Single Emergency Medical Services Research Articles

Timing of emergency medical services activations for falls

ObjectiveFalls are a major challenge to public health, particularly among older adults. Understanding factors that influence fall risk is pivotal in the prevention of falls and fall-related injuries. This study evaluated the timing of emergency medical service (EMS) activations for falls and transport patterns for adults age ≥65. MethodsA patient care report system at a single fire-based emergency medical service agency in a suburban, Midwest city was retrospectively reviewed. Type of call (lift assist/fall), time of injury (time, day, and month), and demographics (sex, age) were collected for residents age ≥65 who activated 9–1–1 for a lift assist or fall. Results1169 calls met inclusion criteria. Mornings and afternoons were the time of day associated with falls (33 % and 36 % of EMS activations, respectively, vs. 21 % and 10 % for evenings and nights, respectively; p = 0.002) while day of the week and month were not associated with falls or lift assists. More males requested lift assists than females (256 vs. 238) and more females called for falls than males (408 vs. 267; p < 0.001). Falls were more likely to be associated with transport to the hospital than lift assists (78% vs. 7 %). Female sex was associated with increased risk for transport to the hospital (60 % of females vs. 40 % of males; p < 0.001). ConclusionsMornings and afternoons were associated with increased risk for falls and sex (female) with increased risk for transport to the hospital.

Use of Stroke Alert Sticker in the Field Decreases Time to Acute Interventions for Ischemic Stroke Patients.

BACKGROUND: Stroke is a medical emergency requiring timely intervention to optimize patient outcomes. The only treatments currently Food and Drug Administration approved for acute stroke are intravenous (IV) thrombolytics, which require obtaining specific medical history to be administered safely. This medical history may be overlooked in the prehospital setting or lost during patient handoff between emergency medical services (EMS) personnel and hospital staff, delaying treatment. We evaluated whether utilization of a "stroke alert sticker" by EMS to capture key information in the field would decrease door-to-needle (DTN) time. METHODS: Bright-orange "stroke alert stickers" were disseminated to our local EMS agency to be placed on all suspected stroke patients in the field prompting documentation of key elements needed for timely treatment decisions. The "stroke alert sticker" included time last known well, contact information, presenting symptoms, and relevant medications. We evaluated the impact of the "stroke alert sticker" on acute stroke metrics, including DTN time. RESULTS: The project included 220 consecutive stroke alert patients brought to our comprehensive stroke center by a single EMS agency from May 2021 through February 2022. Twenty-one patients were treated with an IV thrombolytic. Overall "stroke alert sticker" use compliance was 40%; for the subgroup of patients who were given an IV thrombolytic, the "stroke alert sticker" was used 60% of the time. In patients who received an IV thrombolytic, prehospital EMS notification was 100% with "stroke alert sticker" use, compared with 75% without (P = .13). In addition, with "stroke alert sticker" utilization, DTN time was reduced by 20 minutes (31 [11] minutes with sticker vs 51 [21] minutes without, P = .04). CONCLUSION: Utilization of the "stroke alert sticker" significantly improved DTN times compared with patients without the sticker. This evidence supports continued use of the "stroke alert sticker" to improve DTN times and patient outcomes.

