Number Of Emergency Medical Services Research Articles

Are High School Students Ready to Stop the Bleed from Injuries? Needs Assessment in a Low Resource Country

Background: Life-threatening bleeding is a major cause of trauma-related deaths. Stop the Bleed—Active bleeding control (ABC) program in Hyderabad recently showed that lay first responders can be effectively trained. However, the willingness of high school students to train in bleeding control is unknown. We report Stop the Bleed training needs assessment from high schools in India and estimate the potential multiplier effect. Methods: A cross-sectional survey was conducted from 12 randomly selected schools in Hyderabad. The study was to understand current knowledge, skills and willingness to get trained and respond to life-threatening bleeding from injuries. 107 Participants (35 Teachers and 72 students) were purposively selected for telephonic interviews with a structured questionnaire. Results: Response rate was 93% overall. 80% of participants have never been trained in bleeding control. 84% reported willingness to be trained, train others and help bleeding victims. All the teachers reported that stop the bleed training would be useful in high schools. 70.6% of teachers recommended that training could start from middle school (10 to 15 years), 47% preferred the online training mode. Only 20% of participants had prior training in lifesaving first aid and 32% did not know the number of emergency medical services (EMS). Each trained participant has the potential to train 3 to 4 people at the household level and perhaps more at the community level. Conclusion: The surveyed schools in Hyderabad do not have the knowledge, skills, or training curriculum in Stop the Bleed. Students and teachers are willing to be trained and train others, with great potential for a “multiplier-effect” in the community.

The Association Between the Number of Prehospital Providers On-Scene and Out-of-Hospital Cardiac Arrest Outcomes

Objective: The ideal number of emergency medical services (EMS) providers needed on-scene during an out-of-hospital cardiac arrest (OHCA) resuscitation is unknown. Our objective was to evaluate the association between the number of providers on-scene and OHCA outcomes. Methods: This was a secondary analysis of adults (18 years old) with non-traumatic OHCA from a 10-site North American prospective cardiac arrest registry (Resuscitation Outcomes Consortium) including a 2005–2011 cohort and a 2011–2015 cohort. The primary outcome was survival to hospital discharge. We calculated the median number of EMS providers on-scene during the first 10 minutes of the resuscitation and used multivariable logistic regression adjusting for age, sex, witness status, bystander CPR, arrest location, initial rhythm, and dispatch to EMS arrival time. Results: There were 30,613 and 41,946 patients with necessary variables in the 2005–2011 and 2011–2015 cohorts, respectively. Survival to hospital discharge (95% CI) was higher with 9 or more providers on-scene (17.2% [15.8–18.5] and 14.0% [12.6–15.4]) compared to 7–8 (14.1% [13.4–14.8] and 10.5% [9.9–11.1]), 5–6 (10.0% [9.5–10.5] and 8.5% [8.1–8.9]), 3–4 (10.5% [9.3–11.6] and 9.3% [8.5–10.1]), and 1–2 (8.6% [7.2–10.0] and 8.0% [7.1–9.0]) providers for the 2005–2011 and 2011–2015 cohorts, respectively. In multivariable logistic regressions, compared to 5–6 providers, there were no significant differences in survival to hospital discharge for 1–2 or 3–4 providers, while having 7–8 (adjusted odds ratios (aORs) 1.53 [1.39–1.67] and 1.31 [1.20–1.44]) and 9 or more (aORs 1.76 [1.56–1.98] and 1.63 [1.41–1.89]) providers were associated with improved survival in both the 2005–2011 and 2011–2015 cohorts, respectively. Conclusions: The presence of seven or more prehospital providers on-scene was associated with significantly greater adjusted odds of survival to hospital discharge after OHCA compared to fewer on-scene providers.

Virtual Overdose Response for People Who Use Opioids Alone: Protocol for a Feasibility and Clinical Trial Study.

