Prehospital Emergency Research Articles

Challenges of pre-hospital emergency care at Addis Ababa Fire and Disaster Risk Management Commission, Addis Ababa, Ethiopia: a qualitative study

BackgroundA challenge to pre-hospital emergency care is any barrier or obstacle that impedes quality pre-hospital care or impacts community pre-hospital utilization. The Addis Ababa Fire and Disaster Risk Management Commission (AAFDRMC) provides pre-hospital emergency services in Addis Ababa, Ethiopia. These services operate under a government-funded organization that delivers free emergency services, including out-of-hospital medical care and transportation to the most appropriate health facility. This study aimed to assess the challenges of pre-hospital emergency care at the Addis Ababa Fire and Disaster Risk Management Commission in Addis Ababa, Ethiopia.MethodsA qualitative descriptive study was conducted from November 20 to December 4, 2022. Data were collected through in-depth, semi-structured interviews with 21 experienced individuals in the field of pre-hospital emergency care, who were selected using purposeful sampling. A thematic analysis method was used to analyze the data.ResultsThis study includes twenty-one participants working at the Addis Ababa Fire and Disaster Risk Management Commission. Three major themes emerged. The themes that arose were the participants’ perspectives on the challenges of pre-hospital emergency care in Addis Ababa, Ethiopia.Conclusion and recommendationThe Fire and Disaster Risk Management Commission faces numerous challenges in providing quality pre-hospital emergency care in Addis Ababa. Respondents stated that infrastructure, communication, and resources were the main causes of pre-hospital emergency care challenges. There has to be more focus on emergency management in light of infrastructure reform, planning, staff training, and education, recruiting additional professional power, improving communication, and making pre-hospital emergency care an independent organization in the city.

A study of prehospital EMS response time and influencing factors in the main urban area of Chongqing, China.

Shortening the prehospital emergency medical service (EMS) response time is crucial for saving lives and lowering mortality and disability rates in patients with sudden illnesses. Descriptive analyses of prehospital EMS response time and each component were conducted separately using ambulance trip data from the 120 Dispatch Command Centre in the main urban area of Chongqing in 2021, and then, logistic regression analyses were used to explore the influencing factors. The median prehospital EMS response time in the main urban area of Chongqing was 14.52 min and the mean was 16.14 min. A 44.89% of prehospital EMS response time exceeded 15 min. Response time was more likely to surpass this threshold during peak hours and in high population density areas. Conversely, lower probabilities exceeding 15 min were observed during the night shift, summer, and autumn seasons, and areas with a high density of emergency station. 33.28% of preparation time was >3 min, with the night shift and high population density areas more likely to be >3 min, while for the summer and autumn seasons, high Gross National Product (GDP) per capita areas had a lower likelihood of having preparation time >3 min. 45.52% of travel time was >11 min, with peak hours, summer and autumn, and high GDP per capita areas more likely to have had a travel time >11 min, while night shift and high emergency station density areas had a lower likelihood of travel time >11 min. The primary factors influencing prehospital EMS response time were shifts, traffic scenarios, seasons, GDP per capita, emergency station density, and population density. Relevant departments can devise effective interventions to reduce response time through resource allocation and department coordination, staff training and work arrangement optimisation, as well as public participation and education, thereby enhancing the efficiency of prehospital emergency medical services.

Prehospital emergency care family satisfaction scale for care provided by emergency medical technicians: Scale development and validation.

