Emergency Medical Services System Research Articles

The Integration of Nurse Practitioners Into Mass Gathering Medical Teams.

Mass gathering events can greatly impact overburdened emergency medical service systems and emergency departments, which frequently experience staffing shortages and overcrowding. Nurse practitioners (NPs) were introduced into an event medicine team at mass gatherings to reduce emergency transports to local emergency departments as well as offering a "treat and release" disposition for patients presenting to medical tents. This study aimed to examine the impact of NPs at mass gathering events; 147 chart reviews were performed from 05/01/2023 to 09/30/2023 for all patients assessed by an NP at events staffed by an event medicine team; 60% of patients assessed by an NP were treated and released from the event, potentially reducing the number of patient transports and emergency department visits considerably. NPs can provide higher levels of care at events, treating common complaints such as heat-related illness, nausea, vomiting, minor trauma, and laceration repairs. Although this study did not compare data from events where NPs were not present versus when they were utilized to grasp the statistical impact their presence has had since their introduction to the team model, the study clearly shows the benefits NPs bring to mass gathering medical care. This is significant for emergency NPs as this research validates the need to include these providers in this new setting and role in which they can practice. More research is needed to compare patient outcomes with and without NPs present.

Needs Assessment and Tailored Training Pilot for Emergency Care Clinicians in the Prehospital Setting in Rwanda

Background: In low- and middle-income countries (LMIC), 45% of deaths could be addressed by implementation of an emergency medical services (EMS) system. Prehospital care is a critical component of EMS worldwide, and basic, affordable training has been shown to improve EMS systems. However, patient outcome impact is unclear. In this study we aimed to assess the current state of prehospital care in Kigali, Rwanda, through a needs assessment, focused training intervention, and analysis of current practices and patient outcomes. Methods: We identified 30 clinicians through the prehospital medical command office and included them in the study. A prospective, nonrandomized, interrupted time-series approach was used. Data collected through closed- and open-ended questionnaires included age, sex, training, and knowledge assessment. We used the data to create a tailored, 18-hour training after which immediate and 11-month post-tests were administered. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes and prehospital process indicators that included training skill application, airway intervention, intravenous fluid administration, and glucose administration. Results: Of 30 clinicians, 18 (60%) were female, 19 were nurses, and 11 were nurse anaesthetists. Median age was 36, and median years providing care was 10 (IQR 7–11). Twenty-four (80%) participants completed immediate and post-test assessments. Mean knowledge across 12 core skills significantly improved from a pre-test mean of 59.7% (95% confidence interval [CI] 42.2–77.20) to a post-test mean of 87.8% (95% CI 74.7–100). At 11 months post-training, the score improvement maintained, with a mean score of 77.6%(95% CI 59.2–96.8). For patient outcomes, the total sample size was 572 patients; 324 of these patients were transported to the ED during the pre-training period (56.4%), while 248 were transported post-training. Prehospital oxygen administration for patients with a saturation level of <95% significantly increased pre- to post-training (66.7% to 71.7%; Δ = 5.0%; Δ95% CI 1.9,−8.1%). No significant changes were noted in patient treatment outcomes or other process indicators due to small sample sizes. Conclusion: This study provides insights on Rwandan EMS and demonstrates that a tailored intervention targeting education on prehospital process indicators has positive impacts on clinician knowledge and practice.

Validation of a Service Behavior Measurement According to Emergency Medical Standards of Health Personnel: Cross-Sectional Study

Background: Emergency medical services are in pre-hospital health services. This is a critical time, important to the lives of emergency patients. Using a measure to assess the service behavior according to emergency medical standards (SB-EMS) will help medical personnel perform their work according to standards, resulting in emergency patients having more chances of survival and safety. Objective: To validate the measurement tool of SB-EMS for evaluating quality, accuracy, and reliability. Materials and Methods: The present study was a cross-sectional study executed between January and May 2024 designed by collecting data based on 205 health personnel, which consisted of professional nurses, paramedics, and emergency medical technicians working in the Bangkok emergency medical service system through stratified random sampling. The data were collected with a 6-rating scale questionnaire. An initial sampling from 30 participants gave a Cronbach’s alpha of 0.77 to 0.84 and item-total correlations of 0.55 to 0.79. Data was analyzed by confirmatory factor analysis (CFA) using LISREL version 8.72. Results: CFA confirmed the construct validity of measures with empirical data. The 16-item of service behavior according to the emergency medical standards scale achieved an overall Cronbach’s alpha of 0.93 and factor loading between 0.59 to 0.87. There was a chi-square value of 166.35 at 85 degrees of freedom. The probability was 0.000, comparative fit index (CFI) was 0.99, root mean square error of approximation (RMSEA) was 0.06, and standardized root mean square residual (SRMR) was 0.04. Conclusion: The developed scales serve as high-quality assessment tools for human resources specialists or academicians in screening or assessing SB-EMS of health personnel.

