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European Journal of Public Health Aug 2020Syndromic surveillance can supplement conventional health surveillance by analyzing less-specific, near-real-time data for an indication of disease occurrence. Emergency... (Review)
Review
BACKGROUND
Syndromic surveillance can supplement conventional health surveillance by analyzing less-specific, near-real-time data for an indication of disease occurrence. Emergency medical call centre dispatch and ambulance data are examples of routinely and efficiently collected syndromic data that might assist in infectious disease surveillance. Scientific literature on the subject is scarce and an overview of results is lacking.
METHODS
A scoping review including (i) review of the peer-reviewed literature, (ii) review of grey literature and (iii) interviews with key informants.
RESULTS
Forty-four records were selected: 20 peer reviewed and 24 grey publications describing 44 studies and systems. Most publications focused on detecting respiratory illnesses or on outbreak detection at mass gatherings. Most used retrospective data; some described outcomes of temporary systems; only two described continuously active dispatch- and ambulance-based syndromic surveillance. Key informants interviewed valued dispatch- and ambulance-based syndromic surveillance as a potentially useful addition to infectious disease surveillance. Perceived benefits were its potential timeliness, standardization of data and clinical value of the data.
CONCLUSIONS
Various dispatch- and ambulance-based syndromic surveillance systems for infectious diseases have been reported, although only roughly half are documented in peer-reviewed literature and most concerned retrospective research instead of continuously active surveillance systems. Dispatch- and ambulance-based syndromic data were mostly assessed in relation to respiratory illnesses; reported use for other infectious disease syndromes is limited. They are perceived by experts in the field of emergency surveillance to achieve time gains in detection of infectious disease outbreaks and to provide a useful addition to traditional surveillance efforts.
Topics: Ambulances; Call Centers; Communicable Disease Control; Communicable Diseases; Data Collection; Disease Outbreaks; Emergency Medical Services; Emergency Service, Hospital; Humans; Sentinel Surveillance; Triage
PubMed: 31605491
DOI: 10.1093/eurpub/ckz177 -
Scandinavian Journal of Trauma,... Nov 2023Fixed-wing air ambulances play an important role in healthcare in rural Iceland. More frequent use of helicopter ambulances has been suggested to shorten response times...
BACKGROUND
Fixed-wing air ambulances play an important role in healthcare in rural Iceland. More frequent use of helicopter ambulances has been suggested to shorten response times and increase equity in access to advanced emergency care. In finding optimal base locations, the objective is often efficiency-maximizing the number of individuals who can be reached within a given time. This approach benefits people in densely populated areas more than people living in remote areas and the solution is not necessarily fair. This study aimed to find efficient and fair helicopter ambulance base locations in Iceland.
METHODS
We used high-resolution population and incident location data to estimate the service demand for helicopter ambulances, with possible base locations limited to twenty-one airports and landing strips around the country. Base locations were estimated using both the maximal covering location problem (MCLP) optimization model, which aimed for maximal coverage of demand, and the fringe sensitive location problem (FSLP) model, which also considered uncovered demand (i.e., beyond the response time threshold). We explored the percentage of the population and incidents covered by one to three helicopter bases within 45-, 60-, and 75-min response time thresholds, conditioned or not, on the single existing base located at Reykjavík Airport. This resulted in a total of eighteen combinations of conditions for each model. The models were implemented in R and solved using Gurobi.
RESULTS
Model solutions for base locations differed between the demand datasets for two out of eighteen combinations, both with the lowest service standard. Base locations differed between the MCLP and FSLP models for one combination involving a single base, and for two combinations involving two bases. Three bases covered all or almost all demand with longer response time thresholds, and the models differed in four of six combinations. The two helicopter ambulance bases can possibly obtain 97% coverage within 60 min, with bases in Húsafell and Grímsstaðir. Bases at Reykjavík Airport and Akureyri would cover 94.2%, whereas bases at Reykjavík Airport and Egilsstaðir would cover 88.5% of demand.
CONCLUSION
An efficient and fair solution would be to locate bases at Reykjavík Airport and in Akureyri or Egilsstaðir.
Topics: Humans; Air Ambulances; Iceland; Time Factors; Emergency Medical Services; Aircraft
PubMed: 37915061
DOI: 10.1186/s13049-023-01114-9 -
Human Factors Feb 2022The purpose of this study is to understand the communication among care teams during telemedicine-enabled stroke consults in an ambulance.
