Prehospital Emergency Management Research Articles

Comparison of GAP, R-GAP, and new trauma score (NTS) systems in predicting mortality of traffic accidents that injure hospitals at Mashhad University of medical sciences

BackgroundThere are several trauma scoring systems with varying levels of accuracy and reliability that have been developed to predict and classify mortality in trauma patients in the hospital admission. Considering the importance of the country's emergency organization and the World Health Organization in the category of traffic accidents, we used this information in the study. The objective of this study is to evaluate and compare the predictive power of three scoring systems (R-GAP, GAP, and NTS) on traffic accident injuries. MethodsIn an analytical cross-sectional study, all the data related to the mission of traffic accidents at the pre-hospital emergency management of Mashhad University of Medical Sciences in 2022 were extracted from the automation system, and the outcome of the patients in the hospital was recorded from the integrated hospital system. Then, GAP, R-GAP, and New Trauma Scores (NTS) were calculated, and their results were compared using ROC curve and logistic regression. ResultsIn this study, 47,971 injuries from traffic accidents were evaluated. Their average age was 30.16 ± 10.93 years. R-GAP showed negligible difference than GAP and NTS scores (the area under the curve equals 0.904, 0.935, and 0.884, respectively), and the average scores of R-GAP, GAP, and NTS are equal to 22.45/45 ± 1/9, 22.25 ± 1.5, and 22.49 ± 1.3, respectively. Injury severity based on R-GAP, GAP, and NTS scores was mild in most patients. The effect of these models on the patient outcome based on OR values, R-GAP, GAP, and NTS models showed high values. All analysis was performed in SPSS 26. ConclusionAccording to the study results, it seems that R-GAP, GAP, and NTS, have the highest power to predict death in traffic accident injuries. It is recommended to include these points in the electronic file of the pre-hospital emergency for the injured. Also, the severity and outcome of the patient can be predicted by these scores, which play an important role in the triage of the injured and determining the appropriate treatment center.

EMS Potentials in MENA region

Background Emergency Medical Services (EMS) have been always considered as a vital service provided by of many Red Cross and Red Crescent (RCRC) national societies worldwide and in Middle East and North Africa (MENA) region in particular during emergency and non-emergency contexts. The role to supporting the national wide health system in prehospital stage has got special attention during COVID 19 due to overwhelming health care facilities. The national societies have played a key role in mitigating the impact of the COVID 19 on the healthcare facilities by activating and growing their EMS capacities and expanding their scope of services in the prehospital stage. To define capacities and areas for improvement in RCRC national societies, we've developed a tool to survey different aspects of EMS. Methodology A questionnaire was designed by the IFRC MENA health team based on Prehospital emergency management system PEMS conceptual framework for assessment. 67 questions were grouped into 5 domains: governance and dispatch, Human Resources (H.R.) & Logistics, EMS Education, EMS operation and quality , and EMS disaster preparedness. Two open-ended questions were added to define areas of improvement and what national societies can offer to enhance capacities for other national societies in the region… The questionnaire was piloted with EMS leaders at Lebanese Red Cross. Between the period of April 2022 and August 2022, the online questionnaire was sent to four national society EMS managements, Lebanese Red Cross LRC , Palestine Red Crescent Society PRCS , Saudi Red Crescent Authority SRCA and Syria Arab Red Crescent SARC. The answers were collected using SurveyMonkey platform and validation workshops were held with all four EMS managements. For the qualitative questions of the perceived weaknesses and strengths, interviews with EMS managements were recorded and transcript. Analysis tools of SurveyMonkey was utilized for quantitative data analysis, and qualitative data was explored manually using thematic analysis methodology. Results The input from the four national societies revealed variation in governance, structure, and scope of services of EMS among them. We can highlight the main outcomes under each domain EMS Governance and Dispatch The four NSs are considering scoop and run operational model. The percentage of acute to cold cases in day to day practice is varying with predominance of cold cases among all. SRCA, PRCS in West Bank, and LRCS central dispatch center are using fully automated dispatch system, while LRC is using semi-automated in the regional dispatch centers, and SARC and PRCS branches in Gaza and Jerusalem are using manual (paper based) dispatch system. EMS H.R. & Logistics LRC, PRCS and SARC are mainly relying on volunteers to run EMS daily operations while SRCA depends on 6000 full time employees to operate 24/7 EMS services. SRCA EMS fleet is considered the largest among the four NSs with around 1,400 vehicles, LRC came next with 390 vehicles, then PRCS with 180, and lastly SARC with 112. EMS Education Both LRC and SRCA are running international accredited emergency courses including Basic Life Support (BLS), Advanced Life Support, Prehospital Trauma Life Support (PTLS), Advanced Trauma Life Support, and other relevant courses. On the other hand, PRCS and SARC are considering academic and locally customized training courses to train their EMS staff and volunteers. EMS Operation and Quality The service coverage of the four EMS in urban areas ranges between 80 – 100% while coverage decreases in rural areas to reach under 50% in some regions. Quality assurance and regular monitoring are areas that need to be standardized and systematized in most cases. EMS Disaster Preparedness Specialized training program for Mass Causality Incidences (MCI) is conducted in LRC, PRCS and SRCA. LRC, SARC, and SRCA possess a standardized approach for major incidence management as part of their disaster management

