Prehospital Emergency Services Research Articles

Time Indices of Prehospital Emergency Services in Ardabil City, Iran, 2020

Background: The role and function of Emergency Medical Service (EMS) in people’s health and the need for continuous evaluation of its function, especially delivering services to the patients, are essential. So, the present study was conducted to determine the time indices of prehospital emergency services in Ardabil City, Iran. Materials and Methods: This study was a retrospective cross-sectional study. Out of all calls recorded in EMS centers of Ardabil in the first 6 months of 2020, 327 calls, which resulted in the patient’s transfer to a hospital, were randomly selected. Then, the required data, including time indices and demographic information, were extracted from EMS forms filled by a medical emergency technician for each mission. The obtained data were analyzed using descriptive statistics, including mean, standard deviation, and inferential statistics, including 1-way analysis of variance and the Chi-square test in SPSS v. 22. Results: In terms of time indices, the average delay time (1.01 minutes), the response time (7.87 minutes), on-scene time (13.81 minutes), transport time (12.53 minutes), the total run time (transport time, response time, and on-scene time) (35.15 minutes), and the round trip time (52.50) had been recorded. According to the Chi-square test, there was a significant relationship between the total run time (transport time, response time, and on-scene time), transport time, round trip time, and the location of the emergency base. Conclusion: EMS time indices were at the desired level. Updating information systems, ambulances, medical equipment, and holding training courses for personnel working in this system can effectively improve time indicators.

Exploring Barriers and Facilitators of Inter-Organizational Management in Response to Mass Casualty Traffic Incidents: A Qualitative Study.

Objective:To investigate and understand the current status of inter-organizational management in relief organizations as well as the relief organizations personnel behavior when facing mass traffic incidents (MCTI). The inter-organizational barriers and facilitators are also discussed in response to MCTI management and in order to help direct future actions to improve pre-hospital emergency services.Methods:The current qualitative study was performed through face-to-face, semi-structured interviews with 31 individuals from pre-hospital emergency services authorities and personnel, Red Crescent and Yazd, Kohgiluyeh and Boyer-Ahmad, Fars, and Qom provinces police. These provinces were selected by purposive sampling in 2018-2019. The conventional content analysis method was applied to analyze the data in this research. Results:Three main categories and 14 subcategories were determined. The categories are including relief organizations coordination (having four subcategories: independent relief organizations, interdepartmental services integration, insufficient knowledge of organizations about one other, and performance based on job descriptions), resource and infrastructure management (having four subcategories: adverse information management, proper information management, lack of medical resources and capacities considered, and upgrading of medical resources and capacities considered), and response management of relief organizations (having six subcategories: incomplete assessment, improving the quality of assessment, weakness in establishing scene security, scene security management, poor response, and cooperation in response).Conclusion:Relief organizations need to perform under a unified command. It has inter-organizational cooperation and provide integration of interdepartmental services in order to manage responsiveness at the scene. It also prevents an independent, chaos, and inability of the injured to properly understand and needs in MCTI.

Epidemiology Study on Poisoning in Patients Received Pre-hospital Emergency Services in Ghaemshahr, Iran

Background: Poisoning is an important public health issue and causes high mortality rate each year worldwide. Having epidemiological information can lead to proper planning for its prevention and intervention. Objective: This study aims to investigate the one-year prevalence and causes of poisoning in patients received pre-hospital emergency services in Ghaemshahr, Mazandaran, Iran. Materials and Methods: This is a descriptive cross-sectional study. After reviewing the medical files of 12552 patients collected from the Medical Emergency and Accident Management Center in Ghaemshahr, Iran in 2016, 398 poisoned patients were found. Their data including age, gender, place of residence, agent and cause of poisoning, and received therapeutic interventions were extracted and recorded. Results: Of 398 patients, 17.3% had received treatment; 271 (68.1%) were male and 127 (31.9%) were female. The most common cause of poisoning was abuse (58.1%); 58.3% of the poisonings were caused by the use of medications and the rest were non-medication poisonings. Tramadol (29.6%) was the most common medication that had caused poisoning. Among non-medication poisonings, the most common agent were substances (22.6%) and alcohol (13.1%). The most common route of exposure to poisoning agent (toxins) was by ingestion. Conclusion: Due to the increasing abuse of substances and medications such as tramadol among young people and considering the high prevalence of intentional poisoning in young women, there are a need for psychological support, proper monitoring of medicine distribution, and creating social and recreational opportunities for the young people in Iran.