BackgroundA recent quarterly report released by Alberta Health reports that on average 2.5 Albertans die every day from accidental overdose deaths, and that between April 1, 2020, and June 30, 2020, the province lost a total of 301 people. In Canada, between January 2016 and March 2020, a total of 16,364 people died due to opioid-related overdose. The World Health Organization reports that 70% of the 0.5 million deaths worldwide caused by drugs are related to opioid overdose. Although supervised consumption sites or safe injection sites have been shown to be effective in reducing the harms associated with the use of illicit substances and increasing uptake of addiction treatment and other health services, there is still significant stigma associated with them, and it is unlikely that all of the people who would benefit from supervised consumption service will ever access a site.ObjectiveTo help prevent deaths in populations that cannot or will not access physical safer consumption services in Alberta, we propose to provide virtual (telephone-based) overdose response services, staffed by people with lived experience.The primary outcome for this study is uptake of the service as measured by the number of calls to the service. Secondary outcomes will include patterns of use of the phone line (days of the week and time of calls) and outcomes from the calls (number of emergency medical services dispatches for overdoses from the service and the results of those dispatches).MethodsThis phase 1 clinical study is set to officially launch in early May 2020. The service will be available to up to 15 participants who self-disclose as using opioids unobserved and have given informed consent for both data collection and interviews. This group will have access to a toll-free telephone number and be invited to call when they plan to use opioids alone.ResultsThe analysis will include mixed methods. To improve the design of the service and ensure safety of all involved, quantitative data will be collected on phone calls and participant health care usage, while qualitative data will be collected from both participants and virtual overdose response operatorsConclusionsThis clinical trial aims to test the feasibility of a service that provides virtual overdose response in order to help prevent deaths in populations that cannot or will not access physical supervised consumption services in Alberta.Trial RegistrationClinicalTrials.gov NCT04391192; https://www.clinicaltrials.gov/ct2/show/NCT04391192International Registered Report Identifier (IRRID)DERR1-10.2196/20183

Association between case volume of ambulance stations and clinical outcomes of out-of-hospital cardiac arrest: A nationwide multilevel analysis

ObjectivesThe case volume effects of ambulance stations on the survival of out-of-hospital cardiac arrest (OHCA) patients are uncertain. This study was conducted to evaluate the association between the case volume of ambulance stations and clinical outcomes in OHCAs by the number of emergency medical services (EMS) providers at the scene. MethodsAdult cardiac EMS-treated OHCAs between 2015 and 2018 were enrolled. The main exposure was the annual OHCA case volumes of 204 ambulance stations in Korea, which were categorized into three groups; low-volume (<100), moderate-volume (100–159) and high-volume (≥160). The primary and secondary outcomes were good neurological recovery and survival to discharge. Multilevel multivariable logistic regression analysis was conducted to calculate adjusted odds ratios (AORs). Interaction analysis between the number of EMS providers at the scene and the exposure variable was performed. ResultsA total of 92,534 patients were enrolled. OHCAs in the low-volume group tended to be arrest in a public place or a non-metropolitan area, less prehospital administration of an advanced airway and intravenous management. Significant differences were found the main analysis: AORs (95% CIs) compared to the low-volume group were 1.15 (1.03–1.29) and 1.14 (1.03–1.27) in the high-volume and moderate-volume groups for good neurological recovery and 1.19 (1.07–1.33) and 1.14 (1.04–1.25) in the high-volume and moderate-volume groups for survival to discharge. Significant interaction effects between the number of EMS providers at the scene and case volume on clinical outcomes were found. ConclusionOHCA case volumes of ambulance stations are associated with clinical outcomes after cardiac arrest.

Double external defibrillation for shock-refractory ventricular fibrillation cardiac arrest: A step towards standardization.

