Medical Services Personnel Research Articles

Comparison of Patient Safety Ethics of Health Professionals: A Qualitative Content Analysis of the Ethical Principles by the Type of Profession

Purpose: This study aimed to determine the similarities and differences in patient safety ethical principles according to the type of healthcare professional defined by South Korea’s legislation.Methods: This comparative study used a qualitative content analysis of the patient safety ethical principles established by the central associations of each profession. In July 2024, we collected ethical principles, including codes of ethics, guidelines, charters, oaths, and declarations. 17 out of 20 types of healthcare professionals’ ethical principles were analyzed by unitizing, sampling, recording, coding, reducing, abductively inferring, and narrating.Results: Among the 20 types of health professionals, including medical personnel and health and medical services personnel, oriental medicine pharmacists and sanitarians did not have ethical principles. Physicians, nurses, and dentists do not threaten patient safety in common with their own conditions or practices. The ethical principles of healthcare professionals in the same clinical setting are not unified in either form or content.Conclusion: Healthcare professionals require a unified ethical basis to share core ethical values and patient safety cultures. Furthermore, a cross-sectional survey or focus group discussion evaluating knowledge, attitudes, and practices of patient safety ethics may provide more scientific evidence for amending ethical principles.

Assessment of work-related stress and burnout among clinical research occupations

Background: Burnout syndrome is included by the World Health Organization (WHO) in the International Classification of Diseases, and it has a direct impact on the health of workers and also on the performance of companies. In this work, we propose a comprehensive methodology for evaluating work stress and burnout in various occupations within a healthcare organization. Methods: The work stress questionnaire and the Maslach Burnout Inventory were administered to employees of 7 different occupations within a company. The effect of the stressors is established using Cohen's d test, as well as the relationship between the main stressors, burnout and occupation. Results: The results of the study indicated that medical service personnel had the highest levels of stress and burnout syndrome, but significant stress levels and burnout scores were also identified among finance, clinical operations, and marketing professionals. Conclusions: Stress and burnout can vary by department, team, or individual in a company. Based on the study, it was concluded that a single approach to assessing stress and burnout may not provide a complete understanding, in fact, a better alternative is to assess each occupation specifically.

Preparedness for mass gatherings: rescue and emergency medical services\u2019 workloads during mass gathering events

BackgroundMass gathering (MG) events may cause delayed emergency responses via various mechanisms and strain the resources of local emergency services. Therefore, preparedness, including adequate pre-planning and sufficient resourcing during MG events, is vital. The aim of this retrospective register study was to investigate the impact of MG events on the workload of rescue and emergency medical service (EMS) personnel during events to enable more precise and sufficient deployment of these authorities’ operative resources.MethodsThe data from Finland covered of 25,124 EMS and rescue service missions during a three-year period (2015–2017), including data from nine MG events and reference material for the same weekdays two weeks before and after the event. The data were analysed through statistical and geospatial analyses.ResultsOur findings showed that missions increased in most events included in this study. Analysis of the missions’ reasons showed that the categories of violence, traffic accidents and other accidents and injuries increased during events, with violence-related missions showing the highest relative risk (RR 1.87, 95% CI 1.43–2.44). In the four-grade (A–D) urgency grading, the analysis showed an increase in category C missions and a decrease in non-urgent category D missions. The analysis indicated an increase in missions during the evening and night-time. The geospatial analysis revealed dense hotspots of missions in the vicinity of the event area.ConclusionThe workload for EMS and rescue service personnel increases during MG events. Most of the increase is allocated to EMS staff, peaking in evening and night hours. The geospatial analysis showed hotspots of missions on the outskirts of the actual event area during events; thus, the workload can also increase for those authority resources that are not directly allocated to the event. Detailed information regarding workloads is valuable for the authorities that are responsible for resource planning and preparedness for MG events. Replicating the study internationally would improve the methodology for the future.