723 Provincial Burn Mass Casualty Incident Planning: Preliminary Results

Abstract Introduction Burn mass casualty incident (BMCI) response planning includes involving relevant stakeholders, assessing regional burn care capacity, and addressing the specialized needs of burn patients. An essential component of these processes is an evaluation of existing resources and plans. In this study, a province with three important elements—a singular health authority to plan for, two burn centres, and updated health technology—was selected for evaluation. Aim What are the current policies, protocols, and practices that address a provincial response to a BMCI? Methods In this ethics approved case study, qualitative description methodology was used for data analysis. Data were gathered from documents outlining the health system response to a mass casualty incident from the health system internal emergency response plans. Health care professionals directly involved in the response were recruited for interviews. Participants were recruited from prehospital emergency management services, hospital emergency departments, inpatient burn units, and a provincial patient transport department. Interviews were conducted online, recorded, and transcribed. Qualitative description was used to code common themes across documents and transcripts. Results Thirteen documents and nine participant interviews were included. Only two documents included burn-specific considerations. Current policies and protocols were limited to all-hazards mass casualty incident planning and did not address specialized needs of burn care. Current plans were based on assumptions that all burn patients would be triaged and transported to burn centres and that surge capacity would be adequate to accommodate for increased demands. Prehospital participants (n=3) felt that existing plans would adequately manage a BMCI. Six participants stated the current plans were not sufficient to manage a BMCI. A comprehensive description of the complex health system response to a potential BMCI was obtained. Some major deficiencies identified included a lack of strategies to bolster burn care staffing capacity such as just-in-time training resources for non-burn trained staff or utilization of outpatient burn clinic staff. Considerations for increased operating room and wound care resources were absent. Conclusions Current provincial all hazards response plans are not sufficient to support adequate response to a BMCI and need to be amended to address the specialized needs of burn patients. Strategies for expanding capacity such as care of burn patients at non burn facilities and utilization of outpatient clinics must be integrated into future plans. Applicability of Research to Practice The provincial health authority needs to support BMCI response planning efforts to better address this unique hazard prior to an incident occurring for best patient outcomes.

The Aspects of Running Artificial Intelligence in Emergency Care; a Scoping Review.

Artificial Inteligence (AI) application in emergency medicine is subject to ethical and legal inconsistencies. The purposes of this study were to map the extent of AI applications in emergency medicine, to identify ethical issues related to the use of AI, and to propose an ethical framework for its use. A comprehensive literature collection was compiled through electronic databases/internet search engines (PubMed, Web of Science Platform, MEDLINE, Scopus, Google Scholar/Academia, and ERIC) and reference lists. We considered studies published between 1 January 2014 and 6 October 2022. Articles that did not self-classify as studies of an AI intervention, those that were not relevant to Emergency Departments (EDs), and articles that did not report outcomes or evaluations were excluded. Descriptive and thematic analyses of data extracted from the included articles were conducted. A total of 137 out of the 2175 citations in the original database were eligible for full-text evaluation. Of these articles, 47 were included in the scoping review and considered for theme extraction. This review covers seven main areas of AI techniques in emergency medicine: Machine Learning (ML) Algorithms (10.64%), prehospital emergency management (12.76%), triage, patient acuity and disposition of patients (19.15%), disease and condition prediction (23.40%), emergency department management (17.03%), the future impact of AI on Emergency Medical Services (EMS) (8.51%), and ethical issues (8.51%). There has been a rapid increase in AI research in emergency medicine in recent years. Several studies have demonstrated the potential of AI in diverse contexts, particularly when improving patient outcomes through predictive modelling. According to the synthesis of studies in our review, AI-based decision-making lacks transparency. This feature makes AI decision-making opaque.