Improving outcomes from paediatric cardiac arrest in low resource setting

Abstract Introduction Both out of (OHCA) and in hospital (IHCA) pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. This is further magnified by resuscitation protocols are typically articulated from the perspective of ideal resource environment without consideration of applicability in district hospitals or non-tertiary centres. Purpose To determine clinical outcomes from both paediatric OHCA and IHCA in low-resource setting and to identify shortcomings in relation to resuscitation in these areas, possible solutions and to suggest future research priorities. Methods This was a multicenter retrospective study in a middle sized city (estimated population 390000) served by a single Emergency Medical Services (EMS) system. All records of OHCA and IHCA under 16 years old were reviewed from the Cardiac Arrest Registry from 2017 to 2022. Data collected included demographic profiles, etiology of cardiac arrest, initial cardiac rhythm, time of initiation of cardiopulmonary resuscitation (CPR) and adrenaline administration by EMS team and duration of CPR. Outcomes of interest included return of spontaneous circulation (ROSC) and survival to hospital discharge (STHD). Results From the 5-year study period, 68 children (mean age of 5.8±1.2 yrs) were included in this study. 22 (32.4%) were infants (&amp;lt;1 year old) and 7 (10.3%) were neonates (&amp;lt;28 days old). Total mortality was observed at 63.2% (n=43). Return of spontaneous circulation (ROSC) was achieved in 40 (58.8%) patients and 33.8% (n=23) survived to hospital discharge. OHCA was witnessed in 52 (83.8%) children from total OHCA and bystander CPR was delivered only in 19 (30.6%) cases. All IHCA were witnessed. Asystole was the most common (n=39) initial rhythm. A delay in initiating cardiopulmonary resuscitation (CPR) and adrenaline administration was observed in 49 cases of OHCA and 1 in IHCA. The median time from emergency call to CPR and from CPR to first adrenaline administration was 20.9±1.2 min and 2.9±1.3 min for OHCA and 0.4±0.2 min and 1.5±0.7min for IHCA [Table 1]. Longer time to CPR and adrenaline administration was associated with lower chance of achieving ROSC and STHD. Using multivariate analyses, fewer adrenaline doses (p&amp;lt;0.05), witnessed cardiac arrest (p=0.001), initial rhythm of ventricular fibrillation (p&amp;lt;0.05) and shorter CPR duration (p=0.007) were good prognostic factors for ROSC and STHD. Conclusion Outcomes from OHCA and IHCA in low resource settings are poor. Unwitnessed arrest, delays in initiation of CPR and adrenaline administration were associated with poor survival. Recognition and identification of at-risk patients, early high-quality CPR and adrenaline administration are imperative to improve mortality. Early recognition and effective resuscitation protocols for children in the community and encouraging bystander CPR should be developed collaboratively with local experts and the EMS team.

Optimizing a Drone Network to Respond to Opioid Overdoses.

Introduction:Effective out-of-hospital administration of naloxone in opioid overdoses is dependent on timely arrival of naloxone. Delays in emergency medical services (EMS) response time could potentially be overcome with drones to deliver naloxone efficiently to the scene for bystander use. Our objective was to evaluate a mathematical optimization simulation for geographical placement of drone bases in reducing response time to opioid overdose. Methods: Using retrospective data from a single EMS system from January 2016-February 2019, we created a geospatial drone-network model based on current technological specifications and potential base locations. Genetic optimization was then used to maximize county coverage by drones and the number of overdoses covered per drone base. From this model, we identified base locations that minimize response time and the number of drone bases required. Results: In a drone network model with 2,327 opioid overdoses, as the number of modeled drone bases increased the calculated response time decreased. In a geospatially optimized drone network with four drone bases, response time compared to ambulance arrival was reduced by 4 minutes 38 seconds and covered 64.2% of the county. Conclusion: In our analysis we found that in a mathematical model for geospatial optimization, implementing four drone bases could reduce response time of 9-1-1 calls for opioid overdoses. Therefore, drones could theoretically improve time to naloxone delivery.

A 12-month retrospective descriptive analysis of a single helicopter emergency medical service operator in four South African provinces.

Helicopter Emergency Medical Services (HEMS) is integrated into modern emergency medical services because of its suggested mortality benefit in certain patient populations, it is an expensive resource and appropriate use/feasibility in low- to middle income countries (LMIC) is highly debated. To maximise benefit, correct patient selection in HEMS is paramount. To achieve this, current practices first need to be described. The study aims to describe a population of patients utilising HEMS in South Africa, in terms of flight data, patient demographics, provisional diagnosis, as well as clinical characteristics and interventions. A retrospective flight- and patient-chart review were conducted, extracting clinical and mission data of a single aeromedical operator in South Africa, over a 12-month period (July 2017 - June 2018) in Gauteng, Free State, Mpumalanga and North-West provinces. A total of 916 cases were included (203 primary cases, 713 interfacility transport (IFT) cases). Most patients transported were male (n=548, 59.8%) and suffered blunt trauma (n=379, 41.4%). Medical pathology (n=247, 27%) and neonatal transfers (n=184, 20.1%) follows. Flights occurred mainly in daylight hours (n=729, 79.6%) with median mission times of 1-hour 53 minutes (primary missions), and 3 hours 10 minutes (IFT missions). Median on-scene times were 26 minutes (primary missions) and 55 minutes (IFT missions). Almost half were transported with an endotracheal tube (n=428, 46.7%), with a large number receiving no respiratory support (n=414, 45.2%). No patients received fibrinolysis, defibrillation, cardioversion or cardiac pacing. Intravenous fluid therapy (n=867, 94.7%) was almost universal, with common administration of sedation (n=430, 46.9%) and analgesia (n=329, 35.9%). Apart from the lack of universal call-out criteria and response to the high burden of trauma, HEMS seem to fulfil an important critical care transport role. It seems that cardiac pathologies are under-represented in this study and might have an important implication for crew training requirements.

