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Resuscitation Plus Sep 2024Sri Lanka is a leading nation in healthcare provision in the South Asia. Notably, it recorded amongst the lowest maternal and neonatal mortality rates in the region.... (Review)
Review
"1990 Suwa Seriya" the national pre-hospital care ambulance service of Sri Lanka; a narrative review describing the EMS system with special emphasis on Out of Hospital Cardiac Arrest (OHCA) in Sri Lanka.
BACKGROUND
Sri Lanka is a leading nation in healthcare provision in the South Asia. Notably, it recorded amongst the lowest maternal and neonatal mortality rates in the region. However a significant deficit in improving all-cause mortality rates was the absence of a cohesive system of pre-hospital care.
METHOD
This narrative review delves into the evolution of Sri Lanka's Emergency Medical Services (EMS) system over the past decade. It examines the historical context, challenges encountered, and the transformative role of the "1990 Suwa Seriya" ambulance service on all causes of morbidity and mortality rates including out-of-hospital cardiac arrest (OHCA).
RESULTS
The review elucidates the path from no organised pre-hospital system in 2015 to a comprehensive free to public, pre-hospital care emergency ambulance service that effectively serves 22 million people nationa-wide in 6 short years. Collaborations with emergency medicine, novel approaches to training and credentialing, as well as evolving research initiatives illustrate an approach to be emulated in countries with emerging pre-hospital systems. 1990 Suwa Seriya's response during the COVID-19 pandemic and its implications on public perception are discussed in conjunction with efforts to limit morbidity and mortality from OHCA.
CONCLUSION
In conclusion, the article underscores 1990 Suwa Seriya's dedication to continuous improvement and its potential as a model for bolstering emergency healthcare. By addressing challenges, fostering collaborations, and adapting to crises like the COVID-19 pandemic, 1990 Suwa Seriya exemplifies a pathway towards elevating pre-hospital care standards in lower-middle-income countries (LMICs).
PubMed: 38827272
DOI: 10.1016/j.resplu.2024.100649 -
Intensive & Critical Care Nursing May 2024Emergency Reflex Action Drills (ERADs) are meant to decrease stress-associated cognitive demand in high urgency situations. The aim of this study was to develop and test...
BACKGROUND
Emergency Reflex Action Drills (ERADs) are meant to decrease stress-associated cognitive demand in high urgency situations. The aim of this study was to develop and test an ERAD for witnessed traumatic cardiac arrest (TCA), an event in which potentially reversible causes need to be systematically addressed and treated in a short period of time. We hypothesize that this ERAD (the TCA-Drill) helps ground Emergency Medical Services (EMS) nurses in overcoming performance decline during this specific high-pressure situation.
METHODS
This was a prospective, experimental one-group pre-post intervention study. Ground EMS nurses participated in a session of four simulated scenarios, with an in-between educational session to teach the TCA-Drill. Scenarios were video recorded, after which adherence and time differences were analyzed. Self-confidence on clinical practice was measured before and after the scenarios.
RESULTS
Twelve ground EMS nurses participated in this study. Overall median time to address reversible causes of TCA decreased significantly using the TCA-Drill (132 vs. 110 s; p = 0.030) compared with the conventional ALS strategy. More specifically, participants adhering to the TCA-Drill showed a significantly lower time needed for hemorrhage control (58 vs. 37 s; p = 0.012). Eight of 12 (67 %) ground EMS nurses performed the ERAD without protocol deviations. Reported self-confidence significantly increased on 11 of the 13 surveyed items.
CONCLUSIONS
The use of an ERAD for TCA (the TCA-Drill) significantly reduces the time to address reversible causes for TCA without delaying chest compressions in a simulated environment and can be easily taught to ground EMS nurses and increases self-confidence.
IMPLICATIONS FOR CLINICAL PRACTICE
The use of an ERAD for TCA (the TCA-Drill can significantly reduce the time to address reversible causes for TCA without delaying chest compression. This drill can be easily taught to ground EMS nurses and increases their self-confidence in addressing TCA-patients.
PubMed: 38823272
DOI: 10.1016/j.iccn.2024.103731 -
Air Medical Journal 2024We present the case of a 10-year-old previously healthy male who suffered an out-of-hospital cardiac arrest because of abdominal trauma and survived with excellent...
We present the case of a 10-year-old previously healthy male who suffered an out-of-hospital cardiac arrest because of abdominal trauma and survived with excellent neurologic outcomes and near complete return to baseline functional status at hospital discharge. The rapid response and efficient mobilization of resources led to an excellent patient outcome despite the severity of injuries, including intra-abdominal injuries with expected mortality, out-of-hospital traumatic arrest, coagulopathy, and an extended pediatric intensive care unit stay. This case underscores the significance of timely advanced trauma life support interventions, especially early blood product administration, efficient transport, and airway management, while sharing a remarkable case of out-of-hospital pediatric traumatic arrest with near full recovery.