Abstract Su607: Which would be major? witnessed collapse or bystander resuscitation?

Background: Witnessed collapse and bystander cardiopulmonary resuscitation (CPR) are two variables commonly used to predict outcomes in out-of-hospital cardiac arrest (OHCA). Some published studies have shown that bystander CPR were not significantly associated with outcomes after confounders adjusted. This may imply that witnessed collapse would be a superior prognostic factors beyond bystander CPR. Hypothesis: Witnessed collapse and bystander CPR may not contribute equally to prehospital return of spontaneous circulation (ROSC), and the former may be major. Aims: To investigate four prediction models for prehospital ROSC using stratification of the witnessed collapse and bystander CPR. Methods: The study enrolled OHCA patients treated by the emergency medical service (EMS) from January 2010 to December 2022 in three EMS systems in Taiwan. Data were extracted from the records of each medical service encounter, including patient demographics, dispatch timing, prehospital management, witnessed collapse and bystander CPR. The primary outcome was any prehospital ROSC. Patients were stratified into four groups by witnessed collapse (with/without) and bystander CPR (with/without) status, namely W+B+, W-B+, W+B- and W-B-. Prehospital ROSC prognostication were identified using multivariable logistic regression analysis. Results: The analysis comprised 17,323 patients, among whom 1,165 (6.7%) achieved prehospital ROSC. The W+B+ group demonstrated the highest prehospital ROSC rate at 13.0%, as compared with the other groups significantly (9.0%, 3.4%, and 4.1%, as depicted in Image 1). Stratification of the prehospital ROSC model (Image 2) indicated that the W+B+ group had several common predictors including age, traumatic arrest, no-flow time, public access defibrillation (PAD), and resuscitation events. However, certain predictors in other groups were removed during regression process. Notably, no-flow time significantly influenced prehospital ROSC only in the W+B+ and W+B- groups. Conversely, in the W-B- group, most variables had minimal impact on prehospital ROSC, reflecting the limited effectiveness of traditional predictors within this subgroup. Conclusion: The significance of witnessed collapse as a prognostic factor may be equal to or even greater than that of bystander CPR. Further studies are needed to confirm.

Thematic analysis of six Asian prehospital emergency medical systems to explore development principles

Abstract Background Well-designed and functioning emergency medical service (EMS) can provide equitable access to emergency care to improve health issues, especially in low- and middle-income countries where the majority of deaths are due to conditions that could be treated with emergency care. To address this gap, this study explored the contextually appropriate development process in addition to the system architecture, which is lacking in Global South EMS research. Method This study was a thematic analysis of the development of EMS systems in six Asian countries. Experts in emergency care were selected through convenience sampling. Each country described and evaluated its EMS system using a standardized form with 102 EMS items that cover the emergency care system in terms of leadership, governance, financing, community-based activities, prehospital care, and quality assessment. From the descriptions, various themes were extracted focusing on the developmental perspective of EMS in Asia. Result The study identified the domain of the developmental focus, best practices, and future strategies for EMS in the Asian region. The identified areas for developmental focus are governance, multidisciplinary collaboration, communication/coordination, community participation, decentralization, equitable access, supply-demand balance, and quality assurance activities. Conclusion Countries under investigation achieved progress in planning, implementing, and sustaining EMS through varied strategies in the mentioned focal areas that can be emulated by other countries in this region. Further, their development levels varied according to the extent to which each country realized the development principles identified in this study.

