Emergency Medical Care System Research Articles

Weaknesses of the existing organization of emergency medical care in European countries

The importance of an emergency medical care system for ensuring affordable and quality healthcare in any country is indisputable. Studying and analyzing existing problems in organizing this system is the first step to solving them. The present study aimed to investigate and outline the possible scope of the problems of emergency medical care, their recurrence, and similarity in 17 European countries. Content analysis of documents was used. The most characteristic organizational problems in providing emergency medical care for each of the countries are identified and grouped into five categories: Direct patient access to hospital emergency departments; Overloading of emergency departments by non-urgent, self-referral patients; Telephone triage by dispatchers - nurses or assistants; Existing and/or impending shortage of doctors in Emergency Medical Services (EMS); Regional and social inequalities in access to emergency medical care. A quantitative measurement of the categories and their relative weight were reported. Based on the analysis, the conclusions of the study were drawn. The identified problems, grouped into categories of weaknesses of the existing emergency medical care organization in European countries, may serve as a basis for undertaking health care reforms.

Research on emergency medical care system in public health events based on Kano model

In recent years, the frequency and impact of disease outbreaks in public health events have become increasingly prominent, and the effectiveness of the medical care system has become a key factor in meeting the challenges. Based on the Kano model, this paper aims to study the demand and expectation of the users of the emergency medical care system in public health events. Through the analysis of the user satisfaction and importance evaluation, this study deeply understands the users demand for the system, and puts forward the guidance of improvement and optimization. The findings are summarized as follows: the Kano model is a valuable tool, but its limitations and challenges need to be taken into account; future research can combine big data and artificial intelligence technologies, taking into account psychosocial factors, the introduction of user participatory design and interdisciplinary collaborative research to enhance user experience and satisfaction. This study provides a scientific basis for the improvement and optimization of emergency medical care system in public health events, and has important practical significance.

History of creation and development of emergency medical care in City of Moscow

The article is devoted to the history of the creation and development of emergency medical care for the population of Moscow. The stages of the activity of the home care centers, the night emergency room at the Ambulance Station and their subsequent organization in the district emergency centers are considered. The main regulatory and legal documentation is indicated, in the development of which the heads of the Station n. a. A. S. Puchkov and A. M. Nechaev took part. The work on the creation of a system of emergency and emergency medical care for adults and children in Moscow, the rules of action of the doctor of the emergency room upon receipt of appeals is shown. The article describes the search for effective ways to solve organizational and material problems in the field of emergency and emergency medical care at different stages of the development of the emergency service. The role of the Moscow Ambulance and Emergency Medical Care Station in the development and implementation of organizational and methodological measures to improve the work of emergency departments in the capital is shown. A description of a major project is given, the purpose of which was the full integration of emergency medical care for adults and children into the structure of the Ambulance and emergency Medical Care Station in Moscow at the present stage, the organization of a Single city dispatch center for emergency and emergency medical care with the formation of a single information space, the previous preparatory work for receiving calls on a single federal number 103 on the base of the Station. During its history, the Moscow emergency medical Service has passed a difficult path. Thanks to the efforts made, the service is now an integral part of the Ambulance n. a. A. S. Puchkov and Emergency Medical Care Station in Moscow.

95<sup>th</sup> anniversary of Boris Dmitrievich Komarov

February 20, 2023 marks the anniversary of Boris Dmitrievich Komarov, participant in the Stalingrad meeting, corresponding member of the Russian Academy of Sciences, Honored Scientist of the Russian Federation, surgeon professor, scientist, one of the largest creators of the Soviet state system of emergency medical care.

Comparison of out-of-hospital cardiac arrests during the COVID-19 pandemic with those before the pandemic: an updated systematic review and meta-analysis.

