Prehospital Emergency Medical Services Research Articles

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.

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.

Predictors of emergency medical transport refusal following opioid overdose in Washington, DC.

Patient initiated transport refusal during Emergency Medical Service (EMS) opioid overdose encounters has become an endemic problem. This study aimed to quantify circumstantial and environmental factors which predict refusal of further care. In this cross-sectional analysis, a case definition for opioid overdose was applied retrospectively to EMS encounters. Selected cases had sociodemographic and situational/incident variables extracted using patient information and free text searches of case narratives. 50 unique binary variables were used to build a logistic model. Prehospital EMS overdose encounters in Washington, DC, USA, from July 2017 to July 2023. Of EMS encounters in the study timeframe, 14 587 cases were selected as opioid overdoses. Predicted probability for covariates was the outcome variable. Model performance was assessed using Stratified K-Fold Cross-Validation and scored with positive predictive value, sensitivity and F1. Prediction accuracy and McFadden's pseudo-R squared are also determined. The model achieved a predictive accuracy of 78% with a high positive predictive value (0.83) and moderate sensitivity (0.68). Bystander type influenced the refusal outcome, with decreased refusal probability associated with family (nondescript) (-28%) and parents (-16%), while presence of a girlfriend increased it (+28%). Negative situational factors like noted physical trauma (-62%), poor weather (-14%) and lack of housing (-14%) decreased refusal probability. Characteristics of the emergency response team, like a prior crew member encounter (+20%) or crew experience <1year (-36%), had a variable association with transport. Refusal of emergency transport for opioid overdose cases in Washington, DC, USA, has expanded by 43.8% since 2017. Several social, environmental and systematic factors can predict this refusal. Logistic regression models can be used to quantify broad categories of behavior in surveillance medical research.

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.

Exploring Prehospital Data for Pandemic Preparedness: A Western Brazilian Amazon Case Study on COVID-19.

The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios. This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020. A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30-67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6-67.7) (p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 (p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase (p = 0.0007). The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.

Assistance time and peripheral oxygen saturation in prehospital emergency data as predictors of COVID19 hospital outcomes

To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0–78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p < 0.001). Lower pre-hospital SpO2 was associated to death (p = 0.025). Death was more common among patients with respiratory support needs, especially in the invasive ventilation group (262/287; 91.3%) (p < 0.001). In addition, IMV was more common among elderly individuals (p < 0.001). Patients admitted to ICU had a greater chance of dying when compared to non-ICU admitted patients (p < 0.001), and closely related to IMV (p < 0.001). Patients in ICU were also older (p = 0.003) and had longer hospital stay (p < 0.001). Mortality was associated with mechanical ventilation (p < 0.001), ICU admission (p < 0.001), and older age (p < 0.001). Patients who died had a shorter length of both ICU and total hospital stay (p < 0.001). Prehospital EMS may provide feasible and early recognition of critical patients with SARS in strained healthcare systems, such as in low-resource settings and pandemics.

The challenges of delivery in pre-hospital emergency medical services ambulances in Iran: a qualitative study

BackgroundAlthough unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emergency Medical Technicians (EMTs), midwives, and expectant mothers to examine the causes of giving birth in ambulances and the challenges EMTs, pregnant women, and midwives face during delivery.MethodsA qualitative study was conducted, and 28 EMTs, midwives, and pregnant women who had experience with pre-hospital births in the ambulance were interviewed. Data were analyzed using thematic content analysis. The MAXQDA/10 software was employed for data analysis and code extraction.ResultsThe analysis of the interviews revealed two main categories: factors that cause delivery in the ambulance and its challenges. The factors include cultural problems, weak management, and inaccessibility to facilities. The challenges consist of fear and anxiety, native culture, and lack of resources.ConclusionsSeveral approaches should be implemented to reduce the number of births in ambulances and Pre-hospital Emergency Medical Services (PEMS). These include long-term community cultural activities, public education, awareness campaigns, education and follow-up for pregnant women, and improved accessibility to health facilities. Additionally, EMTS need to receive proper education and training for ambulance deliveries. Enhancing ambulance services and supporting EMTs in dealing with litigation claims are also critical.

