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International Journal of Stroke :... Oct 2023Prehospital care including recognition of stroke symptoms by the public and professionals combined with an efficient and effective emergency medical service (EMS) is...
BACKGROUND
Prehospital care including recognition of stroke symptoms by the public and professionals combined with an efficient and effective emergency medical service (EMS) is essential to increase access to effective acute stroke care. We undertook a survey to document the status of stroke prehospital care globally.
METHODS
A survey was distributed via email to the World Stroke Organization (WSO) members. Information was sought on the current status of stroke prehospital delay globally, including (1) ambulance availability and whether payment for use is required, (2) ambulance response times and the proportion of patients arriving at hospital by ambulance, (3) the proportion of patients arriving within 3 h and more than 24 h after symptom, (4) whether stroke care training of paramedics, call handlers, and primary care staff, (5) availability of specialist centers, and (6) the proportion of patients taken to specialist centers. Respondents were also asked to identify the top three changes in prehospital care that would benefit their population. Data were analyzed descriptively at both country and continent level.
RESULTS
Responses were received from 116 individuals in 43 countries, with a response rate of 4.7%. Most respondents (90%) reported access to ambulances, but 40% of respondents reported payment was required by the patient. Where an ambulance service was available (105 respondents) 37% of respondents reported that less than 50% of patients used an ambulance and 12% less than 20% of patients used an ambulance. Large variations in ambulance response times were reported both within and between countries. Most of the participating high-income countries (HIC) offered a service used by patients, but this was rarely the case for the low- and middle-income countries (LMIC). Time to admission was often much longer in LMIC, and there was less access to stroke training for EMS and primary care staff.
CONCLUSIONS
Significant deficiencies in stroke prehospital care exist globally especially in LMIC. In all countries, there are opportunities to improve the quality of the service in ways that would likely result in improved outcomes after acute stroke.
Topics: Humans; Stroke; Emergency Medical Services; Ambulances; Surveys and Questionnaires; Hospitals
PubMed: 37154607
DOI: 10.1177/17474930231177204 -
BMC Public Health Nov 2023Sub-Saharan African countries, Nigeria inclusive, are constrained by grossly limited access to quality pre-hospital trauma care services (PTCS). Findings from pragmatic...
BACKGROUND
Sub-Saharan African countries, Nigeria inclusive, are constrained by grossly limited access to quality pre-hospital trauma care services (PTCS). Findings from pragmatic approaches that explore spatial and temporal trends of past road crashes can inform novel interventions. To improve access to PTCS and reduce burden of road traffic injuries we explored geospatial trends of past emergency responses to road traffic crashes (RTCs) by Lagos State Ambulance Service (LASAMBUS), assessed efficiency of responses, and outcomes of interventions by local government areas (LGAs) of crash.
METHODS
Using descriptive cross-sectional design and REDcap we explored pre-hospital care data of 1220 crash victims documented on LASAMBUS intervention forms from December 2017 to May 2018. We analyzed trends in days and times of calls, demographics of victims, locations of crashes and causes of delayed emergency responses. Assisted with STATA 16 and ArcGIS pro we conducted descriptive statistics and mapping of crash metrics including spatial and temporal relationships between times of the day, seasons of year, and crash LGA population density versus RTCs incidence. Descriptive analysis and mapping were used to assess relationships between 'Causes of Delayed response' and respective crash LGAs, and between Response Times and crash LGAs.
RESULTS
Incidences of RTCs were highest across peak commuting hours (07:00-12:59 and 13:00-18:59), rainy season and harmattan (foggy) months, and densely populated LGAs. Five urban LGAs accounted for over half of RTCs distributions: Eti-Osa (14.7%), Ikeja (14.4%), Kosofe (9.9%), Ikorodu (9.7%), and Alimosho (6.6%). On intervention forms with a Cause of Delay, Traffic Congestion (60%), and Poor Description (17.8%), had associations with LGA distribution. Two densely populated urban LGAs, Agege and Apapa were significantly associated with Traffic Congestion as a Cause of Delay. LASAMBUS was able to address crash in only 502 (36.8%) of the 1220 interventions. Other notable outcomes include: No Crash (false calls) (26.6%), and Crash Already Addressed (22.17%).