The coronavirus disease of 2019 (COVID-19) pandemic, directly and indirectly, affected the emergency medical care system and resulted in worse out-of-hospital cardiac arrest (OHCA) outcomes and epidemiological features compared with those before the pandemic. This review compares the regional and temporal features of OHCA prognosis and epidemiological characteristics. Various databases were searched to compare the OHCA outcomes and epidemiological characteristics during the COVID-19 pandemic with before the pandemic. During the COVID-19 pandemic, survival and favorable neurological outcome rates were significantly lower than before. Survival to hospitalization, return of spontaneous circulation, endotracheal intubation, and use of an automated external defibrillator (AED) decreased significantly, whereas the use of a supraglottic airway device, the incidence of cardiac arrest at home, and response time of emergency medical service (EMS) increased significantly. Bystander CPR, unwitnessed cardiac arrest, EMS transfer time, use of mechanical CPR, and in-hospital target temperature management did not differ significantly. A subgroup analysis of the studies that included only the first wave with those that included the subsequent waves revealed the overall outcomes in which the epidemiological features of OHCA exhibited similar patterns. No significant regional differences between the OHCA survival rates in Asia before and during the pandemic were observed, although other variables varied by region. The COVID-19 pandemic altered the epidemiologic characteristics, survival rates, and neurological prognosis of OHCA patients. Review registration: PROSPERO (CRD42022339435).

Efforts at our Emergency Department as a Designated Medical Institution for the Tokyo 2020 Games: How We Prepared for it during COVID-19 Pandemic

Introduction:The Tokyo 2020 Games were held without spectators in the fifth wave of the COVID-19 pandemic after one-year postponement. From all over the world, approximately 11,000 Olympians and 4,400 Paralympians participated in the games. As one of the designated medical institutions, Tokyo Medical and Dental University Hospital provided emergency medical care for the personnel referred by medical staff at the venues or the Olympic Village clinics. On the other hand, it played a central role in treatment and care for COVID-19 patients in the Tokyo metropolitan area. The aim of this study was to review the emergency medical care system of the hospital as a designated hospital for the Tokyo 2020 Games and discuss the measures for future large-scale international events.Method:A retrospective analysis of persons involved in the Games who visited our emergency department by request was conducted. COVID-19 patients who were admitted were also analyzed. The study period was from July 13 to August 11 for the Olympics and from August 17 to September 11 for the Paralympics, respectively in 2021. The data was derived from electronic health records from the hospital.Results:The total number of ED visits was 38 during the period. One patient was hospitalized, and another patient was transferred. Twenty-one (55%) were athletes, seven (18%) were staff members, and ten (26%) were others. The reason for the visit was medical disease in 23 (61%) and surgical disease in 15 (39%). There was one COVID-19 positive patient. The number of COVID-19 inpatients was 124.Conclusion:Emergency medical care was provided for the persons involved in the Tokyo 2020 Games in cooperation with all the staff at the hospital. The COVID-19 pandemic ‘disaster’ may have had some impact on our hospital’s role as the designated medical institution.

Impact of coronavirus disease 2019 on the mortality of patients who received emergency transportation: a population-based cross-sectional study.

The spread of coronavirus disease 2019 (COVID-19) has a widespread impact on emergency medical care systems. However, its effects on the mortality of emergency transportation patients are unclear. This population-based, cross-sectional study investigated how COVID-19 impacted the mortality and outcomes of emergency transportation patients. We compared mortality in the emergency department and at day 21 after an emergency visit for patients transported by ambulance to medical facilities in the Osaka Prefecture, Japan, between January 29 and December 31, 2020 (first pandemic year) and between January 29 and December 31, 2019 (immediate pre-pandemic year; 804,718 patients in total), using multivariable analysis to adjust for potential confounders. During the first pandemic year, 50,446 fewer patients received emergency transportation compared with the immediate prepandemic year. Emergency department deaths increased by 603 during the first pandemic year (4,922 versus 4,319 deaths) and 640 within 21 days (14,569 versus 13,929 deaths). Multivariable analysis revealed an association between the first pandemic year and increased mortality rates among patients given emergency transportation compared with the immediate prepandemic year (odds ratio for emergency department deaths 1.31; 95% confidence interval 1.26-1.38; odds ratio for deaths within 21 days 1.17; 95% confidence interval 1.14-1.20). The study results indicate that the spread of COVID-19 impacted the mortality of patients who received emergency transportation. Further studies are expected to clarify the impact of COVID-19 on emergency medical care systems.

