Prehospital Emergency Medical Services Research Articles

Prehospital emergency medical service utilization and associated factors among critically ill COVID-19 patients treated at centers in Addis Ababa, Ethiopia.

The majority of populations in developing countries are living in areas of no access or limited access to prehospital emergency medical services (EMS). In Addis Ababa, the reported prehospital EMS utilization were ranging from zero to thirty-eight percent. However, there is limited research on reasons for the low utilization of prehospital resources in Ethiopia. This study aimed to assess factors associated with prehospital EMS utilization among critically ill COVID-19 patients in Addis Ababa, Ethiopia. A hospital-based cross-sectional study was conducted to collect primary data from 421 COVID-19 patients in Addis Ababa between May and July 2021. Logistic regression was used to identify factors associated with prehospital service utilization. Andersen's Behavioral Model was implemented to address independent variables, including predisposing, enabling, need, and health behaviors-related variables. The level of prehospital care utilization was 87.6%. Being married [AOR 2.6(95%; CI:1.24-5.58)], belief that self-transport is quicker than the ambulance [AOR 0.13(95%; CI: 0.05-0.34)], and perceptions that ambulance provides transportation service only [AOR 0.14(95%; CI:0.04-0.45)] were predisposing factors associated with prehospital service utilization while the source of referrals [AOR 6.9(95%; CI: 2.78-17.30)], and prior knowledge on the availability of toll-free ambulance calling numbers [AOR 0.14(95%; CI: 0.04-0.45)] were identified as enabling factors. Substantial proportions of critically ill COVID-19 patients used prehospital services to access treatment centers. Prehospital EMS utilization in this study varies by predisposing and enabling factors, particularly: marital status, source of referral, prior knowledge on the availability of toll-free ambulances, belief that self-transport is quicker than ambulances, and perceptions that ambulance provides transportation service only. Our findings call for further actions to be taken by policymakers including physical and media campaigns focusing on the identified factors.

Time indices of pre-hospital EMS missions before and during the COVID-19 pandemic: a cross-sectional study in Iran

BackgroundThe COVID-19 pandemic resulted in many changes in pre-hospital emergency medical services (EMS), including wearing full-body protective suits and well-fitted face masks, which can influence time indices in the course of service delivery. The present study aimed to compare the time indices of pre-hospital EMS missions before and during the COVID-19 pandemic in Iran.MethodsThis descriptive cross-sectional study used census sampling to select 17,860 emergency calls that caused patient transfer to medical facilities from March 2018 to March 2021 and then examined the time indices of pre-hospital EMS missions during the COVID-19 pandemic. The data collection tool was a two-part checklist: patients' individual characteristics and pre-hospital EMS mission time indices. The data were further analyzed using the SPSS16 and independent samples t-test.ResultsOut of the patients transferred by the EMS, 11,773 cases (65.9%) were male and 6,087 (34.1%) were female. The most common reason for the emergency calls was accidents (28.0%). Moreover, response time (P < 0.001), on-scene time (P < 0.001), transfer time (P < 0.001), total run time (P < 0.001), and round trip time (P < 0.001) increased significantly during the COVID-19 pandemic.ConclusionsWe concluded that the EMS time indices elevated following the COVID-19 pandemic. Updating pre-hospital information management systems, ambulances and medical equipment, as well as holding training courses for pre-hospital EMS personnel could effectively enhance the time indices of pre-hospital EMS missions.

The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview.

Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.

Comparing the Effectiveness of Motor Ambulances in Pre-hospital Emergency Medical Services Compared to Ambulances in Tehran City, Iran

