Emergency Medical Services System Research Articles

Research on the Rescue Time of the Taiwan Marathon Emergency Medical Service System Between 2013 and 2021.

While there are several studies on marathon injuries worldwide, there are no related studies on the Taipei Marathon regarding the rescue time of onsite injury cases, the incidence of out-of-hospital cardiac arrest (OHCA) cases, and the success rate of recovery of spontaneous circulation (ROSC). This study aims to fill that gap. The rescue time onsite of contact injury cases was in the prime time for lifesaving. Descriptive epidemiological study. Level 2c. This is a retrospective study of numerical and timeflow data using descriptive statistics. Our data were obtained from records of the Taipei Marathon from 2013 to 2021. These included (1) notification data, (2) the time record of the emergency care personnel in contact with patients, (3) incidence of OHCA, (4) the success rate of ROSC, (5) the location of occurrence of OHCA, and (6) emergency medical service capacity and configuration. The average time taken for first contact was 1.56 minutes in OHCA cases, and the total incidence rate of OHCA in 9 years was 4 people per 100,000 people, with a 100% ROSC success rate. Further, the location of OHCA cases was mostly in Q4 of the race (66.67%), followed by Q3 (22.22%) and Q2 (1.11%). The average number of emergency care personnel per marathon was 78, spread across 6 rescue and 6 medical stations and equipped with 8 ambulances and 35 automated external defibrillators. Shortening the arrival time of medical personnel to the scene and implementing a complete chain of survival can improve survival rates. Other ways to provide faster and more timely emergency rescue services require further study. Contact with patients as soon as possible, timely implementation of cardiopulmonary resuscitation, and use of an automated external defibrillator are the basic requirements of the chain of survival theory.

Uwagi na tle postanowienia Sądu Najwyższego z 2 lutego 2017 r. sygn. II KK 306/16 oraz wyroku Sądu Najwyższego z 9 listopada 2017 r. sygn. II KK 215/17

Two paramedics and a dispatcher have been charged with endangering the imminent risk of loss of life or grievous bodily harm the health of a stroke patient who, on the instructions of the dispatcher they transported her to a hospital without conditions or technical facilities for treating strokes conditions and technical facilities for treating strokes, and on the spot refused to transport her to another facility suitable for the clinical condition. The patient survived, but at the cost of great damage to her health, and as an auxiliary defendant the was the husband, who from the outset insisted that his wife be transported elsewhere elsewhere, but for reasons of his own convenience. An altercation with him delayed assistance. In essence, the case concerns the interpretation of the standards governing the transportation of persons in a state of medical emergency by the emergency medical services system medical emergency system, and whether a patient in that system has anything at all to say over the facility to which he or she would be taken.

Determinants and barriers of prehospital emergency medical services utilization among general critical emergency patients in Thailand

This cross-sectional study identified the determinants and barriers of pre- hospital emergency medical services (EMS) utilization among general critical emergency patients in Thailand, using the data of general critical emergency patients (red zone) from the information technology for emergency medical system (ITEMS) of the National Emergency Medical Service Institute. The sample of 889 critical emergency patients was selected through multistage random sampling method. Data were analyzed by multiple logistic regression. The findings indicated that 41.51% of general critical emergency patients used EMS through the EMS rescue hotline system of the National Institute of Emergency Medicine in which most of them were diabetic patients (24.75%). The determinants relating to EMS utilization of general critical emergency patients consisted of level of knowledge on EMS system (AdjOR: 5.77; 95%CI: 2.8-11.87), confidence in the safety of service utilization (AdjOR: 5.04; 95%CI: 3.65-6.98), recognition in service and severity of illness (AdjOR: 3.22; 95%CI: 2.17-4.76), service adequacy (AdjOR: 1.92; 95%CI: 1.41-2.63), educational background (AdjOR:1.69; 95%CI: 1.13-2.53), and service satisfaction (AdjOR: 1.14; 95%CI: 1.07-1.21). Nearly half of the people were utilizing the EMS services in Thailand. However, required level of knowledge on EMS, confidence on safety on service utilization, service adequacy as well as patient’s educational background had tremendous role on the proper utilization of EMS.

Electric Scooter Injuries in Tampa, Florida, Are Associated With High Rates of Head Injury, Hospital Admission, and Emergency Medical Service Transport and Low Rates of Helmet Use.