Topics: Humans; Male; Child; Out-of-Hospital Cardiac Arrest; Wounds, Nonpenetrating; Abdominal Injuries; Emergency Medical Services; Air Ambulances
PubMed: 38821708
DOI: 10.1016/j.amj.2023.12.007 -
Air Medical Journal 2024Because the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to... (Comparative Study)
Comparative Study
OBJECTIVE
Because the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to further investigate the impact of HEMS. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared with ground-based EMS in Finland under current practices.
METHODS
The incremental cost-effectiveness ratio was evaluated using the differences in outcomes and costs between HEMS and ground-based EMS. The estimated mortality within 30 days and quality-adjusted life years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale, and a 1-way sensitivity analysis was conducted on the QALY indexes ranging from 0.6 to 0.8. Survival rates were calculated according to the national HEMS database, and the cost structure was estimated at 48 million euros based on financial statements.
RESULTS
HEMS prevented the 30-day mortality of 68.1 patients annually, with an incremental cost-effectiveness ratio of €43,688 to €56,918/QALY. Fixed costs accounted for 93% of HEMS expenses because of 24/7 operations, making the capacity utilization rate a major determinant of total costs.
CONCLUSION
HEMS intervention is cost-effective compared with ground-based EMS and is acceptable from a societal willingness-to-pay perspective. These findings contribute valuable insights for health care management decision making and highlight the need for future research for service optimization.
Topics: Finland; Cost-Benefit Analysis; Humans; Air Ambulances; Emergency Medical Services; Quality-Adjusted Life Years; Physicians; Male; Female; Middle Aged
PubMed: 38821704
DOI: 10.1016/j.amj.2023.12.006 -
BMC Emergency Medicine May 2024Pre-hospital ambulance service is the most important part of healthcare service. Client satisfaction with the service indicates the degree of adaptation to the...
INTRODUCTION
Pre-hospital ambulance service is the most important part of healthcare service. Client satisfaction with the service indicates the degree of adaptation to the appropriate quality and quantity of services. Patients' dissatisfaction with the service can affect their expectations of the overall services that they will receive later in the definitive care facility. However, it is not a well-addressed area in developing countries, including Ethiopia.
OBJECTIVE
This study aimed to identify the ambulance service satisfaction level and associated factors among service users in Addis Ababa, Ethiopia.
METHODS
A cross-sectional study was conducted in five governmental hospitals in Addis Ababa city. A face-to-face exit interview technique was employed on a total of 410 consecutively selected participants using a pretested tool developed from similar sources. The cleaned data was entered into the Epi-Data Manager 4.6 version and then exported to SPSS version 26 for analysis. The dependent variable was dichotomized into satisfied and unsatisfied to compute bivariate logistic regression. In the multivariate logistic regression model, predictors with a p-value < 0.05 at the 95% CI were considered to have a significant association.
RESULT
A total of 410 respondents were included in the study. The mean of participants' responses regarding ambulance personnel, call operator, treatment on the scene, and ambulance subscale was 3.64, 3.48, 3.40, and 3.43, respectively. The study found that only 21.5% of participants were satisfied by the ambulance service they received. There was a statistically significant association between ambulance service satisfaction and age (AOR = 3.52, 95% CI: 1.01-12.36), monthly income (AOR = 3.13, 95% CI: 1.41-6.94), ambulance response time (AOR = 10.33, 95% CI: 2.09-51.06), type of ambulance used (AOR = 4.55, 95% CI: 2.19-9.43), and previous ambulance usage (AOR = 2.33, 95% CI: 1.34-4.05).
CONCLUSION
The study found a low level of satisfaction among ambulance users. The findings suggest that ambulance personnel performance is a key determinant of user satisfaction, while treatment at the scene and in the ambulances, and call operator areas require improvement. Age, monthly income, ambulance response time, type of ambulance, and previous ambulance use also influenced satisfaction. Improving the quality of services, reducing response time, and ensuring call operators are trained are vital steps to enhance satisfaction.
Topics: Humans; Ethiopia; Female; Cross-Sectional Studies; Ambulances; Male; Patient Satisfaction; Adult; Middle Aged; Young Adult; Adolescent; Emergency Medical Services
PubMed: 38816727
DOI: 10.1186/s12873-024-01007-9 -
BMC Medical Informatics and Decision... May 2024Video consultations between hospital-based neurologists and Emergency Medical Services (EMS) have potential to increase precision of decisions regarding stroke patient...