Десятилетие проблем и решений: к юбилею кафедры скорой медицинской помощи и хирургии повреждений Первого Санкт-Петербургского государственного медицинского университета имени академика И.П.Павлова

Summary. The history of the creation and activity of the Chair of Emergency Medicine and Injury Surgery of the First St. Petersburg State Medical University named after acad. I.P. Pavlov is presented. The main stages of the development of the chair are considered, the scientific potential of the chair and the work of its staff in the creation of the system of emergency and urgent medical care for the population of the city are discribed. It is noted that starting from 2012 the members of the chair in cooperation with the specialists of St. Petersburg Scientific Research Institute of Emergency Care named after I.I. Dzhanelidze made a significant contribution to solving scientific and practical, organizational and methodological problems in the field of emergency medical care in the Russian Federation.

Ambulance in Kyrgyzstan and Abroad (literature review)

This article presents the literature review on medical emergency ambulance service. The problems related to the organizing and improving the medical emergency ambulance service continue to be significant and relevant in modern world that requires further studying. The author has conducted the historical analysis of the literature sources of the medical emergency ambulance service in different countries of the world. The effectiveness of various forms of the emergency medical care at pre-hospitalization and hospitalization stages are studied. One of the areas in healthcare that needs improvement today is the advancement of the emergency medical care systems. The problems related to the ambulance service of Osh city are highlighted. Examining the emergency medical care (organizational forms) outside the Kyrgyz Republic makes it possible to compare the advantages and disadvantages of the service and can contribute to its improvement in Osh, considering the experience of foreign countries. To reduce the workload of the medical emergency ambulance service, the need for optimizing the emergency medical care at the centers of family medicine is determined. The literature review methods that was used in this article are from the databases of the elibrary, cyberleninka, Medline on the organization of the medical emergency ambulance service in different countries of the world.

Factors Associated with Emergency Department Visits and Consequent Hospitalization and Death in Korea Using a Population-Based National Health Database.

We aim to investigate common diagnoses and risk factors for emergency department (ED) visits as well as those for hospitalization and death after ED visits. This study describes the clinical course of ED visits by using the 2014–2015 population data retrieved from the National Health Insurance Service. Sociodemographic, medical, and behavioral factors were analyzed through multiple logistic regression. Older people were more likely to be hospitalized or to die after an ED visit, but younger people showed a higher risk for ED visits. Females were at a higher risk for ED visits, but males were at a higher risk for ED-associated hospitalization and death. Individuals in the highest quartile of income had a lower risk of ED death relative to lowest income level individuals. Disabilities, comorbidities, and medical issues, including previous ED visits or prior hospitalizations, were risk factors for all ED-related outcomes. Unhealthy behaviors, including current smoking, heavy alcohol consumption, and not engaging in regular exercise, were also significantly associated with ED visits, hospitalization, and death. Common diagnoses and risk factors for ED visits and post-visit hospitalization and death found in this study provide a perspective from which to establish health polices for the emergency medical care system.

Work in stressful conditions in medical emergency system during the COVID-19 pandemic.

The pandemic caused a change in the way of providing healthcare services, limiting direct access to doctors, suspending planned treatments and medical consultations, but despite the risks and restrictions, the medical rescue system as a key element of health care for the society continues to function. The system provides medical assistance to patients in the most severe condition, both with a negative result for SARS-CoV-2, as well as with a positive or undiagnosed result. It is a review aimed at analyzing the most important psychological aspects of the work of emergency medical care system personnel during the COVID-19 pandemic. PubMed, Cochrane Library, and Google Scholar search were used to analyze the problem. The following keywords were used to search for information sources: paramedic, work, emergency medical care system, emergency department, ambulance service, COVID-19, pandemic, SARS-CoV-2, coronavirus. The articles were selected in terms of the psychological aspects of the work of the emergency medical care system personnel during the pandemic in 2020-2021. The psychosocial problems that come to the fore during a pandemic include increased levels of stress, anxiety, depression, burnout, emotional exhaustion, vicarious traumatization, and post-traumatic stress disorder. In the context of the increased risk of psychological problems due to pandemic, it is necessary to provide psychological support to the medical staff, both in terms of psychological support for the entire team and individually. Med Pr. 2022;73(3):241-50.