Background Standing electric scooters (e-scooters) were introduced in Tampa, Florida, in 2019. We reviewed 292 e-scooter injury cases at the Tampa General Hospital Emergency Department (ED) to determine what insights we could gain. We sought to identify the characteristics of such presentations, including chief complaint (CC), patient age, day of the week, time of day, length of stay, disposition, acuity, and means of arrival to the ED. We were particularly interested in studying the rates of hospital admission, Emergency Medical Service (EMS) transport, emergent acuity presentations, and head injuries. We also sought to identify the prevalence of alcohol use prior to e-scooter accidents and its effect on the above factors. Methodology This was a retrospective chart review and was exempt from the University of South Florida's Institutional Review Board approval (STUDY004031). Data from routine clinical care in the Tampa General Hospital ED, a Level-1 Trauma Center ED in Tampa, Florida, from July 19, 2019, to May 30,2022, were collected through an operational report within the business intelligence infrastructure of the hospital's electronic medical record system. Data from patients with scooter injury-related encounter codes were extracted to an electronicdata capture form and deidentified. Narratives were reviewed to exclude uncertain cases (e.g., patients with moped, kick scooter, mobility scooter injuries, etc.) and to flag for alcohol endorsement, altered mental status, helmet usage, and head injuries that were not listed as the CC. CC, means of arrival, acuity, disposition, arrival/departure day of week, and arrival/departure hour were collected. Data analysis was completed using Microsoft Excel version 16.5 (Microsoft Corp., Redmond, WA, USA) and SPSS Statistics version 28.0 (IBM Corp., Armonk, NY, USA). Results A total of 292 of 442 collected cases remained after removing irrelevant flags. Overall, 30.8% (n = 90) of patients were between the ages of 21 and 30, and most patients presented on weekends and nights. Moreover, 40.8% (n = 119) suffered head injuries, 40.8% (n = 119) arrived via EMS, 31.5% (n = 92) were admitted to the hospital, and 18.8% (n = 55) were designated as emergent acuity. Apart from the admission rate, these rates were all higher among alcohol endorsers (39, 13.4%) than non-endorsers (253, 86.6%). Only 2.1% of patients endorsed helmet use. Conclusions We found higher rates of hospital admission and EMS transports in our ED than many previous studies in urban areas have reported. Our data suggest that alcohol use increases the risk of more serious e-scooter injuries, characterized by higher acuity, EMS transport rate, and head injuries among alcohol endorsers. These findings are highly relevant due to the rapidly growing e-scooter presence across the United States and may serve to inform hospitals and EMS systems regarding their role in injury management, as well as future policy regarding their safe use.

Clinical Roles in the Medical Communications Centre: A Rapid Scoping Review.

In recent years, 911 call volumes have increased, and emergency medical services (EMS) are routinely stretched beyond capacity. To better match resources with patient needs, some EMS systems have integrated clinician roles into the emergency medical communications centre (MCC). Our objective was to explore the nature and scope of clinical roles in emergency MCCs.Using a rapid scoping review methodology, we searched PubMed for studies related to any clinical role employed within an emergency MCC. We accepted reviews, experimental and observational designs, as well as expert opinions. Studies reporting on dispatcher recognition and pre-arrival instructions were excluded. Title and abstract screening were conducted by a single reviewer, included studies were verified by two reviewers, and data extraction was completed in duplicate, all using Covidence review software. The level of evidence was assessed using the prehospital evidence-based practice (PEP) scale. The protocol was registered in Open Science Framework (10.17605/OSF.IO/NX4T8). Our search yielded 1071 titles, and four were added from other sources; 44 studies were reviewed at the full-text stage and 31 were included. The included studies were published from 2002 to 2022 and represent 17 countries.Studies meeting inclusion criteria consisted of level I (n=4, 11%), II (n=13, 37%), and III (N=6, 17%) methodologies, as well as 12 other studies (34%) with qualitative or other designs.Most of the included studies reported systems that employ nurses in the MCC (n=29, 83%). Twelve (34%) studies reported on the inclusion of paramedics in the MCC, and five (14%) reported physician involvement. The roles of these clinicians chiefly consisted of triage (n=25, 71%), advice (n=20, 57%), referral to non-emergency care (n=14, 40%), and peer-to-peer consulting (n=2, 4%).Alternative dispositions (as opposed to emergency ambulance transport) for low acuity callers included self-care, as well as referral to a general practitioner, pharmacist, or other outreach programs.There is a wide range of literature reporting on clinical roles integrated within MCCs. Our findings revealed that MCC nurses, physicians, and paramedics assist substantively with triage, advice, and referrals to better match resources to patient needs, with or without the requirement for ambulance dispatch.