A pilot, prospective trial of IntuBrite® versus Macintosh direct laryngoscopy for paramedic endotracheal intubation in out of hospital cardiac arrest

BackgroundIntubation in the case of out-of-hospital cardiac arrest (OHCA) is one of the most difficult procedures for Emergency Medical Services (EMS). The use of a laryngoscope with a dual light source is an interesting alternative to classic laryngoscopes. However, there are as yet no prospective data concerning the use of double light direct laryngoscopy (DL) by paramedics in traditional ground ambulance agencies in OHCA.MethodsWe performed a non-blinded trial in a single EMS in Poland within ambulances crews, comparing time and first pass success (FPS) for endotracheal intubation (ETI) in DL using the IntuBrite® (INT) and Macintosh laryngoscope (MCL) during cardiopulmonary resuscitation (CPR). We collected both patient and provider demographic information along with intubation details. The time and success rates were compared using an intention-to-treat analysis.ResultsOver a period of 40 months, a total of 86 intubations were performed using 42 INT and 44 MCL based on an intention-to-treat analysis. The FPS time of the ETI attempt (13.49 vs. 15.55 s) using an INT which was shorter than MCL was used (p < 0.05). First attempt success (34/42, 80.9% vs. 29/44, 64.4%) was comparable for INT and MCL with no statistical significance.ConclusionsWe found a statistically significant difference in intubation attempt time when the INT laryngoscope was used. Intubation first attempt success rates with INT and MCL were comparable with no statistical significance during CPR performed by paramedics.Trial RegistrationTrial was registered in Clinical Trials: NCT05607836 (10/28/2022)

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

Association of Prehospital Needle Decompression With Mortality Among Injured Patients Requiring Emergency Chest Decompression

Prehospital needle decompression (PHND) is a rare but potentially life-saving procedure. Prior studies on chest decompression in trauma patients have been small, limited to single institutions or emergency medical services (EMS) agencies, and lacked appropriate comparator groups, making the effectiveness of this intervention uncertain. To determine the association of PHND with early mortality in patients requiring emergent chest decompression. This was a retrospective cohort study conducted from January 1, 2000, to March 18, 2020, using the Pennsylvania Trauma Outcomes Study database. Patients older than 15 years who were transported from the scene of injury were included in the analysis. Data were analyzed between April 28, 2021, and September 18, 2021. Patients without PHND but undergoing tube thoracostomy within 15 minutes of arrival at the trauma center were the comparison group that may have benefited from PHND. Mixed-effect logistic regression was used to determine the variability in PHND between patient and EMS agency factors, as well as the association between risk-adjusted 24-hour mortality and PHND, accounting for clustering by center and year. Propensity score matching, instrumental variable analysis using EMS agency-level PHND proportion, and several sensitivity analyses were performed to address potential bias. A total of 8469 patients were included in this study; 1337 patients (11%) had PHND (median [IQR] age, 37 [25-52] years; 1096 male patients [82.0%]), and 7132 patients (84.2%) had emergent tube thoracostomy (median [IQR] age, 32 [23-48] years; 6083 male patients [85.3%]). PHND rates were stable over the study period between 0.2% and 0.5%. Patient factors accounted for 43% of the variation in PHND rates, whereas EMS agency accounted for 57% of the variation. PHND was associated with a 25% decrease in odds of 24-hour mortality (odds ratio [OR], 0.75; 95% CI, 0.61-0.94; P = .01). Similar results were found in patients who survived their ED stay (OR, 0.68; 95% CI, 0.52-0.89; P < .01), excluding severe traumatic brain injury (OR, 0.65; 95% CI, 0.45-0.95; P = .03), and restricted to patients with severe chest injury (OR, 0.72; 95% CI, 0.55-0.93; P = .01). PHND was also associated with lower odds of 24-hour mortality after propensity matching (OR, 0.79; 95% CI, 0.62-0.98; P = .04) when restricting matches to the same EMS agency (OR, 0.74; 95% CI, 0.56-0.99; P = .04) and in instrumental variable probit regression (coefficient, -0.60; 95% CI, -1.04 to -0.16; P < .01). In this cohort study, PHND was associated with lower 24-hour mortality compared with emergent trauma center chest tube placement in trauma patients. Although performed rarely, PHND can be a life-saving intervention and should be reinforced in EMS education for appropriately selected trauma patients.

