State Emergency Medical Services Research Articles

The Performance of ChatGPT-4 and Gemini Ultra 1.0 for Quality Assurance Review in Emergency Medical Services Chest Pain Calls

ABSTRACT OBJECTIVES: This study assesses the feasibility, inter-rater reliability, and accuracy of using OpenAI's ChatGPT-4 and Google’s Gemini Ultra large language models (LLMs), for Emergency Medical Services (EMS) quality assurance. The implementation of these LLMs for EMS quality assurance has the potential to significantly reduce the workload on medical directors and quality assurance staff by automating aspects of the processing and review of patient care reports. This offers the potential for more efficient and accurate and identification of areas requiring improvement, thereby potentially enhancing patient care outcomes METHODS: Two expert human reviewers, ChatGPT GPT-4, and Gemini Ultra assessed and rated 150 consecutively sampled and anonymized prehospital records from 2 large urban EMS agencies for adherence to 2020 National Association of State EMS metrics for cardiac care. We evaluated the accuracy of scoring, inter-rater reliability, and review efficiency. The inter-rater reliability for the dichotomous outcome of each EMS metric was measured using the kappa statistic. RESULTS: Human reviewers showed high interrater reliability, with 91.2% agreement and a kappa coefficient, 0.782 (0.654-0.910). ChatGPT-4 achieved substantial agreement with human reviewers in EKG documentation and aspirin administration (76.2% agreement, kappa coefficient, 0.401 (0.334-0.468), but performance varied across other metrics. Gemini Ultra’s evaluation was discontinued due to poor performance. No significant differences were observed in median review times: 01:28 minutes (IQR 1:12 - 1:51 min) per human chart review, 01:24 minutes (IQR 01:09 – 01:53 min) per ChatGPT-4 chart review (p = 0.46), and 01:50 minutes (IQR 01:10-03:34 min) per Gemini Ultra review (p = 0.06). CONCLUSIONS: Large language models demonstrate potential in supporting quality assurance by effectively and objectively extracting data elements. However, their accuracy in interpreting non-standardized and time-sensitive details remains inferior to human evaluators. Our findings suggest that current LLMs may best offer supplemental support to the human review processes, but their value remains limited. Enhancements in LLM training and integration are recommended for improved and more reliable performance in the quality assurance processes.

The Performance of ChatGPT-4 and Gemini Ultra 1.0 for Quality Assurance Review in Emergency Medical Services Chest Pain Calls

ABSTRACT OBJECTIVES: This study assesses the feasibility, inter-rater reliability, and accuracy of using OpenAI's ChatGPT-4 and Google’s Gemini Ultra large language models (LLMs), for Emergency Medical Services (EMS) quality assurance. The implementation of these LLMs for EMS quality assurance has the potential to significantly reduce the workload on medical directors and quality assurance staff by automating aspects of the processing and review of patient care reports. This offers the potential for more efficient and accurate and identification of areas requiring improvement, thereby potentially enhancing patient care outcomes METHODS: Two expert human reviewers, ChatGPT GPT-4, and Gemini Ultra assessed and rated 150 consecutively sampled and anonymized prehospital records from 2 large urban EMS agencies for adherence to 2020 National Association of State EMS metrics for cardiac care. We evaluated the accuracy of scoring, inter-rater reliability, and review efficiency. The inter-rater reliability for the dichotomous outcome of each EMS metric was measured using the kappa statistic. RESULTS: Human reviewers showed high interrater reliability, with 91.2% agreement and a kappa coefficient, 0.782 (0.654-0.910). ChatGPT-4 achieved substantial agreement with human reviewers in EKG documentation and aspirin administration (76.2% agreement, kappa coefficient, 0.401 (0.334-0.468), but performance varied across other metrics. Gemini Ultra’s evaluation was discontinued due to poor performance. No significant differences were observed in median review times: 01:28 minutes (IQR 1:12 - 1:51 min) per human chart review, 01:24 minutes (IQR 01:09 – 01:53 min) per ChatGPT-4 chart review (p = 0.46), and 01:50 minutes (IQR 01:10-03:34 min) per Gemini Ultra review (p = 0.06). CONCLUSIONS: Large language models demonstrate potential in supporting quality assurance by effectively and objectively extracting data elements. However, their accuracy in interpreting non-standardized and time-sensitive details remains inferior to human evaluators. Our findings suggest that current LLMs may best offer supplemental support to the human review processes, but their value remains limited. Enhancements in LLM training and integration are recommended for improved and more reliable performance in the quality assurance processes.