A multi-period capacitated facility location problem with maximum travel time and backup service for locating and sizing EMS stations

Emergency medical services (EMS) is a system that provides emergency medical care for incidents involving serious illness or injury. The location of EMS stations plays an essential role in delivering effective and efficient medical services. Numerous location models have been developed for locating and sizing EMS stations. However, it remains challenging to satisfy all EMS planning criteria within a single location model. In this study, a multi-period capacitated facility location problem with maximum travel time and backup service (EMSLSP) is proposed for locating and sizing EMS stations. The most important criteria for EMS planning are taken into account in EMSLSP: the demand changes due to population mobility, the maximum service capacity of an ambulance, the maximum number of ambulances at each EMS station, the maximum travel time from each EMS station to the locations it serves, the full coverage of dynamic demand, the minimum percent of population covered by EMS service in a specific travel time, and a backup station for each demand location in case of need. A case study in Zhengzhou, a large city in China, demonstrates that effective and efficient locations and sizes of EMS stations can be determined by solving the EMSLSP with various planning parameters. Compared with the existing EMS systems, the average ambulance travel time and the percentage of the population served are significantly improved. Simulations of ambulance scheduling confirm that the relocated and resized EMS stations perform better than those in the existing system. The evaluation-optimization-simulation method outlined in this paper provides a comprehensive and effective approach for EMS station planning.

Prehospital Trauma Compendium: Traumatic Pneumothorax Care – a position statement and resource document of NAEMSP

ABSTRACT Emergency Medical Services (EMS) clinicians manage patients with traumatic pneumothoraces. These may be simple pneumothoraces that are less clinically impactful, or tension pneumothoraces that disturb perfusion, lead to shock, and impart significant risk for morbidity and mortality. Needle thoracostomy is the most common EMS treatment of tension pneumothorax, but despite the potentially life-saving value of needle thoracostomy, reports indicate frequent misapplication of the procedure as well as low rates of successful decompression. This has led some to question the value of prehospital needle thoracostomy and has prompted consideration of alternative approaches to management (e.g., simple thoracostomy, tube thoracostomy). EMS clinicians must determine when pleural decompression is indicated and optimize the safety and effectiveness of the procedure. Further, there is also ambiguity regarding EMS management of open pneumothoraces. To provide evidence-based guidance on the management of traumatic pneumothoraces in the EMS setting, NAEMSP performed a structured literature review and developed the following recommendations supported by the evidence summarized in the accompanying resource document. NAEMSP recommends: EMS identification of a tension pneumothorax must be guided by a combination of risk factors and physical findings, which may be augmented by diagnostic technologies. EMS clinicians should recognize the differences in the clinical presentation of a tension pneumothorax in spontaneously breathing patients and in patients receiving positive pressure ventilation. EMS clinicians should not perform pleural decompression in patients with simple pneumothoraces but should perform pleural decompression in patients with tension pneumothorax, if within the clinician’s scope of practice. When within scope of practice, EMS clinicians should use needle thoracostomy as the primary strategy for pleural decompression of tension pneumothorax in most cases. EMS clinicians should take a patient-individualized approach to performing needle thoracostomy, influenced by factors known to impact chest wall thickness and risk for iatrogenic injury. Simple thoracostomy and tube thoracostomy may be used by highly trained EMS clinicians in select clinical settings with appropriate medical oversight and quality assurance. EMS systems must investigate and adopt strategies to confirm successful pleural decompression at the time thoracostomy is performed. Pleural decompression should be performed for patients with traumatic out-of-hospital circulatory arrest (TOHCA) if there are clinical signs of tension pneumothorax or suspicion thereof due to significant thoraco-abdominal trauma. Empiric bilateral decompression, however, is not routinely indicated in the absence of such findings. EMS clinicians should not routinely perform pleural decompression of suspected or confirmed simple pneumothorax prior to air-medical transport in most situations. EMS clinicians may consider placement of a vented chest seal in spontaneously breathing patients with open pneumothoraces. In patients receiving positive pressure ventilation who have open pneumothoraces, chest seals may be harmful and are not recommended. EMS physicians play an important role in developing curricula and leading quality management programs to both ensure that EMS clinicians are properly trained in the recognition and management of tension pneumothorax and to ensure that interventions for tension pneumothorax are performed appropriately, safely, and effectively.

Resilience Capacity of Pre-hospital Emergency Medical Service (EMS) Providers and the Future Agenda for Sustainable Development of A Resilient EMS System in Thailand