Double (or dual) external defibrillation (DED) has increasingly been used in the last few years by a number of emergency medical services (EMS) as a last resort to terminate ventricular fibrillation and pulseless ventricular tachycardia in adult patients who remain refractory to standard defibrillation. However, no randomized controlled trials comparing DED with standard defibrillation focusing on patient-oriented outcomes as the primary objective have been published to date. Selection criteria, procedure techniques, and protocol are not clearly defined and vary across observational studies. The terms and/or nomenclature used to describe DED are confusing and vary throughout the literature. Despite increased use of DED, many questions remain as to which patients will derive the most benefit from DED, when to implement DED, and the optimal form of delivering DED. The present paper provides a brief overview of the background, procedure techniques, pad placement, and factors affecting how DED is delivered. A further objective of this paper is to offer a proposal for a uniform nomenclature and a standardized protocol in the form of a flowchart for EMS agencies to guide further clinical trials and best practices. This paper should not only help give background on novel definitions and clarify nomenclature for this practice, but more importantly should help institutions lay the groundwork for performing EMS-based large trials to further investigate the effectiveness of DED.

Pre-hospital blood transfusion \u2013 an ESA survey of European practice

BackgroundBlood products are a lifesaving commodity in the treatment of major trauma.Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage.The primary aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The secondary aim was to evaluate opinions about PHBP and also the experience and the personal views of its users.MethodsThe subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d’Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries.ResultsIn total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37 and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%.Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently.ConclusionsWe found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.

Paramedic-reported barriers towards use of CPR feedback devices in Perth, Western Australia

Feedback devices for cardiopulmonary resuscitation (CPR) have been introduced across a number of emergency medical services (EMS) worldwide with the intention of increasing the provision of high quality CPR. In July 2014, St. John Ambulance Western Australia (SJA-WA) introduced the Q-CPRTM device into mandatory clinical practice; however usage rates were lower than expected. Methods: A voluntary, anonymous survey was issued to a convenience sample of SJA-WA paramedics from September to December 2015 to determine the paramedic-reported barriers towards the use of Q-CP Results: Of the 264 paramedics who participated in the survey, 41% reported having used Q-CPR during their last attempted resuscitation. Among those who had not used it, the reason most commonly cited (37%) was that a mechanical chest compression device arrived on scene prior to the Q-CPR being deployed. Secondly, other interventions were prioritized above the use of Q-CPR (20%). Thirdly, pain associated with use of the Q-CPR prevented its utilization in 17% of cases. Other reasons were less frequently reported. Conclusion: Lower usage rates appeared to be primarily linked to the utilisation of other equipment and interventions in preference to the Q-CPR and to a lesser extent due to pain associated with the use of such devices.

Der Telenotarzt als Innovation des Rettungswesens im ländlichen Raum – eine gesundheitsökonomische Analyse für den Kreis Vorpommern-Greifswald

The provision of emergency doctors in rural regions is challenged by guaranteeing early rescue while limiting the number of emergency doctor positions. The first alternative to achieve these objectives is the increase of the number of emergency medical services. Alterna- tives are helicopter rescue and the so-called „telemedicine emergen- cy doctor”. In particular in regions with low population density and geographical barriers (such as Switzerland) one has to choose an al- ternative which minimises the costs while still warranting that the emergency time is kept. This analysis compares the costs of all three alternatives. It becomes obvious that the telemedicine doctor is a promising innovation which is due to become more relevant for Switzerland.

The impact of a pre-hospital critical care team on survival from out of hospital cardiac arrest

Introduction: Survival from out of hospital cardiac arrest (OHCA) remains poor. A number of Emergency Medical Services (EMS) dispatch pre-hospital critical care teams (CCTs) to OHCA, but evidence to support this practice is lacking.