An Analytical Approach for Dispatch Operations of Emergency Medical Services: A Case Study of COVID-19

Emergency medical services (EMS) aims to deliver timely ambulatory care to incidents in communities. However, the operations of EMS may contend with suddenly increasing demands resulting from unexpected disasters such as disease outbreaks (e.g., COVID-19) or hurricanes. To this end, it usually requires better strategical decisions to dispatch, allocate, and reallocate EMS resources to meet the demand changes over time in terms of demographic and geographic distribution of incidents. In this study, we focus on the operation of the EMS resources (i.e., ambulance dispatch) in response to a demand disruption amid the COVID-19 pandemic. Specifically, we present a analytical framework to (1) analyze the underlying demographic and geographic patterns of emergency incidents and EMS resources; (2) develop a mathematical programming model to identify potential demand gaps of EMS coverage across different districts; and (3) provide a remedial reallocation solution to the EMS system with the existing ambulance capacity. The proposed method is validated with emergency response incident data in New York City for the first COVID-19 surge from March to April 2020. We found that it takes a long incident response time to scenes which reflects unexpected incident demands during COVID-19 surge. To cover such disruptive demands, ambulances need to be reallocated between service districts while meeting the response time standard. The proposed framework can be potentially applied to similar disruptive scenarios in the future and other operational systems disrupted by other disasters.HighlightsWe propose an analytical framework using optimization modeling and simulation techniques for EMS resource allocation in response to a demand disruption amid the COVID-19 pandemic.We propose mathematical programming models to identify potential demand gaps of EMS coverage across different districts.We provide a remedial reallocation solution to the EMS system with the existing ambulance capacity.

Temporal Trends in Incidence and Survival From Sudden Cardiac Arrest Manifesting With Shockable and Nonshockable Rhythms: A 16-Year Prospective Study in a Large US Community

The proportion of nonshockable sudden cardiac arrests (pulseless electrical activity and asystole) continues to rise. Survival is lower than shockable (ventricular fibrillation [VF]) sudden cardiac arrests, but there is little community-based information on temporal trends in the incidence and survival from sudden cardiac arrests based on presenting rhythms. We investigated community-based temporal trends in sudden cardiac arrest incidence and survival by presenting rhythm. We prospectively evaluated the incidence of each presenting sudden cardiac arrest rhythm and survival outcomes for out-of-hospital events in the Portland, Oregon metro area (population of approximately 1 million, 2002 to 2017). We limited inclusion to cases of likely cardiac cause with resuscitation attempted by emergency medical services. Out of 3,723 overall sudden cardiac arrest cases, 908 (24%) presented with pulseless electrical activity, 1,513 (41%) with VF, and 1,302 (35%) with asystole. The incidence of pulseless electrical activity-sudden cardiac arrest remained stable over 4-year periods (9.6/100,000 in 2002 to 2005, 7.4/100,000 in 2006 to 2009, 5.7/100,000 in 2010 to 2013, and 8.3/100,000 in 2014 to 2017; unadjusted beta [β]-0.56; 95% confidence interval [CI],-3.98 to 2.85). The incidence of VF-sudden cardiac arrests decreased over time (14.6/100,000 in 2002 to 2005, 13.4/100,000 in 2006 to 2009, 12.0/100,000 in 2010 to 2013, and 11.6/100,000 in 2014 to 2017; unadjusted β-1.05; 95% CI,-1.68 to-0.42) and asystole-sudden cardiac arrests (8.6/100,000 in 2002 to 2005, 9.0/100,000 in 2006 to 2009, 10.3/100,000 in 2010 to 2013, and 15.7/100,000 in 2014 to 2017; unadjusted β 2.25; 95% CI-1.24 to 5.73) did not change significantly over time. Survival increased over time for pulseless electrical activity-sudden cardiac arrests (5.7%, 4.3%, 9.6%, 13.6%; unadjusted β 2.8%; 95% CI 1.3 to 4.4) and VF-sudden cardiac arrests (27.5%, 29.8%, 37.9%, 36.6%; unadjusted β 3.5%; 95% CI 1.4 to 5.6), but not for asystole-sudden cardiac arrests (1.7%, 1.6%, 4.0%, 2.4%; unadjusted β 0.3%; 95% CI,-0.4 to 1.1). Enhancements in the emergency medical services system's pulseless electrical activity-sudden cardiac arrest management were temporally associated with the increasing pulseless electrical activity survival rates. Over a 16-year period, the incidence of VF/ventricular tachycardia decreased over time, but pulseless electrical activity incidence remained stable. Survival from both VF-sudden cardiac arrests and pulseless electrical activity-sudden cardiac arrests increased over time with a more than 2-fold increase for pulseless electrical activity-sudden cardiac arrests.