CONCLUSIONS
Geospatial analysis of past road crashes in Lagos state offered key insights into spatial and temporal trends of RTCs across LGAs, and identified operational constraints of state-organized PTCS and factors associated with delayed emergency responses. Findings can inform programmatic interventions to improve trauma care outcomes.
Topics: Humans; Accidents, Traffic; Ambulances; Nigeria; Cross-Sectional Studies; Risk Factors
PubMed: 37978483
DOI: 10.1186/s12889-023-16996-8 -
Scandinavian Journal of Caring Sciences Mar 2024Ambulance care is characterised by disaster medicine, traumatology and care for acute illnesses and accidents. The focus of ambulance care is clearly on medical care,... (Review)
Review
BACKGROUND
Ambulance care is characterised by disaster medicine, traumatology and care for acute illnesses and accidents. The focus of ambulance care is clearly on medical care, whereas interpersonal interaction between patients and ambulance clinicians appears less prioritised. A patient within ambulance care needs to be listened to, be taken seriously, be treated with empathy and be seen as a unique person. These are fundamental to delivering Person-centred care.
AIM
The purpose is to describe how the care relationship and interaction between patients and ambulance clinicians in prehospital emergency care are described in the literature and how they can be interpreted from a person-centred perspective.
DATA SOURCES AND REVIEW METHODS
A qualitative meta-synthesis was used. Data collection was carried out with PubMed, CINAHL Plus and Web of Science in September-October 2022 and in August-September 2023. The first article searching applied a timeline 1990-2022 and the second applied a timeline 2022-2023. A total of 13 studies employing a qualitative approach were evaluated and included in the interpretive analysis.
RESULTS
Three themes were identified: A good care relationship, Decision-making and Hindrances to practising person-centred care in ambulance care. Trust, good communication and respect for patients' dignity were the most important parts of the good care relationship between patients and ambulance clinicians. Decision-making regarding the examination of patients, medical treatment and transport to the receiving care unit was one of the tasks that ambulance clinicians do independently but in cooperation with patients and family members. Person-centred care within ambulance care may be hindered due to environmental factors, attitudes and behaviour of ambulance clinicians and patient-related factors.
CONCLUSION
Many ambulance clinicians have already adopted Person-centred care, but several factors can hinder Person-centred care in interactions with patients. Although the results build on a limited number of studies, they indicate that person-centred care needs to be further developed and studied for high-quality ambulance care.
Topics: Humans; Ambulances; Emergency Medical Services; Patients; Family; Data Collection
PubMed: 37997183
DOI: 10.1111/scs.13225 -
Air Medical Journal 2023This is a retrospective quality review of LifeFlight Nova Scotia's prone patient transport protocol.
OBJECTIVE
This is a retrospective quality review of LifeFlight Nova Scotia's prone patient transport protocol.
METHODS
Electronic patient care records were queried for acute respiratory distress syndrome, prone position, proning, supine to prone, and prone to prone between February 2017 and June 2022. Eligible electronic patient care records were reviewed for demographics (sex, age, and weight); method of transports (ambulance, rotor wing, or fixed wing); duration of transports; mechanical ventilation parameters; medication infusions; arterial blood gases; occurrences of mild hypoxemia (any oxygen saturation [SpO] < 88% or decrease in SpO > 5%); hypotension (any episode of MAP < 65 mm Hg); severe hypoxemia (any SpO < 80% or decrease in SpO > 10%); refractory hypotension (mean arterial pressure < 65 mm Hg not responsive to vasopressor/inotropes); cardiac arrests; and displacement of central lines, arterial lines, and endotracheal tubes.
RESULTS
Seventeen prone patients were transported by ambulance, rotor wing, and fixed wing with 4 occurrences of mild hypotension, 4 occurrences of mild hypoxemia, and 1 occurrence of refractory hypotension.
CONCLUSION
Interfacility transfer of prone patients by a dedicated critical care team is feasible with minimal adverse occurrences while ensuring patients have access to the specialized lifesaving care they require.