Public Service Motivation of Street- Level Bureaucrats Amidst the COVID-19 Pandemic: An Analysis of Experiences in Implementation of an at-Home Vaccination Program

This article details public service motivation of emergency medical services (EMS) personnel within a local fire department in Texas, as they implemented an at-home vaccination program, amidst the COVID-19 pandemic. EMS personnel were surveyed and interviewed to learn more about their professional experiences. Using mixed methods, this work finds that EMS personnel in the local department exhibit high levels of public service motivation in both deciding to participate in the at-home vaccination program and throughout their experience in administering the vaccine to community members. This research offers insight local public servants’ motives during a time of crisis and while working in a new, innovative capacity.

SEMRES - A Triple Security Protected Blockchain Based Medical Record Exchange Structure

Background and ObjectiveCOVID-19, a serious infectious disease outbreak started in the end of 2019, has caused a strong impact on the overall medical system, which reflects the gap in the volume and capacity of medical services and highlights the importance of clinical data ex-change and application. The most important concerns of medical records in the medical field include data privacy, data correctness, and data security. By realizing these three goals, medical records can be made available to different hospital information systems to achieve the most complete medical care services. The privacy and protection of health data require detailed specification and usage requirements, which is particularly important for cross-agency data exchange. MethodsThis research is composed of three main modules. "Combined Encryption and Decryption Architecture", which includes the hybrid double encryption mechanism of AES and RSA, and encrypts medical records to produce "Secured Encrypted Medical Record". "Decentralize EMR Repository", which includes data decryption and an exchange mechanism. After a data transmission is completed, the content verification and data decryption process will be launched to confirm the correctness of the data and obtain the data. A blockchain architecture is used to store the hash value of the encrypted EMR, and completes the correctness verification of the EMR after transmission through the hash value. ResultsThe results of this study provide an efficient triple encryption mechanism for electronic medical records. SEMRES ensures the correctness of data through the non-repudiation feature of a blockchain open ledger, and complete integrated information security protection and data verification architecture, in order that medical data can be exchanged, verified, and applied in different locations. After the patient receives medical services, the medical record is re-encrypted and verified and stored in the patient's medical record. The blockchain architecture is used to ensure the verification of non-repudiation of medical service, and finally to complete the payment for medical services. ConclusionsThe main aim of this study was to complete a security architecture for medical data, and develop a triple encryption authentication architecture to help data owners easily and securely share personal medical records with medical service personnel.

Abstract 8883: Pre-hospital Physician’s Presence and Neurological Outcome Among Patients Performed Pre-hospital Advanced Airway Management: A Nationwide Multicenter Observational Study in Japan (the Japanese Association for Acute Medicine-out-of-Hospital Cardiac Arrest Registry)

Purpose: Using the out-of-hospital cardiac arrest (OHCA) registry in Japan, we evaluated the effectiveness of pre-hospital advanced airway management under physicians’ presence after adjusting in-hospital treatments. Methods: This was a multicenter cohort study. We registered all consecutive OHCA patients in Japan who, from 1 June 2014 through 31 December 2017, were transported to institutions participating in the Japanese Association for Acute Medicine OHCA Registry. We included OHCA patients performed pre-hospital advanced airway management, who were ≥18 years of age with medical etiology and who received resuscitation from emergency medical services (EMS) personnel and medical professionals in hospitals. The primary outcome was one-month favorable neurological survival.We estimated the propensity score by fitting a logistic regression model that was adjusted for several variables before the arrival of EMS personnel and/ or pre-hospital physician. A multivariable logistic regression analysis in propensity score-matched patients was used to adjust confounders including extracorporeal membrane oxygenation, percutaneous coronary intervention, intra-aortic balloon pumping, and targeted temperature management. Results: We analyzed 9,672 patients. Among them, 2.3% (N = 218) had a neurologically favorable outcome. The adjusted odds ratio (AOR) of pre-hospital advanced airway management under physicians’ presence compared with their absence for primary outcome was 0.96 (95% confidence interval (CI): 0.61-1.51). Among first documented non-shockable cardiac rhythm, the AOR was 3.10 (95% CI: 1.05-10.77). Among first documented shockable cardiac rhythm, the AOR was 0.90 (95% CI: 0.53-1.53). Conclusion: In Japan, pre-hospital advanced airway management under physicians’ presence was not associated with one-month favorable neurological survival among patients with first documented shockable cardiac rhythm, whereas it was associated with a neurologically favorable outcome among patients with first documented non-shockable cardiac rhythm.

