Role Of Emergency Medical Services Research Articles

A community-based ambulance model: lessons for Emergency Medical Services (EMS) and everyday health systems resilience from South Africa.

The role of Emergency Medical Services (EMS) is changing globally as ambulance crews respond to a shifting burden of disease as well as societal stressors such as violence and inequality. New ways of thinking about how to provide emergency care are required to shift EMS from a role primarily focused on clinical care and transporting patients to hospital. In this paper, we present the experience of the Philippi Project (PP), an innovative community-based model of care developed by front-line ambulance crews in a low-income neighborhood in Cape Town, South Africa. Our insights were developed through observational, interview and document review work, within an overall embedded research approach. Our analysis draws on the Everyday Health Systems Resilience framework, which sees resilience as an emergent process that may be stimulated through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies and are underpinned by system capacities (cognitive, behavioral and contextual). We consider the PP as a potentially transformative resilience strategy, defined as a new way of working that offered the promise of long-term health system gains. We found that the PP's initial development was supported by a range of system capacity attributes (such as the intentional development of relationships, a sense of collective purpose, and creating spaces for constructive sensemaking). However, the PP was hard to sustain over time because emergent ways of working were undermined both by other capacity attributes rooted in pre-existing organizational routines, and two contextual shocks (Covid-19 and a violent incident). The paper adds a new empirical contribution to the still-small EHSR literature. In addition, the PP experience offers globally relevant lessons for developing community-based models of EMS care. It demonstrates that frontline staff can develop creative solutions to their stressful daily realities, but only if space is created and protected.

The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls – A descriptive retrospective register-based study

BackgroundMedical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls. MethodsDescriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed. ResultsIn total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required. ConclusionsHospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs.

Emergency department course of patients with asthma receiving initial emergency medical services care-Perspectives From the National Hospital Ambulatory Medical Care Survey.

Although 911 calls for acute shortness of breath are common, the role of emergency medical services (EMS) in acute asthma care is unclear. We sought to characterize the demographics, course, and outcomes of adult emergency department (ED) patients with asthma in the United States receiving initial EMS care. We analyzed data from the 2016-2019 National Hospital Ambulatory Medical Care Survey (NHAMCS). We included patients aged ≥18 years with an ED visit diagnosis of asthma, stratifying the cases according to initial EMS care. Accounting for the survey design of NHAMCS, we generated nationalized estimates of the number of EMS and non-EMS asthma visits. Using logistic regression, we determined the associations between initial EMS care and patient demographics (age, sex, race, and insurance type), ED course (initial vital signs, triage category, testing, medications), and outcomes (hospital admission, ED length of stay). Of 435million adult ED visits during 2016-2019, there were ≈5.3million related to asthma (1.3million annually, 1.2%; 95% confidence interval [CI], 1.1%-1.4%). A total of 602,569 (150,642 annually, 11.3%; 95% CI, 8.6%-14.8%) ED patients with asthma received initial EMS care. Compared with non-EMS asthma patients, EMS asthma patients were more likely to present with an "urgent" ED triage category (odds ratio [OR], 22.2; 95% CI, 6.6-74.9) and to undergo laboratory (OR, 2.78; 95% CI, 1.41-5.46) or imaging tests (OR, 2.42; 95% CI, 1.21-4.83). ED patients with asthma receiving initial EMS care were almost 3 times more likely to be admitted to the hospital (OR, 2.81; 95% CI, 1.27-6.25). There were no differences in demographics, ED use of β-agonists or corticosteroids, or ED length of stay between EMS and non-EMS asthma patients. Approximately 1 in 10 adult ED patients with asthma receive initial care by EMS. EMS asthma patients present to the ED with higher acuity, undergo more diagnostic testing in the ED, and are more likely to be admitted. Although limited in information regarding the prehospital course, these findings highlight the more severe illness of asthma patients transported by EMS and underscore the importance of EMS in emergency asthma care.

Impact of Community Socioeconomic Characteristics on Emergency Medical Service Delays in Responding to Fatal Vehicle Crashes