Exploring the potential for social prescribing in pre-hospital emergency and urgent care: A qualitative study.

There is a sustained increase in demand for emergency and urgent care services in England. The NHS Long Term Plan aims to reduce the burden on emergency hospital services through changing how pre-hospital care operates, including increased delivery of urgent care. Given the recognised potential of social prescribing to address wider determinants of health and reduce costs in other settings, this study aimed to understand the role that social prescribing can play in pre-hospital emergency and urgent care from the perspectives of staff. Semi-structured interviews (n=15) and a focus group (n=3) were conducted with clinical staff (n=14) and non-clinical health advisors (n=4) from an English Ambulance Service covering emergency (999) and non-emergency (111) calls. Data were analysed using a pre-defined framework: awareness of social prescribing; potential cohorts suitable for social prescribing; and determinants of social prescribing. Awareness and knowledge of social prescribing was limited, though when social prescribing was explained to participants they almost universally recognised its benefits for their role. Social prescribing was considered to be most beneficial to those calling for reasons relating to mental health, loneliness or social isolation, in particular older people and frequent users of 999 and 111 services. Determinants of social prescribing were identified across the micro (patient and staff acceptability of social prescribing), meso (triage and referral pathways) and macro (commissioning and funding) levels of analysis. This is the first empirical study to explore social prescribing in pre-hospital emergency and urgent care services, which suggests that it has potential to improve quality of care at the point of people accessing these services. There is a pressing need to address the micro, macro and meso level determinants identified within this study, in order to support staff within pre-hospital emergency and urgent care services to socially prescribe.

Cancer Patients' Prehospital Emergency Care: Post Hoc Analysis from the French Prospective Multicenter Study EPICANCER.

Background: Very little data are available concerning the prehospital emergency care of cancer patients. The objective of this study is to report the trajectories and outcomes of cancer patients attended by prehospital emergency services. Methods: This was an ancillary study from a three-day cross-sectional prospective multicenter study in France. Adult patients with cancer were included if they called the emergency medical dispatch center Service d’Aide Médicale Urgente (SAMU). The study was registered on ClinicalTrials.gov (NCT03393260, accessed on 8th January 2018). Results: During the study period, 1081 cancer patients called the SAMU. The three most frequent reasons were dyspnea (20.2%), neurological disorder (15.4%), and fatigue (13.1%). Among those patients, 949 (87.8%) were directed to the hospital, among which 802 (90.8%) were directed to an emergency department (ED) and 44 (5%) were transported directly to an intensive care unit (ICU). A mobile intensive care unit (MICU) was dispatched 213 (31.6%) times. The decision to dispatch an MICU seemed generally based on the patient’s reason for seeking emergency care and the presence of severity signs rather than on the malignancy or the patient general health status. Among the patients who were directed to the ED, 98 (16.1%) were deceased on day 30. Mortality was 15.4% for those patients directed to the ED but who were not admitted to the ICU in the next 7 days, 28.2% for those who were admitted to ICU in the next 7 days, and 56.1% for those patients transported by the MICU directly to the ICU. Conclusion: Cancer patients attending prehospital emergency care were most often directed to EDs. Patients who were directly transported to the ICU had a high mortality rate, raising the question of improving triage policies.

Modeling a pre-hospital emergency medical service using hybrid simulation and a machine learning approach

Healthcare is one of the most important disciplines to ensure life quality for human beings, especially in unpredictable scenarios such as accidents, natural disasters, or terrorism. In these cases, Emergency Medical Services (EMS) face significant challenges due to the complex nature of pre-hospital events, coordinating several resources according to the collected information in a short time.In this context, both agent-based and discrete event simulation seem to be excellent approaches to find new strategies for facing this complexity. However, there are some challenges presented in the modeling process seeking an accurate representation of the reality.In this work, we introduce a general process of pre-hospital emergency services, a hybrid simulation model based on the general process, and a machine learning approach for key simulation parameters. Our general process benefits from an intensive exchange with a multidisciplinary group of experts from medicine, including practitioners, paramedics, coordination center managers, and stakeholders, among others. Furthermore, we validated our simulation model using real-world data from an emergency coordination center from North Germany. In addition, we introduce a machine learning approach for travel speed forecasting, using seven parameters for more accuracy. Finally, we present an application of our model to analyze critical crew capacity in the coordination center.