Improvement in regional disparities in prehospital emergency medical care systems using the prehospital care index: how the timing of adrenaline administration by paramedics impacts cerebral functioning prognosis

Objective In Japan, the protocol for timing of adrenaline administration by paramedics is determined by the local medical control council. The purpose of this study was to compare, via prehospital care indices, how differences in ‘adrenaline times’ across prefectures influence cerebral functioning prognoses. Methods We included 13,326 cases registered in the nationwide Utstein style database. To compare adrenaline administration times and cerebral functioning at 1-month post-event, the average time of adrenaline administration was calculated for each prefecture. A scatter plot showing the correlation of the rating of ‘good’ cerebral function at 1 month, and an approximately linear, were used to review the correlation. All cases where emergency medical technicians administered adrenaline within 10 minutes of field activity were examined bases on the prehospital care index. Results The nationwide average adrenaline time was 15.4±6.3 minutes, and the rating of good cerebral outcome at 1 month was 3.0%. 5.4% of good cerebral outcome. The prefecture with the slowest average adrenaline time was Hiroshima, with an average of 19.4±6.4 minutes and a 0.9% good cerebral outcome. Examination between average adrenaline times and good ratings for cerebral outcome at 1 month revealed a negative correlation (R2=0.1295) by prefecture. Aichi prefecture achieved the highest prehospital care index at 75.1%. Conclusion Adrenaline administration and the security of intravenous lines should be standardized in practice, with a view to shortening adrenaline administration times, rather than giving adrenaline under on-line medical control. Keywords: Heart Arrest, Epinephrine, Emergency medical technicians, Out-of-hospital cardiac arrest, Survival analysis, Time factors

Present and Future Status of Cardiovascular Emergency Care System in Urban Areas of Japan - Importance of Prehospital 12-Lead Electrocardiogram.

Acute cardiovascular disease, such as acute myocardial infarction and aortic disease, can lead to a serious life-threatening state within minutes to hours, so early accurate diagnosis, and appropriate treatment without delay are essential. To provide high-quality and timely treatment, 24-h availability of medical staff and cardiologists, as well as a cardiac catheterization laboratory are needed. In Japan, the number of patients with acute cardiovascular disease is increasing with the aging population and westernization of lifestyle; however, workstyle reforms for physicians, including a policy to limit overtime work, have been legislated. Under these conditions, it is necessary to centralize hospitals that treat cardiovascular emergency diseases as high-volume centers and build a patient triage system for allocating patients before hospital arrival. The prehospital 12-lead electrocardiogram (ECG) plays a central role in prehospital diagnosis and triage, and its importance will increase in future. We discuss the current and future state of the cardiovascular emergency medical care system utilizing prehospital 12-lead ECG in urban areas of Japan.

Facile, Real‐Time Identification of Blood Components with Self‐Powered Organic–Inorganic Heterostructure Photodetectors

AbstractA rapid and efficient opto‐electrical method for the determination of blood components is demonstrated through a tin oxide (SnO2) quantum dot (QD) fluorene copolymer heterojunction photodetector (FP‐PD). The photo‐active materials, the device structure, and the sensing system are carefully designed to provide miniaturization at a low cost. SnO2 QDs are synthesized with a one‐step solvothermal reaction and a photodetector, and then fabricated in a simple sequential spin‐coating process. Under optimal conditions, the SnO2 QD/FP‐PD shows remarkable responsivity, detectability, fast responses, and stability under self‐powered operation. In this research, optical characteristics of blood components, and interactions between the photodetector and blood components from illuminating two different wavelengths of ultraviolet light, are systemically investigated. Furthermore, three different blood component mixtures are successfully determined by the SnO2 QD/FP‐PD based on specific absorption phenomena, which provides a simple and efficient technique for emergency medical care and health monitoring systems.

