Prehospital Services Research Articles

Burnout, Intention to Resign and Related Factors among Health Professionals

Aim: The purpose of this study was to put forth the exhaustion state of healthcare professionals providing healthcare services in the city of Bitlis located in eastern Turkey and to compare the states of exhaustion of the healthcare professionals providing pre-hospital, first level and second level services. Additionally, determining the ratio of the intention to resign and the factors affect their intentions are among the aims of this study. Material and Methods: The study's target population comprised of all healthcare professionals working in Bitlis between 01.11.2018-01.01.2019. Age, gender, place of work, duty, marital status, number of children, smoking status, years of experience and whether they intend to resign or not of all participants were asked and Maslach burnout inventory (MBI) were filled after their consent. Data were analyzed with SPSS. P values

Willingness to Pay in Choosing Pre-hospital Emergency Services in Iran: A Population-Based Discrete Choice Experiment

Providing pre-hospital emergency services is accessible in Iran but costly for the country’s health system. This study calculated the willingness to pay (WTP) for pre-hospital emergency services in Iran. Discrete choice experiment (DCE) was used to measure the population’s WTP for ambulance services focusing on time, price, and quality of services. Four hundred and sixty people in Rasht city, Iran, participated in this online survey. Participants preferred lower transfer fees (β = -0.7, P ˂ 0.05), lower time of reaching to the scene (β = -0.061, P ˂ 0.05), lower time to arrive to the hospitals (β = -0.038, P ˂ 0.05), Private ambulance (β = -0.151, P ˂ 0.05), and emergency medical services (EMS) technicians (β = 0.209, P ˂ 0.05). Patients’ WTP in selecting EMS services can help policymakers to provide the best services.

Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis

BackgroundOut of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown. ObjectivesTo investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA. MethodsA retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used. Results2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).

Mapping the processes and information flows of a prehospital emergency care system in Rwanda: a process mapping exercise

ObjectiveA vital component of a prehospital emergency care system is getting an injured patient to the right hospital at the right time. Process and information flow mapping are recognised methods...

Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo

BackgroundSignificant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. MethodsThis is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post-operative complications and outcome. ResultsWe admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 ± 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 ± 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short-segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p-value : 0.838 and 0.468 respectively). ConclusionOur establishment faces many challenges in TSCI surgery: lack of pre-hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.

Reduced Pharmacological Intervention of Prehospital Services for Acute Alcohol Intoxication during the COVID-19 Pandemic in A Large District of Southern Italy.

Background Stress during a pandemic increases the risk of alcohol consumption, which may require pharmacological management. Methods An observational single-center retrospective study was conducted from 1 January 2018 to 31 December 2021, and divided into 2-year periods (2018-2019 and 2020-2021). This study focused on calls to one of the emergency departments (EDs) of seven hospitals in the Bari (Italy) metropolitan area for patients requiring emergency services (ESs) who were either admitted or not admitted, due to their refusal. Results A 30% reduction in emergency calls for alcohol-related issues and a 41.17% reduction in calls for patients who refused to be admitted to the ED were observed during the pandemic. During the pandemic, an inverse association was found between pharmacological treatment and number of calls coded green (non-critical) and yellow (fairly critical) in patients admitted to EDs. An inverse association was also found for calls coded green in patients not admitted to EDs and pharmacological treatment. Metadoxine was administered in almost all alcohol-related emergencies, primarily in conjunction with drugs acting on the gastrointestinal tract, irrespective of age, the period considered, and whether patients were admitted or not admitted to the ED. Conclusions ES is the first and only out-of-hospital service encountered by numerous patients with alcohol-use disorders who refuse to be admitted to the ED. These patients should be directed by ES personnel to a multidisciplinary program to receive treatment for drinking, improve their quality of life, and reduce sanitation costs.

