Private Emergency Medical Services Research Articles

Emergency Medical Services in Taiwan: Past, Present, and Future.

This review assessed the development of Taiwan's emergency medical services (EMS) and focused on the optimizing initiatives of the EMS systems, the current state of Taiwan's EMS system, EMS benchmarks in different regions of Taiwan, EMS response during the coronavirus disease 2019 (COVID-19) pandemic, and future design. In the past decade, there has been a noticeable increase in prehospital services, numerous optimizing initiatives to improve patient prognosis, and the medical oversight model. Taiwan's current EMS system, including the dispatch system, out-of-hospital cardiac arrest (OHCA) patient management, time-sensitive critical illness in prehospital settings, and disaster response, has undergone significant improvements. These improvements have been demonstrated to have a measurable impact on patient outcomes, as supported by medical literature. Each region in Taiwan has developed a unique EMS system with local characteristics, such as the implementation of the Global Resuscitation Alliance 10 steps for OHCA-related quality control, hearing automated external defibrillator program, a five-level prehospital triage system, an island-hopping strategy for patients with major trauma, dispatcher-assisted teamwork for OHCA resuscitation, and optimized prehospital care for acute coronary syndrome patients. In response to the COVID-19 pandemic from 2019 to 2023, Taiwan's EMS implemented measures to combat the outbreak such as interagency collaboration to obtain patient's personal information, to optimize prehospital management initiatives, and to provide financial compensation and personal insurance for emergency medical technicians. The areas that need focus include integrating prehospital and in-hospital information to build a national-level database (One-Stop Emergency Management), increasing public awareness of first responders and emergency casualty care, and evolving the EMS system by incorporating private EMS system, initiating school-based education of paramedicine, and legally recognizing paramedics as medical and health care personnel. By improving these areas, we can better prepare for the future and ensure that Taiwan's EMS system continues to provide high-quality care to those in need.

Out-of-hospital cardiac arrests in the city of Cape Town metropole of the Western Cape province of South Africa: a spatio-temporal analysis.

The incidence of out-of-hospital cardiac arrest (OHCA) is expected to increase in sub-Saharan Africa along with the incidence of cardiovascular disease. In low-resource settings (LRS), OHCA carries a negligible survival rate. Interventions to improve OHCA survival might not be cost effective for many LRS, and therefore need to be targeted to areas of high incidence. The aim of this study was to describe the temporal and geographic distribution of OHCA in the City of Cape Town, South Africa, and their proximity to percutaneous coronary intervention (PCI) resources. In this retrospective study, OHCA data between 1 January and 31 December 2018 were extracted from public and one private emergency medical services in the Western Cape. For temporal analysis, distribution of OHCA according to time of day, day of the week and month of the year were subjected to chi-squared testing. For geospatial analysis, cluster and outlier, and hotspot analyses were performed. Proximity analysis was employed to determine the driving time from OHCA location to the closest PCI-capable facility. A total of 929 patients with OHCA received an emergency medical services response in the City of Cape Town, corresponding to an annual prevalence of 23.2 per 100 000 persons. The distribution of OHCA incidence was not explained by month of the year (p = 0.08) or day of the week (p = 0.67). A statistically significant variation in OHCA incidence was explained by time of day (p < 0.01) with 30% (n = 279) of all OHCAs occurring from 05:00 to 09:59. Geospatial analysis yielded a large area of hotspots (99% confidence interval) over the centre of the metropole, Cape Flats and southern suburbs. The median (interquartile range) driving time from the incident to the closest PCI-capable facility was 10:22 (08:05) minutes. Incidents of OHCA occurred predominantly at home during the mid-morning, with hotspots around the city centre and residential suburbs of Cape Town. While the incidents occurred close to PCI-capable facilities, some areas remained underserved and access to PCI for OHCA victims may be impossible due to socio-economic factors. With an increase in OHCA incidence expected, it is essential that contextual, cost-effective management interventions be developed and implemented.