In the current scenario, demand for emergency care is rising due to the shift in disease pattern all around the world, from growing burden of non-communicable diseases to the pre-existing communicable diseases. The principle aim of an emergency medical service (EMS) system is to prevent premature mortality, reduce pain and prevent long term disability. EMS workers serve on the front lines of emergency medical care, which is one of the most important components in an EMS system of any country. Since the latest pandemic has caused increased burn out and stress among the service providers with long term mental and physical effect which is yet to be researched in Thailand, and no study in particular have addressed to evaluate the resilience capacities of the front-line EMS workforce and identify components that influence their performance and response to emergencies. This study aims to measure the resilience capacity of pre-hospital EMS providers of Thailand along with providing recommendations to policy makers regarding EMS service provider future agendas and standard methods for proper workforce development in order to tackle future public health emergency situations. The respondents were EMTs, ENPs, paramedics, frontline rescuers working in the provinces as an EMS service provider under the ministry of public health (MOPH), National Institute of Emergency Medicine (NIEM), Thailand. Total 500 participated in the survey from 32 different provinces. Resilience capacity was divided into high, moderate and low; Components and factors were developed through literature review and grouping was done. With total 41 questions: Safety, Competencies, Wellness and Behavioral Health. Open ended questions reflected the perception and experiences of the EMS service providers regarding the strength and improvement areas of the EMS system in Thailand. The result from the survey shows that the EMS service providers have moderate resilience in terms of Behavioral Health which is related to their psychometric properties and main components to measure the resiliency scales. Similarly, in terms of Safety, Wellness and Competencies components the EMS services have shown moderate level of resilience capacity as a front-line worker in the emergency medical service system to prepare for the future public health emergencies. The findings of the research present the perception and opinions of various EMS providers working in different provinces of Thailand. This study explores the present status/situation of front-line workers of the EMS system in Thailand. The findings provide crucial recommendations to health policy makers for developing resilient EMS system and their workforce in Thailand focusing on pre-hospital care setting. This research suggests measurement tools and plans focusing on the EMS future agenda 2050.

Burden of Non-Protocolized Patient Transport Outside of Response Area on a Rural Emergency Medical Services System

Objectives Transport destination decisions by prehospital personnel depend on a combination of protocols, judgment, patient acuity, and patient preference. Non-protocolized transport outside the service area may result in unnecessary time out of service and inappropriate resource utilization. Scant research exists regarding clinician rationale for destination decisions. Methods We retrospectively reviewed one year of scene transports by a single rural, hospital-based emergency medical services (EMS) system. We collected dispatch, patient demographic, primary impression, and transport data from prehospital records and matched them to emergency department (ED) data. We characterized rationale for transport decisions and compared rates of hospital admission and specialist consultation in the ED as surrogates for decision appropriateness. Results We reviewed 2,223 patient transports, 281 of which were transported out of the service area. The most common reasons for out-of-area transport were patient preference NOT related to prior medical care (40%) and clinician judgment (24%). Admit rates were highest for per protocol (85%) and patient preference related to prior medical care (67%) groups and lowest for no explanation (41%) and clinician judgment (47%) groups. Rates of in person specialist consultation in the ED were highest in per protocol (69%) and clinician judgment (47%) groups and lowest in no explanation (23%) and patient preference NOT related to prior medical care (30%) groups. Clinician judgment was less predictive of admission and specialist consultation for non-trauma and pediatric patients than for all patients. Median time out of service was more than twice as long for out-of-area transports (140 min) compared to patients transported to the nearest facility (62 min). For out-of-area transports discharged from the ED without specialty consultation (n = 104), ambulances traveled an additional 52 miles/patient compared to theoretical transport to nearest facility. Conclusions Unit out of service time more than doubled for non-protocolized transports outside of the service area and rationale for destination decisions variably predicted admission and specialist consultation rates. Patient preference NOT related to prior medical care and, in pediatric and non-trauma populations, clinician judgment, were less predictive of admission and specialist consultation. Transport guidelines should balance rationale for transport destination and patient characteristics with resource preservation, especially in low-resource systems.

Correlation between the accuracy of the emergency response centre’s urgency assessment and emergency medical services non-conveyance: a retrospective register-based study in Finland

BackgroundIn modern emergency medical services (EMS), ambulances increasingly focus on examining and treating the patient at the scene. This has led to increased levels of non-conveyance. In Finland, for instance, approximately 40% of EMS dispatches end up in non-conveyance. As EMS systems evolve, the proportion of non-conveyance could serve as a cost-effective measure to assess the quality of the dispatch criteria, if a link to the performance of urgency assessment would be established. The purpose of this study was to investigate whether the proportion of non-conveyance is associated with the test performance levels of the urgency assessment. This investigation was done separately within each dispatch category.MethodsA retrospective evaluation of the data was conducted on all EMS dispatches in the Pirkanmaa Hospital District from 1 August 2021 through 31 August 2021. There were a total of 7,245 EMS dispatches during the study period of which 829 were excluded. This study was conducted by comparing the existing test performance levels (sensitivity, specificity and under- or overestimation) of the emergency response centre’s urgency assessment with the non-conveyance rate (%) of each dispatch category. The relationships between the variables were measured using Spearman’s rank correlation coefficient.ResultsThe proportion of over-triage was the only urgency assessment’s test performance variable that had a statistically significant correlation with the proportion of non-conveyance (r = 0.568; p = 0.003). Other test performance variables of the urgency assessment had no or little correlation to the proportion of non-conveyance. Of the 6,416 EMS dispatches in the study period, 42% (2,672) resulted in non-conveyance of the patient. In nine dispatch categories, at least half (51–69%) of the dispatches ended in non-conveyance.ConclusionsBased on this study, it seems that the percentage of non-conveyance in the dispatch category could be used, with certain limitations, to assess the proportion of over-triage in the dispatch category. The method is particularly applicable in scenarios where the dispatch criteria have undergone modifications and there is a need to monitor the effect of the changes on the level of over-triage.