Ready for Children Part II: Increasing Pediatric Care Coordination and Psychomotor Skills Evaluation in the Prehospital Setting

Objectives: Treating pediatric patients often invokes discomfort and anxiety among emergency medical service (EMS) personnel. As part of the process to improve pediatric care in the prehospital system, the Health Resources and Services Administration (HRSA) Emergency Services for Children (EMSC) Program implemented two prehospital performance measures -access to a designated pediatric care coordinator (PECC) and skill evaluation using pediatric equipment-along with a multi-year plan to aid states in achieving the measures. Baseline data from a survey conducted in 2017 showed that less than 25% of EMS agencies had access to PECC and 47% performed skills evaluation using pediatric equipment at least twice a year. To evaluate change over time, the survey was again conducted in 2020, and agencies that participated in both years are compared. Methods: A web-based survey was sent to EMS agency administrators in 58 states and territories from January to March 2020. Descriptive statistics, odds ratios, and 95% confidence intervals were conducted. Results: The response rate was 56%. A total of 5,221 agencies participated in both survey periods representing over 250,000 providers. The percentage of agencies reporting the presence of a PECC increased from 24% to 34% (p= <0.001). However, some agencies reported that they no longer had a PECC, while others reported having a PECC for the first time. Fifty percent (50%) of agencies conduct pediatric psychomotor skills evaluation at least twice/year, a 2% increase over time (p = 0.041); however, a third (34%) evaluate skills using pediatric equipment less than once a year. The presence of a PECC continues to be the variable associated with the highest odds (AOR 2.15, 95% CI 1.91–2.43) of conducting at least semiannual skills evaluation. Conclusions: There is an increase in the presence of pediatric care coordination and the frequency of pediatric psychomotor skills evaluation among national EMS agencies over time. Continued efforts to increase and sustain PECC presence should be an ongoing focus to improve pediatric readiness in the prehospital system.

Factors Associated with Emergency Medical Service Reattendance in Low Acuity Patients Not Transported by Ambulance

Background: The decision for emergency medical services (EMS) personnel not to transport a patient is challenging: there is a risk of subsequent deterioration but transportation of all patients to hospital would overburden emergency departments. The aim of this large-scale EMS study was to identify factors associated with an increased likelihood of ambulance reattendance within 48 hours in low acuity patients who were not transported by ambulance. Methods: We conducted a 2-year retrospective cohort study using data from the St John New Zealand EMS between 1 July 2016 and 30 June 2018 to investigate demographic and clinical associations with ambulance reattendance. Results: In total, 83,171 low acuity patients not transported by ambulance were included, of whom 4,512 (5.4%) had an EMS ambulance reattend within 48 hours. There were significant associations between EMS reattendance and patient age, sex, ethnicity, deprivation, and event location. Patients aged 60-74 years old had the highest likelihood of ambulance recall (OR 2.87, 95% CI: 2.51-3.28). Males were more likely to have an EMS ambulance reattend within 48 hours (OR 1.17, 95% CI: 1.09-1.25). Māori and Pacific Peoples had a similar likelihood of EMS recall to European/Others; however, the Asian cohort showed a reduced likelihood of reattendance (OR 0.76, 95% CI: 0.62-0.93). There were significant associations between EMS reattendance and non-transport reason, time spent on scene, event type, clinical acuity level (status), and pain score. Shorter (<30 minutes) on scene times were associated with a decreased likelihood of ambulance reattendance, whereas longer scene times (>45 minutes) were associated with an increased likelihood. Medical events were more likely to require reattendance than accident-related events (OR 1.22, 95% CI: 1.13-1.32). Non-transported patients with a severe pain score (7-10/10) were at increased likelihood of requiring reattendance (OR 1.60, 95% CI: 1.33-1.92). Discussion: The overall low rate of EMS reattendance is encouraging. Further research is needed into the clinical presentation of patients requiring ambulance reattendance within 48 hours to determine if there are early warning signs indicative of subsequent deterioration.