Hockey Puck Strike Rates and Injuries at National Hockey League Games: A Retrospective Analysis of Data from Six Seasons.

This paper provides a large-scale, per-National Hockey League (NHL) season analysis of hockey puck strike (HPS) injury data and also provides estimates of injury frequency and severity. The study's goal was to quantify and describe the rate and type of spectator HPS injuries at NHL games. This was a retrospective review of summary data reports for patients evaluated by on-site health care providers over six seasons (2013-2018). Data were obtained from a single Emergency Medical Service (EMS) agency. Location of study was one US-based NHL venue. There were 51 HPS recorded. This accounted for 0.93% of total patient contacts translating to a patient per 10,000 (PPTT) of 0.116. This was compared to a PPTT of 12.6 for all patient contacts. The average age of a patron with a HPS was 31 years old. There was an even split between male and female patrons with HPS. The most common location for a HPS was the head or face (75%) followed by upper extremity injuries. Laceration was most frequently diagnosed followed by contusions and pain. Approximately one-quarter of people struck by hockey pucks were transported to the hospital, with the transport to hospital rate (TTHR) being 0.027, compared to the total TTHR of 2.7. Hockey is a safe sport to watch, although HPS are the spectator hazard of concern given that pucks can travel into the stands at 100mph. Most injuries are minor and occur only one percent of the time; but when they do occur, these fans tend to need transport to the hospital. Finally, HPS tend to occur along the lateral sides of the rink where the glass level is lower and there is no protective netting.

An Incomplete Medical Record: Transfer of Care From Emergency Medical Services to the Emergency Department

Background: Transition of care from Emergency Medical Services (EMS) to the Emergency Department (ED) represents an intersection at high risk for error. Minimal research has quantitatively examined data transfer at this point. In Pennsylvania, this handoff consists of a transfer-of-care form (TOC) provided by EMS to ED in addition to a verbal report. A prehospital patient care report (PCR) is later filed by EMS up to 72 hours after concluding care.Objective: To evaluate the congruence between prehospital records provided at handoff and the final PCR found in the patient’s medical record. Our hypothesis was that there would be discrepancies between the TOC and final PCR.Methods: A retrospective chart review was conducted comparing the TOC from a single EMS agency to the final PCR found in the electronic medical record. A convenience sample of 200 patients who received advanced life support transport over a one-month period were included. Metrics to assess the discrepancy between the reports included chief complaint, allergies, medications, systolic and diastolic blood pressure (SBP and DBP), pulse, respiratory rate (RR), Glasgow Coma Score (GCS), and prehospital treatment provided. The level of agreement between the two sources was compared using kappa statistics and concordance correlation coefficients (CCC) with 95% confidence intervals.Results: Of the 200 encounters that met inclusion criteria, 72% had matching chief complaints between the TOC and PCR. Medications matched in 66% and allergies matched in 82%. Up to three BP, pulse, and RR readings were collected; only 30% of the third BP readings were available from the TOC, while 68% were available from the PCR. Comparing the three SBP values on the TOC to respective counterparts on the PCR showed a substantial correlation (all CCC >0.95). Pulse and DBP values had moderate-to-substantial correlation (CCC: 0.93, 0.94, 0.96 and 0.77, 0.92, 0.94 respectively). RR showed inconsistent correlation (CCC: 0.37, 0.84, 0.94). GCS showed a moderate correlation between the two forms (CCC: 0.81).Conclusion: There were significant differences between the information transferred to the ED through the TOC compared to what was recorded in the PCR. Further evaluation of the TOC process is needed to improve accuracy.