OBJECTIVE
The purpose of this study is to understand the communication among care teams during telemedicine-enabled stroke consults in an ambulance.
BACKGROUND
Telemedicine can have a significant impact on acute stroke care by enabling timely intervention in an ambulance before a patient reaches the hospital. However, limited research has been conducted on understanding and supporting team communication during the care delivery process for telemedicine-enabled stroke care in an ambulance.
METHOD
Video recordings of 13 simulated stroke telemedicine consults conducted in an ambulance were coded to document the tasks, communication events, and flow disruptions during the telemedicine-enabled stroke care delivery process.
RESULTS
The majority (82%) of all team interactions in telemedicine-enabled stroke care involved verbal interactions among team members. The neurologist, patient, and paramedic were almost equally involved in team interactions during stroke care, though the neurologist initiated 48% of all verbal interactions. Disruptions were observed in 8% of interactions, and communication-related issues contributed to 44%, with interruptions and environmental hazards being other reasons for disruptions in interactions during telemedicine-enabled stroke care.
CONCLUSION
Successful telemedicine-enabled stroke care involves supporting both verbal and nonverbal communication among all team members using video and audio systems to provide effective coverage of the patient for the clinicians as well as vice versa.
APPLICATION
This study provides a deeper understanding of team interactions during telemedicine-enabled stroke care that is essential for designing effective systems to support teamwork.
Topics: Ambulances; Communication; Delivery of Health Care; Humans; Patient Care Team; Stroke; Telemedicine
PubMed: 33657904
DOI: 10.1177/0018720821995687 -
Environmental Health : a Global Access... Jun 2020Evidence on the relationship between different particle size fractions and emergency ambulance dispatches (EAD) remains limited and sparse.
BACKGROUND
Evidence on the relationship between different particle size fractions and emergency ambulance dispatches (EAD) remains limited and sparse.
METHODS
We collected daily data of EAD, ambient air pollution and meteorological data from 2014 to 2018 in Guangzhou, China. We used a generalized additive model with covariate adjustments to estimate the associations between different particle size fractions and EAD related to all-cause, cardiovascular diseases, and respiratory diseases. Several subgroup and sensitivity analyses were also performed.
RESULTS
Significant associations were observed between PM, PM, PM and EADs. A 10 μg/m increase of PM PM, and PM was associated with an increase of 0.98% (95% CI: 0.67, 1.28%), 2.06% (95% CI: 1.44, 2.68%), and 0.75% (95%CI: 0.53, 0.96%) in all-cause EAD, with an increase of 0.69% (95% CI: 0.00, 1.39%), 2.04% (95% CI: 0.64, 3.45%), and 0.60% (95%CI: 0.11,1.10%) in cardiovascular-related EAD, and an increase of 1.14% (95% CI: 0.25, 2.04%), 2.52% (95% CI: 0.72, 4.35%), and 0.89% (95%CI: 0.25,1.52%) in respiratory-related EAD at lag03, respectively. The results were robust in subgroup and sensitivity analyses.
CONCLUSIONS
This study revealed that PM, PM and PM were significantly related with risks of all-cause and cause-specific EAD. More evidence of high quality may be needed to further support our results in this ecological study.
Topics: Aged; Aged, 80 and over; Air Pollutants; Air Pollution; Ambulances; Cardiovascular Diseases; China; Emergency Service, Hospital; Environmental Exposure; Female; Humans; Male; Middle Aged; Models, Theoretical; Particle Size; Particulate Matter; Respiratory Tract Diseases
PubMed: 32552755
DOI: 10.1186/s12940-020-00619-5 -
BMC Geriatrics Dec 2022Little is known about frailty in the ambulance setting, or its association with outcomes relevant to ambulance services. We sought to measure frailty in people aged... (Observational Study)
Observational Study
BACKGROUND
Little is known about frailty in the ambulance setting, or its association with outcomes relevant to ambulance services. We sought to measure frailty in people aged ≥ 50 attended by an ambulance, and describe the relationship between frailty, odds of conveyance to hospital, and duration at scene.
METHODS
An observational study between 01/01/2021-30/06/2021 in North East Ambulance Service, England. Participants were aged ≥ 50 attended by an ambulance, excluding patients requiring immediate treatment for a life-threatening condition or with Glasgow Coma Scale < 15. Paramedics (n = 112) measured patient frailty using the Clinical Frailty Scale (CFS). Additional information was extracted from ambulance care records. Weighted regression models examined associations between frailty, hospital conveyance, and duration at scene.
