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International Emergency Nursing Nov 2021Firefighters perform first aid before the ambulance arrives in areas with a long response time in Sweden; this is called 'While Waiting for the Ambulance' (WWFA). The...
AIM
Firefighters perform first aid before the ambulance arrives in areas with a long response time in Sweden; this is called 'While Waiting for the Ambulance' (WWFA). The aim was to describe WWFA assignments in rural environments, focusing on frequency, event time, actions and survival >30 days after cardiopulmonary resuscitation (CPR) was performed.
METHODS
Retrospective descriptive and comparative design.
RESULTS
Firefighters in the northern part of Sweden were involved in 518 WWFA assignments between 2012 and 2016. From alarm call until ambulance dispatch, median time was 2:20 min; for firefighters, nearly four minutes. Median dispatch time at out-of-hospital cardiac arrests (OHCA) (n = 52) was 1:40 min for ambulance and three minutes for firefighters. Maximal dispatch time was nearly 10 min for ambulance and 44 min for firefighters. Firefighters arrived first at the scene, after 17 min' median, for 95 % of assignments, while the ambulance took nearly twice the amount of time. In OHCA situations, time for firefighters was over 19 min versus ambulance at nearly twice the time. CPR was terminated by ambulance staff at 83% (n = 43) of 52 when firefighters performed prolonged CPR. Return to spontaneous circulation after OHCA was 17%, and 9% were alive after >30 days.
CONCLUSION
The efficiency of incident time and utilisation rate for WWFA assignments can be increased for the benefit of affected persons, especially in OHCA.
Topics: Ambulances; Cardiopulmonary Resuscitation; Emergency Medical Services; Firefighters; Humans; Out-of-Hospital Cardiac Arrest; Retrospective Studies
PubMed: 34781156
DOI: 10.1016/j.ienj.2021.101100 -
BMC Health Services Research Nov 2022NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing...
BACKGROUND
NHS ambulance service staff are at risk of poor physical and mental wellbeing because of the likelihood of encountering stressful and traumatic incidents. While reducing sickness absence and improving wellbeing support to ambulance staff is a key NHS priority, few studies have empirically documented a national picture to inform policy and service re-design. The study aimed to understand how ambulance service trusts in England deal with staff health and wellbeing, as well as how the staff perceive and use wellbeing services.
METHODS
To achieve our aim, we undertook semi-structured telephone interviews with health and wellbeing leads and patient-facing ambulance staff, as well as undertaking documentary analysis of ambulance trust policies on wellbeing. The study was conducted both before and during the UK first COVID-19 pandemic wave. The University of Lincoln ethics committee and the Health Research Authority (HRA) granted ethical approval. Overall, we analysed 57 staff wellbeing policy documents across all Trusts. Additionally, we interviewed a Health and Wellbeing Lead in eight Trusts as well as 25 ambulance and control room staff across three Trusts.
RESULTS
The study highlighted clear variations between organisational and individual actions to support wellbeing across Trust policies. Wellbeing leads acknowledged real 'tensions' between individual and organisational responsibility for wellbeing. Behaviour changes around diet and exercise were perceived to have a positive effect on the overall mental health of their workforce. Wellbeing leads generally agreed that mental health was given primacy over other wellbeing initiatives. Variable experiences of health and wellbeing support were partly contingent on the levels of management support, impacted by organisational culture and service delivery challenges for staff.
CONCLUSION
Ambulance service work can impact upon physical and mental health, which necessitates effective support for staff mental health and wellbeing. Increasing the knowledge of line managers around the availability of services could improve engagement.
Topics: Humans; Ambulances; Pandemics; COVID-19; Qualitative Research; Health Services
PubMed: 36380295
DOI: 10.1186/s12913-022-08729-1 -
BMC Emergency Medicine Apr 2022Swedish Emergency Departments (EDs) see 2.6 million visits annually. Sweden has a strong tradition of health care databases, but information on patients' pathways to the... (Review)
Review
BACKGROUND
Swedish Emergency Departments (EDs) see 2.6 million visits annually. Sweden has a strong tradition of health care databases, but information on patients' pathways to the ED is not documented in any registry. The aim of this study was to provide a national overview of pathways, degree of medical acuteness according to triage, chief complaints, and hospital admission rates for adult patients (≥18 years) visiting Swedish EDs during 24 h.