Topics: Humans; Retrospective Studies; Prone Position; Respiration, Artificial; Hypoxia; Hypotension
PubMed: 37996182
DOI: 10.1016/j.amj.2023.07.012 -
International Emergency Nursing Nov 2023Sexual assault and harassment of ambulance personnel in the workplace is widespread. Prevention via body worn cameras and legal efforts have been positive, however... (Review)
Review
INTRODUCTION
Sexual assault and harassment of ambulance personnel in the workplace is widespread. Prevention via body worn cameras and legal efforts have been positive, however improvement is still needed to ensure the protection of staff from the negative impact of sexual violence at work.
METHODS
A rapid evidence review was conducted following the Cochrane Rapid Review guidance. MEDLINE and CINAHL Complete were searched from inception to February 2023. Screening and data extraction was conducted by one author and verified by the other. Included studies were appraised using a variety of critical appraisal checklists and a narrative synthesis was conducted.
RESULTS
From 46 articles screened, 7 were included in the review representing 3994 ambulance personnel from Australia, Canada, the United States, the United Kingdom and South Korea. Seven themes were identified, including a need for more training, education and resources regarding sexual assault and harassment, differences in perpetrators, poor experiences with organisations, effects on victims outside the workplace, effects on victims within the workplace, barriers to reporting, and increased prevalence of sexual assault and harassment against women.
CONCLUSION
The effect of sexual assault and harassment has far-reaching negative impact on victims' lives. More training and resources are recommended.
Topics: Humans; Female; United States; Sexual Harassment; Ambulances; Sex Offenses; Workplace; Australia
PubMed: 37972520
DOI: 10.1016/j.ienj.2023.101376 -
Critical Care Clinics Jul 2024Aeromedical transport (AMT) is an integral part of healthcare systems worldwide. In this article, the personnel and equipment required, associated safety considerations,... (Review)
Review
Aeromedical transport (AMT) is an integral part of healthcare systems worldwide. In this article, the personnel and equipment required, associated safety considerations, and evidence supporting the use of AMT is reviewed, with an emphasis on helicopter emergency medical services (HEMS). Indications for HEMS as guideded by the Air Medical Prehospital Triage Score are presented. Lastly, physiologic considerations, which are important to both AMT crews and receiving clinicians, are reviewed.
Topics: Humans; Air Ambulances; Critical Illness; Transportation of Patients; Emergency Medical Services; Triage
PubMed: 38796222
DOI: 10.1016/j.ccc.2024.03.004 -
Prehospital and Disaster Medicine Oct 2023Emergency Medical Services (EMS) are integrated services involving doctors, paramedics, nurses, and social workers. This research was carried out to synthesize the... (Review)
Review
INTRODUCTION
Emergency Medical Services (EMS) are integrated services involving doctors, paramedics, nurses, and social workers. This research was carried out to synthesize the evidence concerning social work roles for EMS. The aim of this study was to synthesize literature on the social worker's role in EMS settings.
METHODS
The study was a systematic review. Data were collected through selected databases. The researcher used Scopus, Sociology Database, Social Science Database, and Public Health Database related to EMS and social work settings. English papers were selected, without restrictions on publication time, place, and year. The searched keywords were: "Social Work AND Emergency Medical Services AND Ambulance Services," "Social Worker AND Emergency Medical Systems AND Ambulance Services," "Social Work AND EMS," "Social Worker AND EMS," "Social Work OR Social Worker," "Social Work Role AND EMS," Social Worker AND EMS," "Emergency Medical Services OR/AND Emergency Medical Systems."
RESULTS
The study synthesized the literature about the social work role in pre-EMS, during emergency, and post-EMS. The following themes were highlighted: social workers act as cultural liaisons, effective communicators, emergency workers, and mental health practitioners, collaborating with other disciplines and researchers, for this study. In pre-emergency stages, social workers have roles as educators, communicators, advocates, and awareness builders. During an emergency, social workers act as search and rescue workers, advocates, facilitators, networkers, psychosocial assessors, consultants, counselors, and liaisons for referral activities. And in the post-emergency period, social workers have roles as planners, liaisons, interdisciplinary collaborators, researchers, evaluators, and individuals responsible for follow up.
