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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 -
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 -
Prehospital Emergency Care 2021: The United States is currently facing 2 epidemics: sustained morbidity and mortality from substance use and the more recent COVID-19 pandemic. We tested the hypothesis...
: The United States is currently facing 2 epidemics: sustained morbidity and mortality from substance use and the more recent COVID-19 pandemic. We tested the hypothesis that the pandemic has disproportionately affected individuals with substance use disorder by evaluating average daily 9-1-1 ambulance calls for substance use-related issues compared with all other calls. : This was a retrospective cross-sectional analysis of 9-1-1 ambulance calls before and after the start of COVID-19 in Massachusetts. We used consecutive samples of 9-1-1 ambulance calls, categorized into those which were substance-related or not. An interrupted time series analysis was performed to determine if there were changes in numbers of daily calls before a statewide declaration of emergency for COVID-19 (February 15-March 9, 2020), from the emergency declaration until a stay-at-home advisory (March 10-March 22, 2020) and following the stay-at-home advisory (March 23-May 15, 2020). : Compared with prior to the statewide emergency, the post-statewide emergency average of daily ambulance calls decreased from 2,453.2 to 1,969.6, a 19.7% decrease. Similarly, calls for substance-related reasons decreased by 16.4% compared with prior to the statewide emergency. However, despite an initial decrease in calls, after the stay-at-home advisory calls for substance use began increasing by 0.7 (95% confidence interval (CI) 0.4-1.1) calls/day, while calls for other reasons did not significantly change (+1.2 (95% CI -0.8 to 3.1) calls/day). Refusal of transport for substance-related calls increased from 5.0% before the statewide emergency to 7.5% after the declaration ( < 0.001). : After an initial decline in substance-related ambulance calls following a statewide declaration of emergency, calls for substance use increased to pre-COVID-19 levels, while those for other reasons remained at a lower rate. The results suggest that COVID-19 is disproportionately affecting individuals with substance use disorder.
Topics: Ambulances; COVID-19; Cross-Sectional Studies; Emergency Medical Services; Humans; Pandemics; Retrospective Studies; SARS-CoV-2; United States
PubMed: 33147081
DOI: 10.1080/10903127.2020.1845420 -
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 -
CMAJ : Canadian Medical Association... Sep 2021
Topics: Air Ambulances; Emergency Medicine; Humans; Life Support Care; Ontario; Transportation of Patients
PubMed: 34544785
DOI: 10.1503/cmaj.210354 -
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 -
BMC Emergency Medicine Aug 2022Research examining paramedic care of back pain is limited. (Review)
Review
BACKGROUND
Research examining paramedic care of back pain is limited.
OBJECTIVE
To describe ambulance service use and usual paramedic care for back pain, the effectiveness and safety of paramedic care of back pain, and the characteristics of people with back pain who seek care from paramedics.
METHODS
We included published peer-reviewed studies of people with back pain who received any type of paramedic care on-scene and/or during transport to hospital. We searched MEDLINE, EMBASE, CINAHL, Web of Science and SciELO from inception to July 2022. Two authors independently screened and selected the studies, performed data extraction, and assessed the methodological quality using the PEDro, AMSTAR 2 and Hawker tools. This review followed the JBI methodological guidance for scoping reviews and PRISMA extension for scoping reviews.
RESULTS
From 1987 articles we included 26 articles (25 unique studies) consisting of 22 observational studies, three randomised controlled trials and one review. Back pain is frequently in the top 3 reasons for calls to an ambulance service with more than two thirds of cases receiving ambulance dispatch. It takes ~ 8 min from time of call to an ambulance being dispatched and 16% of calls for back pain receive transport to hospital. Pharmacological management of back pain includes benzodiazepines, NSAIDs, opioids, nitrous oxide, and paracetamol. Non-pharmacological care is poorly reported and includes referral to alternate health service, counselling and behavioural interventions and self-care advice. Only three trials have evaluated effectiveness of paramedic treatments (TENS, active warming, and administration of opioids) and no studies provided safety or costing data.
CONCLUSION
Paramedics are frequently responding to people with back pain. Use of pain medicines is common but varies according to the type of back pain and setting, while non-pharmacological care is poorly reported. There is a lack of research evaluating the effectiveness and safety of paramedic care for back pain.
Topics: Allied Health Personnel; Ambulances; Back Pain; Emergency Medical Services; Emergency Medical Technicians; Humans; Referral and Consultation
PubMed: 35945506
DOI: 10.1186/s12873-022-00699-1 -
Sensors (Basel, Switzerland) Jun 2022It is a well-established practice to build a robust system for sound event detection by training supervised deep learning models on large datasets, but audio data...
It is a well-established practice to build a robust system for sound event detection by training supervised deep learning models on large datasets, but audio data collection and labeling are often challenging and require large amounts of effort. This paper proposes a workflow based on few-shot metric learning for emergency siren detection performed in steps: prototypical networks are trained on publicly available sources or synthetic data in multiple combinations, and at inference time, the best knowledge learned in associating a sound with its class representation is transferred to identify ambulance sirens, given only a few instances for the prototype computation. Performance is evaluated on siren recordings acquired by sensors inside and outside the cabin of an equipped car, investigating the contribution of filtering techniques for background noise reduction. The results show the effectiveness of the proposed approach, achieving AUPRC scores equal to 0.86 and 0.91 in unfiltered and filtered conditions, respectively, outperforming a convolutional baseline model with and without fine-tuning for domain adaptation. Extensive experiments conducted on several recording sensor placements prove that few-shot learning is a reliable technique even in real-world scenarios and gives valuable insights for developing an in-car emergency vehicle detection system.
Topics: Ambulances; Data Collection; Neural Networks, Computer; Sound; Time
PubMed: 35746120
DOI: 10.3390/s22124338 -
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