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Research Square Jun 2024Accurate identification of acute coronary syndrome (ACS) in the prehospital setting is important for timely treatments that reduce damage to the compromised myocardium....
Accurate identification of acute coronary syndrome (ACS) in the prehospital setting is important for timely treatments that reduce damage to the compromised myocardium. Current machine learning approaches lack sufficient performance to safely rule-in or rule-out ACS. Our goal is to identify a method that bridges this gap. To do so, we retrospectively evaluate two promising approaches, an ensemble of gradient boosted decision trees (GBDT) and selective classification (SC) on consecutive patients transported by ambulance to the ED with chest pain and/or anginal equivalents. On the task of ACS classification with 23 prehospital covariates, we found the fusion of the two (GBDT+SC) improves the best reported sensitivity and specificity by 8% and 23% respectively. Accordingly, GBDT+SC is safer than current machine learning approaches to rule-in and rule-out of ACS in the prehospital setting.
PubMed: 38883709
DOI: 10.21203/rs.3.rs-4437265/v1 -
Frontiers in Public Health 2024The precise associations between temperature-related indices and mental and behavioral disorders (MBDs) have yet to be fully elucidated. Our study aims to ascertain the...
INTRODUCTION
The precise associations between temperature-related indices and mental and behavioral disorders (MBDs) have yet to be fully elucidated. Our study aims to ascertain the most effective temperature-related index and assess its immediate impact on emergency ambulance dispatches (EADs) due to MBDs in Shenzhen, China.
METHODS
EADs data and meteorological data from January 1, 2013, to December 31, 2020, in Shenzhen were collected. Distributed lag non-linear models (DLNMs) were utilized to examine the non-linear and lagged effects of temperature-related indices on EADs due to MBDs. The Quasi Akaike Information criterion (QAIC) was used to determine the optimal index after standardizing temperature-related indices. After adjusting for confounding factors in the model, we estimated the immediate and cumulative effects of temperature on EADs due to MBDs.
RESULTS
The analysis of short-term temperature effects on EADs due to MBDs revealed Humidex as the most suitable index. Referring to the optimal Humidex (3.2 percentile, 12.00°C), we observed a significant effect of Humidex over the threshold (34.6 percentile, 26.80°C) on EADs due to MBDs at lag 0-5. The cumulative relative risks for high temperature (90 percentile, 41.90°C) and extreme high temperature (99 percentile, 44.20°C) at lag 0-5 were 1.318 (95% CI: 1.159-1.499) and 1.338 (95% CI: 1.153-1.553), respectively. No significant cold effect was observed on EADs due to MBDs.
CONCLUSION
High Humidex was associated with more EADs due to MBDs in subtropical regions. Health authorities should implement effective measures to raise public awareness of risks related to high temperature and protect vulnerable populations.
Topics: Humans; China; Ambulances; Mental Disorders; Temperature; Male; Female; Adult; Middle Aged; Emergency Medical Dispatch
PubMed: 38883192
DOI: 10.3389/fpubh.2024.1343550 -
Resuscitation Jun 2024The cohort of patients in which cardiac arrest centres (CAC) in rural and suburban populations confer the greatest survival benefit remains unclear. The aim of this...
AIM
The cohort of patients in which cardiac arrest centres (CAC) in rural and suburban populations confer the greatest survival benefit remains unclear. The aim of this study was to assess whether the transfer of resuscitated Utstein-comparator out-of-hospital cardiac arrest (OHCA) patients direct to a CAC was associated with improved survival to hospital discharge compared to patients conveyed to non-specialist centres.
METHODS
A consecutive sample of adult (≥18years old) Utstein-comparator patients (witnessed collapse and initial shockable rhythm) were included from the East of England Ambulance Service NHS Trust Utstein resuscitation registry; 2018-2022. Logistic regression was used to compare survival-to-discharge in patients transported to CACs compared with patients transported to non-specialist centres.