A retrospective descriptive analysis of non-physician-performed prehospital endotracheal intubation practices and performance in South Africa

IntroductionPrehospital advanced airway management, including endotracheal intubation (ETI), is one of the most commonly performed advanced life support skills. In South Africa, prehospital ETI is performed by non-physician prehospital providers. This practice has recently come under scrutiny due to lower first pass (FPS) and overall success rates, a high incidence of adverse events (AEs), and limited evidence regarding the impact of ETI on mortality. The aim of this study was to describe non-physician ETI in a South African national sample in terms of patient demographics, indications for intubation, means of intubation and success rates. A secondary aim was to determine what factors were predictive of first pass success.MethodsThis study was a retrospective chart review of prehospital ETIs performed by non-physician prehospital providers, between 01 January 2017 and 31 December 2017. Two national private Emergency Medical Services (EMS) and one provincial public EMS were sampled. Data were analysed descriptively and summarised. Logistic regression was performed to evaluate factors that affect the likelihood of FPS.ResultsA total of 926 cases were included. The majority of cases were adults (n = 781, 84.3%) and male (n = 553, 57.6%). The most common pathologies requiring emergency treatment were head injury, including traumatic brain injury (n = 328, 35.4%), followed by cardiac arrest (n = 204, 22.0%). The mean time on scene was 46 minutes (SD = 28.3). The most cited indication for intubation was decreased level of consciousness (n = 515, 55.6%), followed by cardiac arrest (n = 242, 26.9%) and ineffective ventilation (n = 96, 10.4%). Rapid sequence intubation (RSI, n = 344, 37.2%) was the most common approach. The FPS rate was 75.3%, with an overall success rate of 95.7%. Intubation failed in 33 (3.6%) patients. The need for ventilation was inversely associated with FPS (OR = 0.42, 95% CI: 0.20–0.88, p = 0.02); while deep sedation (OR = 0.56, 95% CI: 0.36–0.88, p = 0.13) and no drugs (OR = 0.47, 95% CI: 0.25–0.90, p = 0.02) compared to RSI was less likely to result in FPS. Increased scene time (OR = 0.99, 95% CI: 0.985–0.997, p < 0.01) was inversely associated FPS.ConclusionThis is one of the first and largest studies evaluating prehospital ETI in Africa. In this sample of ground-based EMS non-physician ETI, we found success rates similar to those reported in the literature. More research is needed to determine AE rates and the impact of ETI on patient outcome. There is an urgent need to standardise prehospital ETI reporting in South Africa to facilitate future research.

An Investigation into employees’ motivation during the COVID-19 pandemic, at a single private Emergency Medical Services provider in Gauteng

Background: Employee motivation has been identified as pivotal in every organisation, as it assists in the realisation of organisations’ vision and/or mission. The COVID-19 pandemic has had an unprecedented effect across the globe, which extended into personal and professional realms. It may be argued, though, that it had a compounding effect on healthcare providers. Despite healthcare organisations having a COVID-19 disaster response plan in place, the relationship between employees’ motivation and organisational performance has been poorly described. The aim of this research was to investigate and describe factors of motivation amongst emergency operations centre (EOC) employees during the COVID-19 pandemic at a single private emergency medical services (EMS) provider in Gauteng. Methods: The sample included 110 EOC employees, and a probabilistic stratified sampling methodology was utilised. An electronic survey instrument was used to collect data. All recorded data were stored on Google® forms and extracted into an electronic data spreadsheet for analysis (Microsoft® Excel®). Results: A total of 87 participants responded, yielding a 95% confidence interval. The majority of participants were between 25-35 years old (n=53), female (n=53), single (n=43), and had a higher certificate as their highest formal qualification (n=60). It was found that organisational reputation (87.4%), the sense of making a difference (87.4%), and job security (85.1%) were amongst the most prevalent motivational factors amongst EOC employees during the pandemic. Conclusion: The results outline the importance of motivation in a disaster response plan. Employees’ motivation should be prioritised and adequately managed in times of crisis. Based on the link between motivation and organisational performance, a failure to do so may have a negative impact on performance. Organisational reputation, the sense of making a difference, and job security were identified as key motivational factors.

Clinical Predictors of Mortality in Prehospital Distress Calls by Emergency Medical Service Subscribers.