Location optimization of emergency medical services: Considering joint service coverage of ambulances and emergency centers

Emergency Medical Services (EMS) play an essential role in saving lives and improving health outcomes by offering immediate medical care to individuals who experience sudden illnesses or injuries. A complete EMS journey consists of two related trips: one from an EMS station to a scene (Trip 1), and the other from a scene to a definitive care location (Trip 2), where the service is coordinately provided by two types of facilities: EMS stations/ambulances and emergency centers (e.g., trauma centers or stroke centers) that are often affiliated with general hospitals. Current work on EMS location optimization considers only one trip (Trip 1 or Trip 2) which ignores the coordination between EMS stations and emergency centers, or the overall trip alone that overlooks the response time requirement. This paper proposed a spatial optimization model, the maximal coverage location problem based on joint coverage (MCLP-JC), for siting EMS stations and emergency centers simultaneously with a consideration of the two related trips. An empirical study of stroke center planning in Wuhan, China, is implemented to compare the proposed approach with the maximal coverage location problem based on overall coverage (MCLP-OC). The results demonstrate that the MCLP-JC can ensure more people being able to receive the first care from an ambulance within the response time requirement, which is critical to subsequent treatment at emergency centers and the odds of survival. The findings from the two scenarios regarding service relocation and expansion offer insights for future health facility planning.

Rescue Missions with Patients with Psychiatric and Psychosocial Symptoms: An Analysis from Eastern Lower Saxony

Characterization of medical emergencies of patients with psychiatric symptoms or in psychosocial crisis. Analysis of emergency medical services (EMS) mission logs from four German EMS stations of patients aged 12-65 from 2019 to 2020. 23.4% of missions involved patients with psychiatric or psychosocial symptoms (1.6% psychotic, 3.0% suicidal, 7.1% psychosocial crisis, 15.7% intoxicated). On average, these patients were younger than those with other symptoms. 48.9% exhibited additional somatic complaints. The COVID-19 pandemic showed only little impact on the frequency of such emergencies. Psychiatric and psychosocial symptoms account for a significant proportion of rescue missions in our sample. Managing psychiatric and psychosocial emergencies should be an integral part of the training of medical and paramedical staff.

Removing the barriers to prehospital blood: a roadmap to success.

This review describes the necessity, evolution, and current state of prehospital blood programs in the United States. Less than 1% of 9-1-1 Ground Emergency Medical Service agencies have been able to successfully implement prehospital blood transfusions as part of a resuscitation strategy for patients in hemorrhagic shock despite estimates that annually between 54,000 and 900,000 patients may benefit from its use. The use of prehospital blood transfusions as a tool for managing hemorrhagic shock has barriers to overcome to ensure it becomes widely available to patients throughout the United States. Barriers include 1) current state Emergency Medical Services clinicians' scope of practice limitations, 2) program costs and reimbursement of blood products, 3) no centralized data collection process for prehospital hemorrhagic shock and patient outcomes, 4) collaboration between prehospital agencies, blood suppliers, and hospital clinicians and transfusion service activities. The following paper identifies barriers and a proposed roadmap to reduce death due to prehospital hemorrhage.

Emergency Medical Services Protocols for Assessment and Treatment of Patients with Ventricular Assist Devices.

Patients with ventricular assist devices (VADs) represent a growing population presenting to Emergency Medical Services (EMS), but little is known about their prehospital care. This study aimed to characterize current EMS protocols in the United States for patients with VADs. States with state-wide EMS protocols were included. Protocols were obtained from the state EMS website. If not available, the office of the state medical director was contacted. For each state, protocols were analyzed for patient and VAD assessment and treatment variables. Of 32 states with state-wide EMS protocols, 21 had VAD-specific protocols. With 17 (81%) states noting a pulse may not be palpable, protocols recommended assessing alternate measures of perfusion and mean arterial pressure (MAP; 15 [71%]). Assessment of VAD was advised through listening for pump hum (20 [95%]) and alarms (20 [95%]) and checking the power supply (15 [71%]). For treatment, EMS prehospital consultation was required to begin chest compression in three (14%) states, and mechanical (device) chest compressions were not permitted in two (10%) states. Contact information for VAD coordinator was listed in a minority of five (24%) states. Transport of VAD equipment/backup bag was advised in 18 (86%) states. This national analysis of EMS protocols found VAD-specific EMS protocols are not universally adopted in the United States and are variable when implemented, highlighting a need for VAD teams to partner with EMS agencies to inform standardized protocols that optimize these patients' care.