Procedural sedation by advanced practice providers in the emergency medical service in the Netherlands: a retrospective study

BackgroundProcedural sedation and analgesia (PSA) is a technique of administering sedatives to induce a state that allows the patient to tolerate painful procedures while maintaining cardiorespiratory function, a condition that is frequently desired prehospital. Non-physician prehospital clinicians often have a limited scope of practice when it comes to providing analgesia and sedation; sometimes resulting in a crew request for back-up from physician-staffed prehospital services.“. This is also the case if sedation is desirable. Advanced practice providers (APPs), who are legally authorized and trained to carry out this procedure, may be a solution when the physician-staffed service is not available or will not be available in time.MethodsThe aim of this study is to gain insight in the circumstances in which an APP, working at the Dutch ambulance service “RAV Brabant MWN” from January 2019 to December 2022, uses propofol for PSA or to provide sedation. With this a retrospective observational document study we describe the characteristics of patients and ambulance runs and evaluates the interventions in terms of safety.ResultsDuring the study period, the APPs administered propofol 157 times for 135 PSA and in 22 cases for providing sedation. The most common indication was musculoskeletal trauma such as fracture care or the reduction of joint dislocation. In 91% of the situations where propofol was used, the predetermined goal e.g. alignment of fractured extremity, repositioning of luxated joint or providing sedation the goal was achieved. There were 12 cases in which one or more adverse events were documented and all were successfully resolved by the APP. There were no cases of laryngospam, airway obstruction, nor anaphylaxis. None of the adverse events led to unexpected hospitalization or death.ConclusionDuring the study period, the APPs performed 135 PSAs and provided 22 sedations. The success rate of predetermined goals was higher than that stated in the literature. Although there were a number of side effects, their incidences were lower than those reported in the literature, and these were resolved by the APP during the episode of care. Applying a PSA by an APP at the EMS “RAV Brabant MWN” appears to be safe with a high success rate.

Evaluation of Status of Getting ill with SARS CoV-2 and the Knowledge of Using and Attitudes of Personal Protective Equipment at Pre-Hospital Emergency Care Services Employees

Objective: The present study aimed to evaluate the knowledge level of health personnel working in pre-hospital emergency health services in the Konya province regarding the coronavirus disease 2019 (COVID-19) infection and the use of personal protective equipment (PPE) during the pandemic. Material and Methods: A total of 410 health personnel working in emergency health services in the Konya province were included in the study. The data were collected through a questionnaire developed by the researcher inquiring about the demographic data, whether they contracted (COVID-19), knowledge about COVID-19, and knowledge and attitudes regarding the use of PPE. Results: The rate of individuals who experienced mild infection was 27.1% and the rate of individuals who experienced severe infection was 5.6%. Of the subjects who experienced COVID-19 infection, 73.8% had fatigue, 67.9% had bone and muscle ache, 47.7% had fever, 42.5% had a cough and 27% had loss of taste, smell, and gastrointestinal symptoms and 25.3% had dyspnea. Of the health personnel, 83.7% were detected to use PPE. The most commonly used PPE was seen to be gloves (90.8%) and the least was visors and eyeglasses (43.8%). When the symptom frequency was analyzed according to age, the symptoms were found to be most frequent in the age group of 40 years and above and the symptom frequency was seen to increase with age. Conclusion: It was concluded that the health personnel had received in-service training about COVID-19 and had sufficient knowledge. The rate of PPE use was found to be high. There was no difference between males and females in contracting COVID-19 infection.