(1) Introduction: Most studies rely on in-hospital data to predict cardiovascular risk and do not include prehospital information that is substantially important for early decision making. The aim of the study was to define clinical parameters in the prehospital setting, which may affect clinical outcomes. (2) Methods: In this population-based study, we performed a retrospective analysis of emergency calls that were made by patients to the largest private emergency medical services (EMS) in Israel, SHL Telemedicine Ltd., who were treated on-site by the EMS team. Demographics, clinical characteristics, and clinical outcomes were analyzed. Mortality was evaluated at three time points: 1, 3, and 12 months’ follow-up. The first EMS prehospital measurements of the systolic blood pressure (SBP) were recorded and analyzed. Logistic regression analyses were performed. (3) Results: A total of 64,320 emergency calls were included with a follow-up of 12 months post index EMS call. Fifty-five percent of patients were men and the mean age was 70.2 ± 13.1 years. During follow-up of 12 months, 7.6% of patients died. Age above 80 years (OR 3.34; 95% CI 3.03–3.69, p < 0.005), first EMS SBP ≤ 130 mm Hg (OR 2.61; 95% CI 2.36–2.88, p < 0.005), dyspnea at presentation (OR 2.55; 95% CI 2.29–2.83, p < 0001), and chest pain with ischemic ECG changes (OR 1.95; 95% CI 1.71–2.23, p < 0.001) were the highest predictors of 1 month mortality and remained so for mortality at 3 and 12 months. In contrast, history of hypertension and first EMS prehospital SBP ≥ 160 mm Hg were significantly associated with decreased mortality at 1, 3 and 12 months. (4) Conclusions: We identified risk predictors for all-cause mortality in a large cohort of patients during prehospital EMS calls. Age over 80 years, first EMS-documented prehospital SBP < 130 mm Hg, and dyspnea at presentation were the most profound risk predictors for short- and long-term mortality. The current study demonstrates that in prehospital EMS call settings, several parameters can be used to improve prioritization and management of high-risk patients.

Out-of-hospital cardiac arrests in the city of Cape Town, South Africa: a retrospective, descriptive analysis of prehospital patient records

ObjectivesWhile prospective epidemiological data for out-of-hospital cardiac arrest (OHCA) exists in many high-income settings, there is a dearth of such data for the African continent. The aim of this study...

Medication storage in Emergency Medical Services: Temperature ranges from a South African sample

Background: Pre-hospital emergency care providers working in emergency medical services (EMS) are licenced to administer medication to the acutely ill and injured. In South Africa, there are significant seasonal variations in temperature, sometimes far exceeding the recommended medication storage temperature. The aim of this study was to determine the summer temperature ranges inside select emergency vehicles and storage facilities in four provinces in South Africa. Methods: A prospective, observational study was conducted in four (Cape Town, Western Cape; Johannesburg, Gauteng; Durban, KwaZulu-Natal; Potchefstroom, North West) provinces during the summer (February – March) months of 2019. A continuous temperature monitoring device was placed in the medication storage room, the response vehicle drug bags, and an ambulance at a single private EMS base in each of the provinces. Temperature data were recorded in fifteen-minute intervals. The data were extracted after six weeks and subjected to descriptive analysis. Data were also analysed in six-hourly strata to account for daily temperature variations. Results: A total of 36 002 temperature readings were recorded during the study period. The mean (range) temperature across the four bases was 25.4°C (13.1–56.8) for ambulances, 25.7°C (13.3–49.1) for primary response vehicles, and 24.4°C (17.3–33.9) for medication storage facilities. The highest mean (range) temperatures, of 33.7°C (20.4–47.9), were recorded in a Johannesburg-based primary response vehicle between 12h00 and 18h00. Conclusion: Current medication storing and transporting practices not maintain temperatures according to the recommended storage conditions. Further investigation should address the implication of temperature fluctuations on medication degradation, and a sustainable, cost-effective solution should be developed to store medication in the pre-hospital setting.

The barriers and facilitators to the telephonic application of the FAST assessment for stroke in a private emergency dispatch centre in South Africa.