ST-T segment changes in prehospital emergency physicians in the field: a prospective observational trial

AimsDue to time-critical decision-making, physical strain and the uncontrolled environment, prehospital emergency management is frequently associated with high levels of stress in medical personnel. Stress has been known to cause ischemia like changes in electrocardiograms (ECGs), including arrhythmias and deviations in ST-T segments. There is a lack of knowledge regarding the occurrence of changes in ST-T segments in prehospital emergency physicians. We hypothesized that ST-T segment deviations occur in prehospital emergency physicians in the field.MethodsIn this prospective observational trial, ST-T segments of emergency physicians were recorded using 12-lead Holter ECGs. The primary outcome parameter was defined as the incidence of ST-T segment changes greater than 0.1 mV in two corresponding leads for more than 30 s per 100 rescue missions. The secondary outcomes included T-wave inversions and ST-segment changes shorter than 30 s or smaller than 0.1 mV. Surrogate parameters of stress were measured using the NASA-Task Load Index and cognitive appraisal, and their correlation with ST-T segment changes were also assessed.ResultsData from 20 physicians in 36 shifts (18 days, 18 nights) including 208 missions were analysed. Seventy percent of previously healthy emergency physicians had at least one ECG abnormality; the mean duration of these changes was 30 s. Significantly more missions with ECG changes were found during night than day shifts (39 vs. 17%, p < 0.001). Forty-nine ECG changes occurred between missions. No ST-T segment changes > 30 s and > 0.1 mV were found. Two ST-T segment changes < 30 s or < 0.1 mV (each during missions) and 122 episodes of T-wave inversions (74 during missions) were identified. ECG changes were found to be associated with alarms when asleep and NASA task load index.ConclusionECG changes are frequent and occur in most healthy prehospital emergency physicians. Even when occurring for less than 30 s, such changes are important signs for high levels of stress. The long-term impact of these changes needs further investigation.Trial registration The trial was registered at ClinicalTrials.gov (NCT04003883) on 1.7.2019: https://clinicaltrials.gov/ct2/show/NCT04003883?term=emergency+physician&rank=2

Intensive care medicine in Europe: perspectives from the European Society of Anaesthesiology and Intensive Care.

BACKGROUNDAnaesthesiology represents a rapidly evolving medical specialty in global healthcare, currently covering advanced peri-operative, pre-hospital and in-hospital critical emergency management (CREM), intensive care medicine (ICM) and pain management. The aim of the European Society of Anaesthesiology and Intensive Care (ESAIC) is to develop and promote a coordinated interdisciplinary and multidisciplinary European network of Anaesthesiology and Intensive Care Medicine (AICM) societies for improvement of patient safety and outcome, and to enhance political and public awareness of the role of anaesthesiologists all over Europe. The ESAIC promotes coordinated interdisciplinary and multidisciplinary care for severely compromised patients, based on the European training requirements (ETR) within the European Union of Medical Specialists (UEMS).METHODSTo define the current situation of AICM in Europe, a survey was sent in April 2019 to the ESAIC Council and the ESAIC National Anaesthesiologists Societies Committee (NASC) members. The survey posed questions regarding the year of foundation, the inclusion of ICM in the society name, and if, and to what extent, various kinds (postoperative, general, specific, mixed) of national ICUs are being run by differing medical specialties. The study data were compiled and analysed by the ESAIC Board, Council and NASC in December 2019.RESULTS AND CONCLUSIONAmongst the 42 European national societies surveyed (41 members of ESAIC-NASC plus Luxembourg), nineteen (45%) also include terms related to critical care medicine or ICM in their names, seven (17%) include terms related to reanimation and three (7%) to resuscitation. In recent years, several national societies revised their names to better reflect their gradual embrace of peri-operative medicine, ICM, CREM and pain management. Approximately 70% of ICU beds in Europe, and 100% in Scandinavia, are being run by anaesthesiologists, the remaining 30% being managed by physicians from other surgical or medical specialties. To emphasise future needs and resources of European AICM, the ESAIC drafted an ICM roadmap in terms of clinical practice, organisation of healthcare, interprofessional and interdisciplinary collaboration, patient safety, outcome and empowerment, professional working conditions, and changes in research, teaching and training required to meet future challenges and expectations.