Impact of SARS-CoV-2 pandemic among health care workers in a secondary teaching hospital in Spain.

The COVID-19 pandemic has posed a huge challenge to healthcare systems and their personnel worldwide. The study of the impact of SARS-CoV-2 infection among healthcare workers (HCW), through prevalence studies, will let us know viral expansion, individuals at most risk and the most exposed areas in healthcare organizations. The aim of this study is to gauge the impact of SARS-CoV-2 pandemic in our hospital workforce and identify groups and areas at increased risk. This is a cross-sectional and incidence study carried out on healthcare workers based on molecular and serological diagnosis of SARS-CoV-2 infection. Of the 3013 HCW invited to participate, 2439 (80.9%) were recruited, including 674 (22.4%) who had previously consulted at the Occupational Health Service (OHS) for confirmed exposure and/or presenting symptoms suggestive of COVID-19. A total of 411 (16.9%) and 264 (10.8%) healthcare workers were SARS-CoV-2 IgG and rRT-PCR positive, respectively. The cumulative prevalence considering all studies (IgG positive HCW and/or rRT-PCR positive detection) was 485 (19.9%). SARS-CoV-2 IgG-positive patients in whom the virus was not detected were 221 (9.1%); up to 151 of them (68.3%) did not report any compatible symptoms nor consult at the OHS for this reason. Men became more infected than women (25% vs 18.5%, p = 0.0009), including when data were also classified by age. COVID-19 cumulative prevalence among the HCW assigned to medical departments was higher (25.2%) than others, as well as among medical staff (25.4%) compared with other professional categories (p<0.01). The global impact of the COVID-19 pandemic on HCW of our centre has been 19.9%. Doctors and medical services personnel have had the highest prevalence of SARS-CoV-2 infection, but many of them have not presented compatible symptoms. This emphasizes the performance of continuous surveillance methods of the most exposed health personnel and not only based on the appearance of symptoms.

Impact of a Standardized EMS Handoff Tool on Inpatient Medical Record Documentation at a Level I Trauma Center

Background The emergency department (ED) poses challenges to effective handoff from emergency medical services (EMS) personnel to ED staff. Despite the importance of a complete and accurate patient handoff report between EMS and trauma staff, communication is often interrupted, incomplete, or otherwise ineffective. The Mechanism of injury/Medical Complaint, Injuries or Inspections head to toe, vital Signs, and Treatments (MIST) report initiative was implemented to standardize the handoff process. The objective of this study was to evaluate whether documentation of prehospital care in the inpatient medical record improved after MIST implementation. Methods Research staff abstracted data from the EMS and inpatient medical records of trauma patients transported by EMS and treated at a Level I trauma center from January 2015 through June 2017. Data included patient demographics, mechanism and location of injury, vital signs, treatments, and period of data collection (pre-MIST and post-MIST). We summarized the MIST elements in EMS and inpatient medical records and assessed the presence or absence of data elements in the inpatient record from the EMS record and the agreement between the two sets of records over time to determine if implementation of MIST improved documentation. Results We analyzed data from 533 trauma patients transported by EMS and treated in a Level I trauma center (pre-MIST: n = 281; post-MIST: n = 252). For mechanism of injury, agreement between the two records was ≥96% before and after MIST implementation. Cardiac arrest and location of injury were under-reported in the inpatient record before MIST; post-MIST, there were no significant discrepancies, indicating an improvement in reporting. Reporting of prehospital hypotension improved from 76.5% pre-MIST to 83.3% post-MIST. After MIST implementation, agreement between the EMS and inpatient records increased for the reporting of fluid administration (45.6% to 62.7%) and decreased for reporting of pain medications (72.2% to 61.9%). Conclusions The use of the standardized MIST tool for EMS to hospital patient handoff was associated with a mixed value on inpatient documentation of prehospital events. After MIST implementation, agreement was higher for mechanism and location of injury and lower for vital signs and treatments. Further research can advance the prehospital to treatment facility handoff process.