RESULTS
During the study period, resuscitation was attempted in 18,276 OHCA patients. N=2448 (13.4%) met the Utstein comparator definition and 1151 patients were included in the final analysis; per protocol. Survival was greater for patients conveyed to a CAC (n=768, 60.7%) compared to non-specialist centres (n=383, 47.3%); adjusted OR 1.44 (95%CI 1.07-1.94),p=0.017. Amongst the centres analysed in this study, there was significant inter-hospital variability in survival between CACs (p=0.017). There was no association between patient volume and survival (p=0.850).
CONCLUSION
Direct transport to a cardiac arrest centre was associated with a 44% increase in the odds of survival compared to conveyance to a non-specialist centre for resuscitated adult patients presenting with witnessed collapse and initial shockable OHCA rhythm.
PubMed: 38880470
DOI: 10.1016/j.resuscitation.2024.110280 -
Emergency Medicine Journal : EMJ Jun 2024Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the...
BACKGROUND
Tranexamic acid (TXA) decreases mortality in injured patients and should be administered as soon as possible. Despite international guidelines recommending TXA in the prehospital setting, its use remains low. The aim of this study was to assess the prehospital administration of TXA for injured patients in a Swiss region.
METHODS
We conducted a retrospective observational study in Switzerland between 2018 and 2021. Inclusion criteria were injured patients ≥18 years for whom an ambulance or helicopter was dispatched. The exclusion criterion was minor injury defined by a National Advisory Committee for Aeronautics score <3. The primary outcome was the proportion of patients treated with TXA according to guidelines. The European guidelines were represented by the risk of death from bleeding (calculated retrospectively using the Bleeding Audit for Trauma and Triage (BATT) score). Factors impacting the likelihood of receiving TXA were assessed by multivariate analysis.
RESULTS
Of 13 944 patients included in the study, 2401 (17.2%) were considered at risk of death from bleeding. Among these, 257 (11%) received prehospital TXA. This represented 38% of those meeting US guidelines. For European guidelines, the treatment rate increased with the risk of death from bleeding: 6% (95% CI 4.4% to 7.0%) for low risk (BATT score 3-4); 13% (95% CI 11.1% to 15.9%) for intermediate risk (BATT score 5-7); and 21% (95% CI 17.6% to 25.6%) for high risk (BATT score ≥8) (p<0.01). Women and the elderly were treated less often than men and younger patients, irrespective of the risk of death from bleeding and the mechanism of injury.
CONCLUSION
The proportion of injured patients receiving TXA in the prehospital setting of the State of Vaud in Switzerland was low, with even lower rates for women and older patients. The reasons for this undertreatment are probably multifactorial and would require specific studies to clarify and correct them.
PubMed: 38876768
DOI: 10.1136/emermed-2023-213806 -
Frontiers in Public Health 2024Prior literature suggests that mass gathering events pose challenges to an emergency medical services (EMS) system. We aimed to investigate whether events influence EMS...
BACKGROUND
Prior literature suggests that mass gathering events pose challenges to an emergency medical services (EMS) system. We aimed to investigate whether events influence EMS call rates.
MATERIALS AND METHODS
This study is a retrospective review of all primary response ambulance calls in Rhode Island (US) between January 1st, 2018 and August 31st, 2022. The number of EMS calls per day was taken from the state's EMS registry. Event data was collected using a Google (Google LLC, Mountain View, CA) search. We used separate Poisson regression models with the number of ambulance calls as the dependent and the social event categories sports, agricultural, music events, and public exhibitions as independent variables. All models controlled for the population at risk and the period of the COVID-19 pandemic. Results are presented as increases or decreases in calls per 100,000 inhabitants from the mean over the study period.
RESULTS
The mean number of daily EMS calls was 38 ± 4 per 100,000 inhabitants. EMS encountered significantly more missions on days with music events (+3, 95% CI [2; 3]) and public exhibitions (+2, 95% CI [1; 2]). In contrast, days with agricultural events were associated with fewer calls (-1, 95% CI [-1; 0]). We did not find any effect of sports events on call rates.