Crossing the line: access to trauma care across state borders

ObjectiveThis study investigates the challenge posed by state borders by identifying the population, injury, and geographic scope of areas of the country where the closest trauma center is out-of-state, and...

A Comparison of State-Specific Pediatric Emergency Medical Facility Recognition Programs, 2020.

Prior research suggests that the presence of state-specific pediatric emergency medical facility recognition programs (PFRPs) is associated with high emergency department (ED) pediatric readiness. The PFRPs aim to improve the quality of pediatric emergency care, but individual state programs differ. We aimed to describe the variation in PFRP characteristics and verification requirements and to describe the availability of pediatric emergency care coordinators (PECCs) in states with PFRPs. In mid-2020, we collected information about each PFRP from 3 sources: the state Emergency Medical Services for Children (EMSC) website, the EMSC Innovation and Improvement Center website, or via communication with the state's EMSC program manager. For each state with a PFRP, we documented program characteristics, including program start date, number of tiers, whether participation was required/optional, and requirements for verification. Overall, we identified 17 states with active PFRPs. Five states had only 1 tier or level of recognition whereas the others had multiple. All programs did require presence of a PECC for verification. However, some PRFPs with multiple verification tiers did not require presence of a PECC to achieve each level of verification. In states with PFRPs, EDs with higher total visit volumes, a separate pediatric ED area, located in the Northeast, and earlier program start date were all more likely to have a PECC. There is variation in state PFRPs, although all prioritize the presence of a PECC. We encourage further research on the effect of different aspects of PFRPs on patient outcomes.

Promoting Emergency Medical Service Infrastructure Equality to Reduce Road Crash Fatalities

Timely emergency medical service (EMS) is critical to mitigate outcomes of severe traffic crashes, especially in rural areas. The urban–rural inequality of the EMS infrastructure has been one of the factors contributing to a higher death rate for patients in rural road crashes. To address the spatial imbalance of EMS infrastructure, this study aimed to provide a methodological framework for evaluating the existing EMS infrastructure by taking South Korea’s EMS infrastructure expansion plans as the case study. Specifically, this study developed a road crash data-driven methodology to promote spatial balance and economical expansion of EMS infrastructure of all types, including EMS stations, hospitals, the helicopter fleet, and landing spots. Geographically weighted binary logit regression and spatial analysis identified strategic locations for prioritizing the EMS infrastructure expansion using crash victim data and road networks to close the gap between urban and rural areas. The analysis of access to existing EMS infrastructure showed that the 16 to 20 min EMS response time, including on-scene time and transport time ranging from 11 to 15 min, are significantly associated with higher crash fatalities. The results also suggested that EMS stations and heliports are inadequate to meet the EMS time thresholds in the central province of Korea. The findings of this research could inform policymakers as they are working toward expanding the EMS infrastructure and creating a more equitable EMS response when it comes to transporting rural road crash patients.

Ustawa o zawodzie ratownika medycznego oraz samorządzie ratowników medycznych. Uwagi na tle nowych rozwiązań prawnych

The study presents the basic assumptions of the new statutory solution for the paramedic profession and the paramedic self-government together with analogies of the existing State Emergency Medical Services Act, using the scientific descriptive-dogmatic method, together with conclusions and final postulates. It has been shown that already at the beginning of the new Act on the profession of paramedic and the self-government of paramedics there are postulates and certain criticisms. Nevertheless, as a whole, the legal solutions in the initial version can be assessed as satisfactory. How successful this legal act will be, depends on the outcome of work on eliminating possible contradictions between the new act and the State Emergency Medical Services Act. Analysis in this area should be implemented without delay in this regard.