Development and validation of a clinical nomogram for predicting in-hospital mortality in patients with traumatic brain injury prehospital: A retrospective study

ObjectiveTraumatic brain injury (TBI) is among the leading causes of death and disability globally. Identifying and assessing the risk of in-hospital mortality in traumatic brain injury patients at an early stage is challenging. This study aimed to develop a model for predicting in-hospital mortality in TBI patients using prehospital data from China. MethodsWe retrospectively included traumatic brain injury patients who sustained injuries due to external forces and were treated by pre-hospital emergency medical services (EMS) at a tertiary hospital. Data from the pre-hospital emergency database were analyzed, including demographics, trauma mechanisms, comorbidities, vital signs, clinical symptoms, and trauma scores. Eligible patients were randomly divided into a training set (241 cases) and a validation set (104 cases) at a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were employed to identify independent risk factors. Analyzed the discrimination, calibration, and net benefit of the nomogram across both groups. Results17.40 % (42/241) of TBI patients died in the hospital in the training set, while 18.30 % (19/104) in the validation set. After analysis, chest trauma (odds ratio [OR] = 4.556, 95 % confidence interval [CI] = 1.861–11.152, P = 0.001), vomiting (OR = 2.944, 95%CI = 1.194–7.258, P = 0.019), systolic blood pressure (OR = 0.939, 95%CI = 0.913–0.966, P < 0.001), SpO2 (OR = 0.778, 95%CI = 0.688–0.881, P < 0.001), and heart rate (OR = 1.046, 95%CI = 1.015–1.078, P = 0.003) were identified as independent risk factors for in-hospital mortality in TBI patients. The nomogram based on the five factors demonstrated well-predictive power, with an area under the curve (AUC) of 0.881 in the training set and 0.866 in the validation set. The calibration curve and decision curve analysis showed that the predictive model exhibited good consistency and covered a wide range of threshold probabilities in both sets. ConclusionThe nomogram based on prehospital data demonstrated well-predictive performance for in-hospital mortality in TBI patients, helping prehospital emergency physicians identify and assess severe TBI patients earlier, thereby improving the efficiency of prehospital emergency care.

A discrete-event simulation study for pre-hospital emergency systems

ABSTRACT Ambulance dispatch, deployment, and relocation are crucial decisions in pre-hospital emergency medical services (EMS) that significantly impact response times. In metropolitan areas, the rapid movement of people and complex traffic conditions create a challenging environment for effective decision-making. This paper presents a discrete-event simulation framework designed to evaluate and improve pre-hospital emergency systems by capturing core EMS workflows and incorporating comprehensive, dynamic data. To demonstrate the practical application of this framework, a simulation instance is implemented and validated in the context of downtown Shanghai, with an analysis of key performance indicators for EMS in this area. Additionally, we propose a dynamic ambulance relocation model to improve the alignment between ambulance deployment plans and emergency calls. Simulation experiments show that dynamic ambulance relocation effectively reduces response times. Due to its ability to integrate real-time data, this framework has the potential to support immediate decision-making and evaluate proposed strategies in the real world.

Prehospital guidelines on in-water traumatic spinal injuries for lifeguards and prehospital emergency medical services: an international Delphi consensus study

