Prehospital Emergency Care Of Patients Research Articles

Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey.

Ambulance nurses in prehospital emergency care must assess, treat, and triage patients with mental health issues. This study aimed to investigate the self-perceived competence of ambulance nurses in prehospital emergency care of patients with mental illness. A cross-sectional questionnaire survey was done, a question-index value (Q-IV; range: 0–1.0) was defined as a summary of the proportion of positive responses (%). Correlations of self-perceived competence with education and professional experience were also examined. Overall self-perceived competence was good (mean Q-IV, 0.80). For six of the nine questions, women rated their abilities slightly lower than men. Women rated themselves as fairly good in providing “information about types of effective help available” (Q-IV, 0.55) and in “suggesting tactics for helping a person with mental illness feel better” (Q-IV, 0.56). Men rated their competence as fairly good in “directing patients to appropriate sources of help” (Q-IV, 0.58). Self-perceived competence did not correlate with education level or professional experience. In conclusion, these results indicate that in encounters with patients who have mental illness, ambulance nurses perceive their overall competencies as good, with some sex-based differences in self-perception for specific knowledge areas. Education level and professional experience did not correlate with self-perceived competence.

Effect Evaluation of Sequential Evaluation of Patients' Condition in Pre-hospital Emergency Care for Patients with Craniocerebral Trauma

Effect Evaluation of Sequential Evaluation of Patients' Condition in Pre-hospital Emergency Care for Patients with Craniocerebral Trauma

Prehospital emergency care of patients exposed to poisoning: Assessment of epidemiological, clinical characteristics and quality of care

ObjectiveTo describe the characteristics of paediatric patients with suspected poisoning treated by advanced life support (ALS) units, and to evaluate quality indicators (QI) for the prehospital emergency care of these patients. MethodA one-year observational study of patients under 18 years of age exposed to poisoning and treated by an ALS unit of the Medical Emergency System in Catalonia. Severe clinical criteria were defined, with 8 QI being evaluated for prehospital emergency care of poisoned paediatric patients. ResultsThe study included a total of 254 patients, with a median age of 14 years old (p25-75=7–16), with intentional poisoning in 50.8% of cases. The most frequently involved toxic agent was carbon monoxide (CO) (33.8%). Poisoning was found in 48.8% of those patients, being serious in 16.5%. Intentionally (OR 5.1; 95% CI: 1.9–13.8) and knowledge of the time of exposure (OD 3.1; 95% CI: 1.3–7.3) were independent risk factors associated with the appearance of severe clinical symptoms. Five QI did not reach the quality standard and included, availability of specific clinical guidelines, activated charcoal administration in selected patients, oxygen therapy administration at maximum possible concentration in carbon monoxide poisoning, electrocardiographic assessment in patients exposed to cardiotoxic substances, and recording of the minimum data set. ConclusionsPaediatric patients attended by ALS units showed specific characteristics, highlighting the involvement of CO and adolescents with voluntary poisoning. The QI assessment was useful to detect weak points in the quality of care of these patients and to develop strategies for improvement.

Care pathways for low-risk transient ischaemic attack

Background: In secondary care, the urgency of review for transient ischaemic attack (TIA) has relied upon the use of the ABCD2 score, but this tool is not validated for use by emergency ambulance crews. There is a need to evaluate alternative care pathways for patients who might be eligible for direct referral to TIA clinics without prior conveyance to the emergency department (ED). Aim: The aim of this national survey was to describe current service provision across the UK for pre-hospital emergency care of patients with TIA. Methods: The authors approached all UK Ambulance trusts (n=13) by email, asking them to provide details of TIA patient referral pathways. Findings: Twelve ambulance services responded to the survey and nine reported that they had no current pathway; one had discontinued a pathway because of service reconfiguration; and three were currently using one. All pathways used the ABCD2 tool to screen patients and classified patients as low-risk if the ABCD2 score was 3 or below. Non-conveyance exclusion criteria varied. Although compliance with referral pathways was audited in an initial pilot in one service, no other evaluations of the effectiveness of pathways were reported. Conclusion: A minority of UK ambulance services report introducing referral pathways for low-risk TIA patients, avoiding initial assessment in the ED. Safety, effectiveness and acceptability of such pathways have not been evaluated to date.