To date, family satisfaction with emergency medical technicians (EMTs) has only been reported through narrative statements in subjective evaluations. Although a quantitative assessment of healthcare professional satisfaction is desirable, no specific measures have been devised to assess family satisfaction with the healthcare and care provided by EMTs. This study aimed to develop and validate an EMT care family satisfaction scale to measure patient satisfaction with prehospital emergency care. The study population comprised 216 family members (N = 216) of patients who used ambulances between November 2020 and May 2021 in a single region in Japan. Questionnaires were distributed to the participants who provided informed consent. An exploratory factor analysis of construct validity was performed to validate the Family Satisfaction Scale. The Cronbach's alpha was used to validate the internal consistency reliability of the scale. The exploratory factor analysis results revealed a four-factor structure: 'explanation and communication,' 'physical treatment,' 'psychological support,' and 'environment in the ambulance.' The Cronbach's range (0.80-0.93) for the total score for each of these four factors and the overall total score confirmed favorable internal reliability of this study. The family satisfaction scale developed in this study was constructed and validated to highlight the role of EMTs and needs of the families in the prehospital care settings. Moreover, this scale can be applied in the evaluation and consideration of interventions to improve family satisfaction with EMTs.

Qualification requirements for prehospital emergency physicians are too low: we need a higher uniform standard!

Qualification requirements for prehospital emergency physicians are too low: we need a higher uniform standard!

Population-Based Analysis of 6534 Seizure Emergency Cases from Emergency Medical Services Data.

Seizures are common reasons to call an ambulance, and this study aims to analyze the burden of seizures in the prehospital setting based on incidence, hospital admission rate, and costs. This was a population-based, cross-sectional analysis of prehospital emergency medical services (EMS) data on suspected seizure cases from the federal state of Hesse, Germany, in 2019. A total of 6534 suspected seizure cases were identified, of which most were those with a known seizure disorder. Incidence rate for epilepsy-related seizures (ES; pediatric epilepsy, first seizure [1stS], seizure with known seizure disorder [SEPI]) was 205.7 per 100,000 inhabitants and incidence rate for pediatric febrile seizures (PFS) was 36.7 per 100,000 inhabitants, corresponding to 171,275 ES and 28,500 PFS (99.3% < 18years) cases in Germany. A prehospital EMS physician was involved in 40.0% (SEPI) to 54.4% (PFS) of suspected seizure cases. Depending on the type of seizure, 70.7% (SEPI) to 80.9% (1stS) were admitted to hospital for inpatient stay of ≥ 24h. An additional 4% (PFS) to 16% (1stS) of cases needed immediate intervention at hospital. Prehospital EMS staff needed 8:24min:s (SD 7:24; n = 5004) after the emergency call to arrive at the scene of the ES and 10:58min:s (SD 27:39; n = 321) for PFS. ES and PFS cases caused estimated costs of 48.5 and 8.1million euros for Germany in 2019, respectively, not including hospital treatment-related costs. This study identified a high number of suspected seizure-related emergency casesand proportion of patients admitted to hospitals, as well as high associated costs in Germany.

Prehospital emergency care for trauma victims in Nepal: a mixed-methods study

Prehospital emergency care for trauma victims in Nepal: a mixed-methods study

Community First Responders' role in the current and future rural health and care workforce: a mixed-methods study.

Community First Responders are trained volunteers dispatched by ambulance services to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to support ambulance services in rural communities, where access to prehospital emergency care is more likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is provided and how this might be improved. We aimed to describe Community First Responder activities, organisation, costs of provision and outcomes of care together with perceptions and views of patients, public, Community First Responders, ambulance service staff and commissioners of their current and future role including innovations in the rural health and care workforce. We used a mixed-methods design, using a lens of pragmatism and the 'actor', 'behaviour change' and 'causal pathway' framework to integrate quantitative routine and qualitative (policy, guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance services. We identified potential innovations in Community First Responder provision and prioritised these using a modified nominal group technique. Patients and public were involved throughout the study. In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did also attend lower-category calls for conditions such as falls. We examined 10 documents from seven ambulance services. Ambulance policies and protocols integrated Community First Responders into ambulance service structures to achieve the safe and effective operation of volunteers. Costs, mainly for training, equipment and support, varied widely but were not always clearly delineated. Community First Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming a Community First Responder, the Community First Responder role, governance and practice, and the positive views of Community First Responders from stakeholders despite public lack of understanding of their role. Community First Responders' scope of practice varied between ambulance services and had developed into new areas. Innovations prioritised at the consensus workshop were changes in processes and structures and an expanded scope of practice supported by training, which included counselling, peer support, better communication with the control room, navigation and communication technology, and specific mandatory and standardised training for Community First Responders. Missing data and small numbers of interviews in some stakeholder groups (patients, commissioners) are sources of bias. Future research should include a robust evaluation of innovations involving Community First Responders. This trial is registered as ClinicalTrials.gov, NCT04279262. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127920) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 18. See the NIHR Funding and Awards website for further award information.

