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CMAJ : Canadian Medical Association... Nov 2021
Topics: Air Ambulances; Humans
PubMed: 34810169
DOI: 10.1503/cmaj.210354-f -
BMJ Open Dec 2023Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response... (Review)
Review
OBJECTIVES
Dynamic ambulance relocation means that the operators at a dispatch centre place an ambulance in a temporary location, with the goal of optimising coverage and response times in future medical emergencies. This study aimed to scope the current research on dynamic ambulance relocation.
DESIGN
A scoping review was conducted using a structured search in PubMed, Scopus and Web of Science. In total, 21 papers were included.
RESULTS
Most papers described research with experimental designs involving the use of mathematical models to calculate the optimal use and temporary relocations of ambulances. The models relied on several variables, including distances, locations of hospitals, demographic-geological data, estimation of new emergencies, emergency medical services (EMSs) working hours and other data. Some studies used historic ambulance dispatching data to develop models. Only one study reported a prospective, real-time evaluation of the models and the development of technical systems. No study reported on either positive or negative patient outcomes or real-life chain effects from the dynamic relocation of ambulances.
CONCLUSIONS
Current knowledge on dynamic relocation of ambulances is dominated by mathematical and technical support data that have calculated optimal locations of ambulance services based on response times and not patient outcomes. Conversely, knowledge of how patient outcomes and the working environment are affected by dynamic ambulance dispatching is lacking. This review has highlighted several gaps in the scientific coverage of the topic. The primary concern is the lack of studies reporting on patient outcomes, and the limited knowledge regarding several key factors, including the optimal use of ambulances in rural areas, turnaround times, domino effects and aspects of working environment for EMS personnel. Therefore, addressing these knowledge gaps is important in future studies.
Topics: Humans; Ambulances; Emergencies; Prospective Studies; Emergency Medical Services; Time
PubMed: 38101827
DOI: 10.1136/bmjopen-2023-073394 -
Health Affairs (Project Hope) Jun 2023
Topics: Humans; Ambulances; Ethnicity; Emergency Medical Services
PubMed: 37276468
DOI: 10.1377/hlthaff.2023.00422 -
Health Care Management Science Dec 2019Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency... (Review)
Review
Ambulance offload delay (AOD) occurs when care of incoming ambulance patients cannot be transferred immediately from paramedics to staff in a hospital emergency department (ED). This is typically due to emergency department congestion. This problem has become a significant concern for many health care providers and has attracted the attention of many researchers and practitioners. This article reviews literature which addresses the ambulance offload delay problem. The review is organized by the following topics: improved understanding and assessment of the problem, analysis of the root causes and impacts of the problem, and development and evaluation of interventions. The review found that many researchers have investigated areas of emergency department crowding and ambulance diversion; however, research focused solely on the ambulance offload delay problem is limited. Of the 137 articles reviewed, 28 articles were identified which studied the causes of ambulance offload delay, 14 articles studied its effects, and 89 articles studied proposed solutions (of which, 58 articles studied ambulance diversion and 31 articles studied other interventions). A common theme found throughout the reviewed articles was that this problem includes clinical, operational, and administrative perspectives, and therefore must be addressed in a system-wide manner to be mitigated. The most common intervention type was ambulance diversion. Yet, it yields controversial results. A number of recommendations are made with respect to future research in this area. These include conducting system-wide mitigation intervention, addressing root causes of ED crowding and access block, and providing more operations research models to evaluate AOD mitigation interventions prior implementations. In addition, measurements of AOD should be improved to assess the size and magnitude of this problem more accurately.
Topics: Allied Health Personnel; Ambulance Diversion; Ambulances; Crowding; Emergency Service, Hospital; Humans; Operations Research; Resource Allocation; Time Factors
PubMed: 29982911
DOI: 10.1007/s10729-018-9450-x -
International Journal of Biometeorology Oct 2023Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association... (Meta-Analysis)
Meta-Analysis Review
Ambulance data has been reported to be a sensitive indicator of health service use during hot days, but there is no comprehensive summary of the quantitative association between heat and ambulance dispatches. We conducted a systematic review and meta-analysis to retrieve and synthesise evidence published up to 31 August 2022 about the association between heat, prolonged heat (i.e. heatwaves), and the risk of ambulance dispatches. We initially identified 3628 peer-reviewed papers and included 48 papers which satisfied the inclusion criteria. The meta-analyses showed that, for each 5 °C increase in mean temperature, the risk of ambulance dispatches for all causes and for cardiovascular diseases increased by 7% (95% confidence interval (CI): 5%, 10%) and 2% (95% CI: 1%, 3%), respectively, but not for respiratory diseases. The risk of ambulance dispatches increased by 6% (95% CI: 4%, 7%), 7% (95% CI: 5%, 9%), and 18% (95% CI: 12%, 23%) under low-intensity, severe, and extreme heatwaves, respectively. We observed two potential sources of bias in the existing literature: (1) bias in temperature exposure measurement; and (2) bias in the ascertainment of ambulance dispatch causes. This review suggests that heat exposure is associated with an increased risk of ambulance dispatches, and there is a dose-response relationship between heatwave intensity and the risk of ambulance dispatches. For future studies assessing the heat-ambulance association, we recommend that (1) using data on spatially refined gridded temperature that is either very well interpolated or derived from satellite imaging may be an alternative to reduce exposure measurement bias; and (2) linking ambulance data with hospital admission data can be useful to improve health outcome classification.