Volume versus outcome: More emergency medical services personnel on-scene and increased survival after out-of-hospital cardiac arrest

Background and aim: The large regional variation in survival after treatment of out-of-hospital cardiac arrest (OHCA) is incompletely explained. Communities respond to OHCA with differing number of emergency medical services (EMS) personnel who respond to the scene. The effect of different numbers of EMS personnel on-scene upon outcomes is unclear. We sought to evaluate the association between number of EMS personnel on-scene and survival after OHCA. MethodsWe performed a retrospective review of prospectively collected data on 16,122 EMS-treated OHCA events from December 1, 2005 to May 31, 2007 from a combined population over 21 million people residing in an area of over 33,000 square miles in Canada and the United States. Number of EMS personnel on-scene was defined as the number of EMS personnel who responded to the scene of OHCA within 15min after 9-1-1 call receipt and prior to patient death or transport away from the scene. Associations with survival to hospital discharge were assessed by using generalized estimating equations to construct multivariable logistic regression models. ResultsCompared to a reference number of EMS personnel on-scene of 5 or 6, 7 or 8 EMS personnel on-scene was associated with a higher rate of survival to hospital discharge, adjusted odds ratio [OR], 1.35 (95% CI: 1.05, 1.73). There was no significant difference in survival between 5 or 6 personnel on-scene versus fewer. ConclusionMore EMS personnel on-scene within 15min of 9-1-1 call was associated with improved survival of out-of-hospital cardiac arrest. It is unlikely that this finding was mediated solely by earlier CPR or earlier defibrillation.

The Quality of Prehospital Ischemic Stroke Care: Compliance with Guidelines and Impact on In-hospital Stroke Response

A number of emergency medical services (EMSs) performance measures for stroke have been proposed to promote early stroke recognition and rapid transportation to definitive care. This study examined performance measure compliance among EMS-transported stroke patients and the relationship between compliance and in-hospital stroke response. Eight quality indicators were derived from American Stroke Association guidelines. A prospective cohort of consecutive, EMS-transported patients discharged from 2 large Midwestern stroke centers with a diagnosis of acute ischemic stroke was identified. Data were abstracted from hospital and EMS records. Compliance with 8 prehospital quality indicators was calculated. Univariate and multivariable logistic regression analysis were performed to measure the association between prehospital compliance and a binary outcome of door-to-computed tomography (CT) time less than or equal to 25 minutes. Over the 12 month study period, 186 EMS-transported ischemic stroke patients were identified. Compliance was highest for prehospital documentation of a glucose level (86.0%) and stroke screen (78.5%) and lowest for on-scene time less than or equal to 15 minutes (46.8%), hospital prenotification (56.5%), and transportation at highest priority (55.4%). After adjustment for age, time from symptom onset, and stroke severity, transportation at highest priority (odds ratio [OR], 13.45) and hospital prenotification (OR, 3.75) were both associated with significantly faster door-to-CT time. No prehospital quality metric was associated with tissue-plasminogen activator delivery. EMS transportation at highest priority and hospital prenotification were associated with faster in-hospital stroke response and represent logical targets for EMS quality improvement efforts.