Transfusion préhospitalière des traumatisés sévères

AbstractPre-hospital transfusion of severe trauma patients is developing in many countries, including France, despite a particularly demanding regulatory context. Indeed, there is a growing body of scientific evidence to support the earliest possible use of transfusion in hemorrhagic wounded. However, performing transfusion procedures outside the hospital must not lead to a reduction in transfusion safety, and can therefore represent real logistical and training challenges for pre-hospital emergency teams, as well as for the entire transfusion chain.

Assessing Patient Satisfaction with Pre-Hospital Emergency Services: A Study of Punjab Emergency Service Rescue 1122 in Chiniot, Punjab

First step of health care system is Pre-hospital emergency service to provide treatment facilities to patients. Before admission of patients to hospital, provision of services to patients by pre hospital emergency service causes satisfaction or dissatisfaction for the patients with overall health care system of a society. This study was conducted to measure the satisfaction of patients with Punjab Emergency Service Rescue 1122 in the city of Chiniot, Punjab. There were 340 conscious patients at the time of emergency were included in this study by using systematic sampling technique. Data were analysed by a computer software Statistical Packages for Social Sciences (SPSS). Results of the univariate analysis showed that the majority of the users of the service were male and belong to rural area of the Chiniot 236 and 225 respectively. The majority of the respondents 250 experienced road traffic accidents. The results showed that the satisfaction of the patients from condition of the ambulance, response time, behaviour of the rescue team, efficiency of the service and professionalism of rescue crew was very high. The independent variables including condition of ambulance, behaviour of rescue team and professionalism of team showed a strong positive relationship with patients’ satisfaction. While response time of the ambulance showed a strong negative correlation. The results of the study revealed a very high level of satisfaction of the patients with Punjab Emergency Service Rescue 1122 Chiniot.

Physician utilization in prehospital emergency medical services in Europe: an overview and comparison

Physician utilization in prehospital emergency medical services in Europe: an overview and comparison

A survey of emergency medical service providers' perspectives regarding relatives influence on acute prehospital treatment of adult patients.

In the field of prehospital emergency medicine, specialized emergency medical service (EMS) providers interact with acutely ill patients and their relatives. The influence of family presence during in-hospital resuscitation is well described. However, no studies have previously assessed the influence of relatives' presence in the acute prehospital setting. The aim of this study was to investigate EMS providers' perspectives on relatives' impact on the acute prehospital treatment of adult patients. An online anonymous survey was distributed to all prehospital EMS providers in the Capital Region of Denmark. The survey included 25 research questions on a 5-point Likert scale, investigating relatives' influence on treatment in three different domains: positive, negative, and resuscitation. A higher domain score indicates a high level of agreement or frequency. Two hundred forty-six EMS providers completed the survey (84 ambulance technicians, 87 paramedics, and 75 physicians). There were no significant differences in the positive domain across professions (p = .175). Physicians had a statistically significant lower median score in the negative domain, compared with ambulance technicians and paramedics (2.50 vs. 2.63 and 2.63, p = .024). In the resuscitation domain, paramedics and physicians had a significant lower median score compared with ambulance technicians (3.00 and 3.00 vs. 3.14, p = .003). All professions were equally positive towards the relatives' presence and involvement in the acute prehospital setting. Physicians were less likely to be negatively influenced by the presence of relatives compared with ambulance technicians and paramedics. In all professions, increased experience led to improved comfort with handling relatives.