A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma

BackgroundResuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment.MethodsThe electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ2 tests. A p value < 0.05 was considered statistically significant.ResultsForty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs.ConclusionPrehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage.

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.

Efficacy of bolus-dose epinephrine to manage hypotension in the prehospital setting.

Hypotension in the Emergency Department (ED) and the prehospital setting has been associated with significant morbidity and mortality. Limited literature exists exploring the utilization of intravenous (IV) bolus-dose epinephrine (BDE) by Emergency Medical Services (EMS). A retrospective review evaluated patients transported to an academic medical center who had received IV BDE by a single urban EMS system from 2016 to 2020. The primary outcome was to assess the influence IV BDE had on systolic blood pressure (SBP). Secondary objectives were to assess changes in heart rate (HR), the impact of dose variability on SBP, and the incidence of severe hypertension (SBP > 220 mmHg). A total of 55 patients who received 96 administrations of IV BDE were included in the analysis. The most common individual dose was 10 μg (76.0%) and 45.5% received multiple doses. The median weight-based dose of BDE was 0.14 μg/kg. A significant increase in SBP (median 14.0 mmHg) was noted among all patients following BDE administration compared with baseline (p < 0.001). No significant difference was found in HR following BDE compared with baseline (p = 0.375). Those that received a BDE dose >10 μg were noted to have a significantly greater rise in SBP than those that received 10 μg (30.0 mmHg vs. 11.0 mmHg; p = 0.022). Similarly, patients that received a dose ≥0.2 μg/kg had a significantly greater increase in SBP compared with those that received <0.2 μg/kg (30.0 mmHg vs. 10.0 mmHg; p = 0.048). There were no incidences of severe hypertension following therapy. The utilization of IV BDE in the prehospital setting for acute hypotension resulted in a significant rise in SBP. A dose-response relationship was noted both in terms of a flat-based dose and a weight-based dose, with higher doses yielding a greater change in SBP. Additional investigations are necessary to further explore the most appropriate dose of this agent in this setting and its influence, if any, on clinical outcomes.

Flight Teams’ Learning Needs Assessment on Ultrasound: A Mixed Methods Approach

ObjectiveThe goal of this study was to understand flight clinicians’ learning needs and attitudes with regard to a prehospital ultrasound curriculum.Methods: In this convergent mixed methods study, 21 prehospital clinicians completed a questionnaire, and 20 attended a 1-hour focus group to explore attitudes regarding learning ultrasound. These participants were from a single emergency medical service agency. ResultsFive themes emerged from the focus group transcripts and were supported by the quantitative data: 1) theme 1, hands-on training in ultrasound is a highly preferred modality; 2) theme 2, emergency medical service providers desire learning integrated into shifts and real-life practice; 3) theme 3, prehospital providers express concerns about training and maintenance of competency; 4) theme 4, participants recognize the need for quality control during the training phase and after; and 5) theme 5, participants were enthusiastic about how ultrasound could help guide clinical decision making and potentially improve patient outcomes. ConclusionThose who participated in an evidence-based assessment of prehospital ultrasound needs and barriers were experienced flight clinicians who would use prehospital ultrasound if made available. These adult learners indicated their preferred learning method would be using standardized patients, simulators, and hands-on in the field with physicians. They preferred follow-up courses and simulators to maintain competency.

Barriers and facilitators to the administration of prehospital tranexamic acid: a paramedic interview study using the theoretical domains framework

BackgroundTranexamic acid (TXA) is an antifibrinolytic drug used to prevent bleeding. It was introduced as an intervention for post-traumatic haemorrhage across emergency medical services (EMS) in the UK during 2012....