Background: Pre-hospital emergency medical services are one of the vital parts of the health system, which was created to timely diagnose and treat patients injured in life-threatening conditions. The use of motorcycles has increased in recent years to reach the golden time standard and overcome traffic in some countries, especially Iran. This study was conducted to investigate the effectiveness of a motor ambulance compared to an ambulance in Tehran City, Iran. Materials and Methods: The present study is a cross-sectional descriptive-analytical type. The time to reach the patient’s bedside, death at the scene, and physiological parameters of the patient at the time of delivery to the hospital were studied as effectiveness indicators in this model. Since the primary data on the effectiveness of these two interventions is mortality, according to previous studies, the mortality data should be converted into the form of prevented mortality and enter the analysis phase. In this study, since the mortality index is expressed as a percentage, the difference in the mortality index from 100 was estimated as the prevented mortality index and entered into the analysis. Results: The results showed that the chance of death in the motor ambulance group with an ambulance in severe level patients is 44.8% and 66.9% in the ambulance group. In the motorcycle and ambulance group, the probability of death for patients with mild and moderate injuries was estimated at 0.02% in ambulance missions and 0.7% in motorcycle and ambulance missions (P=0.05). Conclusion: According to the desired outcome (reduction of death), the use of motor ambulance with ambulance was effective in severe group patients. Of course, this outcome alone cannot be an accurate basis for judgment, and outcomes such as survival, disability-adjusted life years, and quality-adjusted life years seem necessary for a more accurate evaluation.

Lasting Effects of COVID-19 Pandemic on Prehospital Emergency Medical Service Missions.

The COVID-19 pandemic confronted prehospital emergency medical services (PHEMS) with immense challenges. This study aimed to investigate the development of PHEMS mission numbers and times in the COVID-affected region of Southwest Saxony (SWS). This was a retrospective analysis of PHEMS in SWS during lockdown periods and equal time spans in the previous and following years. Differences were tested for statistical significance using the chi-squared test and one-way analysis of variance (ANOVA). The total number of missions showed a substantial drop during the first (-16.6%) and the second (-4.5%) lockdown period compared with the previous year. Next-year periods showed a recovery that was nearly equivalent to the starting point. The first lockdown period was not associated with longer overall mission times. The minutes spent at the scene differed significantly between the first lockdown period (31.1 ± 3.52 min), previous year (28.4 ± 4.84 min), and follow-up period (31.8 ± 0.98 min). During the second lockdown, the overall mission times (71.6 ± 2.91 min), response times in minutes (8.9 ± 0.49 min), and minutes spent at the scene (31.4 ± 2.99 min) were significantly longer. The minutes spent at the scene (32.3 ± 18.68 min) and the overall mission time (69.6 ± 1.92 min) remained significantly longer during the control period. Our data confirm the impact of the SARS-CoV-2 pandemic on German PHEMS. It can be concluded that nationwide lockdown measures led to lasting effects regarding a reduction in the total mission number, transport-on-site released-ratio, and emergency time intervals in the following year, without lockdown restrictions. The lasting effects on the transport-on-site released-ratio and emergency time intervals call for a re-evaluation of the delivery of emergency services during pandemics. These findings can inform future policy decisions and resource allocations to ensure optimal emergency medical services.

Analysis of Spatial Distribution of Pre-hospital Emergency Medical Services in Traffic Accidents: Mashhad City, Iran

Background: Physical access to health services is determined by the geographic location of the patient. This study aims to distribute the bases and hospitals of Mashhad City, Iran, and the extent of coverage of the bases in traffic accidents. Materials and Methods: This research is a descriptive cross-sectional and applied study. The study population for high-accident points includes 21142 missions carried out regarding traffic accidents as well as 37 points related to 115 emergency bases in 2014. The information needed by the researcher was collected by receiving the files of the injured from the statistical unit of the center. By forming the database of the road network in Mashhad City in a geographic information system environment as communication links and defining emergency centers as facilities, the radius of emergency centers was drawn using the service area method. Results: In this study, the areas that needed more services and the number of provider centers was less compared to the covered area were identified. After matching the distribution map of the bases with the distribution of accidents, the areas with the lowest distribution of accidents and the highest service of emergency medical services, as well as high accidents and less service were obtained. Conclusion: The distribution of bases and hospitals does not have a proper distribution situation, which can lead to the lowering of the desired level and the creation of illogical concentration. To cover the emergency missions, it is necessary to set up emergency bases and complete the existing hospitals in the city.

Violent Experiences Suffered by Pre-Hospital Healthcare Workers During the COVID-19 Pandemic.