METHODS
A national cross-sectional study including all patients at 43 of Sweden's 72 EDs during 24 h on April 25th, 2018. Pathway to the ED, medical acuteness at triage, admission and basic demographics were registered by dedicated assessors present at every ED for the duration of the study. Descriptive data are reported.
RESULTS
A total of 3875 adult patients (median age 59; range 18 to 107; 50% men) were included in the study. Complete data for pathway to the ED was reported for 3693 patients (98%). The most common pathway was self-referred walk-in (n = 1310; 34%), followed by ambulance (n = 920; 24%), referral from a general practitioner (n = 497; 1 3%), and telephone referral by the national medical helpline "1177" (n = 409; 10%). In patients 18 to 64 years, self-referred walk-in was most common, whereas transport by ambulance dominated in patients > 64 years. Of the 3365 patients who received a medical acuteness level at triage, 4% were classified as Red (Immediate), 18% as Orange (very urgent), 47% as Yellow (Urgent), 26% as Green (Standard), and 5% as Blue (Non-Urgent). Abdominal or chest pain were the most common chief complaints representing approximately 1/3 of all presentations. Overall, the admission rate was 27%. Arrival by ambulance was associated with the highest rate of admission (53%), whereas walk-in patients and telephone referrals were less often admitted.
CONCLUSION
Self-referred walk-in was the overall most common pathway followed by ambulance. Patients arriving by ambulance were often elderly, critically ill and often admitted to in-patient care, whereas arrival by self-referred walk-in was more common in younger patients.
Topics: Adult; Aged; Ambulances; Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Male; Middle Aged; Sweden; Triage
PubMed: 35392826
DOI: 10.1186/s12873-022-00619-3 -
International Journal of Medical... Sep 2020Pre-hospital emergency medical services use clinical decision support systems (CDSS) to triage calls. Call handlers often supplement this by making free text notes...
OBJECTIVE
Pre-hospital emergency medical services use clinical decision support systems (CDSS) to triage calls. Call handlers often supplement this by making free text notes covering key incident information. We investigate whether machine learning approaches using features from such free text notes can improve prediction of unconscious patients who require conveyance.
MATERIALS AND METHODS
We analysed a subset of all London Ambulance Service calls that were triaged through the Medical Priority Dispatch System (MPDS) as involving an unconscious or fainting patient in 2018. We use and compare two machine learning algorithms: random forest (RF) and gradient boosting machine (GBM). For each incident, we predict whether the patient will be conveyed to a hospital emergency department or equivalent using as features 1) the MPDS code, 2) the free text notes and 3) the two together. We evaluate model performance using the area under the curve (AUC) metric. Given the imbalance of outcomes (patient conveyed 71 %, not conveyed 29 %), we also consider sensitivity and specificity.
RESULTS
Using only the MPDS code resulted in an AUC of 0.57. Using the text notes gave an improved AUC score of 0.63 and combining the two gave an AUC score of 0.64 (scores were similar for RF and GBM). GBM models scored better on sensitivity (0.93 vs 0.62 for RF in the combined model), but specificity was lower (0.17 vs. 0.56 for RF in the combined model).
CONCLUSIONS
Using information contained in the free text notes made by call handlers in combination with MPDS improves prediction of unconscious and fainting patients requiring conveyance to a hospital emergency department (or equivalent) when compared with machine learning models using MPDS codes only. This suggests there is some useful information in unstructured data captured by emergency call handlers that complements MPDS codes. Quantifying this gain can help inform emergency medical service policy when evaluating the decision to expand or augment existing CDSS.