Evaluation of Lifelong Learning Tendencies of Health Personnel Providing Prehospital Emergency Health Services

Aim: The acquisition of lifelong learning habits by healthcare professionals for the enhancement of their knowledge and skills post-graduation holds paramount significance for the beneficiaries of healthcare services. The aim of this study was to evaluate the lifelong learning approaches of emergency ambulance employees. Material and Methods: Within the scope of the research, data was collected online from 390 healthcare professionals working in emergency ambulances using the lifelong learning tendencies scale in in Turkey. When evaluating the data, group characteristics were summarized by descriptive analyses and In the comparisons of numerical variables, normal distribution condition was sought and nonparametric comparison tests were used. Results: Within the scope of the research, the mean lifelong learning approach scores of the health personnel working in the emergency ambulance were found to be 113.89±16.03 (min. 61, max. 145) and the obtained score shows that their lifelong learning tendencies are at a low level. The findings indicate that there is no statistically significant difference among groups based on gender, title, age, and years of work experience in terms of the total scores on the Lifelong Learning Tendencies Scale (p&gt;0.05 for each). However, significant differences were observed among certain groups in terms of the subscales of the scale. It was determined that participants aged 30 and above exhibited decreased levels of motivation and perseverance. Additionally, it was found that as years of work experience increased, deficiencies in learning levels and curiosity deficiencies decreased. Conclusion: Emergency ambulance workers need to be prepared and willing to improve their theoretical and practical skills as new evidence emerges in their field, where scientific knowledge is increasing. According the research findings should focus on promoting self-directed and team-based learning, improving access to up-to-date information, and providing easily accessible educational resources.

The effectiveness of non-attendance triage training based on the ESI-IV system on the knowledge and ability of pre-hospital emergency staff in the academic hospitals of Ahvaz Jundishapur university of medical sciences

Introduction: In recent decades, E-learning has gained widespread recognition globally as a vital application of information and communication technology. Objectives: The present study investigated the effectiveness of non-attendance triage training based on the ESI-IV system on the knowledge and ability of pre-hospital emergency staff. Patients and Methods: This study was a semi-experimental interventional study, and the study population consisted of the pre-hospital emergency staff of Ahvaz university of medical sciences academic hospitals in 2021. The study tool was a questionnaire on the awareness and performance of the triage system of hospital emergency (ESI). Initially, both questionnaires were completed, and submitted the triage training file to the intervention group. Two weeks after the first phase—completion of the questionnaire for the first time— and the study of the file by the subjects, the questionnaire was completed again by the intervention group, and the data of both groups were compared. Results: According to the results, the mean of awareness and decision-making in the control group before and after the intervention was (11.8, 10.85, and 13.82) and (7.51, 7.36, and 8.86) respectively. The results indicate that non-attendance triage training based on the ESI-IV system was effective in the knowledge and ability of the pre-hospital emergency personnel had a positive and significant impact, and remains at a good level. Conclusion: The present results of the research indicate that the use of non-attendance training as an effective method can improve interns’ knowledge and ability.

RETRACTION NOTICE: Gender characteristics associated to acute respiratory failure in pre-hospital emergency medical services

Retraction note: Cintora-Sanz, A. M. &amp; Gutiérrez-Misis, A. (2022). Gender characteristics associated to acute respiratory failure in pre-hospital emergency medical services A observational study. TECHNO REVIEW. International Technology, Science and Society Review Revista Internacional De Tecnología, Ciencia Y Sociedad, 12(2), 1–13. https://doi.org/10.37467/revtechno.v11.4398 The Editorial Office of Eurasia Academic Publishing Group has retracted this article. An investigation carried out by our Research Integrity Department has found a group of articles, among which this one is found, that are not within the thematic scope of the journal. We believe that the editorial process was manipulated and, furthermore, acceptance decisions were made under possibly inappropriate peer review.

Emergency physicians' and nurses' perception on the adequacy of emergency calls for nursing home residents: a non-interventional prospective study.

