Prehospital Emergency Research Articles

Impact of the 2020 lockdown on prehospital psychiatric emergencies in alarge city

The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low. The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in alarge German city. Aretrospective analysis was conducted on all prehospital psychiatric emergencies in alarge German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as areference. During the first lockdown there was asignificant increase in the number of emergency missions with respect to psychiatric cases. Asubstantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played aminor role during the lockdown. The lockdown had anotable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both adeterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular.

Mobile emergency teams seen by their users. A look at a pilot project in the canton of Vaud

This article is a contribution to the literature on pre-hospital emergencies. It presents the results of a qualitative investigation into the views and experiences of the beneficiaries of the mobile emergency teams set up in the canton of Vaud. The study shows that the services are appreciated by the beneficiaries, that they are integrated into the care network and care trajectories, and that they make up for the unavailability of the healthcare system. Beneficiary satisfaction is based on the seamless integration of interventions into care trajectories, and on a non-standardized care model that allows nurses the time they need to apply their skills. Finally, the study shows that EMUs are a response to what we propose to call the interstitial emergencies.

Application of a feedforward control-based intervention for preventing hypothermia in trauma patients in a pre-hospital emergency setting.

To investigate the efficacy of a feedforward control-based intervention strategy for preventing hypothermia among trauma patients during pre-hospital emergency care. We conducted a retrospective analysis comparing trauma patients treated before and after implementing the intervention, with 40 cases in each group. All patients received emergency care from the Fuzhou Emergency Center on the scene. Multivariate analysis was used to explore the risk factors for hypothermia. The effective rate, incidence of adverse reactions, quality of body temperature management, medical staff's knowledge, attitudes, and behaviors regarding mild hypothermia prevention, coagulation function, treatment time at various stages, prognosis score, and treatment situation were compared between the two groups. The adverse reactions, intervention methods, and degree of cognitive improvement were influencing factors for hypothermia. The effective rate (92.50%) in the feedforward control group was higher than that in the non-feedforward control group (65.00%), with a lower incidence of adverse reactions (2.50%). The temperature management quality score of the feedforward control group (6.23±0.62) was higher. The feedforward control group achieved a higher quality score for temperature management (6.23±0.62) and exhibited a greater understanding of hypothermia prevention among trauma patients (P<0.05). Compared to the non-feedforward control group, the feedforward control group showed improved coagulation function, better performance in treatment time at each node, and higher prognosis scores. The intervention model based on feedforward control can effectively improve the standard of pre-hospital emergency care and prevent the incidence of hypothermia in trauma patients.

Management Of Psychiatric Emergencies and Associated Comfort Among EMS Physicians in Lombardy, Italy: A Cross-Sectional Study.

The aims of this study were to explore the knowledge of EMS physicians (EMSPs) on the legal aspects related to the management of prehospital psychiatric emergencies, assess their degree of comfort, and measure their perceived communication skills. A survey was distributed to the 376 EMSPs working in the prehospital setting in Lombardy, Italy. Knowledge of medico-legal aspects was measured through multiple-choice questions; the Comfort Score (CS) and perceived Communication Skills Score (CSS) were calculated using Likert Scale questions. CS ranged from 11 points (lowest) to 44 (highest); CSS ranged from 8 points (lowest) to 32 (highest). A total of 272 EMSPs answered the survey (RR= 72.3%); 45.2% were women. Mean age was 45.76 years (SD 8.8). Mean percentage of correct knowledge test answers was 52.4 (SD 12.3); 81.3% believed to have little knowledge of the Italian legislation regarding this topic. Mean CS was 29.3 (SD 5.5); mean CSS was 19.1 (SD 3.9). A higher percentage of correct answers in the knowledge test was associated with lower CS (P = 0.019). Higher self-appraised knowledge of the Italian legislation was associated with higher CS (P < 0.001) and higher CSS (P < 0.001). These findings should prompt policy makers to ensure proper training and support for EMSPs in the matter of prehospital psychiatric emergency management.