RESULTS
Three thousand and fifty-six callouts were observed (mean patient age: 78.1 years, 57.2% female). Frailty prevalence (CFS ≥ 5) was 58.7%. Median duration at scene was 47.0 min (interquartile range 34.0-67.0 min). Ambulances spent a median of 8.2 (95%CI:5.4-11.0) minutes longer with frail patients than non-frail patients. Frail patients were less likely to be conveyed to hospital than non-frail patients (OR:0.75, 95%CI:0.60-0.94).
CONCLUSION
Frailty is common among people aged ≥ 50 attended by an ambulance and an important influence on workload. Ambulance services need a good understanding of frailty to meet patient needs. As populations age, community support should be prioritised to deliver appropriate frailty care and reduce demands on ambulance services.
Topics: Humans; Female; Aged; Male; Ambulances; Frailty; Cross-Sectional Studies; England
PubMed: 36471316
DOI: 10.1186/s12877-022-03633-z -
A Psychological Resilience Briefing Intervention for Helicopter Emergency Medical Service Observers.Air Medical Journal 2022Helicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This...
OBJECTIVE
Helicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This article describes a quality improvement project for HEMS observers at Essex & Herts Air Ambulance.
METHODS
A psychological resilience briefing intervention (PRBi) was developed and delivered during induction training with 60 HEMS observers. The PRBi aimed to raise awareness of traumatic events that observers may experience and provided basic education on 5 domains, including likely forms of trauma exposure, possible psychological reactions, advice on coping strategies and supporting colleagues, and resources that they could use if required. The intervention was intended to bolster resilience and reduce posttraumatic stress disorder symptoms, and to encourage adaptive coping styles in observers.
RESULTS
Observers learned from and valued the PRBi; statistically significant increases were observed in awareness of the 5 domains from pre- to post-delivery, and free-text responses cited a variety of benefits to the observers. There was no indication that the PRBi caused harm.
CONCLUSION
The PRBi has now been included in the routine induction of observers at Essex & Herts Air Ambulance and has the potential to be repurposed for use in other settings, including medical schools.
Topics: Humans; Resilience, Psychological; Air Ambulances; Emergency Medical Services; Aircraft; Retrospective Studies
PubMed: 36494171
DOI: 10.1016/j.amj.2022.07.010 -
Sensors (Basel, Switzerland) Apr 2021Acute Coronary Syndrome (ACS) and other heart emergency events require immediate chest pain identification in the ambulance. Specifically, early identification and...
Acute Coronary Syndrome (ACS) and other heart emergency events require immediate chest pain identification in the ambulance. Specifically, early identification and triage is required so that patients with chest pain can be quickly sent to a hospital with appropriate care facilities for treatment. In the traditional approach, ambulance personnel often use symptom checklists to examine the patient and make a quick decision for the target hospital. However, not every hospital has specialist facilities to handle such emergency cases. If the result of the subsequent cardiac enzyme test performed at the target hospital strongly suggests the occurrence of myocardial infarction, the patient may need to be sent to another hospital with specialist facilities, such as Percutaneous Coronary Intervention. The standard procedure is time consuming, which may result in delayed treatment and reduce patent survival rate. To resolve this issue, we propose AMBtalk (Ambulance Talk) for accurate, early ACS identification in an ambulance. AMBtalk provides real-time connection to hospital resources, which reduces the elapsed time for treatment, and therefore, improves the patient survival rate. The key to success for AMBtalk is the development of the AllCheck Internet of Things (IoT) device, which can accurately and quickly provide cardiovascular parameter values for early ACS identification. The interactions between the AllCheck IoT device, the emergency medical service center, the ambulance personnel and the hospital are achieved through the AMBtalk IoT server in the cloud network. AllCheck outperforms the existing cardiovascular IoT device solutions for ambulance applications. The testing results of the AllCheck device show 99% correlation with the results of the hospital reports. Due to its excellent performance in quick ACS identification, the AllCheck device was awarded the 17th Taiwan Innovators Award in 2020.
Topics: Ambulances; Chest Pain; Emergency Medical Services; Humans; Internet of Things; Taiwan
PubMed: 33920835
DOI: 10.3390/s21082781 -
BMC Emergency Medicine Jun 2022Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to...