A considerable percentage of daily emergency calls are for nursing home residents. With the ageing of the overall European population, an increase in emergency calls and interventions in nursing homes (NH) is to be expected. A proportion of these interventions and hospital transfers may be preventable and could be considered as inappropriate by prehospital emergency medical personnel. The study aimed to understand Belgian emergency physicians' and emergency nurses' perspectives on emergency calls and interventions in NHs and investigate factors contributing to their perception of inappropriateness. An exploratory non-interventional prospective study was conducted in Belgium among emergency physicians and emergency nurses, currently working in prehospital emergency medicine. Electronic questionnaires were sent out in September, October and November 2023. Descriptive statistics were used to analyze the overall results, as well as to compare the answers between emergency physicians and emergency nurses about certain topics. A total of 114 emergency physicians and 78 nurses responded to the survey. The mean age was 38 years with a mean working experience of 10 years in prehospital healthcare. Nursing home staff were perceived as understaffed and lacking in competence, with an impact on patient care especially during nights and weekends. General practitioners were perceived as insufficiently involved in the patient's care, as well as often unavailable in times of need, leading to activation of Emergency Medical Services (EMS) and transfers of nursing home residents to the Emergency Department (ED). Advance directives were almost never available at EMS interventions and transfers were often not in accordance with the patient's wishes. Palliative care and pain treatment were perceived as insufficient. Emergency physicians and nurses felt mostly disappointed and frustrated. Additionally, differences in perception were noted between emergency physicians and nurses regarding certain topics. Emergency nurses were more convinced that the nursing home physician should be available 24/7 and that transfers could be avoided if nursing home staff had more authority regarding medical interventions. Emergency nurses were also more under the impression that pain management was inadequate, and emergency physicians were more afraid of the medical implications of doing too little during interventions than emergency nurses. Suggestions to reduce the number of EMS interventions were more general practitioner involvement (82%), better nursing home staff education/competences (77%), more nursing home staff (67%), mobile palliative care support teams (65%) and mobile geriatric nursing intervention teams (52%). EMS interventions in nursing homes were almost never seen as necessary or indicated by emergency physicians and nurses, with the appropriate EMS level almost never being activated. The following key issues were found: shortages in numbers and competence of nursing home staff, insufficient primary care due to the unavailability of the general practitioner as well as a lack of involvement in patient care, and an absence of readily available advance directives. General practitioners should be more involved in the decision to call the Emergency Medical Services (EMS) and to transfer nursing home residents to the Emergency Department. Healthcare workers should strive for vigilance regarding the patients' wishes. The emotional burden of deciding on an avoidable hospital admission of nursing home residents, perhaps out of fear for medico-legal consequences if doing too little, leaves the emergency physicians and nurses frustrated and disappointed. Improvements in nursing home staffing, more acute and chronic general practitioner consultations, and mobile geriatric and palliative care support teams are potential solutions. Further research should focus on the structural improvement of the above-mentioned shortcomings.

Patients suffering traumatic brain injury: patient characteristics, prehospital triage, primary referral and mortality - A population-based follow-up study