Topics: Humans; Ambulances; Hot Temperature; Temperature; Hospitalization; Cardiovascular Diseases
PubMed: 37495745
DOI: 10.1007/s00484-023-02525-0 -
The Medical Journal of Malaysia Jan 2022A scoping review was conducted to map out the common research focusses on ambulance accidents, their key findings and some of the major knowledge gaps in this area. (Review)
Review
BACKGROUND
A scoping review was conducted to map out the common research focusses on ambulance accidents, their key findings and some of the major knowledge gaps in this area.
MATERIALS AND METHODS
Relevant, peer-reviewed, Englishlanguage articles on land ambulance accidents were independently searched by the authors using the MEDLINE and CINAHL databases. Anecdotal reports, testimonies and stories in trade or popular magazines and other grey literature were excluded. Articles that do not directly address ambulance accidents were also excluded. Additional articles were identified from the reference lists of the selected articles and from Google search engine.
RESULTS
From an initial yield of 879 articles, 19 articles were included. Most of these articles were published from 2001 - 2005 (5 articles, 26.3%) and 2006 - 2010 (5 articles, 26.3%). Eighteen articles (78.3%) are original articles (18 articles, 78.3%) and another one article is a review article. Most of these articles focused on (1) the types of collisions and (2) the risk factors of ambulance accidents. Nine risk factors were identified to have contributed to ambulance accidents: (1) driving in urban areas (2) driving on dry road (3) the use of lights & sirens (4) the failure to use restraints (5) driving for emergency use (6) back seating (7) at road intersection (8) driver's previous records of accidents and (9) interfacility transfer. The two most common risk factors studied were (1) the use of lights & sirens and (2) driving at intersection.
CONCLUSIONS
Most of the above risk factors can be mapped into three categories of risk factors: task-related factors, vehicle-related factors and environment-related factors. The category of risk factors least studied is the category of driver-related factors.
Topics: Accidents, Traffic; Ambulances; Automobile Driving; Databases, Factual; Humans; Risk Factors
PubMed: 35086996
DOI: No ID Found -
The Medical Journal of Australia Sep 2022
Topics: Ambulances; Emergency Medical Services; Emergency Service, Hospital; Humans
PubMed: 35929413
DOI: 10.5694/mja2.51677 -
Tidsskrift For Den Norske Laegeforening... Oct 2022Patients who resist medical assistance can undo the safety straps on the ambulance stretcher. Ambulance personnel have been known to make use of blankets, bandages and...
BACKGROUND
Patients who resist medical assistance can undo the safety straps on the ambulance stretcher. Ambulance personnel have been known to make use of blankets, bandages and Velcro straps to restrain patients in transit. This study aims to establish how often this type of coercion is used.
MATERIAL AND METHOD
In 2021, approximately 400 ambulance service personnel in the county of Innlandet were invited by email to take part in an online survey about the use of coercion vis-à-vis patients who resist medical assistance.
RESULTS
We received 85 responses, and 62 respondents (72.9 %) stated that they had used coercion. Of these, 38 (44.7 %) had restrained the arms/legs of patients using blankets, bandages or Velcro straps in order to keep them safe while in transit. A total of 36 respondents (42.4 %) had observed other personnel travelling in an ambulance without a fastened seatbelt in order to maintain patient safety during transit.
INTERPRETATION
The results clearly show that ambulance personnel regularly use coercion when patients who resist their help are transported by ambulance. There is a need to discuss how such ambulance services can be provided in a safe, secure and caring way.
Topics: Ambulances; Coercion; Emergency Medical Services; Humans; Patient Safety; Surveys and Questionnaires
PubMed: 36226433
DOI: 10.4045/tidsskr.22.0086 -
Australasian Emergency Care Sep 2022Overcrowding decreases quality of care. Triage and patient administration are possible bottlenecks. We aimed to identify factors influencing door-to-triage- and... (Observational Study)
Observational Study
BACKGROUND
Overcrowding decreases quality of care. Triage and patient administration are possible bottlenecks. We aimed to identify factors influencing door-to-triage- and triage-to-patient administration-time in a prospective observational study at a tertiary care center with 70,000 patients per year.
METHODS
Measurement of aforementioned times at convenience-sampled time intervals on 16 days. Linear regression modelling with times as dependent variable, and demographic, medical and structural factors as covariables, testing for interactions with risk factor "weekend".
RESULTS
We included 360 patients (183 female (51%)). Median door-to-triage-time was 6 (IQR 3-11) minutes, triage-to-patient administration-time was 5 (IQR 3-8) minutes. Overall door-to-triage-time was significantly shorter during weekends compared to weekdays (absolute difference 3 (IQR 1-7) minutes; 5 (IQR 3-8) vs. 8 (IQR 4-15) minutes, p < 0.01). Other influencing factors were closing hours of non-emergency department healthcare facilities (3.5 min more), number of ESI 2 patients seen during the interval (3 min more for each patient per hour), and ambulance activity (2 min more for each patient per hour brought by ambulance).
CONCLUSIONS
Day of time and week as well as frequency of patients with urgent conditions and those brought by ambulance significantly increased door-to-triage times. This should be kept in mind when organizing ED workflow.
Topics: Ambulances; Emergency Service, Hospital; Female; Humans; Prospective Studies; Tertiary Care Centers; Triage
PubMed: 35074290
DOI: 10.1016/j.auec.2022.01.001 -
Emergency Medicine Australasia : EMA Dec 2023
Topics: Humans; Ambulances; Medicine; Emergency Medical Services; Volunteers; State Medicine
PubMed: 37899291
DOI: 10.1111/1742-6723.14334