Non-pharmacological interventions for acute pain management in adult trauma victims: a scoping review.

This scoping review aimed to map non-pharmacological interventions to reduce acute pain in adult trauma victims. Acute pain is a consequence of a pathological or traumatic event, and a result of invasive or non-invasive health care procedures. Acute trauma pain, as well as its treatment, is one of the least-studied areas of acute pain. Although non-pharmacological interventions are responsible for pain relief among a significant number of patients, only a small percentage of patients receive non-pharmacological interventions. This scoping review considered all studies conducted on adult victims of trauma, aged 18 years or over, in pre-hospital emergency care, emergency rooms, and trauma-center settings. Studies were considered if they focused on non-pharmacological interventions designed to reduce acute pain, and were implemented and evaluated by health professionals. Non-pharmacological interventions of any type, duration, frequency, and intensity were considered. A comprehensive search strategy across 11 bibliometric databases and gray literature sources was developed. Full texts of selected citations were assessed in detail for eligibility by two independent reviewers. No other relevant studies were identified by searching the references of the included articles. Data extraction was performed independently by two reviewers using an instrument previously developed, and those reviewers were later responsible for its validation. Findings were then extracted directly into tables that are accompanied by a narrative summary to show how they relate to the objectives of the review conducted. This scoping review included nine studies: two retrospective cohort studies, five randomized controlled trials, one case report, and one literature review for five different countries. Non-pharmacological interventions identified and administered to trauma victims in pre-hospital settings, emergency services, and trauma centers were as follows: acupressure, auricular acupressure, auricular acupuncture, transcutaneous electrical nerve stimulation, repositioning, use of pressure relief devices, massage, heat therapy, music therapy, relaxation therapy, immobilization, ice therapy, compression, elevation, and bandage. Non-pharmacological interventions were mainly developed by nurses, physicians, and paramedics. They were, in most studies, poorly described in terms of their efficacy and were mostly reported in minor traumas, such as simple fractures or small wounds. Currently, there is no consensus for the implementation of non-pharmacological interventions in the treatment of acute trauma pain. Their application is primarily used for minor traumas, and their potential for the treatment of major traumas is yet unknown. No studies on the use of non-pharmacological interventions aimed at reducing the impact of traumatic adverse environments were identified. Further investigation on the effects of these interventions should be encouraged so that robust decisions and recommendations can be made.

Smartphone-based dispatch of community first responders to out-of-hospital cardiac arrest - statements from an international consensus conference

BackgroundOver the past decade Smartphone-based activation (SBA) of Community First Responders (CFR) to out-of-hospital cardiac arrests (OHCA) has gained much attention and popularity throughout Europe. Various programmes have been established, and interestingly there are considerable differences in technology, responder spectrum and the degree of integration into the prehospital emergency services. It is unclear whether these dissimilarities affect outcome. This paper reviews the current state in five European countries, reveals similarities and controversies, and presents consensus statements generated in an international conference with the intention to support public decision making on future strategies for SBA of CFR.MethodsIn a consensus conference a three-step approach was used: (i) presentation of current research from five European countries; (ii) workshops discussing evidence amongst the audience to generate consensus statements; (iii) anonymous real-time voting applying the modified RAND-UCLA Appropriateness method to adopt or reject the statements. The consensus panel aimed to represent all stakeholders involved in this topic.ResultsWhile 21 of 25 generated statements gained approval, consensus was only found for 5 of them. One statement was rejected but without consensus. Members of the consensus conference confirmed that CFR save lives. They further acknowledged the crucial role of emergency medical control centres and called for nationwide strategies.ConclusionsMembers of the consensus conference acknowledged that smartphone-based activation of CFR to OHCA saves lives. The statements generated by the consensus conference may assist the public, healthcare services and governments to utilise these systems to their full potential, and direct the research community towards fields that still need to be addressed.