Factors Associated with 24-Hour Clinical Outcome of Emergency Patients; a Cohort Study

Introduction:Pre-hospital and in-hospital emergency management play an important role in quality of care for emergency patients. This prospective cohort study aimed to determine factors associated with the 24-hour clinical outcome of emergency patients.Methods:The sample included 1,630 patients, randomly selected through multi-stage stratified sampling from 13 hospitals in 13 provinces of Thailand. Data were collected during January-November 2018. Clinical outcome was determined using pre-arrest sign score. Data were analyzed via ordinal multivariate regression analysis.Results:Factors influencing 24-hour clinical outcome of emergency patients were age (OR: 0.965; 95% CI: 0.96-0.97), having coronary vascular disease (CAD) (OR: 1.41; 95% CI: 1.05-1.88), and severity of illness based on Rapid Emergency Medical Score (REMS) (OR:1.09; 95% CI: 1.05-1.15). Self-transportation and being transported by emergency medical service ambulance with non-advanced life support (EMS-Non-ALS) did not influence clinical outcome when compared to EMS-ALS transport. Being transported from a community hospital increased pre-arrest sign score 1.78 times when compared to EMS-ALS (OR: 1.78; 95% CI: 1.17-2.72). Increased transportation distance increased the risk of poor clinical outcome (OR: 1.01; 95% CI: 1.002-1.011). Length of stay in emergency department (ED-LOS) more than 4 hours (OR: 0.21; 95% CI: 0.15-0.29) and between 2-4 hours (OR: 0.60; 95% CI: 0.47-0.75) decreased the risk of poor clinical outcome when compared to ED-LOS less than 2 hours.Conclusion:Having CAD, severity of illness, increased transport distance, and ED-LOS less than 2 hours were found to negatively influence 24-hour clinical outcome of emergency patients.

EMERGENCY MANAGEMENT OF THE PRE-HOSPITAL PHASE IN COVID 19 PATIENT: LITERATURE REVIEW

The addition of Covid-19 cases took place quite quickly and has spread between countries. The high incidence is important to improve health services, especially the pre-hospital phase services. In this phase, good emergency management will reduce the number of disability to death by up to 50% by starting from activating calls prior to the incident location, health workers who understand first aid and transportation using an ambulance and being observed until they arrive at the hospital. Knowing the Pre-Hospital Phase Emergency Management in Covid-19 Patient: Literature Review. The research method used is a literature review. In this method, online searches for articles, journals and books are carried out using accessible databases, namely Google Scholar, PubMed, and Biomed Central. It is known from 10 Literature Articles, journals and books in the emergency management of Covid-19 in the Pre-Hospital phase must be done as much as possible to minimize the number of deaths and transmission that occurs. Handling of emergency Covid-19 in the Pre-Hospital phase includes: Basic and Advanced Life Support (BLS), Oxygen Therapy, Personal Protective Equipment (PPE), and Patient Transport. It is important for medical personnel to pay attention to many things in providing emergency nursing care to Covid-19 patient. Pre-Hospital emergency measures for patient with Covid-19 can be carried out in various ways to improve the patient condition while at the Pre-Hospital, besides that, it can also prevent transmission to medical personnel and people around Covid-19 patient.