CONCLUSION
This study synthesizes the roles of social workers in EMS settings. It is the first study on this topic, aiming to produce new knowledge, evidence, and an EMS practice framework for the social worker.
Topics: Humans; Emergency Medical Services; Social Work; Mental Health; Ambulances
PubMed: 37525489
DOI: 10.1017/S1049023X23006143 -
Emergency Medicine Australasia : EMA Aug 2023Telehealth has been successfully implemented in the prehospital setting to expedite emergency care, although applications are still in their infancy. With recent... (Review)
Review
Telehealth has been successfully implemented in the prehospital setting to expedite emergency care, although applications are still in their infancy. With recent advances in technologies, it is not described how prehospital telehealth has evolved over the past decade. This scoping review aimed to answer the research question 'what telehealth platforms have been used to facilitate communication between prehospital healthcare providers and emergency clinicians in the past decade?'. The review was guided by Joanna Briggs Institute scoping review methodology and reported in accordance with the PRISMA checklist for scoping reviews. A systematic search of five databases and Google Scholar was undertaken using key terms 'prehospital', 'ambulance', 'emergency care' and 'telehealth', and results were limited to research articles published in English language between 2011 and 2021. Articles were included if they related to the research question and reported quantitative, qualitative, mixed-method or feasibility studies. A total of 28 articles were included in the review that reported feasibility (n = 13), intervention (n = 7) or observational studies (n = 8) involving 20 telehealth platforms. Platforms were commonly implemented to provide prehospital staff with medical support for general emergency care and involved a range of devices that were used to transmit video, audio and biomedical data. The benefits of prehospital telehealth to patients, clinicians and organisations were identified. Challenges to telehealth involved technical, clinical and organisational issues. Few facilitators of prehospital telehealth were identified. Telehealth platforms to facilitate prehospital to ED communication continue to develop but require technological advances and improved network connectivity to support implementation in the prehospital environment.
Topics: Humans; Emergency Medical Services; Emergency Treatment; Health Personnel; Telemedicine; Ambulances
PubMed: 37102271
DOI: 10.1111/1742-6723.14224 -
Neurological Sciences : Official... Dec 2023Treatment for stroke is time-dependent, and ambulance services play a vital role in the early recognition, assessment and transportation of stroke patients. Innovations... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Treatment for stroke is time-dependent, and ambulance services play a vital role in the early recognition, assessment and transportation of stroke patients. Innovations which begin in ambulance services to expedite delivery of treatments for stroke are developing. However, research delivery in ambulance services is novel, developing and not fully understood.
AIMS
To synthesise literature encompassing ambulance service-based randomised controlled interventions for acute stroke with consideration to the characteristics of the type of intervention, consent modality, time intervals and issues unique to research delivery in ambulance services. Online searches of MEDLINE, EMBASE, Web of Science, CENTRAL and WHO IRCTP databases and hand searches identified 15 eligible studies from 538. Articles were heterogeneous in nature and meta-analysis was partially available as 13 studies reported key time intervals, but terminology varied. Randomised interventions were evident across all points of contact with ambulance services: identification of stroke during the call for help, higher dispatch priority assigned to stroke, on-scene assessment and clinical interventions, direct referral to comprehensive stroke centres and definitive care delivery at scene. Consent methods ranged between informed patient, waiver and proxy modalities with country-specific variation. Challenges unique to the prehospital setting comprise the geographical distribution of ambulance resources, low recruitment rates, prolonged recruitment phases, management of investigational medicinal product and incomplete datasets.
CONCLUSION
Research opportunities exist across all points of contact between stroke patients and ambulance services, but randomisation and consent remain novel. Early collaboration and engagement between trialists and ambulance services will alleviate some of the complexities reported.
REGISTRATION NUMBER
PROSPERO 2018CRD42018075803.
Topics: Humans; Ambulances; Stroke; Randomized Controlled Trials as Topic
PubMed: 37405524
DOI: 10.1007/s10072-023-06910-w