The relationship between anger with general health in emergency personnel

Context: The emergency staff work in stressful environments and deal with critically ill patients. The occupational nature of their work is such that they are always at risk of being exposed to work violence by patients or patient companions. Aim: The aim of this study was to determine the relationship between anger with general health in emergency personnel. Setting and Design: This was a correlational study that was done in prehospital emergency services and hospital emergency departments in Golestan province, in Iran in 2019. Materials and Methods: The study conducted on 400 of emergency personnel. Samples were selected through multistage sampling. The sampling design included stratified sampling, cluster sampling, and convenience sampling in the first, second, and third stage, respectively. Data were collected using demographic, Spielberger's anger, and general health questionnaires. Statistical Analysis Used: Description of sample under study presented using mean, standard deviation, and frequency. Assessment of associations was performed using Mann– Whitney and correlational analysis at significance level of 0.05. Results: The mean total score of anger of emergency personnel was 121.94 ± 14.66 and for the prehospital and hospital emergency personnel were 123.53 ± 14.08 and 119.38 ± 15.26, respectively (P = 0.002). The mean total score of general health was 12.40 ± 4.22 and for prehospital emergency and emergency personnel were 12.23 ± 4.18 and 12.67 ± 4.29, respectively (P = 0.75). There was a positive and significant correlation between all three dimensions of general health and all three dimensions of anger so that with increasing anger, general health decreased. Conclusion: Emergency personnel were in good general health while their anger score was above average. Furthermore, there was a significant inverse correlation between anger and mental health, so that by increasing the dimensions of anger expression, the general health of prehospital and hospital emergency staff was reduced.

Comparison of pre-hospital emergency services time intervals in patients with heart attack in Arak, Iran.

:Background:After cardiac arrest, the possibility of death or irreversible complications will highly increase in the absence of cardiac resuscitation within 4 to 6 minutes. Accordingly, measuring the pre-hospital services time intervals is important for better management of emergency medical services delivery. The purpose of this study then was to investigate pre-hospital time intervals for patients with heart attack in Arak city, based on locations and time variables.Methods:This is a retrospective descriptive cross-sectional study, which was conducted at the Arak Emergency Medical Services (EMS) during 2017-2018. Data were analyzed by SPSS version 13.Results:The total number of heart attack patients registered in Arak emergency medical services was 2,659 of which 51% of patients were males. Six percent of patients were under 25 and about 49 percent were between 46 and 65 years old. The average of activation, response, on-scene, transportation, recovery and total time intervals were 3:30, 7:56, 15:15, 13:34, 11:07, 12:11, and 41:25, respectively. In the city area, the shortest and longest average response time intervals were in spring and winter, respectively. In out of the city area, the shortest average response time interval was in summer and the longest one in autumn. The shortest and the longest average response time intervals in the city area were in June and March, respectively, and in out of the city area, the shortest average response time interval was in June and the longest one in April.Conclusions:The shorter response and delivery time interval compared to the other studies may indicate improvement in the provision of EMS. Special attention should be paid to the facilities and equipment of vehicles during cold seasons to be in the shortest possible time. Also, training and informing the staff more about the code of cardiac patients along with general public education can help improve these intervals.

A-SA SOS: A Mobile- and IoT-based Pre-hospital Emergency Service for the Elderly and Village Health Volunteers

In Thailand, emergency illnesses are life-threatening conditions that constitute serious health problems and quick access to definitive care can improve the survival rate of the elderly dramatically. Currently, the pre-hospital emergency medical services have limitations which prevent the treatment from getting to the accident site on time. In this research, we proposed the A-SA SOS application, a mobile-and IoT-based pre-hospital emergency service for the elderly. The system helps the elderly to send the request to the nearest village health volunteers via a mobile application and smart device. After reaching the elderly, the village health volunteers help carry out basic life support to increase the survival rate before sending the patients directly to the Emergency Management System (EMS) agency. To evaluate the system, we tested it for three months in the Sub-district of Suthep in Chiang Mai city. Finally, the incident report showed that the average time to reach the scene (4.91±0.56) to help elderly patients was less than the standard criteria of an average 3 minutes.