Topics: Ambulances; Emergency Medical Service Communication Systems; Emergency Service, Hospital; Humans; London; Retrospective Studies; Syncope; Triage
PubMed: 32663739
DOI: 10.1016/j.ijmedinf.2020.104179 -
PloS One 2019The triage of patients in prehospital care is a difficult task, and improved risk assessment tools are needed both at the dispatch center and on the ambulance to...
BACKGROUND
The triage of patients in prehospital care is a difficult task, and improved risk assessment tools are needed both at the dispatch center and on the ambulance to differentiate between low- and high-risk patients. This study validates a machine learning-based approach to generating risk scores based on hospital outcomes using routinely collected prehospital data.
METHODS
Dispatch, ambulance, and hospital data were collected in one Swedish region from 2016-2017. Dispatch center and ambulance records were used to develop gradient boosting models predicting hospital admission, critical care (defined as admission to an intensive care unit or in-hospital mortality), and two-day mortality. Composite risk scores were generated based on the models and compared to National Early Warning Scores (NEWS) and actual dispatched priorities in a prospectively gathered dataset from 2018.
RESULTS
A total of 38203 patients were included from 2016-2018. Concordance indexes (or areas under the receiver operating characteristics curve) for dispatched priorities ranged from 0.51-0.66, while those for NEWS ranged from 0.66-0.85. Concordance ranged from 0.70-0.79 for risk scores based only on dispatch data, and 0.79-0.89 for risk scores including ambulance data. Dispatch data-based risk scores consistently outperformed dispatched priorities in predicting hospital outcomes, while models including ambulance data also consistently outperformed NEWS. Model performance in the prospective test dataset was similar to that found using cross-validation, and calibration was comparable to that of NEWS.
CONCLUSIONS
Machine learning-based risk scores outperformed a widely-used rule-based triage algorithm and human prioritization decisions in predicting hospital outcomes. Performance was robust in a prospectively gathered dataset, and scores demonstrated adequate calibration. Future research should explore the robustness of these methods when applied to other settings, establish appropriate outcome measures for use in determining the need for prehospital care, and investigate the clinical impact of interventions based on these methods.
Topics: Aged; Ambulances; Critical Care; Emergency Service, Hospital; Female; Hospitalization; Humans; Machine Learning; Male; Middle Aged; Needs Assessment; Prospective Studies; ROC Curve; Risk Assessment; Sweden; Triage
PubMed: 31834920
DOI: 10.1371/journal.pone.0226518 -
PloS One 2023The COVID-19 pandemic has a significant impact on the health and well-being of all healthcare professionals. However, for ambulance care professionals it is unknown on... (Review)
Review
The COVID-19 pandemic has a significant impact on the health and well-being of all healthcare professionals. However, for ambulance care professionals it is unknown on which health outcomes the impact of COVID-19 is measured, and what the actual impact on these health outcomes is. Therefore, the aim of this study was to gain insight in a) which type of health outcomes were measured in relation to the impact of COVID-19 among ambulance care professionals, and b) to determine the actual impact on these outcomes. A rapid review was performed in PubMed (including MEDLINE) and APA PsycInfo (EBSCO). All types of study designs on health and well-being of ambulance care professionals were included. Selection on title an abstract was performed by pairs of two reviewers. Full text selection, data extraction and quality assessment were performed by one reviewer, with a check by a second independent reviewer. The systematic searches identified 3906 unique hits, seven articles meeting selection criteria were included. Six studies quantitatively measured distress (36,0%) and PTSD (18.5%-30.9%), anxiety (14.2%-65.6%), depression (12.4%-15.3%), insomnia (60.9%), fear of infection and transmission of infection (41%-68%), and psychological burden (49.4%-92.2%). These studies used a variety of instruments, ranging from internationally validated instruments to self-developed and unvalidated questionnaires. One study qualitatively explored coping with COVID-19 by ambulance care professionals and reported that ambulance care professionals use five different strategies to cope with the impact of COVID-19. There is limited attention for the health and well-being of ambulance care professionals during the COVID-19 pandemic. Although the included number of studies and included outcomes are too limited to draw strong conclusions, our results indicate higher rates of distress, PTSD and insomnia compared to the pre-COVID-19 era. Our results urge the need to investigate the health and well-being of ambulance care professionals during and after the COVID-19 pandemic.