Emergency medicine: what's new in 2023

Research in prehospital and in-hospital emergency medicine is essential to the development of this discipline. By calling certain practices into question (thrombolysis for minor strokes, use of coagulation factors for patients with severe polytrauma), providing access to new technologies (video-laryngoscopy, POCT troponins in pre-hospital care) or questioning new practices (double defibrillation, pulmonary US in pneumonia), research enables emergency physicians to adapt their day-to-day practice.

Emergency Medical Service in the Elderly Population in Iran: A Cross-sectional Study Before and During the COVID-19 Pandemic.

This research examines the impact of an aging population in Eastern Iran on prehospital emergency medical services (EMS), with a focus on changes before and during the COVID-19 pandemic. A descriptive cross-sectional analysis was performed on data from 10,264 elderly individuals using EMS in Torbat-e Heydarieh County from March 2019 to March 2022. Statistical analyses, including t-tests and Chi-square tests, were conducted using SPSS software. Findings indicate that 30% of the 33,847 EMS calls received were from older adults. The nature of emergencies evolved from cardiovascular issues pre-pandemic to predominantly impaired consciousness during COVID-19, a statistically significant shift (p < .001). The study concludes with a call for research targeted at this demographic and suggests setting up dedicated EMS response units to cater to the elderly, responding to the increase in elderly-related EMS needs.

Economic Insights to Optimize Chain of Survival in Emergency Response

Background: Since economics is a social science studying individuals&amp;apos; behavior, it is plausible to employ its relevant concepts to study human behavior in the immediate response of lay citizens towards emergency incidents. In this context, economics has identified three types of policy lags in fiscal decisions that are of great interest to our study: recognition lag, decision lag, and implementation lag. Objectives: This study aims to apply the three policy lags in economics to the concept of ‘chain of survival&amp;apos; (CoS), in the hope of enticing rethinking its first link, and to seek solutions for CoS&amp;apos;s optimal activation. Methods: This cross-sectional study explores immediate responses to prehospital emergencies through a global online survey in four languages. It assesses how lay citizens recognize medical emergencies and activate the EMS system. Data is analyzed with SPSS v26 while summarizing qualitative variables via frequencies and percentages. Results: A total of 239 respondents were recruited in the survey from multiple countries. About 32% of the sample had recognition lag 95% CI of [26.3%, 38.2%]. Lower recognition lag scores were significantly associated with male gender, residing in Europe and Oceania, European and North American nationalities, and first aid training in last 5-10 years. Around 70% of our sample had decision lag 95% CI of [63.6%, 75.3%]. The most statistically significant factor contributing to successful decision to calling for an ambulance was prior first aid training. The average implementation lag score was 46%, which was defined as five minutes delay in calling for an ambulance or more. Conclusion: Applying concise terminology to the CoS&amp;apos;s first link (i.e. calling EMS) reveals behavioral constrains to an effective and timely activation of the CoS. These findings clarify immediate behaviors at times of emergencies, and inform targeted awareness programs addressing behavioral elements for a successful activation of the EMS system.

Aplicativo de telefonia móvel com comunicação acessível na urgência pré-hospitalar: e-SU

Abstract Objective To describe the process of developing and evaluating a mobile application prototype to enable people with complex communication needs to call pre-hospital emergency services. Methods This methodological study was conducted in three stages: determining the target population’s functional requirements; developing and making available a prototype application for touchscreen mobile phones to request pre-hospital services; experts assessed the usability heuristics using a checklist, while the target population (people with complex communication needs) used the System Usability Scale. Descriptive statistics were performed, and the scores assigned to the application were analyzed. Results The application obtained high usability scores (mean=58.75) and 21 individuals from the target population reported an excellent user satisfaction index (mean=89.5), which allowed registering and applying for the prototype’s patent. Conclusion The prototype showed the ability to enable individuals with complex communication needs to access and request pre-hospital emergency services.