La influencia de la gestión organizativa en el tiempo puerta-aguja del tratamiento fibrinolítico

IntroductionDoor-to-needle time (DNT) has been established as the main indicator in code stroke protocols. According to the 2018 guidelines of the American Heart Association/American Stroke Association, DNT should be less than 45minutes; therefore, effective and revised pre-admission and in-hospital protocols are required. MethodWe analysed organisational changes made between 2011 and 2019 and their influence on DNT and the clinical progression of patients treated with fibrinolysis. We collected data from our centre, stored and monitored under the Master Plan for Cerebrovascular Disease of the regional government of Catalonia. Among other measures, we analysed the differences between years and differences derived from the implementation of the Helsinki model. ResultsThe study included 447 patients, and we observed significant differences in DNT between different years. Pre-hospital code stroke activation, recorded in 315 cases (70.5%), reduced DNT by a median of 14minutes. However, the linear regression model only showed an inversely proportional relationship between the adoption of the Helsinki code stroke model and DNT (beta coefficient, –0.42; P<.001). The removal of vascular neurologists after the adoption of the Helsinki model increased DNT and the 90-day mortality rate. ConclusionDNT is influenced by the organisational model. In our sample, the application of the Helsinki model, the role of the lead vascular neurologist, and notification of code stroke by pre-hospital emergency services are key factors for the reduction of DNT and the clinical improvement of the patient.

Collaboration for preliminary design of a mobile health solution for ambulance dispatch in Rwanda

The first 60 minutes after a trauma are described as “the golden hour.” For each minute of prehospital time, the risk of dying increases by 5% (Sampalis et al., 1999). Since 90% of the global burden of injuries occur in low- and middle-income countries and lead to 5.8 million deaths annually, addressing rapid access to emergency services is critical in these settings (Nielsen et al., 2012). In most low- and middle-income countries (LMICs), there are no formal trauma systems, and many lack organized prehospital care (Nielsen et al., 2012). Emergency medical dispatch and communication systems are a foundational component of emergency medical services (World Health Organization, 2005). Yet there are no established recommendations of creating these systems inLMICs.Rwanda, a country of over 12 million people, is a rapidly developing leader in East Africa. The Ministry of Health of Rwanda established the Service d’Aide Medicale Urgente (SAMU) in 2007, recognizing the need for public emergency medical services. SAMU’s national dispatch center receives roughly 3,000 calls per month through a national 912 hotline. It organizes regional transportation with 260 total ambulances located at hospitals throughout the country and provides prehospital emergency services in the capital city of Kigali with a fleet of 12 ambulances. In the city, each ambulance has a driver, nurse and anesthetist dispatched for every call. Emergency department nursing and anesthetist staff are dispatched from hospitals around the country to respond to regional emergencies. No formal prehospital cadre of the workforce exists although the SAMU staffhave extensive field experience in prehospital care. SAMU has several challenges to rapid prehospital emergency care including lack of addresses beyond the capital city, unclear location data in densely populated areas, complex communication processes with little information about health facility capacity, and no established electronic dispatch system. The average response time for SAMU ambulances was 59 minutes in 2018, but 39% of calls were not completed within the golden hour.

Healthcare providers experience of working during the COVID-19 pandemic: A qualitative study

BackgroundThe COVID-19 pandemic has had a far-reaching negative impact on healthcare systems worldwide and has placed healthcare providers under immense physiological and psychological pressures.ObjectiveThe aim of current study was to undertake an in-depth exploration of the experiences of health-care staff working during the COVID-19 crisis.MethodsUsing a thematic analysis approach, a qualitative study was conducted using semi-structured interviews with 97 health care professionals. Participants were health care professionals including pre-hospital emergency services (EMS), physicians, nurses, pharmacists, laboratory personnel, radiology technicians, hospital managers and managers in the ministry of health who work directly or indirectly with COVID-19 cases.ResultsData analysis highlighted four main themes, namely: ‘Working in the pandemic era’, ‘Changes in personal life and enhanced negative affect’, ‘Gaining experience, normalization and adaptation to the pandemic’ and ‘Mental Health Considerations’ which indicated that mental ill deteriorations unfolded through a stage-wise process as the pandemic unfolded.ConclusionsParticipants experienced a wide range of emotions and development during the unfolding of the pandemic. Providing mental health aid should thus be an essential part of services for healthcare providers during the pandemic. Based on our results the aid should be focused on the various stages and should be individual-centred. Such interventions are crucial to sustain workers in their ability to cope throughout the duration of the pandemic.