This work was carried out to determine the causes of violence against Prehospital Emergency Medical Services Personnel (PHEMSP) who performed their duties without any special security measures during the COVID-19 pandemic, and who were subjected to violence because of their work. The approach of this research is in accordance with case study design, which is concerned with the examination of unique cases. For this study, a volunteer announcement was made on social media for PHEMSPs from 3 different branches (Emergency Medical Technicians or EMTs, paramedics, and doctors) who had been actively working in ambulances during the transportation of COVID-19 patients throughout the pandemic, and who had declared that they were subjected to verbal abuse or physical violence. The data was collected through structured interviews from 60 voluntary participants. As a result of the analysis of the data, 3 main themes were revealed as the source of violence that PHEMSPs had been exposed to during the pandemic. They are the following: (1) violence caused by the nature of the disease, (2) violence caused by society, and (3) violence caused by working areas and systems. The reasons which created these themes, were accepted as codes. The codes that arose due to the theme of (1) violence caused by the nature of the disease were 'the fear of contagion,' 'the requirement for disinfection,' and 'triage problems,' which caused both verbal abuse and physical violence. In addition to these codes, the code of 'stigma' due to protective equipment was found only to elicit verbal abuse. The codes for the theme (2) 'violence caused by society,' were determined as societal perceptions regarding high wages, attempts to misuse health services, and distrust. All 3 of these codes were found to evoke both verbal abuse and physical violence. The codes for the theme (3) 'violence caused by working areas and systems,' included team mismatch in PHEMSPs, resignation ban, and long working hours, as well as mismatch between in-hospital HCWs and PHEMSPs, mobbing, feeling unsupported, and gender disadvantage. It has been revealed among these codes that only the team mismatch in PHEMSPs caused both verbal abuse and physical violence, while all the others only lead to verbal abuse. If a 0 tolerance for 'violence in the healthcare system' is to be targeted, it should start in the pre-hospital phase and with all PHEMSPs, since this is the 0 point where the healthcare system, and patients first meet. Additionally, this group should be considered a vulnerable group for workplace violence (WPV), especially due to the COVID-19 pandemic.

Increased Prehospital Emergency Medical Service Time Interval and Nontransport Rate of Patients With Fever Using Emergency Medical Services Before and After COVID-19 in Busan, Korea.

In Korea, patients with fever have been preemptively isolated to isolation beds in the emergency department (ED) since the coronavirus disease 2019 (COVID-19) pandemic began. However, isolation beds were not always available, and transport delays or failure (nontransport), especially for infants, were reported in the media. Few studies have focused on delays and failure in transporting fever patients to the ED. Therefore, this study aimed to examine and compare the emergency medical service (EMS) time interval and nontransport rate of patients with fever using EMSs before and after COVID-19. This retrospective observational study analyzed the prehospital EMS time interval and nontransport rate of fever patients who contacted EMSs in Busan, South Korea, from March 1, 2019 to February 28, 2022, using emergency dispatch reports. All fever patients (≥ 37.5°C) who contacted EMSs during this study were included. The EMS time interval was defined as the time between the patient's EMS call and ED arrival time. Nontransport was defined as a case recorded as not being transported in the emergency dispatch reports. The study population of 2019 was compared to the population of 2020 and 2021 with the independent t-test, Mann-Whitney U test, and χ² test. As a subgroup, the EMS time intervals and nontransport rates of infants with fever were compared before and after COVID-19. A total of 554,186 patients accessed the EMS during the study period, and 46,253 patients with fever were included. The EMS time interval (mean ± standard deviation, minutes) of fever patients was 30.9 ± 29.9 in 2019, 46.8 ± 127.8 in 2020 (P < 0.001) and 45.9 ± 34.0 in 2021 (P < 0.001). The nontransport rate (%) was 4.4 in 2019, 20.6 in 2020 (P < 0.001), and 19.5 in 2021 (P < 0.001). For infants with fever, the EMS time interval was 27.6 ± 10.8 in 2019, 35.1 ± 15.4 in 2020 (P < 0.001), and 42.3 ± 20.5 in 2021 (P < 0.001), and the nontransport rate (%) was 2.6 in 2019, 25.0 in 2020, and 19.7 in 2021. After the emergence of COVID-19, in Busan, the EMS time interval of fever patients was delayed, and approximately 20% of fever patients were not transported. However, infants with fever had shorter EMS time intervals and higher nontransport rates than the overall study population. A comprehensive approach, including prehospital and hospital ED flow improvements, is required beyond increasing the number of isolation beds.