Helicopter Emergency Medical Services Out-of-Hospital Cardiac Arrests During the Initial COVID-19 Lockdown Versus Nonpandemic: A Comparison

ObjectiveCOVID-19 may have contributed to an excess of out-of-hospital cardiac arrests (OOHCAs). This observational study identified changes in OOHCA epidemiology pre– and post–COVID-19 lockdown in a single UK helicopter emergency medical service (HEMS). MethodsA retrospective, single-center (Essex & Herts Air Ambulance), observational study was undertaken with anonymized OOHCA data (demographics, etiology, and outcomes) from March 23, 2020, to June 23, 2020, and comparative data from March 23, 2019, to June 23, 2019. Supplementary data (total OOHCAs and patient outcomes) were provided by the East of England Ambulance Service National Health Service Trust. Data were analyzed using the Mann-Whitney U test and chi-square test; P < .05 was statistically significant.Results: Of the HEMS activations during national lockdown, 33.6% were for OOHCAs compared with 25.8% during the reference time frame. The frequency of young and female OOHCAs demonstrated a statistically significant increase. Statistically significant variations in medical etiology and initial cardiac rhythm were identified. ConclusionDuring the initial UK-wide lockdown, the OOHCA characteristics attended by 1 HEMS team were altered. The changes seen may be due to the pathophysiology of COVID-19 or an alteration in dispatch due to the demand placed on the wider ambulance service; this may require further consideration for any future lockdowns or pandemics.

Reasons behind failed prehospital intubation attempts while combining C-MAC videolaryngoscope and Frova introducer.

High first-pass success rate is achieved with the routine use of C-MAC videolaryngoscope and Frova introducer. We aim to identify potential reasons and subgroups associated with failed intubation attempts, analyse actions taken after them and study possible complications. We conducted a retrospective observational study of adult intubated patients at a single helicopter emergency medical service unit in southern Finland between 2016 and 2018. We collected data on patient characteristics, reasons for failed attempts, complications and follow-up measures from a national helicopter emergency medical service database and from prehospital patient records. 1011 tracheal intubations were attempted. First attempt was successful in 994 cases (FPS 994/1011, 98.3%), 15 needed a second or third attempt and two a surgical airway (non-FPS 17/1011, 1.7%, 95% CI 1.0-2.7). The failed first attempt group had heterogenous characteristics. The most common cause for a failed first attempt was obstruction of the airway by vomit, food, mucus or blood (10/13, 76%). After the failed first attempt, there were six cases (6/14, 43%) of deviation from the protocol and the most frequent complications were five cases (5/17, 29%) of hypoxia and four cases (4/17, 24%) of hypotension. When a protocol combining the C-MAC videolaryngoscope and Frova introducer is used, the most common reason for a failed first attempt is an airway blocked by gastric content, blood or mucus. These findings highlight the importance of effective airway decontamination methods and questions the appropriateness of anatomically focused pre-intubation assessment tools when such protocol is used.

Incidence of hyperoxia in trauma patients receiving pre-hospital emergency anaesthesia: results of a 5-year retrospective analysis

