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International Journal of Gynaecology... Sep 2013Most maternal deaths are preventable with emergency obstetric care; therefore, ensuring access is essential. There is little focused information on emergency transport... (Review)
Review
BACKGROUND
Most maternal deaths are preventable with emergency obstetric care; therefore, ensuring access is essential. There is little focused information on emergency transport of pregnant women.
OBJECTIVES
The literature on emergency transport of pregnant women in low- and middle-income countries (LMICs) was systematically reviewed and synthesized to explore current practices, barriers, and facilitators for transport utilization.
SEARCH STRATEGY
MEDLINE, EMBASE, BNI, Cochrane Library, CINAHL, African Index Medicus, ASSIA, QUALIDATA, RHL, and Science Citation Index (inception to April 2012) were searched without language restriction.
SELECTION CRITERIA
Studies using qualitative methodology and reporting on emergency transportation in LMICs were included.
DATA COLLECTION AND ANALYSIS
Thematic framework and synthesis through examination and translation of common elements were used to analyze and synthesize the data.
MAIN RESULTS
Twenty-nine articles were included. Eight major themes were identified: time for transport; transport options; geography; local support; autonomy; culture; finance; and ergonomics. Key issues were transport availability; transport speed; terrain; meteorology; support; dependence for decision making; cultural issues; cost; and lack of safe, comfortable positioning during transport.
CONCLUSION
Themes should be appreciated within local contexts to illuminate barriers and facilitators. Potential solutions include motorcycle ambulance programs, collaboration with taxi services, community education, subsidies, and vehicle maintenance.
Topics: Ambulances; Developing Countries; Emergencies; Female; Humans; Maternal Mortality; Pregnancy; Pregnancy Complications; Time Factors; Transportation of Patients
PubMed: 23806250
DOI: 10.1016/j.ijgo.2013.03.030 -
Antimicrobial Resistance and Infection... Jun 2023Clinical laboratories provide diagnostic testing services to support the effective delivery of care in today's complex healthcare systems. Processing clinical material... (Review)
Review
BACKGROUND
Clinical laboratories provide diagnostic testing services to support the effective delivery of care in today's complex healthcare systems. Processing clinical material and the use of chemicals or radiation presents potential hazard to laboratory workers, from both biological and chemical sources. Nevertheless, the laboratory should be a safe workplace if the identification of possible hazards, clear guidelines, safety rules and infection prevention and control (IPC) precautions are applied and followed. The main aim of this systematic review was to identify, critically appraise and synthesise the research evidence to gain a clear explanation of the implementation and knowledge, attitude and practice (KAP) of IPC guidelines among hospital laboratory staff.
METHODS
For this systematic review we searched MEDLINE, EMBASE, Scopus and CINAHL (EBSCO), PubMed, grey literature, reference lists and citations for studies published between database inception and November, 2021. All qualitative, quantitative and mixed-methods studies whose aim was to explore risk perception and KAP of IPC guidelines among laboratory staff in any healthcare setting were included, without language or date restrictions. Evidence was narratively synthesised into group of themes. The quality of the evidence was assessed with Joanna Briggs Institutes Critical Appraisal Tools.
RESULTS
After the full-text screening, a total of 34 articles remained and were included in the final review. Thirty papers were considered to be of high quality and the remaining four were considered to be of low quality. The available evidence shows that there was good knowledge, good attitudes and moderate immunisation status, but there was still poor practice of IPC precautions and an inadequate level of training among laboratory workers.
CONCLUSION
There is a gap among KAP related to the implementation of IPC guidelines, which indicates that laboratory staff may be at high risk of acquiring infections in the workplace. These findings suggest that training (including IPC precautions, safety policies, safety equipment and materials, safety activities, initial biohazard handling, ongoing monitoring and potential exposure) of laboratory staff to increase their knowledge about IPC precautions could improve their use of these precautions.