CONCLUSION
Increased ambulance call volumes are observed on days with music events and public exhibitions. Days with agricultural events are associated with fewer EMS calls.
Topics: Humans; Retrospective Studies; Emergency Medical Services; COVID-19; Rhode Island; Ambulances; SARS-CoV-2; Sports
PubMed: 38873322
DOI: 10.3389/fpubh.2024.1394384 -
Laboratory Animals Jun 2024Two healthy Landrace pigs anaesthetized with propofol suffered rapid onset of fatal sepsis. Clinical signs included severe arterial hypotension, loss of peripheral...
Two healthy Landrace pigs anaesthetized with propofol suffered rapid onset of fatal sepsis. Clinical signs included severe arterial hypotension, loss of peripheral oxygenation, low end-tidal CO, clinical onset of pulmonary oedema and cardiac dysfunction. Gross and histopathological examination revealed loss of vascular integrity with severe lung oedema and congestion, haemorrhages in several organs and fluid leakage into body cavities. Large numbers of Gram-negative bacteria, primarily sp., were present in the anaesthetic infusion containing propofol and were also cultured from internal organs of both pigs. The propofol was likely contaminated by bacteria after inappropriate handling and storage in the operating room. This report illustrates the potential for severe nosocomial infection when applying propofol in animals and humans and may serve as a reminder of the importance of strict aseptic practice in general, and specifically in the handling of this anaesthetic agent.
PubMed: 38863139
DOI: 10.1177/00236772231200524 -
BMC Emergency Medicine Jun 2024Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and... (Review)
Review
BACKGROUND
Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as 'callers' in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers' smartphones to emergency medical dispatch centres.
METHODS
A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews.
RESULTS
Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers' (referred to as 'dispatcher/s' in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols.
CONCLUSION
Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers.
Topics: Humans; Smartphone; Video Recording; Emergency Medical Dispatcher; Emergency Medical Service Communication Systems; Emergency Medical Dispatch; Emergency Medical Services; Cardiopulmonary Resuscitation
PubMed: 38862922
DOI: 10.1186/s12873-024-01015-9 -
International Journal of Emergency... Jun 2024Falls among older individuals contribute significantly to the rise in ambulance transport use. To recognize the importance of future countermeasures, we estimated the...
BACKGROUND
Falls among older individuals contribute significantly to the rise in ambulance transport use. To recognize the importance of future countermeasures, we estimated the projected number and percentage of fall-related emergency medical service (EMS) calls.
METHODS
We examined the sex, age group, and location of falls among patients aged ≥ 65 years who contacted emergency services in Sapporo City from 2013 to 2021. Annual fall-related calls per population subgroup were calculated, and trends were analyzed. Four models were used to estimate the future number of fall-related calls from the 2025-2060 projected population: (1) based on the 2022 data, estimates from the 2013-2022 data using (2) Poisson progression, (3) neural network, (4) estimates from the 2013-2019 data using neural network. The number of all EMS calls was also determined using the same method to obtain the ratio of all EMS calls.
RESULTS
During 2013-2022, 70,262 fall-related calls were made for those aged ≥ 65 years. The rate was higher indoors among females and outdoor among males in most age groups and generally increased with age. After adjusting for age, the rate increased by year. Future estimates of the number of fall calls are approximately double the number in 2022 in 2040 and three times in 2060, with falls accounting for approximately 11% and 13% of all EMS calls in 2040 and 2060, respectively.
CONCLUSION
The number of fall-related EMS calls among older people is expected to increase in the future, and the percentage of EMS calls will also increase; therefore, countermeasures are urgently needed.
PubMed: 38862902
DOI: 10.1186/s12245-024-00654-w -
Journal of Educational Evaluation For... 2024The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation...
PURPOSE
The duties of paramedics and emergency medical technicians (P&EMTs) are continuously changing due to developments in medical systems. This study presents evaluation goals for P&EMTs by analyzing their work, especially the tasks that new P&EMTs (with less than 3 years' experience) find difficult, to foster the training of P&EMTs who could adapt to emergency situations after graduation.