BackgroundTraumatic brain injury (TBI) is a potential high-risk condition, but appropriate care pathways, including prehospital triage and primary referral to a specialised neurosurgical centre, can improve neurological outcome and survival. The care pathway starts with layman triage, wherein the patient or bystander decides whether to contact a general practitioner (GP) or emergency services (1-1-2 call) as an entryway into the health care system. The GP or 112-health care professional then decides on the level of urgency and dispatches emergency medical services (EMS) when needed. Finally, a decision is made regarding referral of the TBI patient to a specialised neurotrauma centre or a local hospital. Recent studies have shown that injuries are generally more severe in patients entering the health care system through EMS (112-calls) than through GPs; however, no information exists on whether mortality and morbidity outcomes differ depending on the referral choice. The aim of this study was to examine triage pathways, including the method of entry into the health care system, as well as patient characteristics and place of primary referral, to determine the associated 30-day and 1-year mortality rates in TBI patients with confirmed intracranial lesions.MethodsThis retrospective observational population-based follow-up study was conducted in the Central Denmark Region from 1 February 2017 to 31 January 2019. We included all adult patients who contacted hospitals and were ascribed a predefined TBI ICD-10 diagnosis code in the Danish National Patient Register. The obtained TBI cohort was merged with prehospital data from the Prehospital Emergency Medical Services, Central Denmark Region, and vital status from the Danish Civil Registration System. Binary logistic regression analysis of mortality was conducted. In all patients with TBI (including concussions), the primary outcome was primary referral to a specialised centre based on mode of entry (‘GP/HCP’, ‘112-call’ or ‘Unreferred’) into the health care system. In the subgroup of patients with confirmed intracranial lesions, the secondary outcomes were the relative risk of death at day 30 and 1 year based on the place of primary referral.ResultsOf 5,257 first TBI hospital contacts of adult patients included in the cohort, 1,430 (27.2%) entered the health care system via 1-1-2 emergency medical calls. TBI patients triaged by 112-calls were more likely to receive the highest level of emergency response (15.6% vs. 50.3%; p < 0.001) and second-tier resources and were more frequently referred directly to a specialised centre than were patients entering through GPs or other health care personnel. In the subgroup of 1188/5257 (22.4%) patients with confirmed intracranial lesions, we found no difference in the risk ratio of 30 day (RR 1.04 (95%CI 0.65–1.63)) or 1 year (RR 0.96 (95%CI 0.72–1.25)) all-cause mortality between patients primarily referred to a regional hospital or to a specialised centre when adjusting for age, sex, comorbidities, antiplatelet/anticoagulant treatment and type of intracranial lesions.ConclusionTBI patients mainly enter the health system by contact with GPs or other health care professionals. However, patients entering through 112-calls are more frequently triaged directly to specialised centres. We were unable to demonstrate any significant difference in the adjusted 30-day and 1-year mortality based on e primary referral to a specialised centre. The inability to demonstrate an effect on mortality based on primary referral to a specialised centre may reflect a lack of clinical data in the registries used. Considerable differences may exist in nondocumented baseline characteristics (i.e., GCS, blood pressure and injury severity) between the groups and may limit conclusions about differences in mortality. Further research providing high-quality evidence on the effect of primary referral is needed to secure early neurosurgical interventions in TBI patients.

Governance and legal considerations supporting prehospital emergency care in low and middle-income countries—For the Special Series on Prehospital Care in LMICs

The global imperative to expand prehospital emergency care in low and middle-income countries to reduce health disparities and improve outcomes for time-sensitive health conditions is well established in academic literature and public policy discussions. However, the governance and legal frameworks essential for the strategic development of prehospital systems remain understudied and inadequately addressed. This paper delves into the critical role of governance in prehospital systems, emphasizing its impact on equity, human rights, and the provision of timely, quality emergency care.Health system governance, defined as a complex interplay of mechanisms, processes, and institutions, is a neglected yet pivotal component of prehospital care. By highlighting previously described barriers, we underscore the opportunity to strengthen prehospital care through improved governance, particularly in leadership and legislative standards. Drawing on the World Health Organization’s Health System Building Blocks and the Emergency Care System Framework, we elucidate the multifaceted nature of governance in the prehospital context, including the coordination of diverse stakeholders, the establishment of standards, and the creation of accountability mechanisms. We emphasize the importance of applying a human rights perspective to governance, ensuring non-discriminatory and timely access to emergency care. Through the application of an established governance framework of 10 principles to assess prehospital system governance, we offer policymakers and stakeholders a structured approach to identify weaknesses, propose solutions, and evaluate progress in the prehospital system.To provide practical insights, we present a contemporary case study of Ghana’s National Ambulance Service Act and the Health Institutions and Facilities Act of 2011, which establish a structured approach to governance and oversight while reflecting Ghana’s commitment to advancing emergency care yet faces common challenges to operationalizing the laws.We advocate for a renewed focus on governance as an essential building block for effective prehospital emergency care. By providing a comprehensive framework and case study analysis, the paper offers actionable insights to guide policymakers and stakeholders in developing and evaluating governance initiatives that improve the availability, accessibility, acceptability, and quality of prehospital care globally.