Influence of coronavirus disease 2019 case surges on prehospital emergency medical service for patients with trauma in Kobe, Japan.

In the current era of the coronavirus disease 2019 (COVID-19) pandemic, the responsiveness of emergency medical service (EMS) transport for patients with internal illness is often delayed. However, the influence of the COVID-19 pandemic on prehospital transport for patients with trauma has not yet been fully elucidated. This study aims to examine the effect of COVID-19 case surges on EMS transport for patients with trauma during the COVID-19 states of emergency in Kobe, Japan. EMS data during the states of emergency were compared with those in the 2019 prepandemic period. The incidence of difficulty securing hospital acceptance (four or more calls to medical institutions and ambulance staying at the scene for 30 min or more) was evaluated as a primary outcome. Secondary outcomes were the time spent at the trauma scene and the number of calls requesting hospital acceptance. The time spent at the trauma scene was stratified by trauma severity. The incidence of difficulty securing hospital acceptance increased (1.2% versus 3.2%, P < 0.01). Logistic regression analysis revealed that the duration of the states of emergency was associated with difficulty securing hospital acceptance (odds ratio [OR] 2.08, 95% confidence interval 1.77-2.45; P < 0.01). Although the mean time spent at the trauma scene among the less severe, moderately severe, and severe trauma groups was prolonged, the time for the life-threatening group did not change. The number of request calls increased during the states of emergency. Difficulty securing hospital acceptance increased; however, the time spent at the trauma scene did not significantly change for the life-threatening group.

Tranexamic acid in polish pre-hospital emergency medicine and the competencies of medical rescue teams

INTRODUCTION: Medical rescue teams (MRTs) are the basic components of the Polish Emergency Medicine System (PEMS) that provide pre-hospital emergency medical services. However, despite the possibility for paramedics to use 47 drugs and many complicated medical procedures, tranexamic acid was not found there. Efficacy of pre-hospital emergency medical services could be improved by using tranexamic acid (TXA) in the management of traumatic hemorrhage and traumatic brain injury (TBI). The aim of this study was to demonstrate that the competencies of MRTs should be expanded and that Polish paramedics should be authorized to independently administer TXA to TBI patients. MATERIAL AND METHODS: The main research method was an analysis of the literature, including studies focusing on TXA administration and the associated risks. The article was written in the last two years. RESULTS: The study demonstrated that TXA contributes to the effective management of selected types of hemorrhage and TBI and that the risk of adverse effects associated with TXA administration is minimal. CONCLUSIONS: The gathered evidence suggests that paramedics should be authorized to independently administer TXA in pre-hospital care to maximize the efficacy of emergency medical services provided to patients in the PEMS.

Self-reported Emergency Skills Competence among Pre-hospital Emergency Personnel in a Rural Area of Indonesia

Background: Pre-hospital emergency medical services (EMS) personnel are responsible for providing intervention outside of the hospital setting. Consequently, the pre-hospital emergency personnel demand high capability of the personnel to perform emergency aid at the scene and during transport to the hospital. Objective: The purpose of this study is to explore emergency skills competence among pre-hospital emergency personnel in the area on the north coast of Java. Method: This study used the Essential Knowledge and Skills Questionnaire (EKSQ) as the instrument. There was 42 pre-hospital emergency personnel participated in this study. Results: This study revealed that most pre-hospital emergency personnel are nurses (93%). Most respondents reported not having sufficient competency in resuscitation (2,78 of 5 points) and giving medication (2,81 of 5 points). Age and experience were significantly correlated with pre-hospital emergency personnel's competence. Conclusion: This study concluded that there was a lack of competence in resuscitation. Hence, continuous professional-development courses are necessary to maintain pre-hospital emergency personnel's professional proficiency.