BackgroundStroke is one of the leading contributors to morbidity and mortality globally. The incidence of stroke is on the increase in Sub-Saharan countries such as South Africa. As stroke is a time-sensitive condition, emergency medical services (EMS) play an important role in the early recognition of stroke. The telephonic application of the FAST (Face, Arm, Speech, Time) assessment has been suggested to screen patients for stroke, but this is not applied consistently. This study aimed to identify the barriers and facilitators to the telephonic application of the FAST assessment.MethodsThis retrospective, exploratory study sampled 20 randomly selected emergency calls to a private EMS in South Africa, with suspected stroke. After verbatim self-transcription, data were analysed using inductive content analysis to identify the barriers and facilitators to the application of the FAST assessment. Results were arranged according to themes.ResultsResults indicated that in 15/20 (75%) of the calls, the FAST assessment was successfully applied. Eight barriers under three themes (practical barriers, emotionality, and knowledge and understanding) and three facilitators under one theme (clear communication) were identified. Most notably, language discordance, lack of empathy and caller frustration featured prominently as barriers while caller cooperation and clear instructions were prominent facilitators.ConclusionWith the barriers known, methods to address these may be constructed. Additional training and credentialing for call-takers may be a reasonable first step. These lessons can likely be applied to other telephonic acuity and recognition algorithms.

South African paramedic perspectives on prehospital palliative care

BackgroundPalliative care is typically performed in-hospital. However, Emergency Medical Service (EMS) providers are uniquely positioned to deliver early palliative care as they are often the first point of medical contact. The aim of this study was to gather the perspectives of advanced life support (ALS) providers within the South African private EMS sector regarding pre-hospital palliative care in terms of its importance, feasibility and barriers to its practice.MethodsA qualitative study design employing semi-structured one-on-one interviews was used. Six interviews with experienced, higher education qualified, South African ALS providers were conducted. Content analysis, with an inductive-dominant approach, was performed to identify categories within verbatim transcripts of the interview audio-recordings.ResultsFour categories arose from analysis of six interviews: 1) need for pre-hospital palliative care, 2) function of pre-hospital healthcare providers concerning palliative care, 3) challenges to pre-hospital palliative care and 4) ideas for implementing pre-hospital palliative care. According to the interviewees of this study, pre-hospital palliative care in South Africa is needed and EMS providers can play a valuable role, however, many challenges such as a lack of education and EMS system and mindset barriers exist.ConclusionChallenges to pre-hospital palliative care may be overcome by development of guidelines, training, and a multi-disciplinary approach to pre-hospital palliative care.

196 Comparing Response Times, Intensity of Care and Outcomes between Private versus Municipal Emergency Medical Services Systems

The financial and oversight complexities associated with providing emergency medical services (EMS) in the United States ultimately led to the creation of both private and municipal-based EMS systems providing out-of-hospital medical care to our communities. For over four decades an emotional debate has spurned regarding which system can provide better coverage and quality of care to patients. Although there are many heated editorials and commentary papers on this topic, there is very little scientific research to support one method of delivery over the other. The primary objective of this study was to identify any quantitative differences in care between private and municipal EMS systems related to response times, intensity of services and patient outcomes. This IRB approved retrospective chart review included all patients presenting to a 60 bed community Emergency Department (ED) via advanced life support (ALS) ambulance between Jan 1, 2017 and March 31, 2017. Our ED receives ambulance traffic from 9 EMS agencies (7 municipal, 2 private) who provide 911 coverage for approximately 20 square miles of suburban communities. Data were collected using the hospital’s electronic records and included patient age, emergency severity index score (ESI), out-of-hospital response and transport times, IVs started, fluids and medications given, airway interventions (oxygen delivery, CPAP, Intubation), cardiac monitoring, 12 lead EKGs, ED intubations, ED mortality, hospital mortality and ICU admission. Categorical data were summarized as counts and percentages, and continuous data as means with corresponding standard deviations. Between-group mean differences were compared by calculating t-tests for independent measures. Categorical data were compared using the chi-square test for association or Fisher’s exact test. A total of 769 patients were included into the study sample with 483 in the private EMS cohort and 286 in the municipal EMS cohort. A detailed breakdown of cohort demographics, out-of-hospital response times, intensity of services, outcomes and comparisons between these groups are displayed in Table 1. A p-value ≤0.05 (two-tail) was considered statistically significant. The current operating structure of providing EMS to our communities is based around the premise that there are no significant quality and safety differences between municipal and private EMS systems. It is therefore surprising to see so many statistically and potentially clinically significant differences between these two modes of EMS delivery. Municipal EMS agencies in our community were identified to provider faster care with more intense services in nearly every out-of-hospital time and intensity of care metric. Despite these differences, no outcome disparities were identified in regards to ED and hospital mortality, ICU admissions or ED intubations. Recognizing strengths and potential weakness related to these two systems is essential as we continue to minimize any disparities in care to our communities and maximize the benefits of mutual aid within our national EMS system.