End-tidal Carbon Dioxide + Return of Spontaneous Circulation After Cardiac Arrest (RACA) Score to Predict Outcomes After Out-of-hospital Cardiac Arrest.

The return of spontaneous circulation after cardiac arrest (RACA) score is a well-validated model for estimating the probability of return of spontaneous circulation (ROSC) in patients with out-of-hospital cardiac arrest (OHCA) by incorporating several variables, including gender, age, arrest aetiology, witness status, arrest location, initial cardiac rhythms, bystander cardiopulmonary resuscitation (CPR), and emergency medical services (EMS) arrival time. The RACA score was initially designed for comparisons between different EMS systems by standardising ROSC rates. End-tidal carbon dioxide (EtCO2) is a quality indicator of CPR. We aimed to improve the performance of the RACA score by adding minimum EtCO2 measured during CPR to develop the EtCO2 + RACA score for OHCA patients transported to an emergency department (ED). This was a retrospective analysis using prospectively collected data for OHCA patients resuscitated at an ED during 2015-2020. Adult patients with advanced airways inserted and available EtCO2 measurements were included. We used the EtCO2 values recorded in the ED for analysis. The primary outcome was ROSC. In the derivation cohort, we used multivariable logistic regression to develop the model. In the temporally split validation cohort, we assessed the discriminative performance of the EtCO2 + RACA score by the area under the receiver operating characteristic curve (AUC) and compared it with the RACA score using the DeLong test. There were 530 and 228 patients in the derivation and validation cohorts, respectively. The median measurements of EtCO2 were 8.0 times (interquartile range [IQR] 3.0-12.0 times), with the median minimum EtCO2 of 15.5 millimeters of mercury (mm Hg) (IQR 8.0-26.0 mm Hg). The median RACA score was 36.4% (IQR 28.9-48.0%), and a total of 393 patients (51.8%) achieved ROSC. The EtCO2 + RACA score was validated with good discriminative performance (AUC, 0.82, 95% CI 0.77-0.88), outperforming the RACA score (AUC, 0.71, 95% CI 0.65-0.78) (DeLong test: P < 0.001). The EtCO2 + RACA score may facilitate the decision-making process regarding allocations of medical resources in EDs for OHCA resuscitation.

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.

Evaluation of Out-of-Hospital Cardiac Arrests in Births and Neonates: Opportunities to Improve Care [ID: 1377387

INTRODUCTION: Home births have increased 77% from 2004 to 2017 and further increased with the COVID-19 pandemic. While the majority of home births are uneventful, some are complicated and require attendance of emergency medical services (EMS). Understanding characteristics of out-of-hospital births and EMS care is increasingly important to improve care. METHODS: We conducted a chart review of pediatric out-of-hospital cardiac arrests (POHCAs) from EMS agencies across the United States to evaluate the care provided by first responders. The study was approved by Oregon Health &amp; Science University and respective IRBs. RESULTS: Of 1,020 POHCAs, 54 were responses to births and 43 were for other neonates. While most neonatal POHCAs occurred in a home or residence (84%), some births occurred at other locations such as a health care facility, public or commercial building, and street or highway. Bystander cardiopulmonary resuscitation was performed in less than half of births but more than half of other neonates. Return of spontaneous circulation was twice as likely for births as for other neonates (27% versus 13%). Overall, serious adverse safety events were observed in three-fourths of neonatal resuscitations. Births were more likely to be associated with failure to follow the correct resuscitation algorithm and lack of positive pressure ventilation. CONCLUSION: There are unique challenges in the care of out-of-hospital births for the EMS system. There is an opportunity to improve use of neonatal resuscitation protocols and early ventilation.