METHODS
A questionnaire was created based on prior job analyses of P&EMTs. The survey questions were reviewed through focus group interviews, from which 253 task elements were derived. A survey was conducted from July 10, 2023 to October 13, 2023 on the frequency, importance, and difficulty of the 6 occupations in which P&EMTs were employed.
RESULTS
The P&EMTs' most common tasks involved obtaining patients' medical histories and measuring vital signs, whereas the most important task was cardiopulmonary resuscitation (CPR). The task elements that the P&EMTs found most difficult were newborn delivery and infant CPR. New paramedics reported that treating patients with fractures, poisoning, and childhood fever was difficult, while new EMTs reported that they had difficulty keeping diaries, managing ambulances, and controlling infection.
CONCLUSION
Communication was the most important item for P&EMTs, whereas CPR was the most important skill. It is important for P&EMTs to have knowledge of all tasks; however, they also need to master frequently performed tasks and those that pose difficulties in the field. By deriving goals for evaluating P&EMTs, changes could be made to their education, thereby making it possible to train more capable P&EMTs.
Topics: Humans; Emergency Medical Technicians; Republic of Korea; Surveys and Questionnaires; Allied Health Personnel; Clinical Competence; Educational Measurement; Female; Male; Focus Groups; Adult; Emergency Medical Services; Cardiopulmonary Resuscitation; Communication; Paramedics
PubMed: 38862391
DOI: 10.3352/jeehp.2024.21.13 -
BMJ Open Jun 2024Traumatic brain injury (TBI) is a common presentation in the prehospital environment. At present, paramedics do not routinely use tools to identify low-risk patients who...
Head Injury Evaluation and Ambulance Diagnosis (HOME) Study protocol: a feasibility study assessing the implementation of the Canadian CT Head Rule in the prehospital setting.
INTRODUCTION
Traumatic brain injury (TBI) is a common presentation in the prehospital environment. At present, paramedics do not routinely use tools to identify low-risk patients who could be left at scene or taken to a local hospital rather than a major trauma centre. The Canadian CT Head Rule (CCHR) was developed to guide the use of CT imaging in hospital. It has not been evaluated in the prehospital setting. We aim to address this gap by evaluating the feasibility and acceptability of implementing the CCHR to patients and paramedics, and the feasibility of conducting a full-scale clinical trial of its use.
METHODS AND ANALYSIS
We will recruit adult patients who are being transported to an emergency department (ED) by ambulance after suffering a mild TBI. Paramedics will prospectively collect data for the CCHR. All patients will be transported to the ED, where deferred consent will be taken and the treating clinician will reassess the CCHR, blinded to paramedic interpretation. The primary clinical outcome will be neurosurgically significant TBI. Feasibility outcomes include recruitment and attrition rates. We will assess acceptability of the CCHR to paramedics using the Ottawa Acceptability of Decision Rules Instrument. Interobserver reliability of the CCHR will be assessed between paramedics and the treating clinician in the ED. Participating paramedics and patients will be invited to participate in semistructured interviews to explore the acceptability of trial processes and facilitators and barriers to the use of the CCHR in practice. Data will be analysed thematically. We anticipate recruiting approximately 100 patients over 6 months.
ETHICS AND DISSEMINATION
This study was approved by the Health Research Authority and the Research Ethics Committee (REC reference: 22/NW/0358). The results will be published in a peer-reviewed journal, presented at conferences and will be incorporated into a doctoral thesis.
TRIAL REGISTRATION NUMBER
ISRCTN92566288.
Topics: Humans; Feasibility Studies; Ambulances; Emergency Medical Services; Tomography, X-Ray Computed; Canada; Brain Injuries, Traumatic; Prospective Studies; Adult; Craniocerebral Trauma; Clinical Decision Rules
PubMed: 38862222
DOI: 10.1136/bmjopen-2023-077191