Barriers to the implementation of prehospital thrombolysis in the treatment of ST-segment elevation myocardial infarction in South Africa: An exploratory inquiry.

IntroductionEvidence-based guidelines advocate percutaneous coronary intervention (PCI) as the mainstay reperfusion strategy for ST-segment elevation myocardial infarction (STEMI). However, the South African health system is not well positioned to provide PCI as a ‘mainstay strategy’. In response, the Health Professions Council of South Africa approved the use of prehospital thrombolysis (PHT) for emergency care practitioners in 2009. However, since its approval, prehospital thrombolysis has failed to reach a level of systematic uptake indicative of successful implementation. The current study aimed to explore, through a qualitative inquiry, barriers to PHT for the treatment of myocardial infarction within a South African context.MethodsA qualitative single-case study design was used where a series of semi-structured interviews were conducted involving purposefully selected participants. The case comprised a nationalised private emergency medical service, and participants were selected in view of relevant experience and knowledge. Requisite data was conceptualised through the consolidated framework for implementation research, and thematic analysis outlined the data coding procedures of the study.ResultsThe study identified potential barriers to the implementation of PHT. These comprised cost, logistics, inter-professional collaboration, leadership engagement, and beliefs or scepticism associated with PHT.ConclusionA lack of strategic implementation has resulted in a poor introduction of evidenced-based prehospital cardiac care, affecting vulnerable populations who may have otherwise benefited from receiving this level of care. Given the time-sensitive nature of STEMI management, and severely limited access to ‘primary reperfusion’, PHT resembles not only a logical but also appealing solution in the South African context.

Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) Design and Methodology.

The objective of this study is to describe the Longitudinal Emergency Medical Technician (EMT) Attributes and Demographic Study (LEADS) design, instrument development, pilot testing, sampling procedures, and data collection methodology. Response rates are provided, along with results of follow-up surveys of non-responders (NRs) and a special survey of Emergency Medical Services (EMS) professionals who were not nationally certified. Annual surveys from 1999 to 2008 were mailed out to a random, stratified sample of nationally registered EMT-Basics and Paramedics. Survey weights were developed to reflect each respondent's probability of selection. A special survey of NRs was mailed out to individuals who did not respond to the annual survey to estimate the probable extent and direction of response bias. Individuals who indicated they were no longer in the profession were mailed a special exit survey to determine their reasons for leaving EMS. Given the large number of comparisons between NR and regular (annual) survey respondents, it is not surprising that some statistically significant differences were found. In general, there were few differences. However, NRs tended to report higher annual EMS incomes, were younger, healthier, more physically fit, and were more likely to report that they were not practicing EMS. Comparisons of the nationally certified EMS professionals with EMS professionals who were not nationally certified indicated that nationally certified EMS providers were younger, had less EMS experiences, earned less, were more likely to be female and work for private EMS services, and less likely to work for fire-based services. These differences may reflect state and local policy and practice, since many states and local agencies do not require maintenance of national certification as a requirement to practice. When these differences were controlled for statistically, there were few systematic differences between non-nationally certified and nationally certified EMS professionals. The LEADS study is the only national, randomized, and longitudinal data source for studying EMS professionals in the United States. Although not without flaws, this study remains an excellent source of information about EMS provider demographics, attributes, attitudes, workplace issues and concerns, and how the profession has changed from 1999 to 2008. Levine R . Longitudinal Emergency Medical Technician Attributes and Demographic Study (LEADS) design and methodology. Prehosp Disaster Med. 2016;31(Suppl. 1):s7-s17.

Reduction in unavailable-for-response episodes in a private emergency medical services agency.