This study aimed to determine the impact of community socioeconomic status on emergency medical services' response time for fatal vehicle crashes. Authors used the 2019 National Highway Traffic Safety Administration Fatality Analysis Reporting System and 2019-2020 Area Health Resource Files to obtain emergency medical services' time intervals and county socioeconomic characteristics (e.g., median household income, availability of trauma centers, and rurality), generating a study sample of 18,540 individuals involved in fatal vehicle crashes between January and December 2019. Generalized linear models with log-link and Gamma-family were used to obtain estimates, and other variables were adjusted in the model. Both the mean time of the emergency medical service arrival to the site of the crash and the mean transport time from the crash site to hospital varied by county SES. Counties with a higher mean household income had 12% shorter emergency medical services' arrival times and up to 7% shorter emergency medical services' hospital transport times than counties with lower SES. The emergency medical services' hospital transport times by emergency medical services also varied by proximity to trauma centers and were 15% shorter in counties that had ≥2 trauma centers than in counties without trauma centers. This study shows socioeconomic disparities in emergency medical service rescue time for fatal vehicle crashes. Community characteristics play a major role in emergency medical services' arrival time intervals. Prior research demonstrated a strong link between the timeliness of emergency medical service response and the likelihood of survival in fatal motor vehicle accidents. These findings showing that socioeconomically disadvantaged areas and those lacking trauma facilities had slower emergency medical service rescue times, suggest that socioeconomic status may be a predictor of mortality in fatal motor vehicle accidents. Effective emergency medical services are essential to reduce the morbidity and mortality among motor vehicle crash victims; however, disparities exist in the timeliness of these services by geographic and socioeconomic county characteristics. Further research is urgently needed to inform policy interventions.

Mobile Integrated Health and Hospital Utilization for Congestive Heart Failure in a Rural Setting

Background: Heart failure is a leading cause of hospitalization with a high readmission rate. Mobile integrated health care (MIH) programs have expanded the role of emergency medical services to provide community-based care to patients with chronic disease, such as heart failure. However, there is little data published on the outcomes of MIH programs. Objective: This study evaluated the effect of a rural MIH program on emergency department and inpatient utilization for patients with congestive heart failure. Methods: A retrospective propensity score matched case-control study patients was performed for patients who participated in the MIH program associated with a single rural Pennsylvania health system between April 2014 and June 2020. Cases and controls were matched based on demographics and comorbidities. Pre- and post-intervention utilization were examined at 30, 90, and 180 days from the index encounters within the treatment groups, and then compared to the change in utilization among controls. Results: 1237 patients were analyzed. The change in all-cause ED utilization among cases was significantly better than the change in ED utilization among controls at 30 (Δ = -3.6%; 95% CI: −6.1%, −1.1%) and 90 days (Δ = -3.5%; 95% CI: −6.7%, −0.2%). There was no significant change in all-cause inpatient utilization at 30, 90, or 180 days. Limiting to CHF-only encounters also showed no significant change in utilization between cases and controls at any of the time intervals. Conclusion: Analysis of this MIH program demonstrates efficacy in delivering community-based care to reduce all-cause ED utilization. Prospective studies should be conducted to better assess the effects on inpatient utilization, cost data, and patient satisfaction to evaluate the effectiveness of such programs more holistically.

Advanced-level paramedics’ support needs for developing and utilising competence

IntroductionParamedic competence plays a vital role in emergency medical services (EMS), as the pre-hospital setting demands a wide variety of competencies from paramedics. The aim of the study was to examinethesupportthatadvanced-level paramedics need from their supervisors to develop and utilise their competence. MethodsQualitative essay material was collected from a group of experienced advanced-level paramedics (n = 41). The material was analysed with inductive content analysis. ResultsTwenty-eight sub-categories emerged, forming 6 categories further leading to the grouping of two main categories: 1) the enablement of human resource (HR) management and leadership; and 2) guidelines on how to operate EMS adequately. ConclusionsSupervisors can and should support advanced-level paramedics in their competence utilisation and development. This can be achieved by enabling professional growth by recognising competencies and generating supportive leadership in EMS. Paramedics would also benefit from clear operative guidelines. Overall, supporting paramedics’ competence utilisation and development is strongly connected with leadership standards in daily practices.

Rajindra Singh Gill

<h3>Background</h3> Low/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical...

Challenges of Emergency Medical Services Response to Arasbaran Twin Earthquakes; a Content Analysis

Introduction:One of the most important concerns in responding to disasters is providing Basic Life Support (BLS) services. Considering the key role of Emergency Medical Services (EMS) in providing BLS, the purpose of this study is to investigate the experience of provincial EMS during their response to the Arasbaran twin earthquakes and its challenges in Iran.Methods:This study was conducted using a qualitative approach and the conventional content analysis method. Data were collected through Focused Group Discussions (FGD) and semi-structured in-depth interviews with purposively-selected EMS paramedics and officials in East Azerbaijan Province, Iran. To form the main categories, the interviews were encoded in three stages and the similar codes were placed under the same subcategories and merged. Results:A total of 26 EMS paramedics participated in the study. The codes extracted from the interviews, after three stages of reduction, were placed in the top ten categories, including the lack of preparedness and coordination, dead bodies' management challenges, responders’ psychosocial support, deficiencies in supplies and ambulances, difficulty of access to rural areas, volunteer management, non-documentation of the experiences, communication challenges, recalling, and deploying of EMS responders. Conclusion:Timely response of the EMS and paramedics’ sense of responsibility for providing services were positive and successful points about the emergency response operations. The weaknesses of EMS should, therefore, be addressed through transferring of experiences and by planning and arranging training courses.