Approaches for Enhancing Pre-hospital EMS Response during the COVID-19 Pandemic Machine Learning

Background: Coronavirus disease 2019 (COVID-19) caused an unprecedented healthcare crisis and warranted a need to use artificial intelligence (AI) and machine learning (ML) for enhancing caller screening and triage within pre-hospital Emergency Medical Services (EMS) specifically tailored to COVID-19 cases. This study aimed to analyze existing AI and ML models and assess their accuracy and precision. Methods: A comprehensive assessment of artificial intelligence (AI) applications used to improve EMS responses in the context of COVID-19 instances was done. The dataset produced by Mexican government was used. This dataset was assessed over different models encompassing logistic regression, random forest, gradient boosting, neural networks, k-nearest neighbors (KNN), Naive Bayes, and clustering (K-means). Results: Multiple models performance evaluation was done employing metrics such as accuracy, precision, recall, and F1-score to comprehensively assess the strengths and limitations of these models. Conclusion: The study\&amp;apos;s findings underline the complexities inherent in caller screening and triage for COVID-19 cases, showcasing diverse strengths and limitations within the deployed machine learning models. The discourse underscores the necessity for a multifaceted approach to effectively manage the intricate challenges associated with caller classification and triage, offering invaluable insights for future research endeavors and guiding the enhancement of emergency healthcare systems.

Effectiveness of the acute stroke care map program in reducing in-hospital delay for acute ischemic stroke in a Chinese urban area: an interrupted time series analysis.

Timely intravenous thrombolysis (IVT) is crucial for improving outcomes in acute ischemic stroke (AIS) patients. This study evaluates the effectiveness of the Acute Stroke Care Map (ASCaM) initiative in Shenyang, aimed at reducing door-to-needle times (DNT) and thus improving the timeliness of care for AIS patients. An retrospective cohort study was conducted from April 2019 to December 2021 in 30 hospitals participating in the ASCaM initiative in Shenyang. The ASCaM bundle included strategies such as EMS prenotification, rapid stroke triage, on-call stroke neurologists, immediate neuroimaging interpretation, and the innovative Pre-hospital Emergency Call and Location Identification feature. An interrupted time series analysis (ITSA) was used to assess the impact of ASCaM on DNT, comparing 9 months pre-intervention with 24 months post-intervention. Data from 9,680 IVT-treated ischemic stroke patients were analyzed, including 2,401 in the pre-intervention phase and 7,279 post-intervention. The ITSA revealed a significant reduction in monthly DNT by -1.12 min and a level change of -5.727 min post-ASCaM implementation. The ASCaM initiative significantly reduced in-hospital delays for AIS patients, demonstrating its effectiveness as a comprehensive stroke care improvement strategy in urban settings. These findings highlight the potential of coordinated care interventions to enhance timely access to reperfusion therapies and overall stroke prognosis.

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

Correlation Study of Neurotransmitter and Immune Levels in Pre-Hospital Emergency Nurses with Post-Traumatic Stress Disorder

E-FAST Ultrasound Training Curriculum for Prehospital Emergency Medical Service (EMS) Clinicians.