Increased demand for emergency medical services (EMS), financial constraints, emergency department overcrowding, EMS crews kept in hospital, all result in ambulance unavailability. This study seeks to identify daily temporal patterns for unavailable-for-response episodes, impact of increasing staffing during peak periods, and evaluating the extent of reduction in unavailable-for-response episodes due to temporally precise increases in staffing during critical time periods and the resulting cost/benefit analysis. The authors evaluated all EMS responses during a 7-month time period and recorded all unavailable-for-response episodes. This identified clusters of unavailable-for-response episodes for which incremental staffing changes were implemented. Internal audit of cost/revenues was recorded. Midsized private EMS agency in Northwest Pennsylvania. EMS Responders/Agency calls. Temporally precise increases in staffing during critical time periods/unavailable-for-response episodes. Reduction in unavailable-for-response episodes, cost effectiveness. Evaluating 23,833 EMS responses that occurred during the study period, staffing changes resulted in a 93 percent average reduction and 100 percent maximum reduction in unavailable-for-response episodes and were cost effective, based on evaluation of cost versus revenue, in this EMS agency. Identification of opportunities for system staffing improvement in a midsized EMS agency demonstrated feasibility and usability of mapping temporal patterns of unavailable-for-response episodes to substantially reduce the number of unavailable-for-response episodes and was cost effective.

Actual Operation of Private Prehospital Emergency Medical Service Systems in Certain Regions of South Korea

This study aims to analyze the actual conditions of the managers and employees of private emergency medical service systems and to provide basic data for the activation of a private Emergency Medical Service System (EMSS). Structured questionnaires were distributed to the managers and employees of private emergency patient transport services. From August 1 to October 30, 2013, a survey was conducted face-to-face by personal visits and the collected data were processed using IBM SPSS Statistics 20.0. The average monthly income of the managers was 13.69 million won and net profit after operating expenses was 3.3 million won. Of total employees, 62.7% were in their twenties, while 68.7% earned an average of 1.5 million won or less a month and 31.3% more than 1.5 million won a month. This study found that the operational situation of the private transport services was very poor and that they were poorly managed; therefore, in order to achieve qualitative improvements in public health care, there is a need for private transport services to obtain financial assistance for Emergency Medical Service (EMS) and to have stable administration.

Prehospital Naloxone Administration as a Public Health Surveillance Tool: A Retrospective Validation Study.

Abuse or unintended overdose (OD) of opiates and heroin may result in prehospital and emergency department (ED) care. Prehospital naloxone use has been suggested as a surrogate marker of community opiate ODs. The study objective was to verify externally whether prehospital naloxone use is a surrogate marker of community opiate ODs by comparing Emergency Medical Services (EMS) naloxone administration records to an independent database of ED visits for opiate and heroin ODs in the same community. A retrospective chart review of prehospital and ED data from July 2009 through June 2013 was conducted. Prehospital naloxone administration data obtained from the electronic medical records (EMRs) of a large private EMS provider serving a metropolitan area were considered a surrogate marker for suspected opiate OD. Comparison data were obtained from the regional trauma/psychiatric ED that receives the majority of the OD patients. The ED maintains a de-identified database of narcotic-related visits for surveillance of narcotic use in the metropolitan area. The ED database was queried for ODs associated with opiates or heroin. Cross-correlation analysis was used to test if prehospital naloxone administration was independent of ED visits for opiate/heroin ODs. Naloxone was administered during 1,812 prehospital patient encounters, and 1,294 ED visits for opiate/heroin ODs were identified. The distribution of patients in the prehospital and ED datasets did not differ by gender, but it did differ by race and age. The frequency of naloxone administration by prehospital providers varied directly with the frequency of ED visits for opiate/heroin ODs. A monthly increase of two ED visits for opiate-related ODs was associated with an increase in one prehospital naloxone administration (cross-correlation coefficient [CCF]=0.44; P=.0021). A monthly increase of 100 ED visits for heroin-related ODs was associated with an increase in 94 prehospital naloxone administrations (CCF=0.46; P=.0012). Frequency of naloxone administration by EMS providers in the prehospital setting varied directly with frequency of opiate/heroin OD-related ED visits. The data correlated both for short-term frequency and longer term trends of use. However, there was a marked difference in demographic data suggesting neither data source alone should be relied upon to determine which populations are at risk within the community.