Changes in NHS Major Incident management and their relevance to the Defence Medical Services

High-profile Major Incidents in the UK civilian setting in the last few years have appropriately raised awareness of the principles and frameworks involved in the design of reliable response systems....

Abstract 283: Cerebral Regional Oxygen Saturation (rSO 2 ) Will Support to Evaluate an Oxygenation for Emergency Patients Who Can Not Measure SpO 2 at the Scene

Introduction: There are some critical ill patients who cannot measure oxygen saturation (SpO 2 ) by pulse oximeter at the pre-hospital settings. For example, among emergency patients who were treated by emergency medical service (EMS) personnel of Osaka Municipal Fire Department in 2016, there were 3,571 patients who had urgent conditions judged by on-scene EMS personnel but did not have cardiopulmonary arrest (CPA), but the measurement of SpO 2 at the scene could not be measured for 395 patients. On the other hand, the measurement of cerebral regional oxygen saturation (rSO 2 ) during resuscitation has been recently paid to attention. Purpose: To evaluate whether rSO 2 could be measured for these patients.Materials and Methods: We developed portable rSO 2 monitors and equipped them in nine ambulances (There are 63 ambulances in Osaka City). We measured serial changes in cerebral rSO 2 among emergency patients who had urgent conditions judged by on-scene EMS personnel and could not be measured SpO 2 at the scene from April 1st 2018 through March 31st 2019. Results: During the study period, there were 788 patients with incapable-measurement SpO 2 who had urgent conditions judged by on-scene EMS personnel but did not have CPA. We evaluated serial changes in cerebral rSO 2 among 12 patients at the pre-hospital settings. The values of many cases were lower than the normal rangemeasured from healthy adults (71.2 ± 3.9%, on room air). Some cases could not be measured at once during transport to a hospital in spite of any oxygenation. Three cases had &amp;gt; 60 mmHg of systolic blood pressure or an un-palpable radial artery. At some cases, rSO 2 value increased by oxygenation or ventilation. Conclusions: We could measure serial changes in cerebral rSO 2 among fourteen patients without the measurement of SpO 2 at the scene. Our data suggest that pre-hospital monitoring of cerebral rSO 2 might be a new physiological monitoring for urgent patients during transport.

Abstract WP319: Improvement in Stroke Survey Scores for Rural EMS Providers

Introduction: The extended time window for mechanical thrombectomy in acute stroke has added additional challenges to rural regions. Given the topography of the Appalachian region, much of the initial treatment time windows are spent with emergency medical service (EMS) personnel. Few centers in our region are equipped to treat large vessel ischemic strokes and transferring between centers leads to substantial delays and lost treatment opportunities. Now more than ever, EMS providers must understand how to recognize stroke symptoms, know the treatment time windows, and acquire vital pieces of the medical history in order to facilitate appropriate and timely care. Methods: We provided basic stroke education to rural EMS providers during the months of August 2017 to May 2018. An eight-question previously validated survey was given prior to and immediately after the education session. Questions included stroke intervention options and time windows, identification of blood thinners, and stroke prevalence and symptoms. Answers were confidential and participates had between 0 and 50 years of experience. In total, 61 pre-surveys and 63 post-surveys were completed. Results: A Wilcoxon signed-rank test showed that the education program elicited a statistically significant change in stroke knowledge for EMS providers ( Z = -4.013, p &lt;.001). Median percentage was 57.1 before education and 71.4 after. The question with largest improvement in pre to posttest scores, 44 to 71 percent correct (p=.002), was recognition of stroke symptoms. Conclusion: Our study demonstrates that educational sessions can improve stroke knowledge in EMS providers, particularly in the recognition of stroke symptoms. However, the clinical impact of education alone is unclear, especially in the era of extended window mechanical thrombectomy. Future studies incorporating interactive EMS mobile systems are likely needed to address this void.