Topics: Humans; Health Knowledge, Attitudes, Practice; Health Facilities; Databases, Factual; Infection Control; Knowledge
PubMed: 37312142
DOI: 10.1186/s13756-023-01257-5 -
International Archives of Occupational... Dec 2011Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel... (Review)
Review
PURPOSE
Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health surveillance (WHS) activities and (2) the effectiveness of job-specific WHS interventions with respect to work functioning, for selected jobs.
METHODS
The search strategy systematically searched the PubMed, PsycINFO and OSH-update databases. The search strategy consisted of several synonyms of the job titles of interest, combined with synonyms for workers' health surveillance. The methodological quality was checked.
RESULTS
At least one study was found for each of the following occupations fire fighters, ambulance personnel, police personnel and military personnel. For the first objective, 24 studies described several job-specific WHS activities aimed at aspects of psychological, 'physical' (energetic, biomechanical and balance), sense-related, environmental exposure or cardiovascular requirements. The seven studies found for the second objective measured different outcomes related to work functioning. The methodological quality of the interventions varied, but with the exception of one study, all scored over 55% of the maximum score. Six studies showed effectiveness on at least some of the defined outcomes. The studies described several job-specific interventions: a trauma resilience training, healthy lifestyle promotion, physical readiness training, respiratory muscle training, endurance and resistance training, a physical exercise programme and comparing vaccines.
CONCLUSIONS
Several examples of job-specific WHS activities were found for the four occupations. Compared to studies focusing on physical tasks, a few studies were found that focus on psychological tasks. Effectiveness studies for job-specific WHS interventions were scarce, although their results were promising. We recommend studying job-specific WHS in effectiveness studies.
Topics: Emergency Responders; Employment; Female; Humans; Male; Military Personnel; Occupational Diseases; Occupational Exposure; Population Surveillance; Workplace
PubMed: 21318608
DOI: 10.1007/s00420-011-0614-y -
Environmental Pollution (Barking, Essex... Nov 2019A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital... (Meta-Analysis)
Meta-Analysis
A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital data. Previously, no reviews focused solely on ambulance dispatch data. These data sets have excellent potential for environmental health research. For this review, publications up to April 2019 were identified using three main search categories covering: ambulance services including dispatches; air pollutants; and health outcomes. From 308 studies initially identified, 275 were excluded as they did not relate to ambulance service dispatches, did not report the air pollutant association, and/or did not study ambient air pollution. The main health outcomes in the remaining 33 studies were cardiac arrest (n = 14), cardiovascular (n = 11) and respiratory (n = 10) dispatches. Meta-analyses were performed to summarise pooled relative risk (RR) of pollutants: particulate matter less than 2.5 and 10 μm (PM, PM), the fraction between PM and PM (coarse) and suspended particulate matter (SPM) per 10 μg/m increase, carbon monoxide (CO) per 1 ppm increase and of sulphur dioxide (SO), nitrogen dioxide (NO), and ozone (O) per 10 ppb increment and ambulance dispatches. Statistically significant associations were found for ambulance dispatch data for all-respiratory and PM at 1.03 (95% CI:1.02-1.04) and at 1.10 (95% CI:1.00-1.21) for asthma and NO associations. For dispatches with subsequent paramedic assessment for cardiac arrest with PM, CO and coarse dispatches at 1.05 (95% CI:1.03-1.08), 1.10 (95% CI:1.02-1.18) and 1.04 (95% CI:1.01-1.06) respectively. For dispatches with subsequent physician diagnosis for all-respiratory and PM at 1.02 (95% CI:1.01-1.03). In conclusion, air pollution was significantly associated with an increase in ambulance dispatch data, including those for cardiac arrest, all-respiratory, and asthma dispatches. Ambulance services should plan accordingly during pollution events. Furthermore, efforts to improve air quality should lead to decreases in ambulance dispatches.