142 Emergency Medical Services, Injury, and Illness at the 2013 Boy Scout Jamboree

The 2013 Boy Scouts of America (BSA) National Jamboree attracted 36,261 youth, staff, and volunteers to 11,000 acres of West Virginia, a new permanent home for the BSA. All attendees camped and participated in events including mountain biking, BMX biking, skateboarding, climbing and other activities. The environment, length of event and the fact that all attendees were participants makes the Jamboree a unique challenge for Emergency Medical Services (EMS). The EMS plan involved a coordinated effort by BSA volunteers, US military, and private local EMS and air medical providers. A licensed EMS provider was established for the site: Summit EMS. State regulations were established to allow ambulance transport to temporary on-site medical facilities and to allow volunteers to practice in West Virginia. Non emergent transport capability was also provided. There were 13 Jamboree medical facilities, 2 with X-ray capability. To quantify the volume, chief complaint and destination of EMS transports at the 2013 BSA Jamboree and gain an understanding of illness and injury patterns for future events. A unified dispatch system was used to manage and track EMS resources. A combination of paper patient care reports (for military and volunteer units) and electronic run reports (for private EMS) were used. All reports were scanned into the Jamboree medical record system and a data registry was created. During 12 days of activity on the site there were 883 emergency medical services transports. Private, locally based EMS handled all off-site transports. There were 757 on site transports, 148 were by BSA EMS utility vehicle (UTV), 483 were by military field litter ambulance (FLA), 126 were by private EMS provider. There were 121 patients transported off site by ground to local hospitals. and 5 patients were transported to an on-site landing zone for helicopter transport to hospital facilities. 468 transports were related to injuries (238 extremity injuries, 230 injuries to other site), 415 transports were for medical complaints (150 heat related, 21 suspected cardiac complaints, 244 assorted medical complaints and 1 cardiac arrest). There were 347 non-emergent patients transported by van. Coordination of services between private, military and volunteer services permitted all areas to be covered with multiple possible transport methods depending on the nature and severity of complaints. There were a large percentage of non-emergent transports likely due to the terrain and geography of the site. A change in regulations permitted ambulance resources to be available for onsite and off-site transports, making more effective use of available resources and limiting the number of transports to local hospitals. There were a large number of heat-related complaints, the role and effectiveness of prevention strategies should be examined. A review of injury prevention methods should also be reviewed.

Does Ambulance Response Time Influence Patient Condition among Patients with Specific Medical and Trauma Emergencies?

The relation between patient outcome and ambulance response times is unknown. We sought to measure the influence of shorter response times on patient outcomes. The objective of the study was to determine whether ambulance response time makes a difference in the outcomes of emergency medical services (EMS) patients with specific traumatic and medical emergencies. This study was conducted in a metropolitan EMS system serving a population of 800,000, including urban and rural areas. Cases were included if the private EMS service was the first medical provider on scene, the case was priority 1, and the patients were 13 years old and older. A 14-month time period was used for the data evaluation. Four diagnoses were examined: motor vehicle crash injuries, penetrating trauma, difficulty breathing, and chest pain complaints. Data collected included ambulance response times, initial vital signs, and the number of vital signs out of range. Cases seen at the single major trauma center were selected for evaluation of hospital outcome. Correlation coefficients were used to evaluate interactions between independent and outcome variables. Of the 2164 cases we reviewed, the EMS service responded significantly faster to trauma complaints at 4.5 minutes (n = 254) than medical complaints at 5.9 minutes (n = 1910). In the trauma center sample of 559 cases, response time was not related to hospital days (P = 0.5), admissions (P = 0.7), intensive care unit admissions (P = 0.4), or deaths (P = 0.3). This study showed that in cases seen at a major trauma center, longer response times were not associated with worse outcomes for the diagnostic groups tested.