What causes Emergency Medical Services (EMS) delay? Unravel high-risk buildings using citywide ambulance trajectory data

Emergency Medical Services (EMS) delay poses a challenge to public health, especially in ultra-dense cities and aging societies. The potential relationship between the built environment and the ambulance response time (ART) has not been thoroughly investigated at the building-level. This impedes the unraveling of high-risk buildings for EMS delay, and thus the precise optimization of urban EMS systems. Our study develops a quantitative-qualitative approach to construct a building-level ART prediction model and then validated it with ambulance drivers' experiences. A comprehensive theoretical framework is tailored for ART prediction incorporating neglected built environment factors of land use and development intensity. Based on 73,129 ambulance trajectories, a machine learning model is constructed and then employed to predict the ART for each of the 253,475 buildings in central Shanghai under multiple combinations of traffic periods and weather conditions. The results show that the accuracy of high-risk buildings for EMS delay achieves 91%. Moreover, three of the neglected built environment factors, medical POIs density, business POIs density and floor area ratio, rank high in the factor importance. The ambulance drivers’ experiences validate the importance of these built environment factors and emphasize the value of bus priority lanes for ambulance to borrow for swift access. In addition, to illustrate potential applications, we simulated the effects of built environment interventions in case areas predicted to concentrate high-risk buildings. This work provides a new computer-based tool to pinpoint the service blind spots of such urban emergency systems and to develop built environment interventions.

A Survey of Patient Utilization and Trust of Emergency Medical Services

Little is known about patients’ decisions to come to the Emergency Department (ED) via emergency medical services (EMS) versus privately owned vehicle (POV); this is problematic as trust in EMS systems impacts patient care decisions. Furthermore, no studies exist that evaluate patients’ trust of the EMS system as it relates to a patient’s race. Patients completed a multi-method survey during their ED stay. Quantitative data included: patient demographics (age, gender, race) income, insurance status, previous medical training, highest level of education, self-reported medical and social history, number of ED visits in the past three months, and two scales assessing trust and empathy: the Group-Based Medical Mistrust Scale and the Jefferson Scale. Characteristics of patients who came to the ED via EMS versus POV were shown. A Wilcoxon signed rank test described differences in EMS trust scales by race. Logistic regression showed which factors contribute to the decision of EMS or POV. Qualitative comments described patients’ rationale for EMS versus POV. 23/72 (31.94%) patients utilized EMS transport and 49/72 (68.06%) utilized POV. 59.09% of patients self-identified as Black and 40.91% self-identified as White. The Group-Based Medical Mistrust Scale found Black patients had less trust in the EMS system (p=0.0001), while the Jefferson Scale of Patient Perception of Physician Empathy showed no significant difference in patient perceptions of EMS provider empathy (p=0.608). Logistic regression indicated that age predicted the use of EMS over POV (p<0.001). Lack of access to POV, physical limitations, cost, speed, perception of emergency, and fear were identified as reasons that supportg patients’ decision to use EMS or POV. Many factors can influence patients’ transportation decisions and this study highlights trust, age, and other social and economic factors. These findings could inform policy decisions and ensure emergency care systems that are accessible for all patients.