Ultra-Hydrophobic Gauze Driving Super-Haemostasis.

Controlling bleeding by applying pressing cotton gauze is the most facile treatment in prehospital emergencies. However, the wettable nature of cotton fibers leads to unnecessary blood loss due to excessive blood absorption, inseparable adhesion-induced pain, and pliable to infection. Here, a kind of ultra-hydrophobic haemostatic anti-adhesive gauze whose surface is loaded with polydimethylsiloxane (PDMS) and hydrophobic-modified cellulose nanocrystals (CNCs), achieving a water contact angle of ≈160° is developed. It is demonstrated that the mechanism by which hydrophobic CNCs promote blood clotting is associated with their ability to activate coagulation factors, contributing to fibrin formation, and promoting platelet activation. The blood-restricting effect results from the low surface energy layer formed by PDMS and then the alkyl chains of hydrophobic CNCs are combined. The produced ultra-hydrophobic gauze resists blood flow and diffusion, decreases blood loss, is effortlessly peelable, and minimizes pathogen adhesion. Compared to the commercial cotton gauze, this gauze achieved effective haemostasis and antiadhesion by reducing blood loss by more than 90%, shortening haemostasis time by more than 75%, lowering peeling force by more than 90% and minifying bacterium attachment by more than 95%. This work presents promising applications in terms of prehospital first aid.

Lived experiences of Iranian prehospital emergency technicians in facing women’s emergencies: a phenomenological study

Introduction: This study aimed to investigate the work problems and challenges of male prehospital emergency technicians when faced with female medical emergencies. Given that qualitative research has not been done in this field, planning to find the weak points and improve the quality of prehospital emergency as the first line of treatment for female emergency patients, which is considered an important part of the health care system, is considered important and valuable. Therefore, this phenomenological study was conducted in 2023.MethodsThis study was conducted using a qualitative method of phenomenology in 2023. The environment of the research was urban and road prehospital emergency centers in Iran and the data were collected through interviews with EMS technicians. The collected data were analyzed using Smith’s approach to explain the lived experiences of EMS technicians facing female emergencies or women’s emergencies in Iran.ResultsAll the 15 participants were men. Their mean age was 35 years, with a range of 25 to 45 years, and with a mean work experience of 10.54 years with a range of 4 to 20 years. The lived experiences of 115 emergency technicians in facing women’s emergencies in Iran were placed in four main themes cultural-social factors, organizational factors, human resources-related factors, and administrative-legal factors.ConclusionEMS personnel face various obstacles in carrying out missions related to women’s emergencies, Considering the critical nature of women’s emergencies, it is recommended that policymakers and clinical educators improve the level of community culture, communication skills, theoretical and practical training, respecting privacy, hiring female personnel, adding specialized equipment, amending and changing laws, removing road-traffic obstacles and to support personnel, patients and their families psychologically to optimize performance in women’s emergencies.

Development and Deployment of a Pre-Planned Hospital Emergency Response Team (HERT) for EMS Augmentation: Case Report and Program Review

With the establishment and growth of the Emergency Medical Services (EMS) subspecialty, significant attention has been focused on clinical activities performed by EMS physicians in the out-of-hospital environment. An EMS fellowship includes special operations education to develop preparedness for responding to field situations requiring physician expertise. With only a thousand Board Certified EMS physicians in North America, EMS physicians may not be available 24 h per day to respond to field emergencies. Non-EMS physicians with minimal experience in prehospital or austere care may be called upon to respond to complex prehospital emergencies requiring advanced skills. The Los Angeles County EMS Agency implemented a policy in 1992 to establish Hospital Emergency Response Teams (HERT) as a regional resource to provide time-critical, specialized prehospital services within an EMS system. Activation of the HERT is rare, most frequently prompted by need for field amputation to enable extrication. We describe one such incident of a field intervention by HERT and detail the staffing, training, and equipment considerations within our large regional EMS system.