Prehospital Emergency Research Articles

Adaption of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care of children.

The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers. The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers. The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement. This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

Patient-centric perspectives on non-conveyance decisions following pre-hospital emergency calls: A qualitative study

Patient-centric perspectives on non-conveyance decisions following pre-hospital emergency calls: A qualitative study

Optimizing ambulance nurse performance in southern Tuscany: insights from a Delphi study

This study aims to enhance the performance of ambulance nurses in Southern Tuscany through a Delphi method analysis. Conducted from January to December 2022, the research engaged 16 expert participants from a Tuscan health agency. Data on 89 interventions performed by "India" ambulances, which are nurse-led emergency vehicles, were collected. The Delphi method facilitated structured communication among the experts over three rounds, resulting in consensus on nine key intervention proposals. These proposals span areas including staff training, measurement and data collection methods, technologies and materials, and work environments. Key recommendations include prioritizing high-fidelity simulation training, improving data collection for clinical risk, and standardizing equipment across all emergency units. The study highlights the importance of continuous professional development, technological integration, and supportive work environments to optimize the effectiveness of pre-hospital emergency care. These findings provide a practical roadmap for enhancing the competencies and performance of ambulance nurses, ultimately improving patient outcomes in emergency situations.

Rationale and development of a prehospital goal-directed bundle of care to prevent rearrest after return of spontaneous circulation.

In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.

Psychometric properties of the Persian version of the Impulsive Behavior Scale of Barratt on pre-hospital personnel

Introduction: Impulsivity means acting with the least thought towards future behaviors or acting based on thoughts that are not the best option for a person or others. This study was conducted to investigate psychometric properties of the Persian version of the Impulsive Behavior Scale (IBS) of Barratt on pre-hospital personnel of Shiraz University of Medical Sciences in 2023. Materials and Methods: This methodological study was conducted 18 pre-hospital emergency centers of Shiraz University of Medical Sciences during 2022-2023. In this study, the Persian version of the IBS has been used. Face and content validity of the scale in this study was confirmed using qualitative and quantitative methods, and construct validity was confirmed by exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The reliability of the questionnaire was calculated by Cronbach's alpha and intra-class correlation coefficient (ICC) for each field and the scale. Results: The IBS had three unplanned, motor and attentional subscales with 23 items and the varimax rotation showed variance of 52.06%. In CFA, root mean square error of approximation (RMSEA) was equal to 0.093 and normalized fit index (NFI), comparative fit index (CFI), goodness of fit (GFI) and incremental fit index (IFI) were higher than 0.9. Cronbach's alpha coefficient in the scale was 0.85%, and the intra-subject correlation coefficient (ICC) was 0.84%. Conclusion: The study results showed that the scale for pre-hospital personnel had the required validity and reliability, and it can be used for the impulsive behavior in pre-hospital personnel.

Active armed offender: A novel clinical practice guideline for pre-hospital care in Ireland

Incidents involving pre-hospital clinicians responding, or being caught in, active situations of those armed with knives and guns are rising in Ireland. These high-profile and high-stress situations require prior planning to minimise loss of life and maintain the safety of paramedic staff. Better situational awareness has been identified by veteran paramedics involved in active armed offender incidents as a key priority in preventing assault of staff. This novel proposed Clinical Practice Guideline (CPG) for the Pre Hospital Emergency Council (PHEC) Ireland is based on existing similar guidelines in Australia. This CPG combines pre-hospital emergency guidelines with established tactical medicine principles from the military and police services worldwide. This CPG seeks to minimise harm to clinicians as well as inform them of appropriate clinical priorities while operating in an unsafe situation

Prehospital point of care ultrasound in Helicopter Emergency Medical Services: a 5-year experience study in Belgium

IntroductionThe utilization of Clinical Ultrasound (CUS) in Helicopter Emergency Medical Services (HEMS) has become increasingly prevalent, reflecting its significant role in emergency care.MethodsThis descriptive, monocentric study, conducted at the Helicopter Medical Center (CMH) of Bra-sur-Lienne, Belgium, aimed to describe the use of CUS within HEMS and evaluate its potential impact on diagnostic accuracy, therapeutic interventions, and hospital destination decisions.ResultsOver a 5-year period, from January 2018 to December 2022, our retrospective analysis included 6,126 HEMS interventions, with CUS performed in 29.55% of cases. The study demonstrated that CUS led to therapeutic changes in 30.88% of instances and affected the hospital destination in 9% of cases, despite a potential bias toward directing patients to the University Hospital Center of Liège (CHU of Liège) due to operational constraints. The agreement between prehospital CUS findings and hospital imaging was substantial, with an 80.39% concordance rate, underscoring CUS's utility in enhancing prehospital diagnostic accuracy. We found no significant increase in on-scene time due to CUS usage, with most exams completed in <5 min.DiscussionOur findings highlight the interesting role of CUS in HEMS, facilitating more informed and confident medical decision-making in prehospital emergency care. However, variability in CUS application emphasize the need for standardized guidelines to optimize its use. The study's limitations include its retrospective, monocentric design and the focus on on-scene ultrasound evaluations. Future research should aim at a more extensive, prospective analysis to further validate the benefits of CUS in emergency medical services.