Caring for Transgender and Gender Diverse Prehospital Patients: a NAEMSP Position Statement and Resource Document

ABSTRACT Transgender and gender diverse (TGD) people have long faced significant barriers to safely accessing medical care–especially gender-affirming care, which has been shown to strikingly improve health outcomes like suicidality and depression. In the prehospital setting, gender-affirming care amounts to showing respect for the TGD patient’s identified gender and maintaining a safe environment that fosters a positive therapeutic relationship throughout the encounter. This represents a challenge for many Emergency Medical Services (EMS) systems due to the lack of TGD-specific training for EMS clinicians, a paucity of TGD-specific research to inform EMS education and clinical care, and in some cases the resistance of EMS clinicians to such training. Transgender and gender diverse people are facing a regression in legal access to essential medical care. With this position statement, NAEMSP joins other professional medical societies in providing recommendations to improve care for TGD patients, thereby affirming TGD individuals’ right to exist as their authentic selves, as well as their entitlement to the same high-quality prehospital medical care as their cisgender peers. NAEMSP Recommends: EMS clinicians should maintain basic cultural competency regarding TGD populations, including familiarity with TGD-related health and health care disparities, consideration of TGD populations as underserved, and understanding the centrality of stigma and transphobia in creating disparities and other challenges which complicate daily life for TGD people. EMS clinicians should demonstrate cultural humility towards the TGD community, which includes self-assessment of knowledge gaps, as well as openness to new or unfamiliar ideas, information, and advice from those with different lived experiences. EMS clinicians should understand basic TGD-specific terminology and use appropriate language–including patient-identified name and pronouns–during direct patient care, in handoffs, and in documentation. EMS clinicians should treat a patient’s TGD status as sensitive health information and take care not to inadvertently disclose this information without the patient’s express permission. EMS clinicians should have a basic understanding of social transitioning and of gender-affirming medical and surgical treatments. EMS clinicians should employ a trauma-informed approach when caring for TGD patients. EMS education and training should incorporate learning domains that address comprehensive care for TGD patients, with educational content providing the specific knowledge and skills required to promote equitable care. EMS workplaces should implement policies to improve recruitment and retention of TGD personnel, covering harassment protection, non-discrimination practices, inclusive working environments, equal advancement opportunity and tailored employee benefits. Future EMS research should focus on elucidating the disparities in and barriers to prehospital care of the TGD patient population with emphasis on patient experience and education of prehospital clinicians.

Complicated cardiac arrest and its resuscitation characteristics in patients with intracerebral hemorrhage: Chinese Stroke Center Alliance.

Cardiac arrest (CA) is one of the most severe complications in patients with intracerebral hemorrhage (ICH), increasing the risk of death. This study explored the factors influencing CA occurrence and its resuscitation characteristics in ICH patients. Data were retrieved from the Chinese Stroke Center Alliance database. The primary outcome was CA, and the secondary outcomes were in-hospital death and survival post-CA. Absolute standardized and rate differences were utilized for intergroup comparisons, while logistic regression was employed for correlation analysis. A total of 85,105 patients were enrolled in this study. Among them, 1651 (1.9%) patients experienced CA, of whom 1032 (62.5%) died in hospital. At baseline, prehospital notification from the emergency medical service system (PRE-EMS) was a co-factor influencing CA occurrence and the presence of a death outcome (OR: 1.71, 95% CI: 1.47-1.98, p < 0.001; OR: 0.50, 95% CI: 0.41-0.62, p < 0.001). In terms of complications, post-hospital hematoma expansion and swallowing dysfunction were co-factors influencing CA occurrence and the presence of a death outcome (OR: 3.78, 95% CI: 3.20-4.47, p < 0.001, OR: 1.39, 95% CI: 1.11-1.76; p < 0.001; OR: 7.66, 95% CI:5.48-10.70, p < 0.001, OR: 1.66, 95% CI: 1.08-2.57, p < 0.001). The incidence of CA in ICH patients decreased annually from 2015 to 2019, while survival after CA increased annually (p < 0.001). PRE-EMS, posthospital hematoma expansion, and swallowing dysfunction were identified as co-factors contributing to CA occurrence and post-CA mortality following ICH. The proportion of CA patients following ICH decreased, while survival rates improved annually from 2015 to 2019.

Impact of an emergency department closure on out-of-hospital cardiac arrest survival and emergency medical service system in Ulsan, South Korea