Audience and type of curriculum: This hybrid, asynchronous curriculum is designed for prehospital clinician colleagues, including but not limited to emergency medical technicians (EMT), advanced EMTs (AEMT), EMT-paramedics (EMT-P), critical care EMT-Ps (CCEMTP), critical care transport nurses (CCTN), and certified flight registered nurses (CFRN) to learn and practice ultrasound fundamentals in the setting of a standardized extended focused assessment with sonography in trauma (E-FAST) exam. Over a five-month curriculum, learners will perform a pre-test, review online module lectures, attend an ultrasound scanning workshop, and perform post-test examinations. The extended-focused assessment with sonography in trauma (E-FAST) exam can identify intrathoracic and intraabdominal free fluid, as well as pneumothoraces. The E-FAST ultrasound exam has previously been taught to clinicians of various backgrounds in healthcare including emergency medical service (EMS). However, an open-access, systemized curriculum for teaching E-FAST exams to EMS clinicians has not been published. By the end of these training activities, prehospital EMS learners will be able to demonstrate foundational ultrasound skills in scanning, interpretation, and artifact recognition by identifying pertinent organs and anatomically relevant structures for an E-FAST examination. Learners will differentiate between normal and pathologic E-FAST ultrasound images by identifying the presence of free fluid and lung sliding. Learners will also explain the clinical significance and application of detecting free fluid during an E-FAST scan. The educational strategies used in this curriculum include a hybrid, asynchronous curriculum encompassing 2.5 hours of lectures derived from online learning modules and in-person review. In addition, learners will attend 2 hours of hands-on proctored ultrasound scanning practicing E-FAST examinations. An online 13-question pre-test was administered prior to the study. An online post-test and in-person scanning OSCEs were administered at least eight weeks after their scheduled workshop consisting of an online 13-question multiple-choice post-test, a confidence survey, and a hands-on E-FAST Objectively Structured Clinical Exam (OSCE) session. A non-parametric Wilcoxon signed-rank test was performed between each pre-test and post-test metric to examine the statistical differences of paired data. Post-test scores demonstrated statistically significant improvement in both image interpretation exams and ultrasound self-efficacy from the pre-test. The mean pre-test and post-test scores were 55.46% (7.21 ± 1.99) and 84.23% (10.89 ± 1.59) correct out of 13 questions, respectively (p < 0.0001). Participants surveyed an increase in self-efficacy reflected by a Likert scale for ultrasound usage and image interpretation (p < 0.005). The average post-test OSCE E-FAST exam score was 37.89 ± 2.76 out of 42 points (90.21%). This 4.5-hour hybrid asynchronous model demonstrates an effective curriculum for teaching E-FAST ultrasound to prehospital clinicians. Ultrasound, sonography, prehospital clinicians, emergency medical services (EMS), paramedics, critical care transport, extended focused assessment with sonography in trauma (E-FAST), free fluid, sliding lung sign, elective, pain.

Resuscitation with pre-hospital blood products in adults with trauma-related haemorrhagic shock: the RePHILL RCT

Background The treatment of traumatic haemorrhagic shock has been transformed through better haemorrhage control, use of tranexamic acid and use of blood products. The improved survival seen from these strategies has stimulated an interest in pre-hospital transfusion. Objectives To determine if the clinical effectiveness of resuscitation with red blood cells and lyophilised plasma was superior to 0.9% saline for improving tissue perfusion and reducing mortality in adults with haemorrhagic shock following major trauma. Design A multi-centre, allocation concealed, open-label, parallel group, randomised controlled trial (with internal pilot). Setting The trial was conducted in four civilian pre-hospital critical care services who operated within the National Health Service (NHS) England Major Trauma Networks. Participants Adults (aged ≥16 years) who had sustained traumatic injuries, were attended by a pre-hospital emergency medical team and were hypotensive (systolic blood pressure &lt;90 mmHg or absence of radial pulse) as a consequence of traumatic haemorrhage were eligible for inclusion. The exclusion criteria were known or apparently &lt;16 years, blood administered on scene prior to arrival of the RePHILL team, traumatic cardiac arrest where (1) the arrest occurred prior to arrival of the team and/or (2) the primary cause is not hypovolaemia, refusal of blood product administration, known Jehovah’s Witness, pregnancy, isolated head injury without evidence of external haemorrhage, prisoners in the custody of HM Prison and Probation Service. Interventions Participants were randomised to receive up to either two units each of red blood cells and lyophilised plasma or up to 1 L 0.9% saline. Treatment was administered through the intravenous or intraosseous route. Main outcome measures The primary outcome was a composite of episode mortality and/or impaired lactate clearance. The secondary outcomes included the individual components of the primary outcome. Results From 6 December 2016 to 2 January 2021, pre-hospital medical teams randomised 432 participants to red blood cell/lyophilised plasma (n = 209) or 0.9% saline (n = 223) out of a target sample size of 490. Most participants were white (62%), males (82%), median age 38 (interquartile range 26 to 58), involved in a road traffic collision (62%) with severe injuries (median injury severity score 36, interquartile range 25 to 50). Prior to randomisation participants had received on average 430 ml crystalloid fluids and tranexamic acid (90%). The primary outcome occurred in 128/199 (64.3%) of participants randomised to red blood cell/lyophilised plasma and 136/210 (64.8%) randomised to 0.9% saline [adjusted risk difference –0.025% (95% confidence interval –9.0% to 9.0%), p = 0.996]. The event rates for the individual components of the primary outcome, episode mortality and lactate clearance were not statistically different between groups [adjusted average differences −3% (−12% to 7%); p = 0.57 and −5% (−14% to 5%), p = 0.33, respectively]. Limitations Recruitment stopped prematurely due to disruption caused by the COVID-19 pandemic. Future work Identify the characteristics of patients who may benefit from pre-hospital blood products and whether alternative transfusion regimens are superior to standard care. Conclusions The trial did not demonstrate that pre-hospital red blood cell/lyophilised plasma resuscitation was superior to 0.9% saline for trauma-related haemorrhagic shock. Trial registration This trial is registered as ISRCTN62326938. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation Programme (NIHR award ref: 14/152/14) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 2. See the NIHR Funding and Awards website for further award information.