Focused Needs Assessment and Tailored Training Pilot for Emergency Care Providers in Rwanda

Introduction:In lower- and middle-income countries (LMIC), 45% of deaths could be prevented by implementation of emergency care systems. Prehospital care is critical for emergency medical services (EMS) worldwide, and basic affordable training improves EMS systems. This study conducted a needs assessment in addition to a tailored prehospital training intervention. Subsequent changes in prehospital care as well as patient outcomes were measured.Method:Thirty providers identified through the prehospital medical command office participated. A prospective, nonrandomized interrupted time-series approach was utilized for a needs assessment and training intervention. Data collected included age, gender, training level, and a knowledge assessment, and was used to create an 18-hour training, with immediate and 11-month posttests. Prehospital process indicators evaluated on-the-ground application of skills, including airway intervention, intravenous fluid administration, and glucose administration. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes.Results:Of 30 providers, 60% (n=18) female and 40% (n=12) male, 19 were nurses and 11 were nurse anesthetists. Median age was 36 and median years providing care was 10 (IQR: 7,11). 24 (80%) participants completed immediate and post-test assessments, showing a 56% (95%CI: 36.2, 75.8) relative increase in mean knowledge score across 12 core skills that was maintained across post-tests. 324 of 572 total patients transported to the ED during the study were transported during the pre-training period (56.4%). Prehospital oxygen administration for patients with a saturation level of &lt;95% increased pre- to post-intervention (66.7% to 71.7%; Δ = 5.0%; Δ95%CI: 1.9, 8.1%).Conclusion:This study is the first LMIC-based prehospital provider training efficacy study that includes analysis of patient outcomes and clinical process indicators. Results offer important insights on Rwanda’s prehospital care system and demonstrate that affordable, tailored educational interventions targeting process indicators have positive impacts on provider knowledge and practice.

EMS and Bioterrorism Response

Introduction:Previous studies have found that public health systems within the United States are inadequately prepared for an act of biological terrorism. As the COVID-19 pandemic continues, few studies have evaluated bioterrorism preparedness of Emergency Medical Services (EMS), even in the accelerating environment of biothreats.Method:This study utilized an Internet-based survey to assess the level of preparedness and willingness to respond to a bioterrorism attack and identify factors that predict preparedness and willingness among Nebraska EMS providers. The survey was available for 1 month in 2021 during which 190 EMS providers responded to the survey.Results:Only 56.8% of providers were able to recognize an illness or injury as potentially resulting from exposure to a biological agent. Provider Clinical Competency levels ranged from a low of 13.6% (ability to initiate patient care within his/her professional scope of practice and arrange for prompt referral appropriate to the identified condition(s)) to a high of 74% (the ability to respond to an emergency within the emergency management system of his/her practice, institution, and community). Only 10% of the respondents were both willing and able to effectively function in a bioterror environment.Conclusion:To effectively prepare for and respond to a bioterrorist attack, all levels of the healthcare system need to have the clinical skills, knowledge, and abilities necessary to treat patients exposed to biological agents. Policy changes and increased focus on training and drills are needed to ensure a prepared EMS system, which is crucial to a resilient state. EMS entities need to be aware of the extent of their available workforce so that the country can be prepared for the increasing threat of bioterrorism or other novel emerging infectious disease outbreaks. A resilient nation relies on a prepared set of EMS providers who are willing to respond to biological terrorism events.

Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services

BackgroundPrehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process.MethodsThe protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records.ResultsDuring the study period (2012–2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25–42] vs. 29 [IQR 21–39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7–77.8%) to 97.6% (95% CI 96.7–98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0–73.9%) to 93.4% (95% CI 92.3–94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6–88.9%) to 98.5% (95% CI 97.7–99.0%), respectively. Deterioration in compliance indicators was not observed.ConclusionsWe concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.