Mobile computed tomography at the Munich Oktoberfest : From idea to implementation.

The Munich Oktoberfest, the largest folk festival in the world, attracts around 6.2million visitors over 16-18days. Some of the visitors exhibit certain risky behaviors, leading to asignificantly increased number of medical emergencies during the festival. During Oktoberfest, the prehospital and clinical emergency services of the city are heavily strained, as one-third more ambulances are needed, and over 7000 patients must be treated on-site each year. Until 2022, there was no option for guideline-compliant radiological assessment on-site for patients with head or facial trauma and suspected serious trauma-related injuries. This required alarge number of emergency service admissions to hospitals, mostly for outpatient assessments. To relieve the overburdened medical system, amobile computed tomography (CT) scanner was set up on the Oktoberfest grounds in 2022 for the first time. Amobile CT scanner at the Munich Oktoberfest was utilized for diagnosing injuries to the face, cranium, and cervical spine. For an indication of cranial CT, we used acombination of the Canadian CT Head Rule and NEXUS criteria. Despite the complex structural conditions, this integration seamlessly fit into the structured processes of the on-site medical service. Since this deployment was, to our knowledge, the first of its kind globally, we had to develop and implement new clinical concepts and procedures tailored to the unique conditions of afolk festival. We demonstrated that aCT scanner could be effectively integrated into the preclinical processes of amedical service without direct hospital connection. On-site CT diagnostics proved to be ahighly effective means of avoiding unnecessary transportation to the hospital. Consequently, areduction in emergency medical service provision and stabilization of clinical emergency medicine during the Oktoberfest became feasible. From the authors' perspective, establishing amobile CT scanner at events with high or very high demands on preclinical and clinical emergency medicine is feasible and provides significant relief for the system. The primary goal of stabilizing prehospital and clinical emergency structures, as well as improving the detection and treatment of potentially life-threatening patients on-site, was successfully achieved. Careful integration into the overall process flow is essential.

Does the gender of emergency physicians have an impact on the prehospital care of psychiatric emergencies? a retrospective cohort analysis

BackgroundPsychiatric emergencies pose a special challenge for emergency physicians. It is known from other areas of medicine that the influence of a doctor’s gender can have an impact on the type of treatment and quality of patient care. However, this has not yet been investigated in the context of prehospital care in psychiatric emergencies.ObjectivesTo identify whether the gender of the prehospital emergency physicians has an influence on the “on-scene” time, treatment strategy and on the potential escalation of interventions for patients with a psychiatric diagnosis.MethodsA retrospective cohort analysis of emergency missions with a psychiatric diagnosis was performed between January 1, 2015 and December 31, 2021 at the Department of Emergency Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Germany.Results2882 emergency missions with a psychiatric indication/prehospital psychiatric diagnosis were studied and divided into: intoxication (n = 1343, 46.6%), suicidal behavior (n = 488, 16.9%), exceptional mental situation (n = 282, 9.8%), agitation (n = 262, 9.1%), anxiety and panic disorders (n = 262, 9.1%) and “psychiatric miscellaneous” (n = 245, 8.5%). Inpatient hospitalization occurred in 67.9% (n = 1958) of emergency missions. Of these, 20.3% (n = 392) were admitted directly to a psychiatric hospital. Male emergency physicians had a slightly longer "on-scene" time for psychiatric emergencies than female emergency physicians (p = 0.024). However, the variance in "on-scene" time for all interventions was significantly greater for female emergency physicians than for male emergency physicians (p = 0.025). Male emergency physicians were significantly more likely than their female counterparts to administer intravenous hypnotics in prehospital psychiatric emergencies (p = 0.001). For psychiatric patients who refused medically indicated inpatient psychiatric admission (“involuntary psychiatric admission”), male and female emergency physicians were equally likely to take the required action (p = 0.522). However, male emergency physicians were significantly more likely to administer an intravenous hypnotic to enforce involuntary admission (p = 0.009).ConclusionsSimilar to other medical specialties where the influence of physician gender on patient care is certainly relevant, the gender of prehospital emergency physicians also appears to influence their prehospital management strategy in psychiatric emergencies. The influence of gender is sometimes subtle and limited to specific aspects, such as the administration of hypnotics. Prospective study designs are needed to thoroughly investigate the influence of the gender of the prehospital emergency physician on the quality of care in psychiatric emergencies.Trial registrationThe study was approved by the ethics committee of the University Ulm, Trial-Code No. 110/22 and was prospectively registered in the German Clinical Trials Register (DRKS-ID: DRKS00031237). Patient information was not required for retrospective data analysis.

