRS) is a global public health concern, also in Dhaka city, Bangladesh. The study aimed at contributing to improve the EMRS in Dhaka city by assessing and identifying major shortcomings with possible solutions.

Air Medical Transportation Provided by Norte Novo Regional Urgency Mobile Service: What Is the Current Scenario?

ObjectiveThe aim of this study was to investigate, describe, and analyze the Norte Novo regional air medical service provided by the Brazilian Emergency Medical Rescue Service. MethodsThis was a retrospective and descriptive study with a quantitative approach of the incidents registered from November 2016 to December 2019. For general patient classification, descriptive statistics of the following variables were performed: sex, age/age group, type of diagnosis, city where the incident took place, city of destination, length of patient care, ventilatory support, use of sedation, and use of vasoactive drugs. All analyses were performed using the XLSTAT program (Version 19.4; Addinsoft, New York, NY), considering a significance level of 5%. ResultsThere were 1,677 responses divided into clinical (60.8%), traumatic (37.8%), organ transport (1.2%), and interhospital transference (0.2%). The most frequent diagnoses were acute myocardial infarction and stroke (clinical care) and polytrauma (trauma care). The average waiting time until the helicopter arrived at the scene was 25 minutes. ConclusionThis study shows the importance and relevance of this air medical service for the area it covers. Further research is needed to address the profile of this service in our country, which will allow us to elucidate scenarios and develop strategies to assist the population and, thus, design training and simulation exercises for emergency service teams based on local realities.

From Learning “Doing the Work of a Paramedic” to “Being a Paramedic” – the Results of Research on Students of the Last Year of Wroclaw Medical University

Theoretical background: The limited number of scientific studies on the specifics of the professional identity formation of paramedics makes it possible to conclude that this subject is insufficiently identified. In addition, the growing demand for medical professions, including paramedics, has led the authors to fill the research gap related to the recognition of the real professional identity of future representatives of the discussed profession. Accepting the fact that professional identity of paramedics is formed at different stages of the professional life of the person practicing the job, the authors took up the challenge of looking at the problem in question from the perspective of, inter alia , the identification of key determinants of the choice of this profession, the accompanying values and motivations, as well as the degree of fulfilment of expectations from the process of preparation for this profession offered in the framework of higher education. Purpose of the article: The article draws attention to a very important stage in the process of shaping the professional identity of paramedics, which is the higher-level of education. Its purpose is to recognize the opinions of students of the last year of emergency medical care about their values, motivations that determined the choice of this field of study and the competences acquired by them. These elements determine the degree of satisfaction of students with the broadly understood process of study and, consequently, the forming of their professional identity. Research methods: The article refers to the results of own research conducted among students of the last year in the field of medical rescue service at the Medical University of Wroclaw. The study covered a four-year period and was done each time in the second quarter of 2017, 2018, 2019 and 2020. The authors of the article conducted a diagnostic survey using the authors' survey questionnaire. Main findings: Future paramedics, while undertaking higher studies in the said field, though internally convinced that their decisions were right, were guided by different values and motivations. Among the most important were the desire to pursue their passions, fulfill dreams, care for their own health, family and relationships with friends. Work as a value and the directly related need to help others, as well as the resulting economic benefits, were not considered the most important for future paramedics at that moment. The identified dissonance pertaining to the degree of fulfilment of expectations towards the process of education and the degree of benefits gained from that process demonstrate a limited level of satisfaction from preparation for the studied profession. Implications/Recommendations: The attempt made in the article to insight into the professional identity of future paramedics, and in particular the weaknesses and concerns identified in relation to the learned profession, certainly invite further research that can contribute to both, improving the current education system and taking action by further actors in the subsequent stages of shaping this identity. Taking into account the concerns identified by future paramedics and the enormity of tasks they are going to face, the professional predisposition as well as psychophysical characteristics of potential candidates should be taken into account at the stage of recruitment for the studies. In this context the teaching time should be increased for such subjects as psychology, patient communication and stress management. So far, the Polish education system of paramedics offers no planned career path, no vertical differentiation and promotion during professional work, which would certainly be a motivating factor. Continuous professional development should be an important element, which could enable them to develop their professional identity from learning doing the work of a paramedic to being a paramedic.

ASSOCIATION BETWEEN WORKLOAD AND PSYCHOLOGICAL WELL-BEING IN MALAYSIA ELITE FIREFIGHTER

Emergency responders are frequently exposed to life-threatening risks when attending to critical incident events causing an increasing number of psychological health issues among emergency responders. However, few studies are related to workload and its association with Malaysian emergency responders' mental health problems. Hence, the study objective is to identify the level of workload, determine the level of psychological well-being and their association with Malaysian firefighters. A cross-sectional study was conducted among Grade A and B stations firefighters in Kota Bharu Kelantan using a validated NASA-TLX and DASS-21 questionnaire through a purposive sampling method. Respondents were divided into standard operations teams and elite teams such as Emergency Medical Rescue Services (EMRS). Results show that although EMRS, the medical team has the highest overall workload demand, firefighters deemed performance and effort demand a significant workload demand comparing to others. It is also found that most firefighters have higher anxiety issues comparing to depression and stress, where 30% to 61% of respondents develop a certain level of anxiety corresponding to only 15% to 39% for depression and 13% to 28% for stress. Hence, it is suggested that further research should be conducted in investigating and understanding the contributing factors towards Malaysian firefighters’ psychological health problems so that they can be managed or even prevented.