Priorities for Prehospital Evidence-Based Guideline Development: A Modified Delphi Analysis

Objective: Few areas of prehospital care are supported by evidence-based guidelines (EBGs). We aimed to identify gaps in clinical and operational prehospital EBGs to prioritize future EBG development and research funding. Methods: Using modified Delphi methodology, we sought consensus among experts in prehospital care and EBG development. Five rounds of surveys were administered between October 2019 and February 2020. Round 1 asked participants to list the top three gaps in prehospital clinical guidelines and top three gaps in operational guidelines that should be prioritized for guideline development and research funding. Based on responses, 3 reviewers performed thematic analysis to develop a list of prehospital EBG gaps, with participant feedback in Round 2. In Round 3, participants rated each gap’s importance using a 5-point Likert scale, and participants’ responses were averaged. In Round 4, participants rank-ordered 10 gaps with the highest mean scores identified in Round 3. In Round 5, participants indicated their agreement with sets of the highest ranked gaps. Results: Of 23 invited participants, 14 completed all 5 rounds. In Rounds 1 and 2, participants submitted 65 clinical and 58 operational gaps, and thematic analysis identified 23 unique clinical gaps and 28 unique operational gaps. The final prioritized list of clinical EBG gaps was: 1) airway management in adult and pediatric patients, 2) care of the pediatric patient, and 3) management of prehospital behavioral health emergencies, with 79% of participants agreeing. The final prioritized list of operational EBG gaps was: 1) define and measure the impact of EMS care on patient outcomes, 2) practitioner wellness, and 3) practitioner safety in the out-of-hospital environment, with 86% of participants agreeing. Conclusions: This modified Delphi study identifies gaps in prehospital EBGs that, if prioritized for development and research funding, would be expected to have the greatest impact on prehospital clinical care and operations.

Characteristics, management and outcome of prehospital pediatric emergencies by a Dutch HEMS

BackgroundIn prehospital care, the Helicopter Emergency Medical Service (HEMS) can be dispatched for critically injured or ill children. However, little detail is known about dispatches for children, in terms of the incidence of prehospital interventions and overall mortality. The primary objective of this study is to provide an overview of pediatric patient characteristics and incidence of interventions.MethodsA retrospective chart review of all patients ≤ 17 years who received medical care by Rotterdam HEMS from 2012 until 2017 was carried out.ResultsDuring the study period, 1905 pediatric patients were included. 59.1% of patients were male and mean age was 6.1 years with 53.2% of patients aged ≤ 3 years. 53.6% were traumatic patients and 49.7% were non-traumatic patients. 18.8% of patients were intubated. Surgical procedures were performed in 0.9%. Medication was administered in 58.1% of patients. Cardiopulmonary resuscitation (CPR) was necessary in 12.9% of patients, 19.9% were admitted to the intensive care unit and 14.0% needed mechanical ventilation. Overall mortality was 9.5%. Mortality in trauma patients was 5.5% and in non-trauma group 15.3%. 3.9% of patients died at the scene.ConclusionsPatients attended by HEMS are at high risk of prehospital interventions like CPR or intubation. EMS has little exposure to critically ill or injured children. Hence, HEMS expertise is required to perform critical procedures. Trauma patients had higher survival rates than non-traumatic patients. This may be explained by underlying illnesses in non-traumatic patients and CPR as reason for dispatch. Further research is needed to identify options for improving prehospital care in the non trauma pediatric patients.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Students of the Faculty of Education.

The purpose of this study was to evaluate the knowledge regarding tooth avulsion and dental first aid response among Croatian students of the Faculty of Education. A cross-sectional study was conducted among students. Participants (N = 235) were female with an average age of 21.9 ± 2.7 years. The questionnaire contained 10 close-ended questions with two to eleven possible answers. Every participant chose one correct answer. Statistical significance was determined using a Chi-square test. Majority of participants had never received any kind of information on management of a knocked-out tooth. Questions in the nature of tooth injuries, a knocked-out tooth, tooth replantation and whether the knocked-out tooth should be placed back were answered confirmatively by 40.43%, 83.40%, 57.02% and 62.55% of participants, respectively. The questionnaire showed that 18.78% of participants were aware that replantation should be performed within 30 min. The appropriate cleaning and transport medium was chosen by 40.85% and 35.31% of participants, respectively. A nearby dentist would be visited by 66.38% of students. Only 8.08% of participants provided a correct answer to all of the knowledge-based questions. The “I do not know” answer was chosen by 18.30% of participants whenever it was offered. This indicates that the majority (89.78%) were not aware of the fact that the procedure they chose would be inappropriate. The current study confirmed that future primary school teachers have a lack of knowledge for immediate response to tooth avulsion, leaving small chances for a successful prognosis of tooth replantation.