Creation and Establishment of the State Emergency Medical Services and Disaster Medicine Services in Russia (to the 100th Anniversary of the N.V. Sklifosovsky Research Institute for Emergency Medicine)

After the October Revolution of 1917, the creation of the state healthcare and medical education system in the country played a decisive role in the organization of emergency medical services (EMS) in Moscow on the basis of the former Sheremetev Hospital which later became a large multidisciplinary medical institution — N.V. Sklifosovsky Institute of Emergency Medicine (since 1943 — N.V. Sklifosovsky Research Institute for Emergency Medicine), — and the city EMS station as a part of it.In the pre-war period, the working out of the main principles for the EMS provision was critically important for the development of the services. It became possible to solve scientific and methodological problems related to the training of specialists. The Institute grew into a large institution, research in the field of emergency medicine was carried out at the world level. This contributed to the organization of a network of EMS institutions in the country during 1926–1935.The years of the Great Patriotic War of 1941–1945 enriched the practice of providing emergency medical care, including during mass patient admission.In the post-war years (1946–1970s), the Institute became the leading institution on the problems of EMS in the country. Corresponding divisions were created within the Institute, and on its basis — “Emergency Medicine” scientific and practical association, research and organizational structures of the USSR Ministry of Health, the RSFSR Ministry of Health and the USSR Academy of Medical Sciences. Thanks to this, outstanding results were achieved in the EMS organization: the specialty of “emergency medicine physician” was introduced; emergency hospitals were created in a number of the country’s regions; government programs for EMS provision were successfully implemented; а large number of regulatory documents were prepared to facilitate the further EMS development.N.V. Sklifosovsky Research Institute for Emergency Medicine was among the main initiators of the disaster medicine service, which made it possible to fundamentally solve its organizational and technical problems. Thus, a significant contribution was made to the foundation of this service in Moscow and around the country.At the current stage (from 1992 to the present), EMS improvement has been continued, many developments turned out to be relevant for this services in the Russian Federation. In particular, the created structure of the Institute’s admission and intensive care unit remained the flagship among emergency care institutions in the country for about 20 years. The state program “Improving medical care for road accident victims” was successfully implemented. The Institute’s departments are being actively specialized, making it possible to obtain fundamentally new scientific and practical results for widespread implementation.Since 2011, “Scientific achievements in the field of emergency medical care in the Russian Federation” - collections of research works - have been published annually. The information presented in them can be used throughout the country.The experience in treatment for the novel coronavirus infection COVID-19 allowed the Institute to begin a new page in the history of emergency medical services.The recent opening of an emergency inpatient complex at the Institute contributed to optimizing the work of the hospital’s resuscitation and intensive care units and expanding their treatment and diagnostic capabilities.For more than 10 years, the public and consolidating activities of the scientific and practical society of emergency medicine specialists have been effective. Its work primarily concerns the organization and conduct of scientific and practical events, especially congresses of emergency medicine physicians, as well as the publication of Sklifosovsky Journal Emergency Medical Care, which has unifying significance for a large number of Russian specialists in the field of EMS. The decisions made at the congresses and conferences became the basis for expanding the introduction of advanced medical technologies in the Russian regions, as well as for carrying out important structural reforms in EMS institutions.One of the main achievements of the N.V. Sklifosovsky Research Institute for Emergency Medicine is the creation of the state EMS as a separate branch of healthcare in the country. Over the 100 years of the Institute’s activity, the foundations of its theory and practice have been developed, moreover, a contribution of world significance was made to the EMS development, thereby strengthening the scientific foundation for the activities of the Institute for many years to come.

Abstract 15775: Prehospital Scene Delays in the Prehospital Care of ST-Segment Myocardial Infarction (STEMI)

Introduction: Emergency medical services (EMS) are an important link in the chain of care for patients experiencing time-sensitive cardiovascular emergencies, including ST-segment elevation myocardial infarction (STEMI). Recent quality initiatives have focused on reducing delays in STEMI care in both the prehospital and in-hospital environments. For instance, “door-to-balloon times” are tracked to ensure minimal delays from the time a STEMI patient enters a hospital to revascularization. In the prehospital realm, comparably less research has investigated factors contributing to delays in care for STEMI patients. Prolonged “scene times” - the time spent with a patient prior to transport - represents one area where focus is needed. Methods: As part of an ongoing initiative, EMS providers are encouraged to limit scene times to under 20 minutes for STEMI patients. We queried data from the Minnesota State Emergency Medical Services Regulatory Bureau (EMSRB) to ascertain what percentage of EMS encounters involving STEMI patients within the state’s MNSTAR EMS database between 2018 and 2021 had a scene time of greater than 20 minutes. Encounters involving helicopter emergency medical services (HEMS) were excluded. Results: Between 2018 and 2021, there were a total of 5178 STEMI patient encounters meeting eligibility criteria. Approximately 67.6% (n~3501) of patient encounters involved a scene time less than or equal to 20 minutes. Rural communities were associated with prolonged scene times when compared with metropolitan communities. Conclusions: Our preliminary analysis of EMS data from Minnesota shows one-third of STEMI encounters had scene times greater than 20 minutes. Thus, reducing prehospital scene times by EMS may be one method to streamline the care for STEMI patients. Further research should investigate what factors influence EMS crews to spend more than 20 minutes on scene with STEMI patients.