Educação permanente no serviço de atendimento pré-hospitalar móvel de urgência: revisão integrativa

Objetivo: identificar como a educação permanente em saúde vem sendo incorporada na prática de ensino no serviço de atendimento móvel de urgência. Método: revisão integrativa em três bases de dados, com corte temporal de 2010 a 2015. Resultados: três artigos selecionados, emergindo duas categorias: Necessidade da prática de educação para atender demandas no atendimento pré-hospitalar móvel e Incorporação da educação permanente como estratégia para novas práticas no serviço de atendimento móvel de urgência. Conclusão: existência de grande demanda de atendimentos nas redes de urgência, sobretudo no componente pré-hospitalar, mas a incorporação da educação permanente como estratégia para novas práticas no serviço ainda não está bem clara, posto apenas três artigos a referirem. Assim sendo, sugere-se novas pesquisas introduzindo-a na prática do serviço pré-hospitalar móvel de urgência, já que proporciona uma releitura crítica das práticas de trabalho e das necessidades advindas dela, para assim, transformá-las.

Prehospital care and transport costs of severely injured children in NSW Australia

BackgroundInjury is the leading cause of childhood death and disability in Australia. Prehospital emergency services in New South Wales (NSW) are provided by NSW Ambulance. The incidence, pre-hospital care provided and outcomes of children suffering major injury in NSW has not previously been described. MethodsThis retrospective study was conducted between July 2015 and September 2016 and included children <16 years with an injury severity score (ISS) >9, or requiring intensive care admission, or deceased following injury and treated in NSW. Children were identified through the three NSW Paediatric Trauma Centres, the NSW Trauma Registry, NSW Medical Retrieval Registry (AirMaestro, Avinet, Australia). ResultsThere were 359 majorly injured children treated by NSW-based emergency service providers, the majority were male (73.3%) with a mean (SD) age of 8.0 (5.2) years. The median (IQR) injury severity score (ISS) for those transported via NSW emergency medical services was 10 (9-17), with almost half (44.1%) treated prehospital having an ISS >12. The most common documented interventions were intravenous access (44.1%) and oxygen therapy (39.6%). Intubation and chest decompression were recorded in 15.3% and 3.1% of cases respectively. The calculated median (IQR) transport charges for NSW Emergency Services was AUD $942 ($841.3-$1184.6). ConclusionCritical interventions are performed infrequently in children with major injuries in the pre-hospital environment. The monitoring of the incidence and success rates for staff performing these interventions is not readily available from all prehospital emergency medical services operating in NSW. The capacity and processes to monitor and audit all critical interventions in the paediatric population should be resourced and clearly defined.

Magnitude, Characteristics, Maternal and Feto-Neonatal Outcomes of Obstetric Emergencies in Western Ethiopia, Nekemte, Ethiopia

Objective: In Ethiopia very little or probably nothing is known about the significance of obstetric emergencies. This study was therefore aimed at assessing magnitude, characteristics, and outcomes of obstetric emergencies in western Ethiopia.Study Design: Institution based prospective cohort study was employed from January to June 2017. To select the hospitals, area sampling technique was used. Total of 567 pregnant women with obstetric emergencies presented and treated in respective hospitals during the study periods and met the inclusion criteria were consecutively included.Results: Majority (91.7%) of the identified obstetric emergencies have led to termination of pregnancy. Significant proportions of pregnant women (11%) who reached health facility died of obstetric emergencies. Pregnant women with obstetric emergencies traveled to facility carried by people were found to have died about 8 times more likely as compared to those who were transported by ambulance. While 29.21% of women gave birth to normal life births, stillbirth and neonatal death were 8.02% and 7.4% respectively. Higher number of neonatal death was also observed among mothers in whom final mode of delivery was a cesarean section (AOR: 0.19(0.05, 0.62)) compared to spontaneous vaginal delivery.Conclusion: This study has revealed that obstetric emergencies are responsible for the significant number of maternal and perinatal death. If the women have been accessed early and received optimum emergency care, many cases of the occurred death would have been prevented. Better outcome can be achieved through maximum utilization of quality and comprehensive antenatal care and organized pre-hospital obstetric emergency services.