Construction and Application of a Private 5G Standalone Medical Network in a Smart Health Environment: Exploratory Practice From China.

To date, the differentiated requirements for network performance in various health care service scenarios-within, outside, and between hospitals-remain a key challenge that restricts the development and implementation of digital medical services. This study aims to construct and implement a private 5G (the 5th generation mobile communication technology) standalone (SA) medical network in a smart health environment to meet the diverse needs of various medical services. Based on an analysis of network differentiation requirements in medical applications, the system architecture and functional positioning of the proposed private 5G SA medical network are designed and implemented. The system architecture includes the development of exclusive and preferential channels for medical use, as well as an ordinary user channel. A 3-layer network function architecture is designed, encompassing resource, control, and intelligent operation layers to facilitate management arrangements and provide network open services. Core technologies, including edge cloud collaboration; service awareness; and slicing of access, bearer, and core networks, are employed in the construction and application of the 5G SA network. The construction of the private 5G SA medical network primarily involves system architecture, standards, and security measures. The system, featuring exclusive, preferential, and common channels, supports a variety of medical applications. Relevant standards are adhered to in order to ensure the interaction and sharing of medical service information. Security is achieved through mechanisms such as authentication, abnormal behavior analysis, and dynamic access control. Three typical medical applications that rely on the 5G network in intrahospital, interhospital, and out-of-hospital scenarios-namely, mobile ward rounds, remote first aid, and remote ultrasound-were conducted. Testing of the 5G-enabled mobile ward rounds showed an average download rate of 790 Mbps and an average upload rate of 91 Mbps. Compared with 4G, the 5G network more effectively meets the diverse requirements of various business applications in prehospital emergency scenarios. For remote ultrasound, the average downlink rate of the 5G network is 4.82 Mbps, and the average uplink rate is 2 Mbps, with an average fluctuation of approximately 8 ms. The bandwidth, performance, and delay of the 5G SA network were also examined and confirmed to be effective. The proposed 5G SA medical network demonstrates strong performance in typical medical applications. Its construction and application could lead to the development of new medical service models and provide valuable references for the further advancement and implementation of 5G networks in other industries, both in China and globally.

The Impact of Emotional Intelligence on Nurses' Professional Quality of Life in Pre-Hospital Emergency Settings: A Multicentre Mixed-Method Study.

Pre-hospital emergency nurses, frequently exposed to high-stress situations, are at risk for burnout and stress-related issues, affecting their overall well-being. The Professional Quality of Life (ProQoL) scale, widely used among hospital nurses, remains untested in pre-hospital emergency settings. To adapt and validate the ProQoL scale for pre-hospital emergency contexts and explore the protective role of emotional intelligence in professional well-being. A mixed-method study was conducted. The qualitative approach involved semi-structured interviews to inform the modification of items for adapting the ProQoL to the pre-hospital emergency setting. A quantitative method was applied to assess the relationship between emotional intelligence and professional well-being through content and face validity measures. Qualitative interviews suggested refining the ProQoL for pre-hospital emergency settings, emphasising factors such as job satisfaction and professional conduct. The revised 21-item Pre-Hospital Emergency-Professional Quality of Life (PHE-ProQoL) scale demonstrated strong content validity (I-CVI: 0.86-1, S-CVI: 0.9) and face validity. Significant correlations were observed between emotional intelligence and professional well-being, with negative correlations between emotional intelligence and both burnout (Pearson's r = -0.859) and post-traumatic stress (Pearson's r = -0.792), and a positive correlation with compassion satisfaction (Pearson's r = +0.917). Pre-hospital nurses displayed moderate levels of compassion satisfaction (27.3 ± 9.81), high emotional intelligence (28.0 ± 9.58), especially in empathy, and substantial levels of burnout (22.5 ± 6.09) and stress (21.2 ± 4.3). The study found that pre-hospital emergency nurses exhibit moderate compassion satisfaction and above-average emotional intelligence, particularly in perceiving and managing others' emotions. However, they also experience significant levels of burnout and post-traumatic stress. Burnout and post-traumatic stress significantly affect pre-hospital emergency nurses. Enhancing emotional intelligence is crucial for their well-being. Nursing managers now have access to a validated and reliable tool to assess this.