Utilization of pre-hospital emergency medical services: Secondary data analysis of health insurance data from Saxony-Anhalt

Utilization of emergency care is subject to demographic changes. In Germany, there was an increase of 4% to 6% annually between the years 2000 and 2017. Studies revealed that age and regional structures were related to utilization. The aim of this cross-sectional study was to analyze utilization of pre-hospital emergency medical services in Saxony-Anhalt and to identify associated factors. Based on data from the AOK Saxony-Anhalt for 2019, transportation with ground ambulances of insured persons living in Saxony-Anhalt were identified and recorded. Insured time of all AOK insured persons living in Saxony-Anhalt was used to determine incidence rates. For the multivariate analysis of associated factors, a Poisson regression model was adapted. 112,575 transportations of patients were identified; an average of 1.53 events per person or 149.6 per 1,000 person years. Inpatient hospital treatment was provided for 53.2% of emergency patients and outpatient hospital treatment for 37.1%. Frequent users represented 14.6% of the events. The incidence rate was highest for older persons and those with care dependency. In addition, the risk of using emergency services was higher among men and in suburban and urban regions (compared with rural regions), even after adjustment. Utilization is higher in the cohort studied compared to that found in other studies. The high proportion where inpatient hospital treatment is not necessary, as well as the clear association with care dependency and age, offer possible angles of approach for interventions to relieve the burden on emergency services.

Effect of Citrus aurantium Aroma on the Happiness of Pre-Hospital Emergency Staff: A Randomized Controlled Trial.

Happiness is a positive internal experience and an indicator of mental health. Having happy and efficient employees is one of the ideals of healthcare organizations, given its impact on the quality of healthcare services. Emergency healthcare staff members face various unpleasant and stressful events. It has been suggested that fragrant herbs such as Citrus aurantium can have cheerfulness effects on individuals. Therefore, this study was conducted to investigate the effect of Citrus aurantium aroma on the happiness of pre-hospital emergency staff. A randomized placebo controlled clinical trial was carried out on 167 prehospital emergency medical staff who were randomly assigned into two groups of aromatherapy and placebo. The participants received Citrus aurantium aromatherapy and placebo for five work shifts and for two consecutive weeks. Aromatherapy was performed using 10% Citrus aurantium scent applied via a pendant containing 1.5 cc of Citrus aurantium scent. The distance from the nose to the container was about 20 cm with the neck straight and the head in a balanced position. Data regarding staff happiness were collected using the Oxford Happiness Questionnaire, which were analyzed using descriptive and inferential statistics. The mean level of happiness did not differ between the intervention and control groups (p = 0.99). Work experience had a statistically significant inverse association with happiness (coefficient = -0.76, 95% CI: -1.49, -0.03). The findings of this randomized controlled trial indicate that Citrus aurantium aroma has no effect on the happiness of prehospital emergency medical services workers. There is a need to study the effect of a combination of complementary and alternative methods on the creation of positive psychological feelings among pre-hospital emergency staff.

Twelve-month prevalence of injury due to an occupational accident in pre-hospital Emergency Medical Services staff: Data from the EMS Health Study

Background: Pre-hospital emergency medical services (EMS) staff are at a high risk of occupational injuries. Therefore, this analysis aimed to calculate the 12-month prevalence of injuries due to occupational accidents and identify the associated factors in German pre-hospital EMS staff. Methods: We analyzed data from a cross-sectional survey to calculate the 12-month prevalence and the 95% confidence interval (95% CI) of an injury due to an occupational accident. In addition, the variables associated with these injuries were identified by multivariable logistics regression analysis and by calculating adjusted odds ratios (AORs) with 95% CI using JASP software. Results: A total of 2,307 study participants were included in the analysis. The 12-month prevalence of an injury due to an occupational accident was 15.61% (95% CI: 14.15%; 17.15%). The presence of lower back pain or chronic back pain (AOR: 1.65 [95% CI: 1.24; 2,20]; p ≤ 0.001), allergies other than allergic asthma (AOR: 1.42 [95% CI: 1.09; 1.86]; p = 0.009), and osteoarthritis (AOR: 1.85 [95% CI: 1.03; 3.32]; p = 0.039) in the previous 12 months, which are associated with an injury due to an occupational accident, were statistically significant. In addition, participants who were working in rural areas indicated lower odds compared to those working in metropolitan areas (AOR: 0.62 [95% CI: 0.43; 0.90]; p ≤ 0.001). Conclusion: This analysis indicates a high 12-month prevalence and mainly health-related factors associated with injuries due to occupational accidents being statistically significant in the participating German pre-hospital EMS staff.