Pattern of admission, outcome and predictors of trauma patients visiting the surgical emergency department in comprehensive specialized hospital: a retrospective follow up study

Background: Traumatic injuries represent huge burden in the developing world, and significant proportion has found in low- and middle-income countries. However, the pattern, outcome and factors of injury varies from setup to setup and is less studied public health problems. Objective: To assess pattern of admission, outcome and its predictors among trauma patients visiting the surgical emergency department in comprehensive specialized hospital. Methods: A retrospective follow up study was conducted and data was taken from the medical records of patients from 2019 to 2021. Simple random sampling technique was used to get a sample size of 386 from injured patient charts. Data were entered into Epi-Data version 4.6 software and exported to STATA version 14.1 for analysis. The dependent variable was injured patient’s outcome that could be died or not died. The independent variables with P-value less than 0.25 in the bi-variable regression analysis were considered for the multivariable regression. Adjusted Odds Ratio with the 95% Confidence Interval were used to declare statistical significance. Result: About 13.99% of injured patients with (95% CI: 10, 17) had died during the study period. The leading cause of injury was assault (62.44%) followed by road traffic accident (26.17%). Severe Glasgow coma scale (AOR 6.6; 95% CI: 2.6-16.4), Length of hospital stay≥7days (AOR=2.8; 95% CI: 1.2-6.2), time of arrival in between 1-24 hours (AOR=0.15; 95% CI: (0.06-0.37), and upper trunk injury (AOR=6.3; 95% CI: 1.3-28.5) were significantly associated with mortality. Conclusion and Recommendation: Mortality after traumatic injury was considerably high. Severe Glasgow coma scale, Length of hospital stay≥7days, time of arrival in between 1-24 hours, and upper trunk injury were the associated factors for mortality. Priority should be given for injured patients with decreased level of consciousness and upper trunk injury. Establishment of organized pre-hospital emergency services and provision of timely arrival is recommended. We recommend prospective follow up study.

COMPARISON OF PRE-HOSPITAL PRELIMINARY DIAGNOSIS AND DEFINITIVE DIAGNOSIS IN EMERGENCY DEPARTMENT IN PATIENTS BROUGHT BY AMBULANCE

Aim: In this study, it was evaluated whether the anamnesis taken by paramedics before the hospital and the physical examination performed by paramedics in a limited time in non-traumatic patients brought to a second-level district state hospital by ambulance showed targeted effectiveness and whether the appropriate preliminary diagnosis was made in the evaluations made, and these preliminary diagnoses were compared with the final diagnoses made after the examinations in the emergency department. Methods: Between 01.01.2023 and 30.06.2023, patients brought to a State Hospital by ambulance were retrospectively analyzed. All age groups brought from the field for non-traumatic reasons were included in the study. Results: During the study period, all patients brought to our emergency department by ambulance were examined. The mean age of the patients was 66. More than half of the cases were female (57.7%). Comparison of the body systems belonging to the symptoms and preliminary diagnoses considered by the paramedics with the body systems belonging to the definitive diagnoses made in the emergency department showed a statistically moderate level of agreement between the pathologies considered by the 112 teams and the pathologies considered by the emergency department physicians in all body systems except the pathologies of the genitourinary system (Kappa 0.558). Conclusion: It was observed that the preliminary diagnosis or symptom stated in the case form by ambulance workers working in prehospital emergency health services was similar to the definitive diagnostic systems in the emergency department. However, it was found that 74.9% of the case forms indicated symptoms instead of preliminary diagnosis. This may have been due to the fact that paramedics did not want to take responsibility by stating a more general approach in patient delivery.

Changes in temperature in preheated crystalloids at ambient temperatures relevant to a prehospital setting: an experimental simulation study with the application of prehospital treatment of trauma patients suffering from accidental hypothermia