BACKGROUND
Post-traumatic stress disorder (PTSD) is common among ambulance personnel, but its prevalence varies between developed and developing countries. This study aimed to investigate the lived experience of potentially traumatic work events between Saudi and UK ambulance personnel.
METHODS
Semi-structured interviews with 16 ambulance workers from Saudi Arabia and the United Kingdom (8 participants from each country) were conducted to explore their lived experiences of potentially traumatic events at work. Data were analyzed using thematic analysis.
RESULTS
Four key themes were identified from interviews: (1) some events are inherently more stressful than others; (2) pressure of organizational and interpersonal stressors; (3) convergence and divergence in cross-cultural coping strategies; and (4) preferring formal and confidential support.
CONCLUSIONS
There were differences in the nature of traumatic events and the ways of coping between the two cultures, but paramedics in both cultures had an agreement about their preference for individual and formal support. The results of this study may help inform the development of interventions and PTSD prevention programs for ambulance personnel.
Topics: Adaptation, Psychological; Ambulances; Cross-Cultural Comparison; Humans; Saudi Arabia; Stress Disorders, Post-Traumatic; United Kingdom
PubMed: 35761202
DOI: 10.1186/s12873-022-00666-w -
The Western Journal of Emergency... Jan 2023Driving with warning lights and sirens is highly demanding for ambulance drivers, and the crash risk is much higher than that during normal driving. In this study our...
INTRODUCTION
Driving with warning lights and sirens is highly demanding for ambulance drivers, and the crash risk is much higher than that during normal driving. In this study our goals were to establish a coding protocol to observe how often and how long potentially critical driving situations (PCDS) occur during "blue-light" driving (driving with emergency response lights) and to describe traffic and environmental conditions preceding and accompanying the PCDS.
METHODS
We collected randomly drawn video data of real ambulance driving between 2014-2017 in two German federal states. A coding protocol was developed to categorize PCDS into four types ("right of way," "crosswalks," "overtaking" [passing], and "other") and to describe them within the context of road characteristics, incident type, traffic, weather conditions, and driving style.
RESULTS
A total of 172 videos of 71 different drivers were chosen randomly covering 1125 minutes of driving with warning lights and sirens. The drivers had a mean age of 33.7 years, and 25.4% were female. A total of 2048 PCDS occurred with a mean duration of five seconds (range of 1-66), amounting to one PCDS every 33 seconds. Twenty percent of the driving time involved PCDS. The rapid driving style (10.5%) showed more PCDS (one every 28.5 seconds), and the defensive driving style showed fewer PCDS (one every 49.6 seconds). Of all detected PCDS, "right of way" situations (57.5%) were most frequent, followed by "overtaking" [passing] maneuvers (30.2%).
CONCLUSION
This study used a detailed coding protocol to describe driving with warning lights and sirens. The PCDS occurred less frequently than anticipated, although they were still common events when driving an ambulance, representing significant potential for crashes or near-crashes. These results can be used for insight training programs to raise ambulance drivers' awareness of typical PCDS and associated potential crash risk.
Topics: Humans; Female; Adult; Male; Accidents, Traffic; Automobile Driving; Ambulances
PubMed: 36602490
DOI: 10.5811/westjem.2022.8.56114 -
Journal of Religion and Health Feb 2023Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about...
Chaplains are embedded in several ambulance services across Australia, however as Australia's religiosity is currently in decline and questions are being asked about retaining chaplains, little is actually known about their role and value within Ambulance services. The aim of this paper is to present the key findings from interviews with chaplains about their role and value of being ambulance chaplains. These findings are then compared with those of paramedics derived from an earlier phase of this study. Thirteen chaplains participated in semi-structured interviews, and data were analysed using framework analysis. The results indicated that ambulance chaplains provided paramedic-centred emotional and spiritual care through proactively and reactively supporting paramedics in their work. Chaplains saw value in their relational approach which facilitated trust and access, did not seek to 'fix' or diagnose but instead offered physical and emotional presence, and promoted supportive conversations. Chaplains and paramedics valued operationally trained and equipped ambulance chaplains who provided a relational, around the clock, 'frontline' staff support presence in paramedic workplaces, regardless of the paramedic's personal religious/spiritual beliefs.
Topics: Humans; Ambulances; Clergy; Paramedics; Australia; Emotions
PubMed: 36402854
DOI: 10.1007/s10943-022-01685-4