IntroductionThis study evaluated the impact of an emergency department (ED) closure on out-of-hospital cardiac arrest survival outcomes and the emergency medical service system in Ulsan, South Korea. MethodsWe conducted a retrospective observational cohort study from March 2017 to February 2021 and compared survival to hospital discharge and favorable neurological outcomes. We investigated transport time intervals (TTIs) in the total study population and subgroup covered by the closed ED. The analysis methods included propensity score matching (PSM), inverse propensity weighting (IPW), and logistic regression analysis. ResultsThe study included 692 and 920 patients before and after ED closure groups, respectively. After adjusting for covariates, the adjusted odds ratios and 95 % confidence interval for survival discharge and favorable neurological outcomes were 1.040 (0.749–1.444, p = 0.814) and 2.845 (1.563–5.177, p = 0.001), respectively. PSM showed values of 1.015 (0.727–1.416, p = 0.932) for discharge survival and 1.777 (1.074–2.941, p = 0.025) for neurological outcomes. IPW showed values of 0.980 (0.762–1.261, p = 0.875) for discharge survival and 1.782 (1.196–2.656, p = 0.005) for neurological outcomes. The TTI increased from 5.8 ± 5.0 to 6.7 ± 5.5 min (p < 0.001) in the total population and from 9.2 ± 7.9 to 16.2 ± 6.5 min (p < 0.001) in the subgroup. ConclusionsThe findings suggest that while the overall system may remain stable, subgroups could be disproportionately affected by an ED closure, underscoring the importance of the ongoing monitoring of survival outcomes and transport times.

A Comparison of Ketamine to Midazolam for the Management of Acute Behavioral Disturbance in the Out-of-Hospital Setting

ObjectiveAcute behavioral disturbance is characterized by altered mental status and psychomotor agitation. Pharmacological sedation may be required, risking potential respiratory compromise. We compared the need for emergent airway support following administration of midazolam or ketamine to treat acute behavioral disturbance in the prehospital setting. MethodsIn this retrospective cohort study of patients with acute behavioral disturbance in an urban Emergency Medical Service (EMS) system between 2017-2021, we compared the likelihood of prehospital advanced airway management following administration of midazolam or ketamine. Advanced airway management was defined as prehospital endotracheal intubation or supraglottic airway insertion. ResultsAmong 376 eligible patients, the median age was 35; and 78% were male. The most common etiologies of acute behavioral disturbance were substance use (51%), trauma (18%), and presumed postictal agitation (11%). In all, 162 patients (43%) initially received midazolam and 214 (57%) ketamine. The frequency of advanced airway management was similar between these respective groups (12% [n=19] vs 11% [n=24], difference 0.5%, 95% CI -6.0% to 7.0%). Adjusted for potential confounders, the odds of receiving advanced airway management did not differ between midazolam and ketamine (aOR 1.02, 95% CI 0.44 to 2.38), nor were differences observed in emergency department intubation rates (14% in midazolam recipients, 11% for ketamine) or overall mortality (2% in midazolam recipients, 1% for ketamine). ConclusionIn this cohort study of patients with acute behavioral disturbance, emergent airway support nor other outcomes differed following prehospital treatment with midazolam or ketamine.

Perceptions and Use of Automated Hospital Outcome Data by EMS Providers: A Pilot Study.

Our primary objective evaluated the perception of emergency medical service (EMS) providers' review of automated hospital outcome data. Secondarily, we assessed participation in outcome review as a means of microlearning to obtain continuing education (CE). From October-December 2023, three high-volume EMS systems participated in a three-part intervention with results evaluated using a mixed-methods approach. First, EMS providers (emergency medical technicians and paramedics) were invited, via their electronic health record (EHR), to complete a presurvey evaluating their perceptions of reviewing outcomes. Then, EMS providers were notified about the opportunity to earn CE via a microlearning intervention, offering Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE)-approved CE hours for completion of outcome reviews and associated learning modules. Finally, EMS providers were invited to complete a post-survey mirroring the pre-survey. Qualitative analyses identified themes among open-ended responses. Quantitative analyses examined perceptions between pre- and post- surveys. Of 843 providers contacted, 217 responded to the pre-survey (25.7%). The most endorsed rationale for reviewing outcomes included improving clinical knowledge (95%), improving patient care (94%), and knowing whether care made a difference (93%). Nearly all (91%) reported being more likely to review outcomes if CE were awarded. Among the 67 who completed the open-ended items, the three dominant themes included enhance personal confidence and competence (43%); acquire personal knowledge (39%); and operations (21%). Of 211 providers who participated in the intervention, 56 (27%) were awarded CE. A total of 152 providers responded to the post-survey, and the percentage who agreed that reviewing outcomes improves job satisfaction rose from 89% to 95% between pre- and post-surveys (P = 0.05). EMS providers supported the personal and professional development and patient care improvement of reviewing patients' outcomes with associated CE. Further study is warranted to evaluate the generalizability of these findings and the best user experience.