BACKGROUND
Video consultations between hospital-based neurologists and Emergency Medical Services (EMS) have potential to increase precision of decisions regarding stroke patient assessment, management and transport. In this study we explored the use of real-time video streaming for neurologist-EMS consultation from the ambulance, using highly realistic full-scale prehospital simulations including role-play between on-scene EMS teams, simulated patients (actors), and neurologists specialized in stroke and reperfusion located at the remote regional stroke center.
METHODS
Video streams from three angles were used for collaborative assessment of stroke using the National Institutes of Health Stroke Scale (NIHSS) to assess symptoms affecting patient's legs, arms, language, and facial expressions. The aim of the assessment was to determine appropriate management and transport destination based on the combination of geographical location and severity of stroke symptoms. Two realistic patient scenarios were created, with severe and moderate stroke symptoms, respectively. Each scenario was simulated using a neurologist acting as stroke patient and an ambulance team performing patient assessment. Four ambulance teams with two nurses each all performed both scenarios, for a total of eight cases. All scenarios were video recorded using handheld and fixed cameras. The audio from the video consultations was transcribed. Each team participated in a semi-structured interview, and neurologists and actors were also interviewed. Interviews were audio recorded and transcribed.
RESULTS
Analysis of video-recordings and post-interviews (n = 7) show a more thorough prehospital patient assessment, but longer total on-scene time, compared to a baseline scenario not using video consultation. Both ambulance nurses and neurologists deem that video consultation has potential to provide improved precision of assessment of stroke patients. Interviews verify the system design effectiveness and suggest minor modifications.
CONCLUSIONS
The results indicate potential patient benefit based on a more effective assessment of the patient's condition, which could lead to increased precision in decisions and more patients receiving optimal care. The findings outline requirements for pilot implementation and future clinical tests.
Topics: Humans; Emergency Medical Services; Stroke; Video Recording; Patient Simulation; Remote Consultation; Referral and Consultation; Neurologists
PubMed: 38811986
DOI: 10.1186/s12911-024-02539-7 -
BMC Health Services Research May 2024Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers...
BACKGROUND
Paramedics' work, even pre-pandemic, can be confronting and dangerous. As pandemics add extra stressors, the study explored paramedics' lived experience of the barriers to, and enablers of, responding to suspected or confirmed Coronavirus Disease 2019 (COVID-19) cases.
METHODS
This exploratory-descriptive qualitative study used semi-structured interviews to investigate Queensland metropolitan paramedics' experiences of responding to cases during the COVID-19 pandemic. Interview transcripts were analysed using thematic analysis. Registered Paramedics were recruited by criterion sampling of staff who experienced the COVID-19 pandemic as active officers.
RESULTS
Nine registered paramedics participated. Five themes emerged: communication, fear and risk, work-related protective factors, leadership, and change. Unique barriers included impacts on effective communication due to the mobile nature of paramedicine, inconsistent policies/procedures between different healthcare facilities, dispatch of incorrect information to paramedics, assisting people to navigate the changing healthcare system, and wearing personal protective equipment in hot, humid environments. A lower perceived risk from COVID-19, and increased empathy after recovering from COVID-19 were unique enablers.
CONCLUSIONS
This study uncovered barriers and enablers to attending suspected or confirmed COVID-19 cases unique to paramedicine, often stemming from the mobile nature of prehospital care, and identifies the need for further research in paramedicine post-pandemic to better understand how paramedics can be supported during public health emergencies to ensure uninterrupted ambulance service delivery.
Topics: Humans; COVID-19; Qualitative Research; Queensland; Allied Health Personnel; Female; SARS-CoV-2; Male; Adult; Interviews as Topic; Pandemics; Attitude of Health Personnel; Personal Protective Equipment; Emergency Medical Technicians; Leadership; Middle Aged; Paramedics
PubMed: 38811956
DOI: 10.1186/s12913-024-11120-x -
Journal of Paramedic Practice : the... Dec 2023The utilisation of pre-hospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early...
The utilisation of pre-hospital early warning scores in ambulance services is widely endorsed to promptly identify patients at risk of clinical deterioration. Early warning scores enable clinicians to estimate risk based on clinical observations and vital signs, with higher scores indicating an elevated risk of adverse outcomes. Local healthcare systems establish threshold values for these scores to guide clinical decision-making, triage, and response, necessitating a careful balance between identifying critically unwell patients and managing the challenge of prioritisation. Given the limited evidence for optimal early warning scores in emergency department and pre-hospital care settings, a systematic review by Guan et al. (2022) was undertaken to assess the diagnostic accuracy of early warning scores for predicting in-hospital deterioration when applied in the emergency department or pre-hospital setting. This commentary aims to critically appraise the methods used within the review Guan et al (2022) and expand upon the findings in the context of clinical practice.