Uncomfortable yet necessary: The impact of PPE on communication in emergency medicine.

The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team and also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of personal protective equipment (PPE). We sought to analyze the impacts of the COVID-19 pandemic on emergency medical service (EMS) workers and pre-hospital care delivery. We conducted focus groups and one-on-one interviews with fire-based EMS first responders between September 2021 and 2022. Interviews included questions about job-related stress, EMS skills, work experiences and changes during COVID-19. Interviews were recorded, independently dual coded and analyzed for themes. Two hundred twenty-three first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of PPE was reported to have significantly impaired efficiency and perceptions of quality of care-among EMS team members and also between EMS workers and patients. EMS personnels also experienced on-scene hostility on arrival (from both families and other agencies). Extensive use of PPE muffles voices, obscures facial expressions and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone's shoulder, wearing name tags on suits and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. Human connection is an important element of health-care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full-body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider-patient interactions in pre-hospital EMS. Additionally, 'communication-friendly' adaptations of PPE equipment may be an important area for future research and development in manufacturing and the health-care industry.

The system-wide effects of dispatch, response and operational performance on emergency medical services during Covid-19

In this paper, we analyze the Fire Department of New York City’s pre-hospital emergency medical services dispatch data for the period of March 20, 2019–June 13, 2019, and the corresponding Covid lockdown period of March 20, 2020–June 13, 2020. A fixed effects negative binomial model is used to estimate the heterogeneity effects of average ambulance travel or response times on the daily volume of emergency calls, year, day of the week, dispatcher-assigned medical emergency call type, priority rank, ambulance crew response, borough and an offset for missing calls. We also address the limitations of other non-parametric Covid studies or parametric studies that did not properly account for over-dispersion. When our model is estimated and corrected for clustered standard errors, fixed effects, and over-dispersion, we found that Wednesday was the only day of the week that was most likely to increase travel response time with an odd ratio of 6.91%. All grouped call types that were categorized showed significant declines in average travel time, except for call types designated as allergy and an odds ratio of 21.81%. When compared to Manhattan, Staten Island ambulance response times increased with an odds ratio of 19.05% while the Bronx showed a significant decline with an odds ratio of 31.92% advanced life support (ALS) and BLS ambulances showed the biggest declines in travel time with the exception of BLS assigned ambulance types and emergency priority rank of 6. Surprisingly, in terms of capacity utilization, the dispatch system was not as overwhelmed as previously predicted as emergency call volume declined by 8.83% year over year.

A Review of Patient Population Requiring Novel Critical Care Pediatric Transport Stroke Clinical Practice Guideline: A Three Year Single Site Analysis