한정된 응급시설의 최적위치 문제

본 논문은 여러 구역으로 분할된 도시에서 응급환자가 발생하였을 때 이에 대처하기 위한 최대 허용 도착시간 T를 충족시키면서, 응급시설 수 p를 한정시켰을 때 최대한의 주민수를 커버할 수 있는 응급시설의 최적 위치를 결정하는 알고리즘을 제안하였다. 이 문제는 일반적으로 두 구역 간 소요시간이 최대허용 도착시간이내이면 1로, 그렇지 않으면 0으로 하는 정수계획법으로 변환시키고, 선형계획법 도구를 활용하여 해를 구한다. 본 논문은 p=1인 경우 최대로 커버하는 노드로 결정하며, <TEX>$p{\geq}2$</TEX>인 경우 최대한으로 커버할 수 있는 노드 상위 5개를 <TEX>$p_1$</TEX>기준으로 포함-배제 원칙을 적용하여 <TEX>$p_1$</TEX>이 커버하는 영역을 삭제하였을 때 남은 노드들 중에서 최대로 커버하는 노드를 <TEX>$p_2$</TEX>로, <TEX>$p_1,p_2$</TEX> 커버 영역을 삭제시 최대로 커버할 수 있는 노드를 <TEX>$p_3$</TEX>로 결정하였다. 이들 5개 기준 노드 집합 들 중에서 최대로 커버하는 노드 집합을 최적의 응급시설 위치로 결정하였다. 제안된 알고리즘을 12-노드 망, 21-노드 망과 Swain의 55-노드 망에 적용한 결과 최적해를 쉽고 빠르며, 정확하게 결정할 수 있었다. This paper proposes an EMS algorithm designed to determine the optimal locations for Emergency Medical Service centers that both satisfy the maximum ambulance response time T in case of emergency and cover the largest possible number of residents given a limited number of emergency medical services p in a city divided into different zones. This methodology generally applies integer programming whereby cases are categorized into 1 if the distance between two zones is within the response time and 0 if not and subsequently employs linear programming to obtain the optimal solution. In this paper, where p=1, the algorithm determines a node with maximum coverage. In cases where <TEX>$p{\geq}2$</TEX>, the algorithm selects top 5 nodes with maximum coverage. Based on inclusion-exclusion method, this selection entails repeatedly selecting a node with the maximum coverage when nodes with lower numbers are deleted. Among these 5 selected nodes, the algorithm selects a single node set with the greatest coverage and thereby as the optimal EMS location. The proposed algorithm has proven to accurately and expeditiously obtain the optimal solutions for 12-node network, 21-node network, and Swain's 55-node network.

Domestic accidents involving women and first aid knowledge

Domestic accidents (DA) are preventable and untoward events occurring in a house, pool or garage. Those events constitute a major issue in the context of public health. The objective of this study was to highlight the characteristics of female involvement in DA and their level of knowledge regarding first aid. Adult female relatives of patients presenting at the university-based emergency department within the six-month study period comprised the study sample. They were asked to answer a 23-item self-reported questionnaire, and the responses were analyzed. A total of 1017 women (mean age: 29.2±11.1 years) were enrolled in the study. Hand lacerations (n=924, 90.8%), sprain and contusions (n=904, 88.8%) and burns (n=803, 78.9%) were the most commonly reported types of DA. The children were reported to suffer mostly from hits, sprains and contusions (n=478, 91.7%), followed by falls and slipping (n=452, 86.7%). The telephone number of emergency medical services was recalled most frequently (n=871, 85.6%), while that of the poison control center was known least commonly (n=48, 4.7%). The group with the highest level of education had a significantly higher mean number of correct answers than that of the group with the lowest level of education (p=0.001). The knowledge level of the women who worked was significantly lower than that of the unemployed women (p=0.02). Extensive training of women on DA should be undertaken and the mass media should be utilized to achieve this goal.

An Unrecognized Presentation of Cocaine-Associated Pneumomediastinum in the Prehospital Setting

AbstrastCocaine abuse is associated with a significant number of emergency medical services (EMS) calls and emergency department visits every year. The medical complications of recreational cocaine use are diverse, involving almost any body organ, and vary greatly according to the substance used and the route by which is taken. Previous reports have associated cocaine abuse with serious pulmonary complications, including barotrauma. The occurrence of barotrauma is directly related to the way cocaine is consumed. The majority may manifest clinically with subcutaneous emphysema, chest pain, and neck pain. We report a case of cocaine-induced pneumomediastinum in the prehospital environment that masqueraded as an allergic reaction. Prehospital providers should be alert for clinical manifestations suggestive of barotrauma in cocaine users.