Abstract TP275: Impact of a Direct to Computed Tomography Protocol on Tissue Plasminogen Activator Door-to-Needle Time in Acute Ischemic Stroke

Background: Current American Heart Association/American Stroke Association (AHA/ASA) guidelines recommend brain imaging with computed tomography (CT) within 20 minutes of emergency department (ED) arrival and treatment with tissue plasminogen activator (tPA) in eligible patients with acute ischemic stroke within 60 minutes of arrival. In January 2017, we implemented a direct-to-CT protocol which consisted of direct patient transportation by emergency medical services (EMS) personnel from ambulance to CT scanner. Patients were then transported to the ED for evaluation and treatment as appropriate via telemedicine and ED staff. Objective: To determine if a direct-to-CT protocol would improve the percentage of patients with door-to-needle (DTN) time ≤ 60 minutes. Methods: This was a single center retrospective cohort study of patients who received tPA for acute ischemic stroke in the ED between October 2016 and May 2018. Patients were grouped based on the use of a direct-to-CT protocol. Results: Of 64 included patients, 23 patients (36%) were transported via the direct-to-CT protocol and 41 patients (64%) arrived via private vehicle or EMS without use of the protocol. Goal DTN time ≤ 60 minutes was achieved in 78% of patients when the protocol was used compared to 44% when it was not (p=0.0078). The mean DTN time was significantly shorter when the protocol was used (52.83±13.8 vs 70.98±32.6, p=0.003). Following adjustments for time of day and the need for blood pressure management with intravenous anti-hypertensives, a greater percentage of patients in the direct-to-CT protocol group achieved DTN ≤ 60 minutes (OR=8.09;95%CI=1.99-32.91, p=0.003). Conclusions: An EMS activated direct-to-CT protocol improved the percentage of patients achieving DTN ≤ 60 minutes and significantly reduced mean DTN time.

Abstract TP460: Recognizing Large Vessel Occlusions Earlier in the Stroke Alert Process

Background: As an Agency for Healthcare Administration (AHCA) Comprehensive Stroke Center we were looking for ways to decrease our door to groin puncture time for patients that had Large Vessel Occlusions (LVO) requiring mechanical thrombectomy. We found patients were often making two trips to the CT scanner. First for their plain brain CT to rule out blood and then for a CT Angiogram and CT Perfusion scan if it appeared the patient was having a Large Vessel Occlusion (LVO). Our mean groin puncture time for mechanical thrombectomy was 116 minutes in 2015. Purpose: To recognize the signs and symptoms of a LVO and save time by completing the plain brain CT scan, the CT Angiogram, and the CT Perfusion scan on the same trip to the CT department. Method: Our vascular neurologist reviewed the signs and symptoms of Large Vessel Occlusions utilizing V.A.N. (vision, aphasia, neglect) criteria with the Emergency Room Physicians, the Emergency Room Nurses, the Clinical Resource Nurses as well as all Emergency Medical Services (EMS) personnel. Lectures were given as well as hands on demonstrations. Telemedicine was asked to see the patient upon arrival in the ambulance bay to observe for LVO as well. Mock codes were run on both campuses with success. Results: Initially all stroke alerts were getting CT Angiograms and CT Perfusions completed regardless of whether they were VAN positive. However, after we reviewed all the false positives the number of patients actually getting these scans decreased to those that truly needed them. EMS now feels comfortable and competent calling LVO’s in the field. As do the Emergency Room physicians. As a result of these patients getting their required scans in one trip to the CT department, our door to groin puncture time has decreased from 116 minutes to a mean of 56 minutes. Conclusion: In conclusion, we found that adopting the utilization of VAN criteria to recognize LVO’s has decreased the mean door to groin puncture time for mechanical thrombectomy allowing for sooner return of circulation to the brain and improving patient outcomes.