Topics: Air Pollutants; Air Pollution; Ambulances; Asthma; Carbon Monoxide; Environmental Exposure; Environmental Health; Humans; Male; Nitrogen Dioxide; Ozone; Particulate Matter; Risk; Sulfur Dioxide
PubMed: 31419665
DOI: 10.1016/j.envpol.2019.06.065 -
BMC Health Services Research Jul 2006Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the... (Review)
Review
BACKGROUND
Researchers have become increasingly aware that ambulance personnel may be at risk of developing work-related health problems. This article systematically explores the literature on health problems and work-related and individual health predictors in the ambulance services.
METHODS
We identified the relevant empirical literature by searching several electronic databases including Medline, EMBASE, PsychINFO, CINAHL, and ISI Web of Science. Other relevant sources were identified through reference lists and other relevant studies known by the research group.
RESULTS
Forty-nine studies are included in this review. Our analysis shows that ambulance workers have a higher standardized mortality rate, higher level of fatal accidents, higher level of accident injuries and a higher standardized early retirement on medical grounds than the general working population and workers in other health occupations. Ambulance workers also seem to have more musculoskeletal problems than the general population. These conclusions are preliminary at present because each is based on a single study. More studies have addressed mental health problems. The prevalence of post-traumatic stress symptom caseness was > 20% in five of seven studies, and similarly high prevalence rates were reported for anxiety and general psychopathology in four of five studies. However, it is unclear whether ambulance personnel suffer from more mental health problems than the general working population.
CONCLUSION
Several indicators suggest that workers in the ambulance services experience more health problems than the general working population and workers in other health occupations. Several methodological challenges, such as small sample sizes, non-representative samples, and lack of comparisons with normative data limit the interpretation of many studies. More coordinated research and replication are needed to compare data across studies. We discuss some strategies for future research.
Topics: Accidents; Ambulances; Emergency Medical Technicians; Humans; Mortality; Occupational Diseases; Occupational Health; Retirement; Stress Disorders, Post-Traumatic; Workforce
PubMed: 16817949
DOI: 10.1186/1472-6963-6-82 -
Resuscitation Feb 2017Arterial carbon dioxide tension (PaCO) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO makes physiological sense and is recommended as a... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Arterial carbon dioxide tension (PaCO) abnormalities are common after cardiac arrest (CA). Maintaining a normal PaCO makes physiological sense and is recommended as a therapeutic target after CA, but few studies have examined the association between PaCO and patient outcomes. This systematic review and meta-analysis aimed to assess the effect of a low or high PaCO on patient outcomes after CA.
METHODS
We searched MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL, for studies that evaluated the association between PaCO and outcomes after CA. The primary outcome was hospital survival. Secondary outcomes included neurological status at the end of each study's follow up period, hospital discharge destination and 30-day survival. Meta-analysis was conducted if statistical heterogeneity was low.
RESULTS
The systematic review included nine studies; eight provided sufficient quantitative data for meta-analysis. Using PaCO cut-points of <35mmHg and >45mmHg to define hypo- and hypercarbia, normocarbia was associated with increased hospital survival (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.23, 1.38). Normocarbia was also associated with a good neurological outcome (cerebral performance category score 1 or 2) compared to hypercarbia (OR 1.69, 95% CI 1.13, 2.51) when the analysis also included an additional study with a slightly different definition for normocarbia (PaCO 30-50mmHg).
CONCLUSIONS
From the limited data it appears PaCO has an important U-shape association with survival and outcomes after CA, consistent with international resuscitation guidelines' recommendation that normocarbia be targeted during post-resuscitation care.
Topics: Arteries; Carbon Dioxide; Heart Arrest; Humans
PubMed: 27697606
DOI: 10.1016/j.resuscitation.2016.09.019 -
BMJ Open Sep 2021To explore what factors are associated with ambulance use for non-emergency problems in children.
OBJECTIVE
To explore what factors are associated with ambulance use for non-emergency problems in children.