An Assessment of Depression, Anxiety, and Stress Among Nationally Certified EMS Professionals

Objectives. The primary objective of this study was to estimate the prevalence and severity of depression, anxiety, and stress among a cohort of nationally certified emergency medical services (EMS) professionals. The secondary objective was to determine whether there were differences between individuals who were experiencing depression, anxiety, or stress and those who were not. Methods. This was a questionnaire-based, case–control analysis of nationally certified emergency medical technician (EMT)-Basics and paramedics who applied for national recertification in 2009. The three outcome variables of interest included measures of depression, anxiety, and stress, and were assessed using the Depression Anxiety Stress Scale-21 (DASS-21). Descriptive statistics and investigator-controlled backwards-selection logistic regression modeling were utilized to quantify the prevalence of depression, anxiety, and stress and to predict the association of demographic and work–life characteristics with each outcome. Results. A total of 64,032 individuals were eligible to renew their national certification and 34,340 (53.6%) individuals returned a questionnaire. The DASS-21 classified 1,589 (6.8%, 95% confidence interval [CI] = 6.4%–7.1%) EMS professionals as depressed, 1,406 (6.0%, 95% CI = 5.7%–6.3%) as anxious, and 1,382 (5.9%, 95% CI = 5.6%–6.2%) as stressed. Multivariable logistic regression estimates showed that paramedics (odds ratio [OR] = 1.31, 95% CI = 1.22–1.39), those working in county or municipal services (OR = 1.36, 95% CI = 1.16–1.60) or private services (OR = 1.32, 95% CI = 1.14–1.52), and those with ≥16 years of EMS experience (OR = 1.28, 95% CI = 1.01–1.62) had an increased odds of depression. A stepwise increase was found when estimating the effects of self-reported general health on the odds of anxiety (very good, OR = 1.84, 95% CI = 1.53–2.22; good, OR = 3.88, 95% CI = 3.32–4.67; fair/poor, OR = 10.81, 95% CI = 8.14–14.34). Likewise, paramedics (OR = 1.32, 95% CI = 1.23–1.42), those working in a private EMS system (OR = 1.35, 95% CI = 1.16–1.56), and those with ≥16 years of EMS experience (OR = 1.67, 95% CI = 1.28–2.18) had an increased odds of stress. Conclusions. This study was able to estimate the prevalence of depression, anxiety, and stress among a large cohort of nationally certified EMS professionals and identified statistically significant demographic and work–life characteristics that predicted depression, anxiety, and stress. Future research should attempt to follow EMS professionals prospectively to determine specific characteristics associated with occupational traumatic exposure and the development of depression, anxiety, and stress.

Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome

Clinical case: A 58-year-old woman called 9-1-1 with acute onset of chest pain that had persisted for 30 minutes. She had a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus but no previous history of myocardial infarction or heart failure. Her medications included aspirin, atorvastatin, lisinopril, and metoprolol. Paramedics were dispatched, and a prehospital ECG demonstrated 3- to 4-mm ST-segment elevation in leads I, aVL, and V2 through V6 (Figure 1). Her examination revealed a regular pulse of 90 bpm, a blood pressure of 100/60 mm Hg, clear lungs, and normal heart sounds with no murmurs. Paramedics interpreted the prehospital ECG and activated the catheterization laboratory en route to the hospital. On hospital arrival, the patient was transported directly to the catheterization laboratory. Coronary angiography demonstrated an occluded proximal left anterior descending artery, which was successfully treated with balloon angioplasty and a stent. The pertinent time intervals were as follows: paramedic dispatch to balloon time, 56 minutes; paramedic arrival at the scene to balloon time, 46 minutes; hospital door to balloon time, 23 minutes. Her biomarkers revealed a peak troponin T of 2.42 ng/mL and a peak creatine kinase muscle-brain isoenzyme of 26.8 ng/mL. An echocardiogram demonstrated normal left ventricular ejection fraction of 55%, with mild anterior hypokinesis, and the patient was discharged on hospital day 3. Figure 1. Prehospital ECG. American Heart Association national guidelines,1–3 as well as other consensus and scientific statements,4–11 recommend that emergency medical services (EMS) acquire and use prehospital ECGs to evaluate patients with suspected acute coronary syndrome. Despite these recommendations, prehospital ECGs are used in fewer than 10% of patients with ST-segment–elevation myocardial infarction (STEMI),12,13 and this rate has not substantially changed since the mid-1990s. Furthermore, even when a prehospital ECG is acquired, the information is often not …

Traffic Accidents in Access Routes to Cordoba City. Casuistry of ECCO S. A. (A Private Emergency Medical Service) from Year 2000 to Year 2006

Traffic Accidents in Access Routes to Cordoba City. Casuistry of ECCO S. A. (A Private Emergency Medical Service) from Year 2000 to Year 2006