Resilience Capacity of Pre-hospital Emergency Medical Service (EMS) Providers and the Future Agenda for Sustainable Development of A Resilient EMS System in Thailand

In the current scenario, demand for emergency care is rising due to the shift in disease pattern all around the world, from growing burden of non-communicable diseases to the pre-existing communicable diseases. The principle aim of an emergency medical service (EMS) system is to prevent premature mortality, reduce pain and prevent long term disability. EMS workers serve on the front lines of emergency medical care, which is one of the most important components in an EMS system of any country. Since the latest pandemic has caused increased burn out and stress among the service providers with long term mental and physical effect which is yet to be researched in Thailand, and no study in particular have addressed to evaluate the resilience capacities of the front-line EMS workforce and identify components that influence their performance and response to emergencies. This study aims to measure the resilience capacity of pre-hospital EMS providers of Thailand along with providing recommendations to policy makers regarding EMS service provider future agendas and standard methods for proper workforce development in order to tackle future public health emergency situations. The respondents were EMTs, ENPs, paramedics, frontline rescuers working in the provinces as an EMS service provider under the ministry of public health (MOPH), National Institute of Emergency Medicine (NIEM), Thailand. Total 500 participated in the survey from 32 different provinces. Resilience capacity was divided into high, moderate and low; Components and factors were developed through literature review and grouping was done. With total 41 questions: Safety, Competencies, Wellness and Behavioral Health. Open ended questions reflected the perception and experiences of the EMS service providers regarding the strength and improvement areas of the EMS system in Thailand. The result from the survey shows that the EMS service providers have moderate resilience in terms of Behavioral Health which is related to their psychometric properties and main components to measure the resiliency scales. Similarly, in terms of Safety, Wellness and Competencies components the EMS services have shown moderate level of resilience capacity as a front-line worker in the emergency medical service system to prepare for the future public health emergencies. The findings of the research present the perception and opinions of various EMS providers working in different provinces of Thailand. This study explores the present status/situation of front-line workers of the EMS system in Thailand. The findings provide crucial recommendations to health policy makers for developing resilient EMS system and their workforce in Thailand focusing on pre-hospital care setting. This research suggests measurement tools and plans focusing on the EMS future agenda 2050.

Ethiopian Emergency Medical services: Bridging up the Gaps in Prehospital Services

Abstract This review identified the critical gaps in pre-hospital emergency medical services (EMS) in Ethiopia, highlighting their detrimental impact on health outcomes, particularly among vulnerable populations. There are significant barriers to timely access to care, contributing to elevated morbidity and mortality rates from preventable conditions. Establishment of a structured pre-hospital care framework, emphasizing the need for trained emergency medical technicians, national EMS guidelines, and an effective emergency communication system is recommended. These findings advocate for enhanced community awareness and collaboration among stakeholders to address logistical challenges. As result, there is urgency of implementing systemic improvements in pre-hospital care to mitigate health disparities and foster economic development in Ethiopia.

Assessing the psychobiological demands of high-fidelity training in pre-hospital emergency medicine