<h3>Objectives</h3> 1. To identify patients transported by a pediatric critical care transport team for suspected or confirmed acute ischemic stroke who met qualifications of stroke activation. 2. Retrospective calculation of Large Vessel Occlusion (LVO) score of patients meeting criteria for transport stroke protocol activation. <h3>Background</h3> There are many pre-hospital Emergency Medical Service (EMS) and transport protocols as well as Large Vessel Occlusion (LVO) screening tools that exist for rapid transport of an adult patient with suspected or confirmed acute ischemic stroke to the nearest stroke center for rapid diagnosis. These screening algorithms aid in identifying adult patients who benefit from transport directly to an adult comprehensive stroke center. No data has been published on pre-hospital and transport evaluation and treatment algorithms for suspected acute ischemic stroke in children. Our institution created and implemented a transport stroke clinical practice guideline specific to pediatric stroke to improve recognition and management of patients with suspected stroke by our interfacility critical care transport team. <h3>Methods</h3> A retrospective chart review of patients transported by our institution's critical care transport teams from September 1, 2016 and March 1, 2020 meeting institutional criteria for stroke activation. LVO scores were calculated retrospectively based on clinical information documented within the transport medical record. <h3>Results</h3> Of the 17,244 patients transported by our institution's critical care transport, 17 patients met criteria during the defined study period. Average/median age was 173 months, or 14.4 years old. 4 of 17 had radiographic evidence of thrombus with 3 of those 4 underwent definitive management with tPA or endovascular retrieval. Hemiplegia is the most common presenting symptom with confirmed stroke in this population. The confirmed stroke group scored significantly lower on Glasgow Coma Scale (median of 8 vs. 15, p = 0.014), significantly higher on the LAMS LVO score (median 4 vs. 0, p = 0.021) and significantly higher on the RACE LVO (median 4 vs. 0, p = 0.036). <h3>Conclusion</h3> Acute ischemic stroke is a rare occurrence in pediatric patients. A standardized clinical practice guideline for transport can facilitate early recognition, appropriate management, and transport to a pediatric specific stroke care for timely diagnosis and intervention. LVO scores designed for adult population have not been validated for use in pediatric patients for suspected stroke, but may be useful in triage of pediatric patients with stroke-like symptoms to a stroke center with specialized care in pediatric stroke.

Prehospital stroke care in Africa: The reality and potential solutions.

Prehospital stroke care in Africa: The reality and potential solutions.

National research guideline for prehospital emergency medical care: A prospective Delphi-study.

To identify the most important research topics to establish a national research agenda and protocol for prehospital research in Saudi Arabia (KSA). A 3-round modified Delphi consensus methods were used to determine high-priority research topics. Round I included an open-ended question to list all high-priority research topics in a prehospital setting in Riyadh, KSA. Rounds II and III included ranking evaluation and consensus agreement. The included topics were listed based on the agreement of ≥70% of the experts participating in the study. The study was carried out between November 2021 and February 2022. In total, 100 prehospital experts in KSA were invited to participate in all 3 rounds. Of these, 47 responded in round I, 34 in round II, and 39 in round III. In round I, participants submitted 278 research topics. After deduplication and sorting, 78 topics were assessed in the other 2 rounds. In this modified Delphi study, an expert panel identified the top prehospital emergency medical services (EMS) care research priorities. The leading research priorities included clinical and operational ideas. The proposed 32 high-priority topics can be used to guide researchers, research networks, policymakers, and funding organizations involved in EMS.

ANALYZING THE IMPACT OF COVID-19 ON DEPRESSION AMONG HEALTHCARE PROFESSIONALS WORKING IN PRE-HOSPITAL EMERGENCY MEDICAL SERVICES

OBJECTIVE: Coronavirus disease 2019 (COVID-19) pandemic is thought to have affected the mental health of all humanity, especially health workers. It is important to evaluate prehospital healthcare workers fighting COVID-19 at the forefront in terms of depression, which is one of the most common psychiatric diseases, and to determine the factors that affect it. In this study, we aimed to analyze the COVID-19-related depression and associated factors among healthcare professionals working in pre-hospital emergency medical services (PEMS).MATERIAL AND METHODS: This cross-sectional study was conducted using a survey method on 552 healthcare professionals working in PEMS. The perceived risk and fear of being infected, trust in information sources, and depression levels as measured by Beck's Depression Inventory (BDI) were evaluated in relation to COVID-19.RESULTS: Women had higher BDI scores than men (p = 0.009). BDI scores were higher in widowed or divorced compared to married or single individuals. Those with greater perceived risk and fear of being infected with COVID-19 had also increased BDI scores. BDI scores were higher in those with low trust in information sources and a low level of knowledge about the disease.CONCLUSIONS: Women, divorced or widowed, those with greater perceived risk and fear of being infected, those with low trust in information sources, and those with a low level of knowledge about the disease are more prone to depression associated with COVID-19 and hence should be supported.