Knowledge in pre-hospital emergency and risk management among outdoor adventure practitioners in East Africa afro-alpine mountains.

IntroductionThe enjoyment of nature and other benefits of outdoor activities happen amid inherent hazards. This calls for knowledge and competency in emergency and risk management. Practitioners in outdoor activities, such as mountaineering, thus need to be knowledgeable on how to manage risks and attend to emergencies in their practice. The study sought to establish the preparedness of East African mountaineering practitioners in prehospital emergency and risk management. It sought to establish their knowledge on prehospital emergency and risk management, based on their age, gender, level of education and refresher training.MethodsThe study purposively sampled one hundred and thirty six (N = 136) outdoor adventure practitioners from the Afro-alpine mountain areas in East Africa. It was hypothesized that there would be no significant relationship between the outdoor practitioners' knowledge in prehospital emergency risk management and their age, gender, level of education, refresher training. Somers' d was used to test the hypotheses.ResultsIt was established that the knowledge scores of prehospital emergency and risk management for the mountaineering practitioners was low. It was also established that the knowledge scores of outdoor practitioners were not dependent on their age, gender, and work experience. However, there was a significant relationship between the outdoor adventure practitioners' knowledge scores and their highest level of education as well as refresher training.ConclusionsThe study concluded that there were gaps in the knowledge of prehospital risk management of the East African Afro-alpine mountaineering practitioners. It recommends frequent and regular training and re-certification among outdoor adventure practitioners in order to raise the knowledge in prehospital emergency risk management.

Alternative Leadership in Flexible Surge Capacity—The Perceived Impact of Tabletop Simulation Exercises on Thai Emergency Physicians Capability to Manage a Major Incident

Flexible surge capacity aims to activate and utilize other resources than normally are surged in a community during the primary and secondary surge capacity. The presence of alternative leadership, skilled and knowledgeable in hospital and prehospital emergency management, is invaluable. Thai emergency physicians work at both levels, emphasizing their important role in emergency management of any source in a disaster-prone country. We aimed to investigate Thai emergency physicians’ ability in terms of knowledge and preparedness to manage potential emergencies using tabletop simulation exercises. Using an established method for training collaboration, two training courses were arranged for over 50 Thai emergency physicians, who were divided into three teams of prehospital, hospital, and incident command groups. Three scenarios of a terror attack along with a bomb explosion, riot, and shooting, and high building fire were presented, and the participants’ performance was evaluated regarding their preparedness, response and gained knowledge. Two senior observers followed the leadership characteristic in particular. Thai physicians’ perceived ability in command and control, communication, collaboration, coordination, and situation assessment improved in all groups systematically. New perspectives and innovative measures were presented by participants, which improved the overall management on the final day. Tabletop simulation exercise increased the perceived ability, knowledge, and attitude of Thai emergency physicians in managing major incidents and disasters. It also enabled them to lead emergency management in a situation when alternative leadership is a necessity as part of the concept of a flexible surge capacity response system.