Frecuencia de consultas cardiológicas y paros cardíacos extrahospitalarios durante la pandemia COVID-19

Introduction: the COVID-19 pandemic has determined the application of emergency health measures aimed at preventing progression at national level. International reports have suggested that these measures lead to a lack of care in other pathologies, mainly cardiovascular, and eventually increase out-of-hospital cardiac arrests.Objective: to determine the frequency of emergency consultation for chest pain and out-of-hospital cardiac arrests, assisted by the main pre-hospital emergency services of Montevideo, during the COVID-19 pandemic.Methods: information was requested to the medical institutions of Montevideo and all over the country, on the numberof consultations for chest pain and total consultations, in the period March 13- April 30 of 2018, 2019 and 2020. The frequency of out-of-hospital cardiac arrests in Montevideo was requested to the pre-hospital emergency services during the same period. The data is expressed as absolute frequency and incidence rates (x 100,000) with its 95% CI calculated by Fisher.Results: the number of consultations for precordial pain was stable during the 2018-2019 period. During 2020, theseconsultations decreased and represented between 11.3% and 21.7% of the total number of consultations. Out-of-hospital cardiac arrests showed a non significant increase in its incidence rate in 2020 (9.05, 95%IC: 7.15-11.30) compared with 2019 (7.94, 95%IC: 6.19-10.04) and 2018 (7.43, 95%IC: 5.75-9.45).Conclusions: the raw data presented shows that from March 13 to April 30 of 2020, there was a decrease in emergency visits for precordial pain and a non-significant increase in the incidence rate of out-of-hospital cardiac arrests.

Evaluating the Management Information System of Integrated Medical Emergency Care in Batang Regency, Indonesia

An emergency can happen anywhere and anytime, especially in developing countries with a high potential for emergencies, such as Eastern European countries as well as Indonesia. This study aimed to find out the quality of PSC 119 Si Slamet as a prehospital emergency service innovation. The data collection in this study was carried out in a location, namely, Batang Regency, Indonesia, in May–June 2018. The qualitative data collection methods used in this study are in-depth interviews and document reviews. This study was using Service Quality (Servqual) questionnaire. The results show that PSC 119 Si Slamet provides easy access to emergency services to the community 24 hours a day and 7 days a week by simply calling 119 numbers, sending messages via SMS and WhatsApp, or using the Android-based application, with a maximum response time target of 10 minutes. Batang is one of the regencies (rural area) in Central Java province, located on the main coastline, with a hilly geographic condition with many derivatives, climbs, and sharp curves, which is one of the causes of the high number of traffic accidents in the area. This emergency care information systems, with Android-based application, was aimed at improving the quality of services in the health sector, especially emergency services. This service is of good quality as seen from the tangible, reliability, responsiveness, assurance, and empathy dimensions. However, in the implementation, the socialization aspect is not the best to some people. The recommendation given was the need to increase the PSC 119 socialization of Si Slamet not only regionally but also internationally to be massive, especially in developing countries.

Evaluating the Management Information System of Integrated Medical Emergency Care in Batang Regency, Indonesia

An emergency can happen anywhere and anytime, especially in developing countries with a high potential for emergencies, such as Eastern European countries as well as Indonesia. This study aimed to find out the quality of PSC 119 Si Slamet as a prehospital emergency service innovation. The data collection in this study was carried out in a location, namely, Batang Regency, Indonesia, in May–June 2018. The qualitative data collection methods used in this study are in-depth interviews and document reviews. This study was using Service Quality (Servqual) questionnaire. The results show that PSC 119 Si Slamet provides easy access to emergency services to the community 24 hours a day and 7 days a week by simply calling 119 numbers, sending messages via SMS and WhatsApp, or using the Android-based application, with a maximum response time target of 10 minutes. Batang is one of the regencies (rural area) in Central Java province, located on the main coastline, with a hilly geographic condition with many derivatives, climbs, and sharp curves, which is one of the causes of the high number of traffic accidents in the area. This emergency care information systems, with Android-based application, was aimed at improving the quality of services in the health sector, especially emergency services. This service is of good quality as seen from the tangible, reliability, responsiveness, assurance, and empathy dimensions. However, in the implementation, the socialization aspect is not the best to some people. The recommendation given was the need to increase the PSC 119 socialization of Si Slamet not only regionally but also internationally to be massive, especially in developing countries.