Prehospital Emergency Care: A Cross-Sectional Survey of First-Aid Preparedness Among Layperson First Responders in Northern Uganda.

Uganda has a high incidence of road traffic accidents and high mortality rates, yet lacks a mature prehospital emergency care system. Our study addresses this gap by assessing the experiences, training, and confidence in providing first aid (FA) among diverse layperson first responders in Northern Uganda, expanding beyond previous research, which was limited to Central Uganda and specific occupational groups. We conducted a cross-sectional survey among layperson first responders of various occupations in Gulu City, Acholi sub-region, Uganda. Data on socio-demographics, training, experiences, knowledge, and confidence in FA were collected. We included 396 participants, of whom 81.6% (n=323) were male, 47.0.6% (n=186) were aged 21-30 years, 59.3% (n=235) had obtained a secondary level of education, 23.7% (n=94) were commercial motorcyclists, and 45.7% (n=181) had work experience of >5 years. The majority (85.4%, n=338) had witnessed acute illness/trauma. Accidents/bleeding were the most commonly witnessed cases (68.6%, n=232), followed by burn injuries (10.1%, n=34). Most participants (52.3%, n=207) had attended FA training. Only 20.5% (n=81) had obtained an above-average score (≥70%). The majority (67.9%, n=269) were confident in providing FA. Lack of knowledge and skills (61.4%, n=78), fear of taking health risks (18.9%, n=24), and legal implications (7.1%, n=9) were the major reasons for not being willing to confidently give FA. Factors associated with above-average knowledge were tertiary education and being confident in providing FA, while training in FA and prior experience in giving FA were associated with confidence in giving FA. In this study, laypeople in Northern Uganda exhibited a high level of FA training. However, low confidence in providing FA is attributed to inadequate knowledge, fear of health risks, and legal concerns. Therefore, future efforts should focus on assessing FA practices in diverse regions and promoting formal FA training.

The Impact of the COVID-19 Pandemic on Pre-Hospital Emergency Medical Services: The impact of the Covid-19 pandemic on pre-hospital services.

The novel coronavirus (COVID-19) disease outbreak started in China and went on to affect the entire world. Healthcare providers were among the communities that faced severe challenges during the pandemic, and this was especially true of Pre-Hospital Emergency Medical Services (PHEMS) providers. This study aims to investigate the effect of the COVID-19 pandemic on service requests submitted to PHEMS providers via calls made to emergency hotlines. Data were obtained on calls made to 112 (the emergency hotline) during March - August 2020 (i.e., during the pandemic) and the same period the previous year (i.e., the pre-pandemic period). These 2 data sets were analyzed and compared using the SPSS 26 software package (IBM Corp., Armonk, New York, USA). The results of the analysis indicated that the total number of emergency calls received during the pandemic period (11 745) increased compared to the pre-pandemic period (10 747), whereas there was a decrease in the proportion of trauma-related emergency calls during the pandemic period (5.3%) compared to the pre-pandemic period (6.8%). Furthermore, there was a higher proportion of extended service times among ambulances serving in PHEMS during the pandemic period (ambulance movements longer than 90 seconds: 15.6%) compared to the pre-pandemic period (ambulance movements longer than 90 seconds: 8.6%). Non-emergency ambulance usage rate was 44.90% in the pre-pandemic period and 38.90% in the pandemic period. As the study's results show that there was an increase in the number of calls to PHEMS during the pandemic period, especially given that a significant portion of these calls consisted of non-emergency calls, it is recommended that measures be taken to reduce the excessive load on PHEMS during a pandemic.