BackgroundIndividuals who provide critical emergency care mount rapid psychobiological responses when faced with an incident. These responses are adaptive and ensure resources at time of demand; however, frequent activation with minimal opportunity for recovery can have negative consequences for health and wellbeing. Monitoring individuals in real emergency situations would provide an understanding of their stress responses during the provision of critical care; however, this presents logistical challenges. An alternative is to assess individuals during high-fidelity training scenarios. This is the first comprehensive assessment of psychobiological responding during continuous high-fidelity training in pre-hospital emergency medicine.MethodsA sample of doctors and paramedics (N = 27) participated during 10 days of training and a weekend of no activities. Training involved the acquisition of human factors, non-technical and surgical skills, and their application in complex high-fidelity scenarios including road-traffic accidents, firearms incidents, and swift water rescue operations. On each day participants reported levels of state, cognitive, and somatic anxiety, and self-confidence following waking and before sleep, and their anticipated (at wake) and experienced (before sleep) demands of the day. Saliva samples were obtained each day for assessment of diurnal cortisol indices and the Cortisol Awakening Response (CAR). Garmin smartwatches were worn throughout for the collection of heart rate and HRV-derived stress.ResultsThere were significant (p < 0.001) differences across days for state, cognitive, and somatic anxiety; self-confidence; anticipated and experienced demands; aggregated measures of heart rate and HRV-derived stress; levels of cortisol at waking (p = 0.002) and for the CAR (p < 0.001). Measures of psychobiological responding during training were distinct from the weekend and the highest levels of psychobiological responding occurred on days characterised by greater anticipated and experienced demands.DiscussionThis high-fidelity training is typical of the day-to-day requirements of emergency services and these observations are representative of functioning during real-life critical care emergencies. Increased responding during times of demand is adaptive; however, frequent and sustained responding increases allostatic load and is a contributor to burnout. As burnout is a significant concern in emergency medicine, this study identifies patterns of responding and recovery that may impact upon longer-term health and wellbeing.

ECPR-the evolving role in cardiac arrest.

Extracorporeal cardiopulmonary resuscitation (ECPR) describes the use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) to restore blood circulation in patients during refractory cardiac arrest. So far, ECPR is not the standard of care but has become part of clinical routine for select patients in many places. As ECPR is ahighly invasive support option associated with considerable risks for fatal complications, premature use in patients who may have return of spontaneous circulation should be avoided. However, the selection criteria for ECPR are still evolving, as the search for evidence is ongoing. Recent randomized controlled trials of different ECPR strategies support its use within integrated systems built around highly specialized ECPR centers. The ECPR caseload is an important predictor of patient survival, and continuous training is key for evidence-based quality of care. Typical complications after ECPR include vascular injury or malposition of cannulas, thrombotic complications, hemolysis, and bleeding events that require early detection and interdisciplinary management. When provided by highly specialized and well-trained expert teams in dedicated ECPR centers within integrated pre-hospital and intra-hospital emergency care systems, ECPR may improve survival in select patients with refractory cardiac arrest. This article is freely available.

A newly developed, easy-to-use prehospital drug-derived score compared with three conventional scores: A prospective multicenter study.

The use of medications by emergency medical services (EMS) is increasing. Conventional scores are time-consuming and therefore difficult to use in an emergency setting. For early decision-making, an easy-to-use score based on the medications administered by the EMS may have prognostic value. The primary objective of this study was to develop the prehospital drug-derived score (PDDS) for 2-day mortality. A prospective, multicenter, ambulance-based cohort study was conducted in adults with undifferentiated acute diseases treated by EMS and transferred to the emergency department. Demographic data, prehospital diagnosis data, prehospital medication and variables for the calculation of the National Early Warning Score 2 (NEWS2), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) were collected. The PDDS was developed and validated, establishing three levels of risk of 2-day mortality. The predictive capability of each score was determined by the area under the curve of the receiver operating characteristic curve (AUROC) and compared using the Delong's test (p-value). A total of 6401 patients were included. The PDDS included age and the use of norepinephrine, analgesics, neuromuscular blocking agents, diuretics, antihypertensive agents, tranexamic acid, and bicarbonate. The AUROC of PDDS was .86 (95% CI: .816-.903) versus NEWS2 .866 (95% CI: .822-.911), p = .828; versus REMS .885 (95% CI: .845-.924), p = .311; versus RAPS .886 (95% CI: .846-.926), p = .335, respectively. The newly developed easy-to-use prehospital drug-derived PDDS score has an excellent predictive value of early mortality. The PDDS score was comparable to the conventional risk scores and therefore might serve as an alternative score in the prehospital emergency setting.

Evaluation of Emergency Admissions Due to Animal-Related Incidents Based on Prehospital Emergency Medicine Data: A Retrospective Study.

Animal injuries, especially dog bites, are a major public health problem in both developed and developing countries. The majority of these injuries lead to emergency healthcare visits and may have serious consequences such as infection risk and organ injuries. There is a limited number of studies on the demographic and operational characteristics of animal-related 112 emergency visits in Turkey. In this study, we aimed to conduct research to fill this gap. This retrospective study included animal-caused cases received by Ankara 112 Emergency Health Services Emergency Health Automation System (ASOS) between January 1, 2019 and December 31, 2023. A total of 3457 cases were analyzed. Data were evaluated using theIBM SPSS 27.0 program. There was an overall decreasing trend in animal-related emergency admissions between 2019 and 2023. Most cases were recorded during the summer season, especially in July. Male patients predominated (61.2%), with the majority of cases (81.7%) occurring in urban areas. Dog bites were the most common cause, accounting for 49.3% of cases. In the majority of cases, transportation time was below the Ministry of Health quality standards. Dog bites account for the majority of animal-related emergency admissions. The increase in cases during thesummer months emphasizes the importance of social awareness and preventive strategies. The findings of the study provide an important reference for improving emergency health services and developing strategies to prevent such cases.