On-scene time delays for epileptic seizures in emergencies during a social pandemic: A population-based study

ObjectivesThe on-scene time of Emergency Medical Services (EMS), including time for hospital selection, is critical for people in an emergency. However, the outbreak of the novel coronavirus disease 2019 (COVID-19) led to longer delays in providing immediate care for individuals with non-COVID-19-related emergencies, such as epileptic seizures. This study aimed to examine factors associated with on-scene time delays for people with epilepsy (PWE) with seizures needing immediate amelioration. Materials & MethodsWe conducted a population-based retrospective cohort study for PWE transported by EMS between 2016 and 2021. We used data from the Hiroshima City Fire Service Bureau database, divided into three study periods: “Pre period”, the period before the COVID pandemic (2016–2019); “Early period”, the early period of the COVID pandemic (2020); and “Middle period”, the middle period of the COVID pandemic (2021). We performed linear regression modeling to identify factors associated with changes in EMS on-scene time for PWE during each period. In addition, we estimated the rate of total EMS call volume required to maintain the same on-scene time for PWE transported by EMS during the pandemic expansion. ResultsAmong 2,205 PWE transported by EMS, significant differences in mean age and prevalence of impaired consciousness were found between pandemic periods. Total EMS call volume per month for all causes during the same month <5,000 (−0.55 min, 95% confidence interval [CI] −1.02 – −0.08, p = 0.022) and transport during the Early period (−1.88 min, 95%CI −2.75 – −1.00, p < 0.001) decreased on-scene time, whereas transport during the Middle period (1.58 min, 95%CI 0.70 – 2.46, p < 0.001) increased on-scene time for PWE transported by EMS. The rate of total EMS call volume was estimated as 0.81 (95%CI −0.04 – 1.07) during the expansion phase of the pandemic to maintain the same degree of on-scene time for PWE transported by EMS before the pandemic. ConclusionsOn-scene time delays on PWE in critical care settings were observed during the Middle period. When the pandemic expanded, the EMS system required resource allocation to maintain EMS for time-sensitive illnesses such as epileptic seizures. Timely system changes are critical to meet dramatic social changes.

Directed Search for Non-Dominated Emergency Medical System Designs

This research paper is aimed at a specific group of emergency medical service location problems, which are solved to save people’s lives and reduce the rate of mortality and morbidity. Since searching for the optimal service center deployment is a big challenge, many operations researchers, programmers, and healthcare practitioners have been making a great effort to find effective solutions since the 1960s. Within this paper, we study such a system design problem in which two contradictory objectives are taken into account. Since the optimization of one criterion causes deterioration in the value of the other, a specific small finite set of solutions seems to be a sufficient output of the associated solving process for further decision-making. Therefore, we study here several heuristic approaches that enable us to approximate the original Pareto fronts of non-dominated system designs. In addition to the theoretical explanation, we provide the readers with the results of numerical experiments in order to evaluate the quality of the proposed algorithms. Based on the presented results, it can be stated that the suggested approach is able to produce a good approximation of the Pareto front of emergency medical service system designs in acceptable computational time, which is in orders shorter than the one required by the former exact method.

Improving prehospital traumatic shock care: implementation and clinical effectiveness of a pragmatic, quasi-experimental trial in a resource-constrained South African setting

ObjectivesThis project seeks to improve providers’ practices and patient outcomes from prehospital (ie, ambulance-based) trauma care in a middle-income country using a novel implementation strategy to introduce a bundled clinical...

EMS Care of Adult Hospice Patients– a Position Statement and Resource Document of NAEMSP and AAHPM

Emergency medical services (EMS) systems are designed to provide care in the field and while transporting patients to a hospital; however, patients enrolled in hospice may not want invasive therapies nor benefit from hospitalization. For many reasons, encounters with hospice patients can be challenging for EMS systems, EMS clinicians, hospice clinicians, hospice patients, and their families.

Challenges of Emergency Medical Services Utilization by Older Adults in Tabriz, Iran: Data from Health Status of Aged People in Tabriz (HSA-T Study)

Objectives: To evaluate the awareness of older adults in Tabriz of Emergency Medical Services (EMS) and the terms of services. Design: Cross-sectional study. Setting(s): Tabriz, the capital city of East Azerbaijan Province, in northwestern Iran. Participants: A representative sample of≥60 years old noninstitutionalized population containing 1071 participants (514 males and 557 females) in the health status of aged people in Tabriz (HSA-T) study was selected using the probability proportional to the size (PPS) sampling method. Out of all the participants in the HAS-T study, 1062 participants (514 males and 548 females) completed the questionnaire regarding the awareness and knowledge of EMS. Outcome Measures: Service awareness means being informed about the existence of the EMS. Knowledge about EMS is defined as knowing the EMS phone number and knowledge about its free and 24-hour services. Results: Forty-seven percent of the older adults were not familiar with the EMS system. The awareness of EMS in males was higher than that in females (63.4% vs. 44.4%, P&lt;0.001), and it was also higher among those born in cities than those in rural areas (61.2% vs. 46.1%, P&lt;0.001). Furthermore, individuals who hold primary, secondary, and higher education had a higher chance of awareness of EMS compared with illiterate people by more than 2, 4, and 12 times, respectively Odds ratio (OR)=2.53; 95% confidence interval (CI): 1.81–3.52, OR=4.69; 95% CI: 2.79–7.91, and OR=12.09; 95% CI: 4.88–29.94). Conclusions: Due to the high rate of illiteracy and low public awareness, older adults do not have appropriate knowledge about the facilities, conditions, and terms of using EMS and may not be able to demand some of their essential services; therefore, notifying and increasing the older adults’ awareness of the available services is necessary.