BackgroundTrauma guidelines on spinal motion restriction (SMR) have changed drastically in recent years. An international group of experts explored whether consensus could be reached and if guidelines on SMR performed by trained lifeguards and prehospital EMS following in-water traumatic spinal cord injury (TSCI) should also be changed.MethodsAn international three-round Delphi process was conducted from October 2022 to November 2023. In Delphi round one, brainstorming resulted in an exhaustive list of recommendations for handling patients with suspected in-water TSCI. The list was also used to construct a preliminary flowchart for in-water SMR. In Delphi round two, three levels of agreement for each recommendation and the flowchart were established. Recommendations with strong consensus (≥ 85% agreement) underwent minor revisions and entered round three; recommendations with moderate consensus (75–85% agreement) underwent major revisions in two consecutive phases; and recommendations with weak consensus (< 75% agreement) were excluded. In Delphi round 3, the level of consensus for each of the final recommendations and each of the routes in the flowchart was tested using the same procedure as in Delphi round 2.ResultsTwenty-four experts participated in Delphi round one. The response rates for Delphi rounds two and three were 92% and 88%, respectively. The study resulted in 25 recommendations and one flowchart with four flowchart paths; 24 recommendations received strong consensus (≥ 85%), and one recommendation received moderate consensus (81%). Each of the four paths in the flowchart received strong consensus (90–95%). The integral flowchart received strong consensus (93%).ConclusionsThis study produced expert consensus on 25 recommendations and a flowchart on handling patients with suspected in-water TSCI by trained lifeguards and prehospital EMS. These results provide clear and simple guidelines on SMR, which can standardise training and guidelines on SMR performed by trained lifeguards or prehospital EMS.

Prävalenz ausgewählter Erkrankungen bei prähospitalen Rettungskräften in Deutschland

Prevalence of selected diseases among pre-hospital emergency services personnel in Germany – results of the EMS Health Study 2023 Objective: The health of pre-hospital emergency medical services (EMS) staff is crucial for the provision of high-quality medical care. However, currently only limited data on the health monitoring of German EMS staff is available. The aim of the study was therefore to analyse the 12-month prevalence of selected diseases and symptoms among German EMS staff. Methods: A nationwide survey study was conducted. Questions from the GEDA2019/2020 study were used to collect information on the health status of EMS staff. Subsequently, 12-month prevalences were calculated with the corresponding 95 % confidence intervals (95 % CI). Results: In the end, 1,171 active German EMS staff (67.9 % male/31.9 % female) with a median age of 32.0 years were included in the analysis. The results indicate that excess weight and obesity are common health problems among EMS staff, with men (68.4 % [95 % CI: 64.8 %; 71.4 %]) being more affected than women (45.0 % [95 % CI: 39.9 %; 50.2 %]). The highest 12-month prevalence was calculated for lower back pain (51.8 % [95 % CI: 48.9 %; 54.7 %]), followed by pain in the cervical spine (41.9 % [95 % CI: 39.1 %; 44.8 %]), allergies (34.1 % [95 % CI: 31.4 %; 36.9 %]), hypertension (19.1 % [95 % CI: 16.9 %; 21.5 %]) and depression (16.2 % [95 % CI: 14.2 %; 18.5 %]). Compared to the German general population, the 12-month prevalence of obesity, asthma, COPD, hypertension, elevated blood lipid levels, arthritis, depression and obesity was higher for certain gender and age groups of emergency workers. Conclusion: The result of this study indicate a poor health state among German pre-hospital EMS staff and the need for preventive measures. Keywords: 12-month prevalence – emergency medical services – health – obesity – epidemiology

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.

Cross-Sectional Retrospective Epidemiological Study of 9-1-1 Calls to the El Paso, Texas, and Ciudad Juárez International Border Crossing

The El Paso-Juárez metroplex comprises one of the world's busiest international land border crossings. Although prior studies have described prehospital care along the US-Mexico border, the epidemiology of 9-1-1 calls to the El Paso-Juárez border crossings has not been previously reported. Investigators sought to evaluate responses by emergency medical services (EMS) at El Paso-Juárez ports of entry (POE). Methods: This cross-sectional, retrospective study evaluates prehospital care provided by EMS at three international bridges in El Paso. The El Paso Fire Department (EPFD) provided data for all encounters between February 2017 and January 2023. This included date, POE, patient demographics, chief complaint, computer-aided dispatch (CAD), provider impression (diagnosis), and time out of service. Results: Over the study period, 8,407 encounters occurred at one of the three El Paso-Juárez POE, averaging 1,680 per year or 140 calls per month. The busiest month was July, with a median of 132 encounters. 45% of these calls took place at the Paseo Del Norte POE. The study population comprised 59% Hispanics, 4129 (49%) male, and 4266 (51%) female, from 0 to 103 years of age. The most common diagnosis was neurological (1,908, 22.7%), GI/GU (1,263, 15%), and injury or trauma (1117, 13%). 6,420 hours were spent responding to POE calls, the average call resulting in a 46-minute out-of-service time. Conclusion: This was the first study to investigate the epidemiology of prehospital care provided by EMS at the El Paso-Juárez international border crossing. A total of 8,407 prehospital EMS encounters occurred over the study period, which is expected to grow. We found roughly equal proportions of male and female patients with a wide range of ages. The most common diagnoses were weakness, abdominal pain, and non-traumatic pain. The results of this study could be utilized to enhance the quality of EMS offered at international border crossings.