Analisis Implementasi Algoritma Penanganan Kegawat Pra Rumah Sakit Oleh Masyarakat sebagai First Responder di Surakarta

Abstract&#x0D; Background: Between 2006-2015, there were reported at least 6270 disasters affecting 5 continents. Of the total disasters, there were at least 8,197.66 people died, 70,597 survival nd damage to the economic sector was around 1,989,866,263 dollars. The safety of the victims are very dependent on various factors, therefore collaboration of the whole community is needed in providing first aid at the scene before getting help from the health setting. The purpose for this study is to describe the understanding of prehospital emergency management algorithms for the community as the first respondent in Surakarta. Methods: This study uses an pre experimental research design with the Pre-Test-Post Test Group design without control group with the subject of people of Surakarta City after recruited using consecutive sampling techniques and 222 respondent were finally recruited. After following pretest, respondents received training about the implementation of the firtst aid algorythm and post-test was delivered at the end. The variable in this study is the community's ability in providing first aid during emergency in the community. Result: A questionner was used to meassure knowledge before and after following training. Wilcoxon Match Pair test was used to compare the data from pre-test and post-test. The majority of subjects have good knowledge and increased knowledge after following training pertaining to be first responders. Conclusion: Training and simulation are essential in order to increase and maintain first responders capacity in providing aid before referring to health care setting. In addition, community needs to continue to be given socialization and understanding of the existence of PSC 119 so that the first aid that has been given optimally will get maximum further assistance.

Analysis of pre hospital emergency management in case of head injury

Cases of trauma still becomes a health problem in almost all countries causing death in few cases. In some developing countries, the insidences of head injury tend to increase. One of the reasons for the many death and disability may be due to the inavailability and inadequacy of pre-hospital first aid. The general objective of this study is to find out the description of community first responder in providing pre-hospital first aid to head injuries. This study uses qualitative descriptive method. Most of the respondents have variety of educational backgrounds and do not have sufficient knowledge and skills to provide first aid. The average respondents provided help by performing initial assessment, managing effective airway and controlling bleeding. Limited pre-hospital facilities become one of the reasons for respondent not getting help so the efforts provided are not maximal. Respondents prefer to send patients directly to health facilities. Regular education and training programs for the community first responders should be initiated so that the number of death and disability can be minimized.

Knowledge on Pre-Hospital Emergency Management of Tooth Avulsion among Croatian Kindergarten Teachers

The aim of this study was to evaluate knowledge on pre-hospital emergency management of tooth avulsion among Croatian kindergarten teachers. A cross-sectional study was conducted among 33 educators in kindergarten (average 43.9±9.7 years). The questionnaire contained 10 close-ended questions with two or eleven possible answers. Statistical significance was determined using chi-square test. Majority of participants had no experience with tooth injury among children in kindergarten. Questions about the familiarity with the terms of a knocked-out tooth and tooth replantation and whether the knocked-out tooth should be replanted were confirmatively answered by 90.9%, 57.6% and 63.6% of participants, respectively. Only 9.1% of participants provided the correct answer that replantation should be done within 30 minutes. 78.8% of participants would choose correct medium for cleaning if avulsed tooth got dirty. Tooth would be transported in appropriate medium by 48.5% of participants. Correct answers on both the transport medium and the cleaning of knocked-out tooth were provided by 45.5% participants. 57.6% participants would seek help for replantation by visiting the nearest dentist. None of the participants had ever received any kind of information on management of a knocked-out tooth. The kindergarten teachers have a lack of knowledge for immediate response to tooth avulsion. Every kindergarten teacher should be well informed what should be done if some type of dental injury happens. The official communication between dental professionals and kindergarten teachers should be improved at local and regional level.

Is the French Emergency Medical Service System duplicable in developing countries?

Abstract Issue The management of pre-hospital emergencies is a growing issue in developing countries, particularly because of the increase of both road accidents and cardio-vascular diseases. Description of the problem Numerous countries have tried or are currently trying to develop emergency response systems like the French SAMU but the outcome of those actions show a lot of difficulties. It is however proved that efficient care of serious pre-hospital medical emergencies significantly improves both patients’ mortality and morbidity. Results AP-HP, Greater Paris University Hospitals, has a strong experience of supporting the development of this model of care in countries with limited resources. Most of last 30 years’ experiments have been reviewed to understand what the essential prerequisites to succeed in setting up an emergency response system such as SAMU are. The analysis (5 criteria evaluation: efficiency, sustainability, effectiveness, impact, relevance) of past and present experiments in 28 countries showed that main issues are political (what are the priorities?), financial and societal (what does the population expect?). The question of medical resources is also crucial as the French model introduces medical regulation at all levels. Moreover, in France, such a system is built as a health care pathway with a predetermined orientation towards the appropriate and operational structure, which unfortunately is not the case in a lot of countries. Aside from those realized in China or in some Southern American countries, most of the projects so far don’t match all the evaluation criteria, particularly sustainability, as it is based both on stable funding and a strong reactivity of local hospitals. Lessons Future projects will have to fit with the local context. Strong commitments from partner countries must be made on the long term to have a real impact. Key messages There is no universal system easily duplicable. Some major prerequisites must be identified and implemented to succeed in the set-up of an efficient and sustainable EMSS.