An Evaluation of EMD Coding in Livingston County

This research evaluated the Emergency Medical Dispatch (EMD) code implementation in Livingston County, New York. The Livingston County Dispatch Office is an International Academics of Emergency Dispatch (IAED) certified agency that codes jobs for Emergency Medical Services (EMS) with EMD codes. Using data obtained from Livingston County EMS (LCEMS)’s emsCHARTS from 2015 to 2020, we evaluated the accuracy of EMD code implementation by both comparing the EMD code used to the impressions put on the patient’s chart and by comparing the resources sent to the patient with the resources that were needed to treat/transport the patient (disposition). In addition, we evaluated which EMD codes were undertriaged the most and which were overtriaged the most. In our sample, the EMD code matched the impressions on the patient’s chart about 47.30%. The appropriate resources were dispatched to patients roughly three quarters of the time. Undertriage and overtriage were found to be not independent of the EMD code. Four EMD codes were identified that were dispatched BLS but went ALS more often than others and it is our recommendation that, in EMS systems similar to Livingston County’s, these codes be dispatched ALS.

Essential Principles to Create an Equitable, Inclusive, and Diverse EMS Workforce and Work Environment: A Position Statement and Resource Document

POSITION STATEMENT Emergency medical services (EMS), similar to all aspects of health care systems, can play a vital role in examining and reducing health disparities through educational, operational, and quality improvement interventions. Public health statistics and existing research highlight that patients of certain socioeconomic status, gender identity, sexual orientation, and race/ethnicity are disproportionately affected with respect to morbidity and mortality for acute medical conditions and multiple disease processes, leading to health disparities and inequities. With regard to care delivery by EMS, research demonstrates that the current attributes of EMS systems may further contribute to these inequities, such as documented health disparities existing in EMS patient care management, and access along with EMS workforce composition not being representative of the communities served influencing implicit bias. EMS clinicians need to understand the definitions, historical context, and circumstances surrounding health disparities, health care inequities, and social determinants of health in order to reduce health care disparities and promote care equity. This position statement focuses on systemic racism and health disparities in EMS patient care and systems by providing multifaceted next steps and priorities to address these disparities and workforce development. NAEMSP believes that EMS systems should: Adopt a multifactorial approach to workforce diversity implemented at all levels within EMS agencies. Hire more diverse workforce by intentionally recruiting from marginalized communities Increase EMS career pathway and mentorship programs within underrepresented minorities (URM) communities and URM-predominant schools starting at a young age to promote EMS as an achievable profession. Examine policies that promote systemic racism and revise policies, procedures, and rules to promote a diverse, inclusive, and equitable environment. Involve EMS clinicians in community engagement and outreach activities to promote health literacy, trustworthiness, and education. Require EMS advisory boards whose composition reflects the communities they serve and regularly audit membership to ensure inclusion. Increase knowledge and self-awareness of implicit/unconscious bias and acts of microaggression through established educational and training programs (i.e., anti- racism, upstander, and allyship) such that individuals recognize and mitigate their own biases and can act as allies. Redesign structure, content, and classroom materials within EMS clinician training programs to enhance cultural sensitivity, humility, and competency and to meet career development, career planning, and mentoring needs, particularly of URM EMS clinicians and trainees. Discuss cultural views that affect health care and medical treatment and the effects of social determinants of health on care access and outcomes during all aspects of training. Design research and quality improvement initiatives related to health disparities in EMS that are focused on racial/ethnic and gender inequities and include URM community leaders as essential stakeholders involved in all stages of research development and implementation.