The Effects of the Air Pollution On the Frequency of Visits Of Hypertensive Patients at the Emergency Unit in the City of Sao Paulo

P-009 Objective: the objective of this work was to analyze the association between the number of emergency medical services by hypertensive disease at an emergency unit and the concentrations of atmospheric pollutants in the city of São Paulo. Material and Methods: The studied group was of hypertensive patients (ICD 10), which in the period between February 2001 and December 2003 sought services at the emergency unit of the São Paulo hospital with hypertensive complications (elevation of blood pressure and its complications). All the analyzed patients were São Paulo residents. The atmospheric pollution data were collected from CETESB (Environmental Sanitation and Technology Co.) on a daily basis for every period of the study. Results: The data analyzed showed that the elevation on the atmospheric nitrogen dioxide (NO2), carbon monoxide (CO) and sulfur dioxide (SO2) are related to a greater number of services provided to patients who suffer form hypertension at the emergency unit of São Paulo hospital. The greatest effect on the elevation of the blood pressure was given at different moments after exposure for each pollutant previously mentioned. Thus for SO2 it has been observed an important impact until five days after the greatest atmospheric concentration. As for CO and the NO2 the same procedure occurred with seven and two days respectively. Conclusion: it has been concluded that there is an important relationship between a greater concentration of atmospheric pollutants and a greater number of emergency medical services of hypertensive patients at intensive care units.

R ESUSCITATION OF R ESIDENTS WITH D O N OT R ESUSCITATE O RDERS IN L ONG-TERM C ARE F ACILITIES

Background. A considerable number of emergency medical services (EMS) responses for cardiac arrest occur in long-term care facilities. In some instances, these responses are for residents who have expressed wishes not to be resuscitated by signing a do not resuscitate (DNR) order. Objectives. To assess the magnitude of EMS use for cardiac arrest in long-term care facilities for residents with DNR orders and to determine reasons why EMS is called. Methods. A retrospective study was conducted using data collected from medical incident reports between July 1999 and December 2000 for all persons experiencing cardiac arrest in long-term care facilities defined as nursing homes, adult family homes, and assisted-living centers in King County, Washington, excluding Seattle. The authors also surveyed facilities to determine their policies for calling 9-1-1 in the event of cardiac arrest. Results. Of the 392 cardiac arrests in long-term care facilities to which EMS responded, 139 (35%) of the residents had DNR orders. Of these 139, 29 (21%) received attempted resuscitation by EMS. The problem appeared to be greater among nursing homes and adult family homes than in assisted-living centers. Among nursing homes, the primary reason for an EMS call was concern for validity of the DNR order, whereas among adult family homes, the primary concern was appropriate medical authority to declare death. Conclusion. Efforts to clarify existing regulations, streamline the DNR transfer process, and improve communication between EMS and long-term care facilities may result in better fulfillment of residents' end-of-life wishes and a saving of EMS resources.

911 and Emergency Department Use for Chest Pain: Results of a Media Campaign

Study objectives: We evaluated the effects of a community public education campaign that encouraged patients to quickly call 911 after the onset of acute myocardial infarction (AMI) symptoms. Setting and participants: The media campaign focused on residents 50 years of age or older in King County, Washington, which has a population of 1.5 million (1990 census). Design: We determined 911 responses for chest pain, emergency department visits for AMI symptoms, the number of patients admitted to a CCU with an admitting diagnosis of rule-out MI, and the number of confirmed AMIs before and after the campaign. Results: The number of emergency medical services (EMS) responses (911 runs) for patients 50 years of age or older experiencing AMI symptoms increased significantly during the media campaign. ED visits for chest pain also increased significantly during the campaign, as did the number of patients 50 years of age or older admitted to a King County CCU with an admitting diagnosis of rule-out MI. Each of the above increases tapered off with time after the media campaign but remained above baseline. Conclusion: An intense public education campaign can significantly increase EMS use, ED visits, and CCU admissions for AMI symptoms. However, these effects taper off with time after the campaign. [Eppler E, Eisenberg MS, Schaeffer S, Meischke H, Larson MP: 911 and emergency department use for chest pain: Results of a media campaign. Ann Emerg Med August 1994;24:202-208.]