Analysis of Continuous Training Effectiveness of Doctors and Nurses in Emergency

This article describes Emergency Medical Care (EMC) system covering non-communicable, infectious diseases, obstetrics and trauma. Community-based emergency care, as prehospital, refers to emergency care provided outside the hospital. Emergency medicine (EM) potentially plays a critical role in improving the outcomes of acute conditions in healthcare settings. Team of developers including international experts from Kyrgyz State Medical Institite of post graduate Training (KSMIPGT) has developed and drawn up programs for doctors, hospital-level nurses that meet the needs of practical healthcare. Keywords: emergency medical aid, medical care, International Federation of emergency medicine,

Improvement in regional disparities in prehospital emergency medical care systems using the prehospital care index: a study of how the timing of adrenaline administration by paramedics impacts cerebral functioning prognosis

Improvement in regional disparities in prehospital emergency medical care systems using the prehospital care index: a study of how the timing of adrenaline administration by paramedics impacts cerebral functioning prognosis

Патологическая анатомия – 20 лет на службе экстренной медицины

This article is dedicated to the work of the pathological department of the RRCEM and the formation of the pathological service in the emergency medical care system is shown. The analysis of the work was carried out, including autopsy, biopsy studies and the results of the scientific activity of the department.

EMERGENCY MEDICAL CARE IN UKRAINE IN 2020, THE MAIN INDICATORS OF ACTIVITY

Summary. Purpose. It consists in the study of the main indicators of the activity of the emergency medical care system in 2020 based on the results of reports from the centers of emergency medical care and medicine of disasters in the regions in comparison with 2019. Study of positive experience and ways to optimize the organizational and staff structure of emergency medical care, which will allow the most effective use of forces and resources in the process of performing tasks as intended.
 Materials and methods. In the course of researching the reports of the centers of emergency medical care, the following research methods were used: analytical, systematic approach. The regulatory legal acts regulating the activities of emergency medical care were used.
 Results. A detailed analysis of the reports of the centers of emergency medical care in 2020 was carried out, the factors of positive and negative impact on the results of activities were identified.
 Conclusions. In general, the emergency medical care system copes with the tasks set to perform the tasks as prescribed, but there are a number of problematic issues that negatively affect its activities.

THE IMPACT OF WORKING CONDITIONS ON STRESS AND ITS EFFECTS IN THE GROUP OF PARAMEDICS: A SYSTEMATIC REVIEW

Purpose: This is a review to assess the working conditions that affect the stress level of paramedics and their ability to cope with stress. The profession of a paramedic is characterized by constant contact with other people and exposure to many factors, including biological (HIV, flu virus), chemical (causing allergic reactions, burns) physical (noise, low or excessive temperature), psychosocial (aggression, violence, traumatic experiences).
 Methodology: This is a Systematic review paper. The PubMed, Cochrane Library, and Google scholar search were used to analyze the problem. The following keywords were used to search for information sources: paramedic, working conditions, medical rescue, ambulance, stress, coping with stress. Articles were selected according to the impact of working conditions on stress and its consequences among the group of paramedics.
 Main Findings: The work of a rescuer is a constant action under the influence of a high level of stress and emotions, caused by an unforeseen sequence of events and time pressure. The long-term presence of negative factors is the cause of the appearance of burnout syndrome, rumination, PTSD, and somatic symptoms related to stress in the workplace. It can result in a deterioration of the quality of patient care.
 Implications of this study: The above results should be taken into account by units of the emergency medical care system. The paper indicates the occurrence of negative psychological effects of work-related stress and as a consequence the need to train the personnel in the field of stress-coping techniques and to provide emergency medical service workers with mental health monitoring and psychological care in the workplace.
 Novelty in this study: There is a lack of systematic reviews of the impact of working conditions on the mental health of workers in emergency medical care services. The paper is an attempt to assess the impact of working conditions on stress and its effects on the group of paramedics and other emergencies medical care system employees.

The choice of the method of patients triage in the system of emergency medicine

For the timely provision of a full-fledged volume of emergency medical care, it is necessary to triage patients admitted to the emergency department. The article highlights the tool for the prompt and adequate prioritization of the growing number of patients for the provision of emergency medical care, corresponding to the features of the emergency medical care system in Uzbekistan, during which the opinions of experts working in the emergency medicine system were actively accepted.