Medical leadership and management for military clinicians

Abstract The development of medical leadership and management skills is an essential requirement for the progression of Defence Medical Services personnel in both military and medical training. This review will summarise how military experience can contribute to achieving medical leadership and management competencies and will signpost further opportunities and resources available. While it specifically focuses on doctors, this article has relevance to all Defence Healthcare Professionals.

Abstract 168: Association Between Prehospital Advanced Airway Management for Pediatric Out-of-Hospital Cardiac Arrest and Survival

Introduction: It is unclear whether prehospital advanced airway management (AAM: endotracheal intubation and supraglottic airway device placement) for pediatric patients with out-of-hospital cardiac arrest (OHCA) improves patient outcomes. Objective: To test the hypothesis that prehospital advanced airway management during pediatric OHCA is associated with patient outcomes. Methods: We conducted a secondary analysis of a nationwide, prospective, population-based OHCA registry in Japan. We included pediatric patients (&lt;18 years) with OHCA in whom emergency medical services (EMS) personnel resuscitated and transported to medical institutions during 2014 and 2015. The primary outcome was one-month survival. Secondary outcome was one-month survival with favorable functional outcome, defined as cerebral performance category score 1 or 2. Patients who received AAM during cardiopulmonary resuscitation by EMS personnel at any given minute were sequentially matched with patients at risk of receiving AAM within the same minutes based on time-dependent propensity score calculated from a competing risk regression model in which we treated prehospital return of spontaneous circulation as a competing risk event. Results: We included 2,548 patients; 1,017 (39.9%) were infants (&lt;1 year), 839 (32.9%) were children (1 year to 12 years), and 692 (27.2%) were adolescents. Of the 2,548, included patients, 336 (13.2%) underwent prehospital AAM during cardiac arrest. In the time-dependent propensity score matched cohort (n = 642), there were no significant differences in one-month survival (AAM: 32/321 [10.0%] vs. no AAM: 27/321 [8.4%]; odds ratio, 1.33 [95% CI, 0.80 to 2.21]) and one-month survival with favorable functional outcome (AAM: 6/321 [1.9%] vs. no AAM: 5/321 [1.6%]; odds ratio, 1.48 [95% CI, 0.41 to 5.40]). Conclusions: Among pediatric patients with OHCA, we found no associations between prehospital AAM and favorable patient outcomes.

Abstract 351: Predictors of Neurological Outcome After Out-of-Hospital Cardiac Arrest With Ventricular Fibrillation Witnessed by Emergency Medical Service P.ersonnel., JCS-ReSS Study

Background: Effective advanced life support is one of the important link in the chain of survival. In Japan, the emergency medical service (EMS) personnel can perform defibrillation, advanced airway management, intravenous access and administration of epinephrine as an advanced life support intervention for the treatment of out-of-hospital cardiac arrest (OHCA). However, whether these interventions performed by EMS improves neurological outcomes remains unclear. Objective: To evaluate predictors of favorable neurological outcome in patients suffering OHCA with ventricular fibrillation (VF) witnessed by an EMS personnel. Methods: The Fire and Disaster Management Agency (FDMA) of Japan developed a nationwide database of a prospective population-based cohort using an Utstein-style template for OHCA patients since January 2005. To evaluate data after the publication of Guideline2010, data from January 2011 to December 2015 of this database was used for the current analysis. A multivariate logistic-regression analysis was performed to assess factors associated with favorable neurological outcome (defined as Cerebral Performance Category 1 or 2) 1 month after cardiac arrest. Results: Of the 629,471 patients documented for the study period, 2,301 adult patients with an OHCA of cardiac origin and VF for the initial rhythm witnessed by an EMS personnel were included in the present analysis. The overall mortality was 49.6%. Rate of return of spontaneous circulation and favorable neurological outcome were 53.4% and 44.8%, respectively. High age (OR0.387, 95%CI0.316-0.472, p&lt;0.001), delayed defibrillation (OR0.598, 95%CI0.493-0.723, p&lt;0.001), advanced airway management (OR0.305, 95%CI0.223-0.413, p&lt;0.001), administration of epinephrine (OR0.356, 95%CI0.213-0.585, p&lt;0.001) and multiple attempts of defibrillation (OR0.484, 95%CI0.402-0.582, p&lt;0.001) were negatively associated with favorable neurological outcome. Conclusion: In patients with VF witnessed by EMS personnel, resuscitation efforts should simply focus on early defibrillation and CPR without advanced interventions.