Air search and rescue system in the Republic of Poland within the maritime responsibility zone. Issues and proposed changes as well as directions for development

This paper describes the operation of services cooperating with the State EmergencyMedical Service in terms of the search systems operating in the country relatedto the ASAR and SAR services. The cooperation of services during search operations is an extremely important prognosticelement and undoubtedly has a significant impact on the survival of the injured.

Support for the state emergency medical system in the fight against COVID -19 by airborne search and rescue teams of the ASAR service

The COVID-19 pandemic, which undoubtedly left significant imprint in public consciousness,necessitated unprecedented support for medical rescue systems bothin Poland and around the world. During the pandemic, the State Emergency MedicalService in Poland was bolstered with legally available support measures, includingassistance from the Airborne Search and Rescue Teams of ASAR.

An Elucidation on the Challenges of Pre-hospital Emergency Technicians: A Study on Emergency Medical Technicians in Shiraz, Iran

Background: The identification of the strengths and weaknesses of pre-hospital emergency technicians, as the first providers of treatment services to critically ill patients, is of utmost importance. Objectives: This study was conducted to explain the challenges faced by emergency medical technicians in Shiraz, Iran, within 2021 - 2022. Methods: The present study was a qualitative study that was conducted using the traditional qualitative content analysis (Graneheim and Lundman, 2004). Sampling in this study was purposeful. A semi-structured interview was conducted with 17 emergency technicians in Shiraz. Lincoln and Guba’s standards were used to validate the data. Results: This study identified 3 categories and 12 subcategories. These three categories include management challenges, professional problems, and cultural barriers. Subcategories were “insufficient emergency medical services (EMS) stations”, “lack of human resources”, “role ambiguity”, “lack of organizational support”, lack of job prestige”, “high job stress”, “crowded missions”, “lack of psychotherapy and counseling”, “high-risk profession, “public’s false perception of EMS job”, “abuse of emergency call center services”, and “disrespectful behavior”. Conclusions: Considering that the provision of EMS is an inherently stressful and highly anxious job, some measures can be taken to reduce the mental effects of such pressure on the technicians. In addition, they should run public awareness campaigns to improve the cultural level of society to better understand the duties and activities of EMS workers at the community level.

Lost in translation? Information quality in pediatric pre-hospital medical emergencies with a language barrier in Germany

BackgroundIn pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers.MethodsWe conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS).ResultsData from 1,430 pediatric rescue missions were analyzed with 3.1% (n = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results.ConclusionLanguage barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies.Trial registrationThis is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.

Prehospital and emergency department pediatric readiness for injured children: A statement from the American College of Surgeons Committee on Trauma Emergency Medical Services Committee.

Injury is the leading cause of death in children older than 1 year, and children make up 22% of the population. Pediatric readiness (PR) of the nation's emergency departments and state trauma and emergency medical services (EMS) systems is conceptually important and vital to mitigate mortality and morbidity in this population. The extension of PR to the trauma community has become a focused area for training, staffing, education, and equipment at all levels of trauma center designation, and there is evidence that a higher level of emergency department PR is independently associated with long-term survival among injured children. Although less well studied, there is an associated need for EMS PR, which is relevant to the injured child who needs assessment, treatment, triage, and transport to a trauma center. We outline a blueprint along with recommendations for incorporating PR into trauma system development in this opinion from the EMS Committee of the American College of Surgeons Committee on Trauma. These recommendations are particularly pertinent in the rural and underserved areas of the United States but are directed toward all levels of professionals who care for an injured child along the trauma continuum of care.