METHODS
This study is a systematic mapping review and qualitative synthesis of published journal articles and grey literature. Searches were conducted on the following databases, for articles published between January 1980 and July 2020: MEDLINE, EMBASE, PsycINFO, CINAHL and AMED. A Google Scholar and a Web of Science search were undertaken to identify reports or proceedings not indexed in the above. Book chapters and theses were searched via the OpenSigle, EThOS and DART databases. A literature advisory group, including experts in the field, were contacted for relevant grey literature and unpublished reports. The inclusion criteria incorporated articles published in the English language reporting findings for the reasons behind why there are so many calls to the ambulance service for non-urgent problems in children. Data extraction was divided into two stages: extraction of data to generate a broad systematic literature 'map', and extraction of data from highly relevant papers using qualitative methods to undertake a focused qualitative synthesis. An initial table of themes associated with reasons for non-emergency calls to the ambulance for children formed the 'thematic map' element. The uniting feature running through all of the identified themes was the determination of 'inappropriateness' or 'appropriateness' of an ambulance call out, which was then adopted as the concept of focus for our qualitative synthesis.
RESULTS
There were 27 articles used in the systematic mapping review and 17 in the qualitative synthesis stage of the review. Four themes were developed in the systematic mapping stage: socioeconomic status/geographical location, practical reasons, fear of consequences and parental education. Three analytical themes were developed in the qualitative synthesis stage including practicalities and logistics of obtaining care, arbitrary scoring system and retrospection.
CONCLUSIONS
There is a lack of public and caregiver understanding about the use of ambulances for paediatrics. There are factors that appear specific to choosing ambulance care for children that are not so prominent in adults (fever, reassurance, fear of consequences). Future areas for attention to decrease ambulance activation for paediatric low-acuity reports were highlighted as: identifying strategies for helping caregivers to mitigate perceived risk, increasing availability of primary care, targeted education to particular geographical areas, education to first-time parents with infants and providing alternate means of transportation.
PROSPERO REGISTRATION NUMBER
CRD42019160395.
Topics: Ambulances; Caregivers; Humans; Parents; Primary Health Care
PubMed: 34588248
DOI: 10.1136/bmjopen-2021-049443 -
British Paramedic Journal Mar 2021The phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by...
AIMS
The phenomenon of feedback is well-researched within the wider healthcare context, where it is suggested that feedback can improve patient care and patient safety by enhancing clinical performance and staff mental health (Ivers et al., 2012). Within a pre-hospital context, systematic reviews have been conducted for automated feedback from defibrillators and debrief after simulation, but not on the wider concept of feedback. The aim of this systematic review was to identify, describe and synthesise the published literature on the types and effects of feedback received by emergency ambulance staff.
METHODS
This study is a systematic mixed studies review including empirical primary research of qualitative, quantitative and mixed-methods methodology published in peer-reviewed journals in English. Studies were included if they explored the concept of feedback as defined in this review, i.e. the systematised provision of information to emergency ambulance staff regarding their performance within pre-hospital practice and/or patient outcomes. The search strategy consisted of three facets: ambulance staff synonyms, feedback synonyms and feedback content. Databases searched on 11 June 2020 from inception were MEDLINE, EMBASE, AMED, PsycInfo, HMIC, CINAHL and Web of Science. Study quality was appraised using the Mixed Methods Appraisal Tool (Hong et al., 2018), and data were analysed using narrative synthesis guided by Popay et al. (2006) following a parallel-results convergent synthesis design.
RESULTS
The search strategy yielded 2424 articles, excluding duplicates. Seventy-eight studies met the inclusion criteria after full-text review, of which 37 only mentioned feedback as a solution to improving specific circumstances (e.g. decision-making, burnout). The remaining 41 studies consisted of: 34 interventional pre-hospital feedback studies; four non-interventional feedback studies; and three preparatory studies. The source, content and mode of pre-hospital feedback represented in the studies varied greatly and encompassed feedback on behaviour and/or feedback on outcomes of behaviour (Michie et al., 2013). The main outcome measure of included studies was quality of care (e.g. quality of CPR, adherence to guidelines) but softer measures such as staff wellbeing, professional development and clinical decision-making were also represented.