Child Advocacy Centers in the United States and Music Therapy

In the United States, children who suffer trauma or abuse receive services through Children’s Advocacy Centers (CACs). Over 800 CACs provided treatment and services to nearly 325,000 children in 2016 (National Children’s Alliance, 2016b). CACs coordinate the work of multidisciplinary teams (MDT) including law enforcement, mental health, medical, and social service personnel to help children and families heal. CACs are autonomous groups made up of affiliations with many local agencies. This article provides a description of the National Children’s Alliance (NCA) standards for implementing treatment, including the state of music therapy implementation in CACs. The literature has shown that music therapy can be helpful to address needs of children and families who have experienced trauma, suggesting that this may offer a helpful treatment modality in CACs. However, music therapy is rarely available in CACs. This may be, in part, a result of the lack of randomized controlled trials, a key determining factor for inclusion in the annotated bibliography that accompanies the NCA Standards (National Children’s Alliance, 2013). Music therapy practice has addressed the clinical needs of children and teens who have been abused. This work is often presented in clinical reflections, not randomized controlled trials. Music therapy is currently not included in the treatment modalities utilized by CACs because of a perceived lack of evidence base. This article attempts to synthesize the information available to provide CACs with the current state of research in music therapy with children who have been abused. This article also provides music therapists with a depth of information about the structure and function of CACs, including a synthesis of the NCA Standards of Practice. The article presents a description for the implementation of music therapy services in a CAC in New Jersey and includes recommendations for music therapists who wish to seek out opportunities for clinical practice at CACs

Real-time feedback, debriefing, and retraining system of cardiopulmonary resuscitation for out-of-hospital cardiac arrests: a study protocol for a cluster parallel-group randomized controlled trial

BackgroundThe quality of cardiopulmonary resuscitation (CPR) performed by emergency medical services (EMS) personnel affects patient outcomes after cardiac arrest. A CPR feedback device with an accelerometer mounted on a defibrillator can monitor the motion of the patient’s sternum to display and record CPR quality in real time. To evaluate the utility of real-time feedback, debriefing, and retraining using a CPR feedback device outside of the hospital, an open-label, cluster randomized controlled trial will be conducted in five municipalities of Osaka Prefecture, Japan.MethodsEach EMS station within a fire department will be randomly assigned to: 1) the treatment group with real-time feedback, debriefing, and retraining using the CPR feedback device (intervention group); or 2) the conventional treatment group without real-time feedback, debriefing, and retraining (control group). This trial will include 2850 to 3020 patients over about 4 years. The primary outcome of the trial is 1-month favorable neurological survival, defined as cerebral performance category scale score 1 or 2. Secondary outcomes are 1-month survival, survival to hospital discharge, return of spontaneous circulation, and quality of CPR including fraction, depth, tempo, and ventilation rate.DiscussionThe trial will assess whether treatment monitored by the CPR feedback device, which allows for real-time feedback, debriefing, and retraining using CPR quality data, outperforms conventional treatment without real-time feedback, debriefing, and retraining in terms of 1-month favorable neurological survival in cardiac arrest patients receiving CPR outside the hospital.Trial registrationUniversity Hospital Medical Information Network (UMIN) Clinical Trials Registry, UMIN000021431. Registered on 11 March 2016.