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&amp;apos;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.) &amp; 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. &amp; 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

Engagement of female staff in prehospital emergency medical services from the perspective of service recipients: development and psychometric testing of the scale

Engagement of female staff in prehospital emergency medical services from the perspective of service recipients: development and psychometric testing of the scale

Pediatric Life Support in Prehospital Emergency Medicine: An Empirical Investigation in the Context of Taiwan's Critical Shortage of Pediatric Emergency Specialists.

This study aims to facilitate parental identification of designated emergency facilities for expeditious pediatric care within the framework of Taiwan's newly implemented "regional joint defense" approach to pediatric emergency services. The research seeks to elucidate the mechanisms by which this novel system can enhance timely access to appropriate emergency care for children, potentially improving health outcomes and resource utilization in acute pediatric situations. Factor analysis (FA) and triangular entropy matrix (TEM) analyzed the appearance, breathing and skin of pediatric assessment triangle (ABC of PAT), three types of prehospital pediatric emergence condition (PPEC), five levels of Taiwan's pediatric emergency triage (TPET), and applied the social learning theory (SLT) in educational doctrine, using experts' weighted questionnaires. Firstly, to address deficiencies in Taiwan's pediatric prehospital emergency medicine (PEM) system, integrating emergency medical knowledge (EMK) and pediatric life support (PLS) into medical education, staff training, and the national handbook for new parents is crucial. This equips parents to manage children's illnesses and prevent emergencies. Then, in life-threatening situations, immediate emergency room (ER) transport is vital for symptoms like whitish or purple lips, cold limbs, mottled skin, cold sweat, convulsions, dyspnea, chest dimples, weak consciousness, and oxygen saturation below 94%. Finally, for non-life-threatening emergencies, seek medical evaluation if symptoms include wheezing, chest tightness, chest pain, persistent high fever over 39 degrees with convulsions, chills, cold sweats, not eating or urinating for over 12 hours, or fever lasting more than 48 hours. Parents must remain calm and provide their baby with a sense of security while observing the development of physical symptoms. This approach enables them to effectively determine the most appropriate time to take their children to the emergency room, thereby avoiding life-threatening emergencies. Prompt and proper measures and treatments not only alleviate various discomforts caused by illness or medical emergencies but also reduce systemic distress, life-threatening situations, and unfortunate incidents before hospitalization.

Retrospective analysis of penetrating and cutting instrument injury cases from the prehospital emergency medical system perspective

Retrospective analysis of penetrating and cutting instrument injury cases from the prehospital emergency medical system perspective

Long-term risk of death in patients with infection attended by prehospital emergency services.

To develop and validate a risk model for 1-year mortality based on variables available from early prehospital emergency attendance of patients with infection. Prospective, observational, noninterventional multicenter study in adults with suspected infection transferred to 4 Spanish hospitals by advanced life-support ambulances from June 1, 2020, through June 30, 2022. We collected demographic, physiological, clinical, and analytical data. Cox regression analysis was used to develop and validate a risk model for 1-year mortality. Four hundred ten patients were enrolled (development cohort, 287; validation cohort, 123). Cumulative mortality was 49% overall. Sepsis (infection plus a Sepsis-related Organ Failure Assessment score of 2 or higher) was diagnosed in 29.2% of survivors vs 56.7% of nonsurvivors. The risk model achieved an area under the receiver operating characteristic curve of 0.89 for 1-year mortality. The following predictors were included in the model: age; institutionalization; age-adjusted Charlson comorbidity index; PaCO2; potassium, lactate, urea nitrogen, and creatinine levels; fraction of inspired oxygen; and diagnosed sepsis. The model showed excellent ability to predict 1-year mortality based on epidemiological, analytical, and clinical variables, identifying patients at high risk of death soon after their first contact with the health care system.