BackgroundAccidental hypothermia is common in all trauma patients and contributes to the lethal diamond, increasing both morbidity and mortality. In hypotensive shock, fluid resuscitation is recommended using fluids with a temperature of 37–42°, as fluid temperature can decrease the patient’s body temperature. In Sweden, virtually all prehospital services use preheated fluids. The aim of the present study was to investigate how the temperature of preheated infusion fluids is affected by the ambient temperatures and flow rates relevant for prehospital emergency care.MethodsIn this experimental simulation study, temperature changes in crystalloids preheated to 39 °C were evaluated. The fluid temperature changes were measured both in the infusion bag and at the patient end of the infusion system. Measurements were conducted in conditions relevant to prehospital emergency care, with ambient temperatures varying between − 4 and 28 °C and flow rates of 1000 ml/h and 6000 ml/h, through an uninsulated infusion set at a length of 175 cm.ResultsThe flow rate and ambient temperature affected the temperature in the infusion fluid both in the infusion bag and at the patient end of the system. A lower ambient temperature and lower flow rate were both associated with a greater temperature loss in the infusion fluid.ConclusionThis study shows that both a high infusion rate and a high ambient temperature are needed if an infusion fluid preheated to 39 °C is to remain above 37 °C when it reaches the patient using a 175-cm-long uninsulated infusion set. It is apparent that the lower the ambient temperature, the higher the flow rate needs to be to limit temperature loss of the fluid.

Designing, development and validation of an app to reduce the response time of the emergency medical services.

Delays in prehospital care attributable to the call-taking process can often be traced back to miscommunication, including uncertainty around the call location. Geolocation applications have the potential to streamline the call-taking process by accurately identifying the caller's location. To develop and validate an application to geolocate emergency calls and compare the response time of calls made via the application with those of conventional calls made to the Brazilian Medical Emergency System (Serviço de Atendimento Médico de Urgência-SAMU). This study was conducted in two stages. First, a geolocating application for SAMU emergency calls (CHAMU192) was developed using a mixed methods approach based on design thinking and subsequently validated using the System Usability Scale (SUS). In the second stage, sending time of the geolocation information of the app was compared with the time taken to process information through conventional calls. For this, a hypothetical case control study was conducted with SAMU in the Maringá, Paraná, Brazil. A control group of 350 audio recordings of emergency calls from 2019 was compared to a set of test calls made through the CHAMU192 app. The CHAMU192 group consisted of 201 test calls in Maringá. In test calls, the location was obtained by GPS and sent to the SAMU communication system. Comparative analysis between groups was performed using the Mann-Whitney test. CHAMU192 had a SUS score of 90, corresponding to a "best imaginable" usability rating. The control group had a median response time of 35.67 seconds (26.00-48.12). The response time of the CHAMU192 group was 0.20 (0.15-0.24). The use of the CHAMU192 app by emergency medical services could significantly reduce response time. The results demonstrate the potential of app improving the quality and patient outcomes related to the prehospital emergency care services.

Telephone triage and dispatch of ambulances to patients with suspected and verified acute stroke - a descriptive study

ObjectivesIn this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome.Materials and methodsWe conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments.ResultsWe included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene.ConclusionsThis study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC.

Temporal trends of ambulance time intervals for suspected stroke/transient ischaemic attack (TIA) before and during the COVID-19 pandemic in Ireland: a quasi-experimental study

ObjectivesTime is a fundamental component of acute stroke and transient ischaemic attack (TIA) care, thus minimising prehospital delays is a crucial part of the stroke chain of survival. COVID-19 restrictions...

Clinical practice guidelines in prehospital pain management for paramedics: a systematic review protocol.

The purpose of this review is to examine prehospital pain management clinical practice guidelines (CPGs) to identify recommendations that can be adopted or adapted into paramedic clinical practice. An additional aim is to consider the methodological quality of these CPGs and the recommendations within them. Quality, evidence-based CPGs support clinicians and optimize patient care. However, not all CPGs meet rigorous evidence-based standards, and some may be misleading. As pain is a common reason for patients to access ambulance services, the evaluation of pain management CPGs, their quality, and whether their recommendations can be adopted or adapted into practice is required to increase understanding in this area. We will include CPGs for pain management intended for prehospital services in civilian communities. CPGs in English published from 2017, and containing clear recommendations addressing pain of any cause will be considered for inclusion. This review will combine methodologies, including the PICAR framework (population, intervention, comparison, attributes of eligible CPGs, recommendation characteristics) by Johnston et al. , and the JBI umbrella and scoping review methodologies. The search strategy will cover 12 databases, including PubMed, Embase, and specific CPG databases (eg, GIN Library). Additionally, Google Scholar and Google will be searched, and prehospital organizations without regular publications will be contacted. The AGREE II and AGREE-REX tools will be used to assess the methodological rigor and clinical credibility of the CPGs. The characteristics of both CPGs and the recommendations will be extracted and discussed in the review. PROSPERO CRD42022352951.