BackgroundPrevious studies have demonstrated an association between hyperoxia and increased mortality in various patient groups. Critically unwell and injured patients are routinely given high concentration oxygen in the pre-hospital phase of care. We aim to investigate the incidence of hyperoxia in major trauma patients receiving pre-hospital emergency anesthesia (PHEA) in the pre-hospital setting and determine factors that may help guide clinicians with pre-hospital oxygen administration in these patients.MethodsA retrospective cohort study was performed of all patients who received PHEA by a single helicopter emergency medical service (HEMS) between 1 October 2014 and 1 May 2019 and who were subsequently transferred to one major trauma centre (MTC). Patient and treatment factors were collected from the electronic patient records of the HEMS service and the MTC. Hyperoxia was defined as a PaO2 > 16 kPA on the first arterial blood gas analysis upon arrival in the MTC.ResultsOn arrival in the MTC, the majority of the patients (90/147, 61.2%) had severe hyperoxia, whereas 30 patients (20.4%) had mild hyperoxia and 26 patients (19.7%) had normoxia. Only 1 patient (0.7%) had hypoxia. The median PaO2 on the first arterial blood gas analysis (ABGA) after HEMS handover was 36.7 [IQR 18.5–52.2] kPa, with a range of 7.0–86.0 kPa. SpO2 pulse oximetry readings before handover were independently associated with the presence of hyperoxia. An SpO2 ≥ 97% was associated with a significantly increased odds of hyperoxia (OR 3.99 [1.58–10.08]), and had a sensitivity of 86.7% [79.1–92.4], a specificity of 37.9% [20.7–57.8], a positive predictive value of 84.5% [70.2–87.9] and a negative predictive value of 42.3% [27.4–58.7] for the presence of hyperoxemia.ConclusionTrauma patients who have undergone PHEA often have profound hyperoxemia upon arrival at hospital. In the pre-hospital setting, where arterial blood gas analysis is not readily available a titrated approach to oxygen therapy should be considered to reduce the incidence of potentially harmful tissue hyperoxia.

Emergency Medical Services amid New Wave of Coronavirus Disease 2019 Outbreak in Khon Kaen, Thailand

BACKGROUND: COVID-19 outbreaks occurring in many countries around the world have had a significant impact on emergency medical services (EMS) in terms of the number of operations and procedures performed, including those on ambulances. However, the number of EMS amid the rising number of COVID-19 cases in Khon Kaen, Thailand has not been well studied.&#x0D; AIM: The aim of this study was to identify and analyze the relationship between the use of EMS and the outbreak of COVID-19.&#x0D; METHODS: A cross-sectional study was done in Srinagarind Hospital, Khon Kaen, Thailand with a single EMS centered. Data was collected between March 27, 2021 and April 9, 2021 and designated as (Day-7 to Day 7 of pandemic services) as well as normal services which collected data between March 27 and April 9, 2019 (Day-7 to Day 7 of normal services).&#x0D; RESULTS: Three hundred eight EMS operations were examined. A total of 77.9% (n = 95) of pandemic services were for males and the mean age of the patients was 32.1 ± 5.4 years. During the normal services in 2019, the average number of EMS operations was 13.3 ± 2.4 times per day over the two weeks of the study. In 2021, before the outbreak (Day-7 to Day 1), the average number of EMS operations was 13.2 ± 1.8 times/day. After Day 1, there was a drop in the number of EMS operations which was associated with an increase in COVID-19 infections (p &lt; 0.001).&#x0D; CONCLUSIONS: The number of EMS users during the COVID-19 outbreak decreased considerably compared to the pre-epidemic levels and normal service intervals, including the severity of the users, were more severe than normal.

Real Time Telephone Application Use for Consultation in Emergency Medical Services

BACKGROUND: Emergency medical services (EMS) are an operation that requires speed and prompt decision-making to provide patients treatment and rescue them from crisis. A telephone application was created to be a communication channel. However, the effectiveness of EMS consulting via telephone application has not been well studied.&#x0D; AIM: The aim of this study was to describe the use of real-time telephone application use for consultation in EMS.&#x0D; METHODS: A cross-sectional, single EMS centered study at Srinagarind Hospital in Thailand. Data were gathered from LINE® Application under the name of “Current training EMKKU” and the EMS database throughout 2020-2021.&#x0D; RESULTS: A total of 11550 messages with 6221 general text; messages were not involved in patients’ consultant (53.86%). The consultation mostly took place during the afternoon shifts (4PM to 0AM) accounted for 45.11%. We found that Thursday (19.63%) was the day with most frequent consulting services, followed by Tuesday (16.05%) and Friday (16.03%) regarding the consultation. There were 45 active users in the LINE® Application under the name of “Current training EMKKU”. The mean age of the participants was 32.10±5.60 years, and 51.11% (n = 23) of them was female.&#x0D; CONCLUSIONS: The real-time telephone application is used for consultation related to patients' symptoms during EMS operations and ER patient care was most commonly in the afternoon and on Thursdays and Tuesdays.