Expert Consensus on Disaster Medical Rescue Services

Disasters and disaster rescue are accompanied by the development of human history. But disaster medicine has been a discipline only for several decades recently. The establishment of the disaster rescue system in China began with the outbreak of SARS in 2003. As the incident exposed a series of problems in response to emerging infectious diseases, China began to consider how to systematically respond to various disasters and commence establishing a comprehensive emergency management system. The “Emergency Response Law of the People’s Republic of China” implemented in 2007 marks the preliminary establishment of China’s modern disaster rescue system. In December 2011, the Disaster Medicine Branch of Chinese Medical Association was established in Shanghai, marking a new stage of the development of disaster medicine in China. Here, disaster medicine and medical rescue services were summarized to guide the implementation of related work.

Using Travel Times for Optimization Numbers of Medical Rescue Service Points—Case Study from Slovakia

Health care and protection is one of the fundamental human rights, which apply to all people of the world. Life and health threats can occur at any place and time, both at times of peace and security and at times of emergencies of any kind. In many cases, provision of urgent medical care creates a time strain. Emergency medical care in the Slovak Republic is provided by a medical rescue service, including mobile emergency care and ambulances, with or without a doctor. The present article deals with the purpose and role of medical rescue service with an emphasis on mobile emergency care provision by ambulances. The following part defines selected factors affecting medical rescue service station locations and numbers of ambulances. Emphasis is laid on an analysis of theoretical assumptions for optimization of the number of medical rescue service stations and ambulances used by them for the purpose of securing care of life and health of the population and addressing emergencies within selected territorial units in the Self-Governing Region of Žilina. The proposed optimization of the number of medical rescue service stations in municipalities is addressed theoretically as a location issue. The resulting theoretical variant of the proposed new distribution of medical rescue service ambulance stations is a mathematical consideration of assurance of emergency medical care provision within 15 min from each event reporting. The mathematical algorithm used for the proposal of medical rescue service ambulance station distribution is applicable in different regions and countries with a defined time to provision of first aid and emergency medical care.

AI-guided resource allocation and rescue decision system for medical applications

With the robust growth in the social environment, millions of families have vast medical plans nowadays. Each client requires a personalized medical rescue decision, making an intelligent recommendation system highly important. In practice, wealthy families tend to purchase tailored medical services, while others tend to seek medical services from local community hospitals. Noticeably, trillions-scale of medical service transactions occurs daily, making the development of a fully automatic intelligent recommendation system to match the suitable medical services to clients urgent. In this work, we propose a novel Internet-scale deep architecture that automatically recommends personalized and tailored medical rescue services based on the previously discovered clients with different financial tolerance. Specifically, given a massive number of client families, first, we create a set of features that represents the multiple medically related attributes of each family. These features capture the income, health status, type of diseases, occupation, and so on. The features are then combined into a descriptive feature by multi-view learning, which can dynamically assign the importance of each feature channels. Based on the combined feature, affinity graphs are created on a large scale to represent the relations between the client families. Also, an efficient dense subgraph mining is used to categorize the million-scale clients into 10 different medical groups. Finally, various customized medical services can be tailored for each client in a fully automatic and efficient manner. Comprehensive experiments on our collected data sets demonstrated the competitiveness of our proposed intelligent recommendation system. Moreover, the results of visualized dense subgraph mining showed that the client families with different wealth levels can be distinguished accurately.

Templates for handling multi-agency collaboration activities and priorities in mining injury incidents: a Delphi study

PurposeThe purpose of this study was from a Swedish perspective to map experts' opinions on theoretical statements of essential collaboration activities for management of mining injury incidents.Design/methodology/approachA Delphi technique was performed, asking opinions from experts in iterative rounds to generate understanding and form consensus on group opinion around multi-agency management. The experts were personnel from emergency medical service, rescue service and mine industry, all with operative command positions.FindingsThree iterative rounds were performed. The first round was conducted as a workshop to collect opinions about the most important multi-agency collaboration activities to optimize victim's outcome from an injury incident in an underground mine. This resulted in 63 statements and additional three were added during the second round. The statements were divided into one trajectory and seventh time phases and comprised, e.g. early alarm routines, support of early life-saving interventions, relevant resources and equipment for the assignment and command and control center and functions with predefined action plans for response. It also comprised shared and communicated decisions about each agency's responsibility and safety. All statements reached consensus among the experts in Round 3.Research limitations/implicationsThe experts included in this study seem to be adequate but there could be other experts and different statements that other researchers might consider.Practical implicationsThese statements could be used to evaluate collaboration in major incidents exercises. The statements can also be quality indicators for reporting results from multi-agency management.Originality/valueThis paper contributes to the research field of collaboration and joint practices between and among personnel involved in rescue operations.