Application of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma

Objective To investigate the feasibility and clinical effect of tranexamic acid in pre-hospital emergency care of patients with craniocerebral trauma. Methods A randomized, placebo controlled trial was carried out on 77 craniocerebral trauma patients [Glasgow Coma Scale (GCS) ≤12 points] enrolled between May 2015 and December 2016. There were 45 males and 32 females, with an average age of 36.5 years (range, 19-73 years). Among the patients, 37 cases were caused by traffic accidents, 19 falling from high places, 11 falling when walking, and ten by being hit. According to the random number table method, they were divided into control group (39 cases) and treatment group (38 cases). The treatment group received 1 g of tranexamic acid by intravenous injection within ten minutes on the scene and another 1 g of tranexamic acid within eight hours at the hospital. The control group received 0.9% isotonic saline. The operation and medication followed the routine process. The arrival time of ambulance and the time of first medication use were recorded. The plasma fibrin degradation products (FDP) and D-dimer at admission and 1 d post-trauma, the percentage of cranitomy operation, case fatality rate, red blood cell transfusion, length of stay in the neurosurgical intensive care unit (NICU), and the Glasgow Outcome Scale (GOS) at day 28 were all recorded and analyzed. Results No significant differences were found between the two groups in gender, age, injury causes, GCS, arrival time of ambulance, and the time of first medication use (P>0.05). The FDP and D-dimer at admission of the two groups were similar (P>0.05). One day after admission, the expression of plasma FDP was significantly lower in treatment group than that in control group [6758 (4732, 13661) μg/L vs. 11740 (8516, 21756)μg/L](P 0.05). However, treatment group showed shorter stay in NICU [4 (1, 12)days vs. 2 (0, 4)days] and higher GOS [4 (3, 5)points vs. 5 (4, 5)points]than control group (both P<0.01). Conclusions Tranexamic acid can be applied conveniently in pre-hospital emergency care of craniocerebral trauma patients. It can effectively realize the synchronization of pre hospital transport and treatment, eventually reducing the time of NICU treatment as well as improving the prognosis. Key words: Brain injuries; Tranexamic acid; Emergency medical services; Prospective studies

PP22 Alternative care pathways for patients with low risk tia attended by emergency ambulance: a national survey

BackgroundPatients presenting to emergency ambulance services with TIA are usually conveyed to the nearest Emergency Department (ED) with subsequent referral to specialist assessment at a TIA clinic within one week...

PP059 National Survey Of Current United Kingdom Ambulance Service Transient Ischemic Attack Referral Pathways

INTRODUCTION:Patients presenting to emergency ambulance services with Transient Ischemic Attack (TIA) are usually conveyed to the Emergency Department (ED) with subsequent referral to specialist assessment at a TIA clinic within one week if at low risk of stroke. There is opportunity for paramedics to refer patients with TIA at low risk of recurrent stroke directly to a specialist TIA clinic, avoiding the transportation and care at the ED however evidence is lacking about current practice, safety and effectiveness of this intervention.We aimed to describe current service developments across the United Kingdom (UK) for the pre-hospital emergency care of patients with TIA, to inform the development of an intervention for testing.METHODS:We surveyed all UK Ambulance Trusts (n = 13) by email, asking them to identify initiatives related to the management of TIA, and followed up services reporting an alternative TIA pathway by telephone to gather further details.RESULTS:Twelve ambulance services responded to our survey. Eight reported that they had not developed or implemented TIA referral pathways. Three reported currently using a TIA referral pathway; one had discontinued their pathway due to service reconfiguration. All (4/4) pathways used the FAST test and ABCD2 tool to screen patients, in line with national guidelines, and classified patients as low risk if the ABCD2 score was ≤3. All indicated that eligible low-risk TIA patients should be referred by paramedics to specialist care, 2/4 by telephone, and 2/4 by fax.Although protocol compliance was audited in an initial pilot in one service, no formal evaluation of effectiveness was reported.CONCLUSIONS:Several UK ambulance services have introduced similar referral pathways for low risk TIA patients, avoiding transportation of patients to the ED. Existing initiatives can inform the development of an intervention for evaluation in a randomized trial.

Effects of a standard operating procedure on prehospital emergency care of patients presenting with symptoms of the acute coronary syndrome

To determine whether a standard operating procedure (SOP) for prehospital management of patients with the acute coronary syndrome (ACS) improves the quality of patient care in terms of adherence to treatment guidelines of the European Society of Cardiology. Among a total of 1025 patient medical records collected from a period before and after the introduction of the SOP, 269 records included the working diagnosis of ACS and were then reviewed for guideline adherence. Most aspects of patient evaluation, monitoring, treatment, and hospital allocation were fairly guideline adherent (>70%) before the SOP was introduced and were not affected by the SOP. The percentage of cases in whom sublingual nitrate (55.2 vs. 66.7%) or intravenous morphine (26.9 vs. 43.0%) was administered without contraindications was higher after the SOP had been introduced. Therefore, the use of an SOP in prehospital emergency medicine can partly improve the adherence to guideline recommendations for the treatment of patients with ACS.

Prehospital emergency care for patients with suspected hip fractures after falling – older patients' experiences

To describe and explain older patients' lived experiences of prehospital emergency care in cases of suspected hip fractures after falling. Falls among the elderly is an issue internationally and a public health problem that seems to be on the increase. In the emergency medical services, older people are frequent patients after having suffered a fall, but there is little information on how older patients experience prehospital emergency care in cases of suspected hip fractures after falling. Qualitative interview study. Ten older patients were interviewed. These depth interviews were tape-recorded, transcribed verbatim and analysed for meanings. The comprehensive understanding of the phenomenon is: 'Glad to have been rescued, despite bad experiences as well as good'. The older patient is offered care in an open and friendly atmosphere concurrently with feeling anxiety about the treatment. Intervention with streamlined care and treatment can thus simultaneously be beneficial as well as doing harm. Patients experience confusion and the need to ask questions about what really happened in the ambulance. Bad experiences remain unexplained. These findings are based on three themes with relevant subthemes: efficiency, concerned encounters and suffering from care. Our study shows that prehospital emergency care when hip fracture is suspected - from patients' point of view - is insufficient and unsatisfying. Prehospital emergency care for these vulnerable patients could be improved through more compassion being shown towards older patients' existential needs and their increased participation. Furthermore, alternative methods of prehospital pain relief need to be developed. Responsibility for patients' safety regarding pain relief is emphasised. Pain relief in the emergency medical services should be individualised. This development should focus on care that is already good and gradually eradicate compassionless care.