Role of Emergency Medical Services in pre-hospital Management of Road Accidents, appropriate on-site Actions.

Introduction: Around 1.250000 people die each year due to traffic accidents. Traffic accident injuries are the leading cause of death in the most productive age group – 20-45 years old. 20 to 50 million people end up with injuries, disability because of traffic accident injuries.&#x0D; Purpose of study: To identify the most common factors of traffic accidents. To compare the number of accidents and casualties at local, regional and global level. To evaluate the way traffic accidents are handled from urgent medicine services and the Emergency Medical Center (EMC) in particular.&#x0D; To improve the quality of management traffic accident from medical teams.&#x0D; Material and methods: data for this paper is extracted from EMC and archive protocols in different years, carrying out data analysis. We have cooperated with EMC of University Clinical Center of Kosovo (UCCK), and Kosovo Police – Pristina regional unit. Retrospective method of research and afterwards descriptive and analytical method has been applied.&#x0D; Results: According to Police statistics, the largest number of accidents in traffic in Kosovo.&#x0D; The EMC in Pristina had 1024 traffic accident interventions in 2019 but 2020 the traffic accidents are lowest for 181 accidents, because we have the decrease in circulation as a result of the CIVID pandemic 19. The largest number was in August – 198 cases (15.4 %) while the lowest number was in May – 69 (5.4%). Of 604 cases of traffic accidents that have been analyzed, 212 or 35.1 % included persons of age group 16-25. Of the total number, 411 or 68.04 % were males and 193 or 31,9 % were females.&#x0D; Conclusion: The main factor of traffic accidents remains human factor. Traffic accidents increase the incidence of death and disability in general population.&#x0D; Enforcing Emergent Medical Services, promoting and educating the population, institutional cooperating, have positive impact in reducing the number of traffic accident, decreasing mortality and disability caused by traffic accidents.&#x0D; Proposal of measures: organizing seminars in national level for young people in order to increase the awareness about dangers in traffic, educating children in kindergartens, elementary schools and high schools…

Maximizing the Role of Emergency Medical Services in COVID-19 Response.

The Centers for Disease Control and Prevention define 6 intervals of a pandemic: (1) investigation of cases, (2) recognition of the increased potential for ongoing transmission, (3) initiation of a pandemic wave, (4) acceleration of a pandemic wave, (5) deceleration of a pandemic wave, and (6) preparation for future pandemic waves. Each of these stages has 8 domains. Following China's coronavirus disease 2019 (COVID-19) outbreak announcement, Israel's National Emergency Medical Services (EMS) Organization immediately began working in conjunction with the Ministry of Health (MOH) to address the threat of the COVID-19 outbreak. This article will describe how a national EMS organization acted according to these pandemic intervals and domains. In the initial stages, EMS managed a checkpoint in the international airport voluntarily testing people for febrile symptoms. Calls to the dispatch centers that aroused the suspicion of COVID-19 resulted in EMS transport to the hospital with protective gear. During the period of first exposure, the scope of the medical emergency number was increased to include questions concerning coronavirus, telemedicine, and home sampling by protected EMS workers. In the contagion stages, epidemiological tests were conducted by the MOH, and EMS began operating dedicated telephone triage, mass drive-through sampling, and finally, administration of vaccinations.

Moving the needle on fall prevention: A Geriatric Emergency Care Applied Research (GEAR) Network scoping review and consensus statement.