History of the State Medical Rescue Service in Poland

The State Medical Rescue Service in Poland dates back to 1891, when the first ambulance service was established in Cracow. Over 129 years, the system has been fully transformed, starting with medical staff, through numbers, equipment, and modern information and communication systems for emergency calls and assistance during interventions, and medical records. Emergency medical services in Poland had their breakthrough when the current Act of 8 September 2006 on the National Medical Rescue Service was introduced, which is the foundation for the modern organisation of medical rescue and emergency medicine in Poland. According to the Ministry of Health, the total number of Emergency Medical Services Teams operating in 2019 was 1585, including those operating on a seasonal basis.

Road ambulances: working conditions of paramedics - pilot studies.

The article presents the results of selected pilot studies conducted in medical ambulances. Their aim was to determine the working conditions and identify troublesome factors accompanying the performance of basic medical procedures by rescue teams. The study of working conditions was carried out in Mercedes-Benz ambulances, type S and P. Fifty-one paramedics of the Emergency Medical Rescue Service in Siedlce took part in the research. The questionnaire expert survey method and the direct observation method were used. As a result of the applied research methods, knowledge was gained on the irregularities and difficulties that occur at the workplace of a paramedic, i.e., in an ambulance, including the lack of access to essential elements of medical equipment and their different location inside the vehicle, and the diversity of solutions for the spatial structure of ambulances, which all cause difficulties at work. Research has shown that paramedics take, on average, 33 min to familiarize themselves with the location of equipment in an ambulance other than the one in which they are usually on duty. There was no correlation between the lifeguard's length of service and the time necessary for getting acquainted with the equipment, which was studied using Pearson's correlation coefficient. In the study, rescuers also pointed to musculoskeletal ailments, mainly spinal pains resulting from taking forced positions during medical activities in an ambulance. The results obtained constitute the basis for the author's methodology of complex research aimed at defining the ergonomic recommendations necessary in the modification process of the operated medical fleet. The next step will be to formulate uniform guidelines for the construction of medical compartments of ambulances, the application of which will lead to the unification of their spatial structure regardless of the vehicle brand. Int J Occup Med Environ Health. 2020;33(1):91-105.

Epidemiology of Limb Injuries in paediatric patients receiving care from Emergency Medical Service teams: descriptive analysys

INTRODUCTION: Injury-related interventions currently place a heavy workload on emergency medical teams in both adults and paediatric patients. One of the most common types of injuries are limb injuries caused by physical activity, falls or traffic accidents. It is extremely important to provide adequate protection for the paediatric patient in case of injury, as homeostasis disorders can occur very quickly in this age group. The aim of the study was to obtain data on the type and frequency of limb injuries in the group of paediatric patients who received medical rescue services interventions. An attempt was also made to specify the most frequent causes of limb injuries. MATERIAL AND MeTHODS: The study was based on a retrospective analysis of medical records of emergency rescue teams in the period from November 2017 to October 2018. The study included an analysis of interventions to patients under 18 years of age to whom EMS teams intervened due to limb injury. The analysis included sociodemographic data such as age, gender, time and place of the injury, as well as the type of injury based on the ICD-10 classification. RESULTS: In the studied period, 289 interventions in paediatric patients with limb injuries were recorded, which constituted 9.8% of all interventions in paediatric patients. The main site of the injury was a school. Upper limb injuries were reported in 123 cases, which constituted 42.6% of the intervention to the studied group of patients. The upper limb injuries were predominantly caused by forearm fractures (n = 33; Tab. 3), while the lower limb — by knee joint injuries. CONCLUSIONS: Limb injuries account for nearly 10% of all EMS interventions in paediatric patients. The main site of the injury was a school and the most frequent were upper limb injuries including forearm fractures, while for the lower limb — knee joint injuries. Further action should be taken to reduce the number of limb injuries in children.

State Medical Emergency System in Poland

The first ambulance service in Poland was established in 1891 in Cracow. Many tips and assistance concerning the creation of the ambulance were provided by the organisers of the first ambulance in Europe (the Vienna ambulance in 1883). Since January 2007, the Act of 8 September 2006 on the National Medical Rescue Service has been a binding legal act. The aim of the Act is to introduce the functioning of the emergency medical system, both through a high level of health services based on the standards of Western countries and providing the required solutions in the area of emergency notification. The State Medical Rescue System was established to provide assistance to any person in need who is in a state of health emergency. The owner of the PRM system unit must ensure the readiness of people, resources and organizational units. The units of the PRM system providing services only in case of an emergency are: medical rescue teams, including airborne medical rescue teams and hospital emergency departments.