Contributions of mobile applications to pre-hospital care: integrative review

Objective: Analyze the scientific contribution of mobile applications developed for pre-hospital care. Methods: Integrative literature review study; the databases used were the following: Scopus, Web of Science, CINAHL, SciELO, Embase, Lilacs, BDENF, Medline/PubMed, Brazilian Digital Library of Theses and Dissertations, and ProQuest Dissertations &amp; Theses Global; (period 2017-2022), including all article categories (with abstract and full texts available with free access) in Portuguese, English, or Spanish, containing the keywords “Pre-Hospital Assistance”, “Pre-Hospital Care”, “Pre-Hospital Services”, “Pre-Hospital Emergency Care”, “Nursing”, “Mobile applications”, “Portable Software Applications”, and “Mobile Apps” in titles and/or abstracts. Two researchers applied the eligibility criteria of the studies and collected data using a previously prepared instrument. Results: From a total of 944 studies, seven were selected for evaluation. Mobile applications developed for the pre-hospital care area are technological tools that have contributed to triage, pediatric first aid, patient safety, preparation of medications during cardiac arrest, quality of cardiopulmonary resuscitation, and communication between the emergency team and the electronic nursing record. Conclusions: The studies highlighted the potential related to the use of mobile applications in pre-hospital care, contributing especially to improving patient safety and the quality of care provided in pre-hospital urgency and emergencies. The optimization of assistance and early diagnosis times was also shown as a contribution of applications to assistance, in addition to alerting to details that may be unnoticed.

Haemodynamic response to pre-hospital emergency anaesthesia in trauma patients within an urban helicopter emergency medical service.

Pre-hospital emergency anaesthesia is routinely used in the care of severely injured patients by pre-hospital critical care services. Anaesthesia, intubation, and positive pressure ventilation may lead to haemodynamic instability. The aim of this study was to identify the frequency of new-onset haemodynamic instability after induction in trauma patients with a standardised drug regime. A retrospective database analysis was undertaken of all adult patients treated by a physician-led urban pre-hospital care service over a 6-year period. The primary outcome measure was the frequency of new haemodynamic instability following pre-hospital emergency anaesthesia. The association of patient characteristics and drug regimes with new haemodynamic instability was also analysed. A total of 1624 patients were included. New haemodynamic instability occurred in 231 patients (17.4%). Patients where a full-dose regime was administered were less likely to experience new haemodynamic instability than those who received a modified dose regime (9.7% vs 24.8%, p < 0.001). The use of modified drug regimes became more common over the study period (p < 0.001) but there was no change in the rates of pre-existing (p = 0.22), peri-/post-anaesthetic (p = 0.36), or new haemodynamic instability (p = 0.32). New haemodynamic instability within the first 30min following pre-hospital emergency anaesthesia in trauma patients is common despite reduction of sedative drug doses to minimise their haemodynamic impact. It is important to identify non-drug factors that may improve cardiovascular stability in this group to optimise the care received by these patients.