Evaluation of the Implementation of a Novel Fluid Resuscitation Device in the Prehospital Care of Sepsis Patients: Application of the Implementation Outcomes Framework

Objectives Early identification and fluid resuscitation are recognized performance measures within sepsis care. Despite fluid resuscitation, fluid goals are often not achieved in the prehospital environment. Furthermore, description of implementation process and evaluation of implementation success are historically underreported in prehospital research. The objective of this study was to contextualize and evaluate the system-wide implementation of a novel fluid resuscitation device, the LifeFlow PLUS®, in the treatment of prehospital sepsis patients. Methods A single urban emergency medical services (EMS) system internally decided to adopt a novel fluid resuscitation device. This EMS system added the device to the clinical care guidelines of suspected sepsis patients. Prior to and during implementation of the new guidelines, several strategies were undertaken to promote consistent, appropriate system-wide use of the device. A mixed methods study design was deployed. Surveys of EMS clinicians and leaders assessed perceptions of the device and sepsis education prior to field implementation of the device. Clinician and leader semi-structured interviews assessed implementation experience and device adoption. Document analysis evaluated deployment of implementation strategies. Data were triangulated to contextualize implementation and evaluate success. Results Clinician (88%) and leader (91%) confidence in appropriate clinician device use and device superiority for sepsis care (73 and 100%, respectively) were high. Clinicians (58%) were less likely to view the device as easy to implement compared to leaders (73%). Three themes were developed from semi-structured interviews, including “exposure” to the device, “reinforcing factors” to prompt device use, and “clinician buy-in.” Twenty unique implementation strategies (e.g., dynamic trainings, mandating change) were used to promote successful system-wide device adoption. Conclusions The overall implementation success of this novel fluid resuscitation device was moderate. Barriers to adoption included complexity of clinical decision-making and ease of device use. Facilitators to adoption included the use of multiple modes of education, clinical reminders, presenting evidence of device benefit, and prehospital culture. Prior to future prehospital implementation programs, EMS systems should focus on identifying and addressing key barriers and facilitators to improve adoption.

The Impact of Sleep and Mental Health on the Quality of Work Among Paramedics in the Kingdom of Saudi Arabia

The emergency services sector is one of the most arduous and crucial fields wherein an individual’s life lies in the hands of emergency responders such as paramedics and police. Paramedics are crucial figures in the emergency medical services system. They deliver immediate medical care to patients who suffer from critical and life-threatening conditions, serving as a gap-filler between the accident scene and health facilities. In the Kingdom of Saudi Arabia, the health authority has been constantly striving to build a credible, professional, and trustworthy EMS system while discovering challenges faced by the service in the rapidly changing health scenario of KSA. This study employed a mixed-methods approach, combining quantitative surveys and qualitative interviews to assess the relationship between sleep patterns, mental health, and work quality among paramedics in the Kingdom of Saudi Arabia. The results of this study reveal a significant correlation between sleep quality, mental health, and the overall performance of paramedics in the Kingdom of Saudi Arabia. In conclusion, the findings of this comprehensive study emphasize and highlight the critical and significant relationship that exists between sleep quality, mental health, and overall job performance among paramedics working in the Kingdom of Saudi Arabia. This highlights an urgent need for targeted and effective interventions designed specifically to enhance their well-being and support their mental health in the demanding field of emergency services.

Professionalizing Emergency Medical Service Response Time

Abstract Prompt responses by emergency medical services (EMSs) are crucial in delivering efficient prehospital emergency treatment. The prompt arrival of EMS is strongly correlated with improved patient outcomes and increased chances of survival. To reduce the occurrence of long-term impairment or illness, the majority of EMS companies follow globally acknowledged response time benchmarks. Internationally, EMSs strive to achieve a response time of 8 min or less for 90% of life-threatening incidents. This research examines many variables that influence EMS response times and their subsequent consequences on patient outcomes. The measurement of response time starts with receipt of a clinical complaint call and concludes upon the arrival of EMS at the site. Timely and effective reactions are essential for the survival of patients, particularly in urgent medical situations. In contrast, there are data indicating that longer reaction times are associated with increased death rates. Various obstacles might hinder prompt EMS responses, including geographical obstacles, unfavorable weather and traffic conditions, and patient-specific considerations such as the kind of injury or sickness, medical history, age, and gender. In addition, a lack of staff, including insufficient workers, poor training, and the absence of standardized, up-to-date technology that simplify care delivery, may also cause delays in response times. Due to the crucial importance of EMS response times in prehospital emergency treatment, it is essential for EMS systems to make every effort to meet their response time goals.