Topics: Humans; Mental Health; COVID-19; Ambulances; Pandemics; Sleep Initiation and Maintenance Disorders
PubMed: 37432937
DOI: 10.1371/journal.pone.0287821 -
International Journal of Environmental... Jan 2021The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates...
The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates and ambulance services could identify counties where stronger ambulance services are needed. The datasets for 2018 consisted of county level aggregated data of citizens between the ages 15-64. The study examined how both the mortality rates and the ambulance rescue deliveries differ from the national average. The analyses were narrowed down to disease groups, such as acute myocardial infarction, hemorrhagic and ischemic stroke. Inequalities were identified regarding the distribution of number of ambulance deliveries, several counties had rates more than double that of the national average. For both mortality and ambulance services some of the counties had significantly better results and others had significantly worse compared to the national average. In Borsod-Abaúj-Zemplén county's case, hemorrhagic stroke mortality was significantly higher (1.73 [1.35-2.11]), while ambulance deliveries were significantly lower (0.58 [0.40-0.76]) compared to the national average. The research has shown that regarding the investigated mortality rates and ambulance services there are considerable differences between the counties in Hungary. In this regard policy makers should implement policies to tackle these discrepancies.
Topics: Adolescent; Adult; Ambulances; Humans; Hungary; Middle Aged; Myocardial Infarction; Stroke; Young Adult
PubMed: 33504113
DOI: 10.3390/ijerph18031065 -
JAMA Network Open Feb 2024The No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services....
IMPORTANCE
The No Surprises Act implemented in 2022 aims to protect patients from surprise out-of-network (OON) bills, but it does not include ground ambulance services. Understanding ground ambulance OON and balance billing patterns from previous years could guide legislation aimed to protect patients following ground ambulance use.
OBJECTIVE
To characterize OON billing from ground ambulance services by evaluating whether OON billing risk differs by the site of ambulance origination (home, hospital, nonhospital medical facility, or scene of incident).
DESIGN, SETTING, AND PARTICIPANTS
Cross-sectional study of the Merative MarketScan dataset between January 1, 2015, and December 31, 2020, using claims-based data from employer-based private health insurance plans in the US. Participants included patients who utilized ground ambulances during the study period. Data were analyzed from June to December 2023.
EXPOSURE
Medical encounter requiring ground ambulance transportation.
MAIN OUTCOMES AND MEASURES
Ground ambulance OON billing prevalence was calcuated. Linear probability models adjusted for state-level mixed effects were fit to evaluate OON billing probability across ambulance origins. Secondary outcomes included the allowed payment, patient cost-sharing amounts, and potential balance bills for OON ambulances.
RESULTS
Among 2 031 937 ground ambulance services (1 375 977 unique patients) meeting the inclusion and exclusion criteria, 1 072 791 (52.8%) rides transported men, and the mean (SD) patient age was 41 (18) years. Of all services, 1 113 676 (54.8%) were billed OON. OON billing probabilities for ambulances originating from home or scene were higher by 12.0 percentage points (PP) (95% CI, 11.8-12.2 PP; P < .001 for home; 95% CI, 11.7-12.2 PP; P < .001 for scene) vs those originating from hospitals. Mean (SD) total financial burden, including cost-sharing and potential balance bills per ambulance service, was $434.70 ($415.99) per service billed OON vs $132.21 ($244.92) per service billed in-network.
CONCLUSIONS AND RELEVANCE
In this cross-sectional study of over 2 million ground ambulance services, ambulances originating from home, the scene of an incident, and nonhospital medical facilities were more likely to result in OON bills. Legislation is needed to protect patients from surprise billing following use of ground ambulances, more than half of which resulted in OON billing. Future legislation should at minimum offer protections for these subsets of patients often calling for an ambulance in urgent or emergent situations.