Effects of urban environmental factors on heat-related emergency medical services (EMS) response time

Due to the time-sensitive nature of heat-related illnesses, disparities in access to heat-related emergency medical services (EMS) services may contribute to urban health disparities. This paper is an empirical study utilizing Austin-Travis County EMS data to estimate the delays in response time due to traffic congestion through spatiotemporal analysis and to conduct the Ordinary Least Square (OLS) and Geographically Weighted Regression (GWR) models to examine the underlying factors affecting delays in peak traffic rush hours. Our results reveal that heat-related EMS is most delayed in the morning and the evening; there are higher clustering patterns of EMS travel time difference in Austin's metropolitan outskirts, notably in the east and west Austin. OLS and GWR analyses suggest that larger EMS counts, longer distances from an EMS station to the scene and from the scene to a hospital, and neighborhoods with a greater black and Hispanic population exacerbate heat-related EMS delays. Road density, average speed limit, and open space growth rate are statistically significant in the OLS model, although GWR findings suggest coefficient signs vary locally, requiring more investigation. Our findings provided additional insights through the spatial patterns of EMS delays to practitioners for their reference to reduce local response times.

Temporal Changes in Epinephrine Dosing in Out-of-Hospital Cardiac Arrest: A Review of EMS Protocols across the United States.

Administration of epinephrine has been associated with worse neurological outcomes for survivors of out-of-hospital cardiac arrest. The publication of the 2018 PARAMEDIC-2 trial, a randomized and double-blind study of epinephrine in out-of-hospital cardiac arrest, provides the strongest evidence to date that epinephrine increases return of spontaneous circulation (ROSC) but not neurologically intact survival. This study aims to determine if Emergency Medical Services (EMS) cardiac arrest protocols have changed since the publication of PARAMEDIC-2. States in the US utilizing mandatory or model state-wide EMS protocols, including Washington DC, were included in this study. The nontraumatic cardiac arrest protocol as of January 1, 2018 was compared to the protocol in effect on January 1, 2021 to determine if there was a change in the administration of epinephrine. Protocols were downloaded from the relevant state EMS website. If a protocol could not be obtained, the state medical director was contacted. A 2021 state-wide protocol was found for 32/51 (62.7%) states. Data from 2018 were available for 21/51 (41.2%) states. Of the 11 states without data from 2018, all follow Advanced Cardiac Life Support (ACLS) guidelines in the 2021 protocol. Five (15.6%) of the states with a state-wide protocol made a change in the cardiac arrest protocols. Maximum cumulative epinephrine dose was limited to 4mg in Maryland and 3mg in Vermont. Rhode Island changed epinephrine in shockable rhythms to be administered after three cycles of cardiopulmonary resuscitation (CPR) and an anti-arrhythmic. Rhode Island also added an epinephrine infusion as an option. No states removed epinephrine administration from their cardiac arrest protocol. Simple statistical analysis was performed with Microsoft Excel. Several states have adjusted cardiac arrest protocols since 2018. The most frequent change was limiting the maximum cumulative dosage of epinephrine. One state changed timing of epinephrine dosing depending on the rhythm and also provided an option of an epinephrine infusion in place of bolus dosing. While the sample size is small, these changes may reflect the future direction of prehospital cardiac arrest protocols. Significant limitations apply, including the exclusion of local and regional protocols which are more capable of quickly adjusting to new research. Additionally, this study is only focused on EMS in the United States.

Locating emergency medical services to reduce urban-rural inequalities

Emergency Medical Service (EMS) systems provide fundamental services in relation to public health and safety. The spatial configuration of EMS stations is crucial to the efficiency and equality of service provision. While urban-rural inequalities in EMS have been widely acknowledged, how to optimize EMS station locations to reduce such inequalities remains challenging. This research proposes a multi-objective optimization model to reduce urban-rural inequalities in EMS accessibility and coverage, in addition to maximizing the total covered population. The proposed model is applied in an empirical study in Wuhan, China, to seek locations for new EMS stations in order to improve local EMS capacity in the pandemic period. The results indicate that the total covered population, particularly in urban area, decreases when urban-rural equality in service accessibility increases, but it has a U-shaped relationship with urban-rural inequality in service coverage. Pareto-optimal solutions suggest that all new stations should be located in rural areas if lower urban-rural inequality in EMS is to be obtained, but one new station is needed in the urban area if higher coverage of total population is more desirable. The work presented in this paper can aid the planning practice of public services like EMS systems where reducing urban-rural inequalities is an essential concern.