Although falls are common, costly, and often preventable, emergency department (ED)-initiated fall screening and prevention efforts are rare. The Geriatric Emergency Medicine Applied Research Falls core (GEAR-Falls) was created to identify existing research gaps and to prioritize future fall research foci. GEAR's 49 transdisciplinary stakeholders included patients, geriatricians, ED physicians, epidemiologists, health services researchers, and nursing scientists. We derived relevant clinical fall ED questions and summarized the applicable research evidence, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews. The highest-priority research foci were identified at the GEAR Consensus Conference. We identified two clinical questions for our review (1) fall prevention interventions (32 studies) and (2) risk stratification and falls care plan (19 studies). For (1) 21 of 32 (66%) of interventions were a falls risk screening assessment and 15 of 21 (71%) of these were combined with an exercise program or physical therapy. For (2) 11 fall screening tools were identified, but none were feasible and sufficiently accurate for ED patients. For both questions, the most frequently reported study outcome was recurrent falls, but various process and patient/clinician-centered outcomes were used. Outcome ascertainment relied on self-reported falls in 18 of 32 (56%) studies for (1) and nine of 19 (47%) studies for (2). Harmonizing definitions, research methods, and outcomes is needed for direct comparison of studies. The need to identify ED-appropriate fall risk assessment tools and role of emergency medical services (EMS) personnel persists. Multifactorial interventions, especially involving exercise, are more efficacious in reducing recurrent falls, but more studies are needed to compare appropriate bundle combinations. GEAR prioritizes five research priorities: (1) EMS role in improving fall-related outcomes, (2) identifying optimal ED fall assessment tools, (3) clarifying patient-prioritized fall interventions and outcomes, (4) standardizing uniform fall ascertainment and measured outcomes, and (5) exploring ideal intervention components.

Role of Emergency Medical Services in Disaster Response - National Association of EMS Physicians Position Statement

This is the official position statement of the National Association of EMS Physicians on the role of emergency medical services (EMS) in disaster response.

Examining the Timeliness of ST-elevation Myocardial Infarction Transfers.

IntroductionDespite large-scale quality improvement initiatives, substantial proportions of patients with ST-elevation myocardial infarction (STEMI) transferred to percutaneous coronary intervention centers do not receive percutaneous coronary intervention within the recommended 120 minutes. We sought to examine the contributory role of emergency medical services (EMS) activation relative to percutaneous coronary intervention center activation in the timeliness of care for patients transferred with STEMI.MethodsWe conducted a retrospective analysis of interfacility transfers from emergency departments (ED) to a single percutaneous coronary intervention center between 2011–2014. We included emergency department (ED) patients transferred to the percutaneous coronary intervention center and excluded scene transfers and those given fibrinolytics. We calculated descriptive statistics and used multivariable linear regression to model the association of variables with ED time intervals (arrival to electrocardiogram [ECG], ECG-to-EMS activation, and ECG-to-STEMI alert) adjusting for patient age, gender, mode of arrival, weekday hour presentation, facility transfers in the past year, and transferring facility distance.ResultsWe identified 159 patients who met inclusion criteria. Subjects were a mean of 59 years old (standard deviation 13), 22% female, and 93% White; 59% arrived by private vehicle, and 24% presented after weekday hours. EDs transferred a median of 9 STEMIs (interquartile range [IQR] 3, 15) in the past year and a median of 65 miles (IQR 35, 90) from the percutaneous coronary intervention center. Median ED length of stay was 65 minutes (IQR 51, 85). Among component intervals, arrival to ECG was 6%, ECG-to-EMS activation 32%, and ECG-to-STEMI alert was 49% of overall ED length of stay. Only 18% of transfers had EMS activation earlier than STEMI alert. ECG-to-EMS activation was shorter in EDs achieving length of stay ≤60 minutes compared to those >60 minutes (12 vs 31 minutes, P<0.001). Multivariable modeling showed that after-hours presentation was associated with longer ECG-to-EMS activation (adjusted relative risk [RR] 1.05, P<0.001). Female gender (adjusted RR 0.81, P<0.001), prior facility transfers (adjusted RR 0.84, P<0.001), and initial ambulance presentation (adjusted RR 0.93, P = 0.02) were associated with shorter ECG-to-EMS activation.ConclusionIn STEMI transfers, faster EMS activation was more likely to achieve a shorter ED length of stay than a rapid, percutaneous coronary intervention center STEMI alert. Large-scale quality improvement efforts such as the American Heart Association’s Mission Lifeline that were designed to regionalize STEMI have improved the timeliness of reperfusion, but major gaps, particularly in interfacility transfers, remain. While the transferring EDs are recognized as the primary source of delay during interfacility STEMI transfers, the contributions to delays at transferring EDs remain poorly understood.

Pre-Hospital Management, Injuries and Disposition of Ambulance Attended Adults who Fall: A Scoping Review Protocol

Introduction Falls are a globally prevalent health issue, with 37.3 million falls severe enough to require medical attention each year. Falls can result in major trauma and are the second leading cause of unintentional injury deaths worldwide. The role of emergency medical services (EMS) in the pre-hospital emergency treatment of falls is critical, however the sources describing this phase of care has not previously been synthesised. The aim of this scoping review is to identify and map the published literature on the characteristics and injuries of adults who fall, are attended by EMS, EMS interventions and patient disposition. Methods The methods for scoping reviews outlined by the JBI Manual for Evidence Synthesis will be used. Databases including Medline, Scopus, CINAHL Plus, Cochrane, EMBASE and ProQuest will be searched from inception. Reference lists of included sources will also be searched. Two reviewers will independently complete title, abstract and full text screening. Included sources will be summarised using narrative synthesis and conceptual categories including patient characteristics, injuries, EMS intervention and patient disposition will be mapped. Discussion This protocol describes the framework to identify the scope, comprehensiveness and concepts surrounding pre-hospital falls to identify gaps in knowledge regarding the role of EMS in attending patients who sustain a fall.