PubMed: 38808272
DOI: 10.12968/jpar.2023.15.12.516 -
Scandinavian Journal of Trauma,... May 2024Life-threatening conditions are infrequent in children. Current literature in paediatric prehospital research is centred around trauma and paediatric out-of-hospital...
BACKGROUND
Life-threatening conditions are infrequent in children. Current literature in paediatric prehospital research is centred around trauma and paediatric out-of-hospital cardiac arrests (POHCA). The aims of this study were to (1) outline the distribution of trauma, POHCA or other medical symptoms among survivors and non-survivors after paediatric emergency calls, and (2) to investigate these clinical presentations' association with mortality in children with and without pre-existing comorbidity, respectively.
METHODS
Nationwide population-based cohort study including ground and helicopter emergency medical services in Denmark for six consecutive years (2016-2021). The study included all calls to the emergency number 1-1-2 regarding children ≤ 15 years (N = 121,230). Interhospital transfers were excluded, and 1,143 patients were lost to follow-up. Cox regressions were performed with trauma or medical symptoms as exposure and 7-day mortality as the outcome, stratified by 'Comorbidity', 'Severe chronic comorbidity' and 'None' based on previous healthcare visits.
RESULTS
Mortality analysis included 76,956 unique patients (median age 5 (1-12) years). Annual all-cause mortality rate was 7 per 100,000 children ≤ 15 years. For non-survivors without any pre-existing comorbidity (n = 121), reasons for emergency calls were trauma 18.2%, POHCA 46.3% or other medical symptoms 28.9%, whereas the distribution among the 134 non-survivors with any comorbidity was 7.5%, 27.6% and 55.2%, respectively. Compared to trauma patients, age- and sex-adjusted hazard ratio for patients with calls regarding medical symptoms besides POHCA was 0.8 [0.4;1.3] for patients without comorbidity, 1.1 [0.5;2.2] for patients with comorbidity and 6.1 [0.8;44.7] for patients with severe chronic comorbidity.
CONCLUSION
In both non-survivors with and without comorbidity, a considerable proportion of emergency calls had been made because of various medical symptoms, not because of trauma or POHCA. This outline of diagnoses and mortality following paediatric emergency calls can be used for directing paediatric in-service training in emergency medical services.
Topics: Humans; Child; Female; Male; Denmark; Child, Preschool; Comorbidity; Infant; Emergency Medical Services; Adolescent; Cohort Studies; Out-of-Hospital Cardiac Arrest; Wounds and Injuries
PubMed: 38807153
DOI: 10.1186/s13049-024-01212-2 -
BMC Emergency Medicine May 2024Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a... (Observational Study)
Observational Study
BACKGROUND
Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a leading cause of death and injuries are a frequent reason to contact EMCC. We aimed to investigate if video streaming is associated with recognition of a need for first aid during calls regarding injured patients and improve quality of bystander first aid.
METHODS
A prospective observational study including patients from three health regions in Norway, from November 2021 to February 2023 (registered in clinical trials 10/25/2021, NCT05121649). Cases where video streaming had been used as a supplement during the medical emergency call were compared to cases where video streaming was not used during the call. Patients were included by ambulance personnel on the scene of accident if they met the following criteria: 1. Ambulance personnel arrived at a patient who had an injury, 2. One or more bystanders had been present before their arrival, 3. One or more of the following first aid measures had been performed by bystander or should have been performed: airway management, control of external bleeding, recovery position, and hypothermia prevention. Ambulance personnel assessed quality of first aid performed by bystander, and information concerning use of video streaming and patient need for first aid measures recognized by dispatcher was collected through EMCC audio logs and patient charts. We present descriptive data and results from a logistic regression analysis.
RESULTS
Data was collected on 113 cases, and dispatchers used video streaming in addition to standard telephone communication in 12/113 (10%) of the cases. The odds for the dispatcher to recognize a need for first aid during a medical emergency call were more than five times higher when video streaming was used compared to no use of video streaming (OR 5.30, 95% CI 1.11-25.44). Overall quality of bystander first aid was rated as "high". The odds ratio for the patient receiving first aid of higher quality were 1.82 (p-value 0.46) when video streaming was used by dispatcher during the call.
CONCLUSION
Our findings show that video streaming is not frequently used by dispatchers in calls regarding patients with injuries, but that video streaming is associated with improved recognition of patients' first aid needs. We found no statistically significant difference in first aid quality comparing the calls where video streaming as a supplement were used with the calls with audio only.
Topics: Humans; Norway; Prospective Studies; First Aid; Male; Female; Adult; Middle Aged; Wounds and Injuries; Aged; Video Recording; Emergency Medical Service Communication Systems; Adolescent; Child; Young Adult; Emergency Medical Services
PubMed: 38807042
DOI: 10.1186/s12873-024-01010-0