Satisfaction with the performance of emergency medical services: a case study in Tabriz

Objective: Assessing patients’ satisfaction with emergency medical services (EMSs) is an important managerial point of view. The present study aimed to assess the patients’ satisfaction with EMS in Tabriz, Iran. Methods: This is a descriptive-analytic study that was done in the prehospital emergency and disaster management center of Tabriz University of Medical Sciences. In this study, from May to December 2017, we included 659 patients who were transferred to hospitals with our prehospital emergency services. A valid and reliable questionnaire was used to evaluate the satisfaction of patients about the performance of prehospital EMSs. Results: Data of 659 patients were evaluated. Trauma was the most common cause of contact with 115 and help request (33.83%). The results indicated that patients’ level of satisfaction was good and very good. The highest level of satisfaction was related to the treatment of patients and use of medical equipment in the ambulance (n=578 patients, 87.7%) as well as the treatment practiced by the emergency medical technicians (EMTs) (n=575 patients, 87.24%). However, the lowest level of satisfaction was related to the absence of an active EMT in the rear cabin when transferring patients to the hospital (n=337 patients, 51.14%) and transfer of the patient from the accident scene to the ambulance (n=410 patients, 62.21%). Conclusion: Patients’ satisfaction with EMS was optimal. The minimum and maximum satisfaction rates were related to the absence of an active EMT in the rear cabin, treatment of the patient, and use of medical equipment.

Prehospital Emergency Management of Pregnant Women - Obstetric Emergencies Series, Part 1

Maternal emergencies during pregnancy are characterized by a concomitant threat to 2 patients. These emergencies can occur during or even before a hospital stay. Due to the rarity of the latter cases, sustainable methods of knowledge transfer should be implemented so emergency teams have sufficient obstetrical information to provide emergency care during pregnancy. In a series of articles, launched here, individual competencies for prehospital emergency management of pregnant women are described. Part one addresses prehospital emergency care of pregnant women, their emergency transport, handover management on hospital admission, and a team approach to perinatal emergency care.

Combining Unmanned Aerial Vehicles, and Internet Protocol Cameras to Reconstruct 3-D Disaster Scenes During Rescue Operations

Objective: Strong earthquakes often cause massive structural and nonstructural damage, timely assessment of the catastrophe related massive casualty incidents (MCIs) for deploying rescue resource are critical in order to minimize ongoing fatalities. A magnitude 6.6 earthquake struck southern Taiwan on February 6, 2016 (the so-called 02/06 Meinong earthquake). It led to 117 deaths and 522 injuries. Advanced technologies including aerial devices and innovation concept were adopted for more effective rescue efforts. We would like to share our innovative concept in MCIs experienced in 02/06 Meinong earthquake in 2016. Methods: A collapsed building, Weiguan residential apartment complex, was the most devastating building collapsed in Tainan, resulting in 115 people killed. Regional Emergency Medical Operational Centers (REMOCs), supervised by Taiwan Ministry of Health and Welfare, were activated immediately and collaborated with Tainan City government command center to initiate emergency rescue reliefs. Results: We, for the first time, attempted to use cyber devices including an internet-protocol camera and a multi-rotor unmanned aerial vehicle (UAV) equipped with a high-resolution digital camera used to acquire imagery during the rescue operation. Moreover, a photo-realistic 3-D model reconstructed by the acquired UAV imagery could provide real-time information from UAV to rescue team leaders in remote location for effectively deploying medical posts and emergency resources at scene. Conclusion: We proposed the concept of real-time UAV imagery for reconstructing photo-realistic 3-D model, which might greatly improve prehospital emergency management after disaster.