The Role of Israel's Emergency Medical Services During a Pandemic in the Pre-Exposure Period.

The scientific literature on coronavirus disease (COVID-19) is extensive, but little is written about the role of emergency medical services (EMS). The objective of this study is to describe the role of Magen David Adom (MDA), Israel's national emergency prehospital medical organization, in the pre-exposure period, before widespread governmental action. These efforts were based on (1) phone diagnosis, dispatch, and transport; and (2) border management checkpoints. This is a descriptive study of MDA's role in pandemic response during the pre-exposure period. Medical emergency telephone calls from either individuals or medical sources were identified by a dispatcher as "suspected COVID-19" based on symptoms and travel exposure. Data were also collected for travelers approaching the MDA border checkpoint at Ben-Gurion International Airport. The total number of protected transports during this time was 121. Of these, 44 (36.3%) were referred by medical sources, and 77 (63.7%) were identified as "suspected COVID-19" by dispatchers. The checkpoint was accessed by 156 travelers: 87 were sent to home-quarantine; 12 were transported to the hospital; 18 were refused entry; and 39 required no further action. EMS can work effectively in the pre-exposure period through instructing home quarantine, providing protected transport, and staffing border control checkpoints.

The Role of Emergency Medical Services in the Opioid Epidemic

The opioid crisis is an ongoing public health concern and EMS agencies are in a critical position to reach at-risk populations. The traditional role of EMS in treating acute opioid overdoses has expanded to include preventative strategies as well as long-term treatment and recovery options. EMS agencies are uniquely positioned to partner with local community resources and hospitals to combine efforts in implementing harm-reduction strategies.

The Role of Emergency Medical Services in Earthquake Response: Integrating the ABC Approach of Israel's Magen David Adom.

Throughout history, earthquakes have caused devastation and loss of life. Emergency medical services (EMS) plays a vital role in the response to any mass-casualty incident or disaster. Magen David Adom, Israel's premier EMS organization, has a unique strategy known as the ABC approach to earthquake response. It involves thousands of salaried workers and trained volunteers who are prepared to respond to an earthquake based on the extent of the disaster. Depending on the amount of destruction, they will be working locally or available to help in other areas. A Level A earthquake causes local destruction and minimal casualties. Any EMS responders in that area as well as in surrounding areas will be available to help. Furthermore, all responders will need to work automatically and autonomously. A Level B earthquake causes extensive destruction, and all responders in the region will be busy caring for the victims. Anyone available outside of the region will come and help. A Level C earthquake is completely devastating, and all workers nationwide will be involved in responding to the catastrophe. The role of EMS responders using the ABC approach to earthquake response, as described here, may be integrated in part or whole in other EMS systems.

Development of a Logic Model to Guide Implementation and Evaluation of a Mobile Integrated Health Transitional Care Program.

To provide medical and social services to underserved communities, many health care organizations across the United States have expanded the role of emergency medical services to include mobile integrated health and community paramedicine (MIH-CP). Although MIH-CP programs differ in structure and setting, many share the common goal of improving health through home-based, patient-centered care management models. Ideally, these innovative programs reduce use of health care services, including 911 (US emergency system) calls and emergency department visits. In 2018 a large, urban academic medical center partnered with the city's fire department to establish an MIH-CP program to support patients as they transition in their first 30 days at home after hospitalization. Prior to launch, a multidisciplinary team developed a logic model to guide development, implementation, and evaluation of this complex and innovative program. This paper describes the team's structured process for developing a logic model. It also describes key components of the initial logic model and the Transitional Health Support program structure, as well as subsequent revisions to both.

Исторические аспекты учения об остром коронарном синдроме

The milestones of evolution of acute coronary syndrome doctrine were summarized in the literature review. The contribution of national and foreign scientists in understanding of pathogenetic mechanisms of this disease was introduced. The role of emergency medical services, intensive cardiac care units, reperfusion interventions and up to date pharmacotherapy in reducing the mortality rate of acute coronary syndrome patients was highlighted.

Timely access to care for patients with critical burns in India: a prehospital prospective observational study

BackgroundLow/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care...