CONCLUSION
It is anticipated that the review findings will be useful to guide the development of future pre-hospital feedback interventions, for which there is growing interest in the national and international pre-hospital setting. Further empirical research is required to explore whether the published literature reflects current pre-hospital practice.
PubMed: 34421383
DOI: 10.29045/14784726.2021.3.5.4.68 -
Australian and New Zealand Journal of... Feb 2024The objective of this study was to quantify the impact of heatwaves on likelihood of ambulance callouts for Australia. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The objective of this study was to quantify the impact of heatwaves on likelihood of ambulance callouts for Australia.
METHODS
A systematic review and meta-analysis was conducted to retrieve and synthesise evidence published from 1 January 2011 to 31 May 2023 about the association between heatwaves and the likelihood of ambulance callouts in Australia. Different heatwave definitions were used ranging from excess heat factor to heatwave defined as a continuous period with temperatures above certain defined thresholds (which varied based on study locations).
RESULTS
We included nine papers which met the inclusion criteria for the review. Eight were eligible for the meta-analyses. The multilevel meta-analyses revealed that the likelihood of ambulance callouts for all causes and for cardiovascular diseases increased by 10% (95% confidence interval: 8%, 13%) and 5% (95% confidence interval: 1%, 3%), respectively, during heatwave days.
CONCLUSIONS
Exposure to heatwaves is associated with an increased likelihood of ambulance callouts, and there is a dose-response association between heatwave severity and the likelihood of ambulance callouts.
IMPLICATIONS FOR PUBLIC HEALTH
The number of heatwave days are going to increase, and this will mean an increase in the likelihood of ambulance callouts, thereby, spotlighting the real burden that heatwaves place on our already stressed healthcare system. The findings of this study underscore the critical need for proactive measures, including the establishment of research initiatives and holistic heat health awareness campaigns, spanning from the individual and community levels to the healthcare system, in order to create a more resilient Australia in the face of heatwave-related challenges.
Topics: Humans; Ambulances; Australia; Hot Temperature; Cardiovascular Diseases; Climate
PubMed: 38286717
DOI: 10.1016/j.anzjph.2023.100115 -
Emergency Medicine Journal : EMJ Dec 2018Paramedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Paramedics are involved in examining, treating and diagnosing patients. The accuracy of these diagnoses is evaluated using diagnostic accuracy studies. We undertook a systematic review of published literature to provide an overview of how accurately paramedics diagnose patients compared with hospital doctors. A bivariate meta-analysis was incorporated to examine the range of diagnostic sensitivity and specificity.
METHODS
We searched MEDLINE, CINAHL, Embase, AMED and the Cochrane Database from 1946 to 7 May 2016 for studies where patients had been given a diagnosis by paramedics and hospital doctors. Keywords focused on study type ('diagnostic accuracy'), outcomes (sensitivity, specificity, likelihood ratio?, predictive value?) and setting (paramedic*, pre-hospital, ambulance, 'emergency service?', 'emergency medical service?', 'emergency technician?').
RESULTS
2941 references were screened by title and/or abstract. Eleven studies encompassing 384 985 patients were included after full-text review. The types of diagnoses in one of the studies encompassed all possible diagnoses and in the other studies focused on sepsis, stroke and myocardial infarction. Sensitivity estimates ranged from 32% to 100% and specificity estimates from 14% to 100%. Eight of the studies were deemed to have a low risk of bias and were incorporated into a meta-analysis which showed a pooled sensitivity of 0.74 (0.62 to 0.82) and a pooled specificity of 0.94 (0.87 to 0.97).
DISCUSSION
Current published research suggests that diagnoses made by paramedics have high sensitivity and even higher specificity. However, the paucity and varying quality of studies indicates that further prehospital diagnostic accuracy studies are warranted especially in the field of non-life-threatening conditions.
PROSPERO REGISTRATION NUMBER
CRD42016039306.
Topics: Diagnostic Techniques and Procedures; Emergency Medical Services; Humans; Sensitivity and Specificity
PubMed: 30217952
DOI: 10.1136/emermed-2018-207588