진통 분만, 질출혈과 성폭행 환자에 대한 119구급대원의 병원전 응급처치 분석

Purpose: The purpose of this study is to provide basic data to improve prehospital emergency care for patients with labor pain, vaginal bleeding and rape experience by analyzing the reports of 119 emergency medical technicians. Methods: Data were prehospital reports of 190 patients having chief complaints of labor pain, vaginal bleeding and rape in Chungcheongnam-do from January 1, 2012 to December 31, 2012. Data were analyzed using SPSS 21.0 descriptive statistics and <TEX>$x^2$</TEX>-test. Results: From the 190 cases of labor pain, vaginal bleeding and rape, labor pain accounted for 57.9% including 75.5% of normal delivery; vaginal bleeding accounted for 35.8% including 26.5% of postpartum hemorrhage; and rape victims accounted for 6.3%. Cases with more than one vital sign accounted for 94.2%, but cases without primary assessment of the obstetrics and gynaecology accounted for 38.4% from gestation weeks, 78.0% from parity, and 87.4% from history taking relating to event. Patient care including emotional support was the first priority care accounted for 78.4% and 60% of care was keeping the patients warm. Conclusion : In order to handle various emergency situations properly, the records must be supplemented by obstetrical and gynaecological rape checklist and rape victims supporting system should be established.

주호소가 호흡곤란인 환자에 대한 119구급대원의 병원전 응급처치 현황

Purpose : This study intended to improve the quality of prehospital emergency care for patients with dyspnea by figuring out the current situations and problems based on run-sheets of 119 emergency medical technicians (EMTs). Methods : A total of 336 dyspnea patients were transferred to G university hospital by 119 ambulances from January 1, 2011 to December 31, 2011. Results : The data were analyzed by SPSS 19.0. Patients over 60 years old accounted for 57.2% and 48.4% had the history of heart disease. Among the heart disease patients, 31.7% complained of dyspnea and chest pain. The vital sign measurement performance by 119 EMTs increased compared to previous study. The number of prehospital treatment by 119 EMTs significantly increased depending on the mental state of the patients. Conclusion : 119 EMTs should remind the heart disease and other past history of the patients when they perform the dyspnea patient care.

Effect of pre-hospital emergency care for patients with acute cranio-cerebral injury

Objective To know the effect of pre-hospital emergency care for patients with acute cranio-cerebral injury. Methods Selected 312 patients with acute cranio-cerebral injury from Jan of 2005 to Jan of 2009 as the emergency group, selected 285 patients with acute cranio-cerebral injury from Jan of 2000 to Dec of 2004 as the control group. Retrospective analized the clinical condition between the two groups to know the effect of pre-hosptial emergency cares. Results There was significant difference of dead rate betweent the two groups, the prognosis of the two groups was also different. Conclusions Effective pre-hospital emergency care is very important for patients with acute eranio-cerebral injury, which can avoid certain complications and reduce dead rate. Key words: Pre-hospital emergency care; Nursing; Cranio-cerebral injury

Prise en charge préhospitalière du traumatisé crânien grave

Advanced prehospital emergency care of patients with severe head injuries. Advanced prehospital emergency medical care of patients with a severe head injury must essentially focus on the impact of secondary cerebral insults of systemic origin on the outcome. The first objective of prehospital care is to prevent hypoxaemia and hypercapnia. Therefore, all patients with a Glasgow Coma Scale score equal to or lower than 8 must be treated with endotracheal intubation and controlled ventilation under continuous monitoring of SpO 2 and PETCO 2. Treatment is similar in head-injured patients with significant deterioration of consciousness level, seizures, respiratory distress, or severe facial and thoracoabdominal injuries. The endotracheal tube is inserted by the orotracheal route under direct laryngoscopy, after a rapid induction sequence of anaesthesia and immobilization of the cervical spine in neutral position. For the induction of anaesthesia in these high-risk patients (full stomach, unknown medical history, deteriorated haemodynamic status), etomidate and suxamethonium are the preferred agents. Sedation is maintained with an hypnotic-opioid association (fentanyl). Simultaneously, the main goal is the maintenance of an optimal cerebral perfusion pressure, as arterial hypotension severely worsens cerebral ischaemia. Volume loading is accomplished with 0.9% saline and hydroxyethyl starch.

O-23 Prehospital emergency care of patients with acute illness. One year mortality

O-23 Prehospital emergency care of patients with acute illness. One year mortality