Prehospital emergency health literacy assessment of patients in primary healthcare service

ABSTRACT The present study aims to develop a measurement tool to determine the level of health literacy (HL) of individuals applying to Primary Healthcare Service (PHS) regarding the use of emergency health services and to evaluate the study group in terms of Prehospital Emergency Health Literacy (PHEHL). The first stage of the study was carried out on individuals over 18 years of age who applied to 604 PHS to develop Prehospital Emergency Health Literacy Scale (PHEHLS) and Emergency Call Scale (ECS). In the second stage, PHEHLS and ECS were administered to 1255 individuals. The level of PHEHL was above the mean in 67.7% of the study group. The predictors of PHEHL score increase were found to include persons aged between 18-24 years, having a university degree or higher, being unmarried, having a moderate family income, having good health status, having health insurance, and calling the emergency call center for appropriate reasons according to ECS. The PHEHLS is a reliable and valid scale regarding the determination of the level of HL in this subject. Only one in four people in the study group called the helpline for an appropriate reason.

The effect of guided group reflection on the ability and convenience of breaking bad news in pre-hospital emergency staff

BackgroundBad news refers to any information that create negative changes in a person’s understanding or expectations of in present and future. Breaking Bad News (BBN) is a stressful task that may have disturbing effects on the professional performance and general health of the medical staff. Pre-hospital emergency staff often needs to deliver bad news to the patient or his family. This study was conducted to determine the effect of guided group reflection training on the ability and comfort of BBN in pre-hospital emergency staff.MethodsThis quasi-experimental study was conducted on 95 staff of the pre-hospital emergency, in the test and the control groups. For the test group, a 4-hour training workshop on BBN was held, and then a group was formed in virtual space to discuss and exchange opinions about the scenarios of BBN and reflecting on it. Data collection tools were SPIKES Questionnaire and the Visual Analogue Mood Scale. The data were analyzed with SPSS V.18.ResultsThe mean score of the ability to BBN after the intervention was 44.01 ± 6.21 in the test group and 31.40 ± 4.51 in the control group, and a significant difference was found using the independent t-test (P = 0.0001). Besides, the mean scores of the convenience of BBN in post-test was 5.52 ± 1.64 in the test group and 3.50 ± 1.28 in the control group using the independent t-test with a significant difference (P = 0.0001).ConclusionAccording to the findings, training in guided group reflection improved the ability to BBN and its convenience in pre-hospital emergency staff. Therefore, it is suggested the use of this method in training for health care providers. Relating to BBN.

Design of an emergency medical information system for mass gatherings

BackgroundThe frequency of mass gatherings is increasing. Such events often involve many people and carry the risk of mass casualty incidents, which require substantial medical resources from various healthcare institutions. The current medical system, while meeting daily needs, struggles to address the demand for a high volume of emergency resources and real-time data exchange. ObjectiveThe aim of this study was to develop an emergency medical information system for mass gatherings. MethodsWe developed an emergency medical information system for mass gatherings. Based on a unified prehospital and intrahospital emergency data exchange protocol, we can directly standardize medical information data and provide data support for the evacuation decision support algorithms of multiple institutions. Wearable devices, vehicle-mounted devices, video calling systems and surveillance systems are connected to capture real-time scenes. ResultsWe constructed the system via mobile applications and online platforms and deployed it in 3 hospitals, 5 ambulances and 17 on-site medical locations. We constructed a set of electronic medical records covering the whole first aid process according to the basic principles of first aid. The simulation results show that the proposed algorithm is suitable for mass gatherings. The overall survival rate of patients can be improved by 5 %, and the average evacuation efficiency of patients can be improved by 50 %. Furthermore, in a real-world environment, this method can ensure patient survival and achieve good convergence. ConclusionsOur system is capable of providing robust medical information support for emergency medical services during large-scale assembly events, ensuring a visualized full-process emergency response and decision-making for the diversion and subsequent transport of a large patient population.