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.

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.

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.

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.

Prehospital Ground and Helicopter-Based Extracorporeal Cardiopulmonary Resuscitation (ECPR) Reduce Barriers to ECPR: A GIS Model

Introduction Evidence suggests that Extracorporeal Cardiopulmonary Resuscitation (ECPR) can improve survival rates for nontraumatic out-of-hospital cardiac arrest (OHCA). However, when ECPR is indicated over 50% of potential candidates are unable to qualify in the current hospital-based system due to geographic limitations. This study employs a Geographic Information System (GIS) model to estimate the number of ECPR eligible patients within the United States in the current hospital-based system, a prehospital ECPR ground-based system, and a prehospital ECPR Helicopter Emergency Medical Services (HEMS)-based system. Methods We constructed a GIS model to estimate ground and helicopter transport times. Time-dependent rates of ECPR eligibility were derived from the Resuscitation Outcome Consortium (ROC) database, while the Cardiac Arrest Registry to Enhance Survival (CARES) registry determined the number of OHCA patients meeting ECPR criteria within designated transportation times. Emergency Medical Services (EMS) response time, ECPR candidacy determination time, and on-scene time were modeled based on data from the EROCA trial. The combined model was used to estimate the total ECPR eligibility in each system. Results The CARES registry recorded 736,066 OHCA patients from 2013 to 2021. After applying clinical criteria, 24,661 (3.4%) ECPR-indicated OHCA were identified. When considering overall ECPR eligibility within 45 min from OHCA to initiation, only 11.76% of OHCA where ECPR was indicated were eligible in the current hospital-based system. The prehospital ECPR HEMS-based system exhibited a four-fold increase in ECPR eligibility (49.3%), while the prehospital ground-based system showed a more than two-fold increase (28.4%). Conclusions The study demonstrates a two-fold increase in ECPR eligibility for a prehospital ECPR ground-based system and a four-fold increase for a prehospital ECPR HEMS-based system compared to the current hospital-based ECPR system. This novel GIS model can inform future ECPR implementation strategies, optimizing systems of care.

PDenoiser: A Personalized Speech Enhancement Neural Network for Pre-hospital Emergency Medical Services.

Pre-hospital emergency medical service (EMS) tasks often come with complex and diverse noise interferences, posing challenges in implementing ASR-based medical technologies and hindering efficient and accurate telephonic communication. Among the different types of noise distortion, interfering speech is especially annoying. To address these issues, our aim is to develop a technology capable of extracting the intended speech content of the target physician from noisy and mixed audio during EMS tasks. In this work, we propose a monoaural personalized speech enhancement (PSE) method called pDenoiser, which is a real-time neural network that operates in the time domain. By leveraging the prior vocalization cues of emergency physicians, pDenoiser selectively enhances target speech components while suppressing noise and nontarget speech components, thereby improving speech quality and speech recognition accuracy under noisy conditions. We demonstrate the potential value of our approach through evaluations on both public general-domain test sets and our self-collected real-world EMS test sets. The experimental results are promising, as our model effectively promotes both speech quality and ASR performance under various conditions and outperforms related methods across multiple evaluation metrics. Our methodology will hopefully elevate EMS efficiency and fortify security against nontarget speech during EMS tasks.