Abstract WMP46: Rurality Affects Access to Mechanical Thrombectomy for Large Vessel Occlusion Stroke on a Global Scale

Introduction: Global mechanical thrombectomy access (MTA) for large vessel occlusion (LVO) stroke is extremely low. Rural patients are less likely to receive initial care at a thrombectomy-capable hospital. While regional studies have suggested rurality as a barrier to MTA, the magnitude and variability of this effect across countries is unknown. The aim of this study is to evaluate the association of country-level % of the rural population with access to mechanical thrombectomy. Methods: We conducted an online survey of 75 countries through the Mission Thrombectomy 2020+ (MT2020+) global professional peer network between November 22, 2020, and February 28, 2021. Questions included country-level availability of MT centers, operators, procedures, reimbursement, emergency medical services, cultural barriers, and other factors affecting systems of stroke care. MTA was defined as the estimated proportion of patients with thrombectomy-eligible LVOs receiving MT in each region annually. We used the World Bank data to obtain the income class based on per capita GNI of a country and the proportion of rural population expressed as % of total population of each country. In the final analysis, 60 countries were included. We used multivariable-adjusted generalized linear models with logit link to evaluate the association of rural population % with MT access. Results: The median country-level % of rural population among 60 countries was 30.5% (IQR 16.1-45.7%). In univariable generalized linear models, each 5% increase in country-level % of rural population was associated with 22% lower odds of MT access (OR 0.78, 95%CI 0.70-0.86, p&lt;0.001). After adjustment for differences in country-level % of GDP spent on healthcare, reimbursement for MT, country’s income class, prehospital emergency services (EMS) system availability, training, and triage systems, each 5% increase in % of rural population was associated with 6% lower odds of MT access (OR 0.94, 95%CI 0.90-0.99, p=0.013). Conclusion: The % of rural population of countries is a significant independent negative predictor of access to mechanical thrombectomy. The % of rural populations and its distribution within countries needs to be carefully studied, as policies to improve access are created and implemented.

Early experience in use of videolaryngoscopy by a neonatal pre-hospital and retrieval service.

To describe initial experience with use of the Glidescope Go videolaryngoscope by an Australian neonatal pre-hospital and retrieval service. We conducted a 31-month retrospective review of an airway registry for neonates intubated by MedSTAR Kids clinicians. Twenty-two patients were intubated using the Glidescope Go, compared with 50 using direct laryngoscopy. First-pass success was 17/22 (77.3%) with the Glidescope Go and 38/50 (76%) with direct laryngoscopy. Complications occurred in 7/22 (32%) and 8/50 (16%), respectively. On initial review of this practice change, videolaryngoscopy allows neonatal tracheal intubation with a comparable success rate to direct laryngoscopy in a pre-hospital and retrieval setting.

Depressionen und damit assoziierte Faktoren bei Rettungskräften in Deutschland – Ergebnisse aus der EMS-Health-Studie für den Zeitraum 2020/2021

Depression and associated factors among emergency medical services staff in Germany: results from the EMS Health Study for the period 2020/2021 Background: Depression is one of the most common psychological conditions and factors such as pain and psychosocial workload can increase the risk for depression. Since there is little data available for prehospital emergence medical services (EMS) staff in Germany, the aim of the study was to identify factors associated with depression. Methods: This analysis was a nationwide cross-sectional study with prehospital EMS staff in Germany. Factors associated with depression were identified using multivariable logistic regression analysis, calculating adjusted odds ratios (AOR) and associated 95 % confidence intervals (95 % CI). Results: A total of 2,313 EMS staff were included in the analysis. The 12-month prevalence of depression was 15.6 % in women and 12.2 % in men. Significantly associated with depression were qualifications (paramedic*s: AOR: 1.99 [95 % CI: 1.10; 3.58] p = 0.022; paramedic*s: AOR: 1.69 [95 % CI: 1.08; 2.61] p = 0.021; reference: paramedics) and actual working hours (increase per hour: AOR: 1.02 [95 % CI: 1.00; 1.03] p = 0.013). Furthermore, poorer health, severe pain, allergies, and being a former smoker were also associated with a significantly higher chance of depression. In contrast, employees living in a relationship showed a lower chance of suffering from depression. Conclusion: This analysis provides evidence for factors associated with depression in prehospital EMS staff in Germany. Keywords: mental health – rescue service – workload – rescue service personnel – paramedics