Topics: Male; Humans; Adult; Ambulances; Cross-Sectional Studies; Cost Sharing; Financial Stress; Health Facilities
PubMed: 38381432
DOI: 10.1001/jamanetworkopen.2024.0118 -
BMC Emergency Medicine Feb 2022Hypoglycaemia is a potentially serious condition, characterised by lower-than-normal blood glucose levels, common in people with diabetes (PWD). It can be prevented and...
People with diabetes and ambulance staff perceptions of a booklet-based intervention for diabetic hypoglycaemia, "Hypos can strike twice": a mixed methods process evaluation.
BACKGROUND
Hypoglycaemia is a potentially serious condition, characterised by lower-than-normal blood glucose levels, common in people with diabetes (PWD). It can be prevented and self-managed if expert support, such as education on lifestyle and treatment, is provided. Our aim was to conduct a process evaluation to investigate how ambulance staff and PWD perceived the "Hypos can strike twice" booklet-based ambulance clinician intervention, including acceptability, understandability, usefulness, positive or negative effects, and facilitators or barriers to implementation.
METHODS
We used an explanatory sequential design with a self-administered questionnaire study followed by interviews of people with diabetes and ambulance staff. We followed the Medical Research Council framework for process evaluations of complex interventions to guide data collection and analysis. Following descriptive analysis (PWD and staff surveys), exploratory factor analysis was conducted to identify staff questionnaire subscales and multiple regression models were fitted to identify demographic predictors of overall and subscale scores.
RESULTS
113 ambulance staff members and 46 PWD completed the survey. We conducted interviews with four ambulance staff members and five PWD who had been attended by an ambulance for a hypoglycaemic event. Based on surveys and interviews, there were positive attitudes to the intervention from both ambulance staff and PWD. Although the intervention was not always implemented, most staff members and PWD found the booklet informative, easy to read and to use or explain. PWD who completed the survey reported that receiving the booklet reminded and/or encouraged them to test their blood glucose more often, adjust their diet, and have a discussion/check up with their diabetes consultant. Interviewed PWD felt that the booklet intervention would be more valuable to less experienced patients or those who cannot manage their diabetes well. Overall, participants felt that the intervention could be beneficial, but were uncertain about whether it might help prevent a second hypoglycaemic event and/or reduce the number of repeat ambulance attendances.
CONCLUSIONS
The 'Hypos may strike twice' intervention, which had demonstrable reductions in repeat attendances, was found to be feasible, acceptable to PWD and staff, prompting reported behaviour change and help-seeking from primary care.
TRIAL REGISTRATION
Registered with ClinicalTrials.gov: NCT04243200 on 27 January 2020.
Topics: Ambulances; Blood Glucose; Diabetes Mellitus; Humans; Hypoglycemia; Hypoglycemic Agents; Pamphlets
PubMed: 35135499
DOI: 10.1186/s12873-022-00583-y -
Bundesgesundheitsblatt,... Oct 2022Emergency medical services (EMS) and pre-hospital rescue management in Germany as a whole are currently confronted with numerous challenges. In the last decade, the... (Review)
Review
Emergency medical services (EMS) and pre-hospital rescue management in Germany as a whole are currently confronted with numerous challenges. In the last decade, the number of calls has risen in almost every EMS area, resulting in a significant increase of ambulance provision. However, human resources management is becoming increasingly difficult and technical and medical requirements are rising steadily. Increasingly, voices are calling for a fundamental reform of emergency care.The aim of this article is to give an overview of the current developments, trends and future challenges in order to illustrate the requirements for present and prospective rescue management. Different topics and areas of action were identified using a non-systematic literature search. The requirements for rescue management are brought together iteratively.The challenges facing EMS are versatile and complex, as are the demands on its management. The heterogeneous and small-scale organisational structure of emergency medical services in Germany poses a major challenge for reform processes. The lack of scientific competencies in EMS also complicates process optimisation. The increasing academisation and research in this field are to be welcomed.
Topics: Ambulances; Emergency Medical Services; Germany; Humans; Prospective Studies
PubMed: 36112196
DOI: 10.1007/s00103-022-03588-x