-
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 -
BMC Health Services Research Jun 2024Individuals who have the ability to bounce back from stressful events, to recover from their troubles and adverse environmental conditions by getting stronger each time...
BACKGROUND
Individuals who have the ability to bounce back from stressful events, to recover from their troubles and adverse environmental conditions by getting stronger each time are known as resilient people. Some professions may cause more occupational anxiety than others due to their characteristics and working conditions. In this research, we aimed to develop a professional commitment scale for the ambulance team. Another aim was to analyze the relationships between professional commitment, occupational anxiety, resilience, gender, job, seniority and working unit variables.
METHODS
In the study, data were collected from a total of 1142 emergency ambulance workers working in Emergency Ambulance and Emergency Call Centers in 34 different cities in Turkey. Data were collected using the "Professional Commitment of Ambulance Team Scale (PCATS), Occupational Anxiety Scale for Emergency Medical Service Professionals (OASEMSP), and Resilience Scale for Adults (RSA). Scale development analyses were carried out using Classical Test Theory (CTT) and Item Response Theory (IRT). Regression analysis were used to examine the relationships between professional commitment, occupational anxiety, resilience, gender, job, seniority and working unit.
RESULTS
As a result of the exploratory factor analysis (EFA), it was determined that 8 items remaining in the professional commitment scale formed a single-factor structure, explaining 46% of the variance of professional commitment of the team. The Cronbach's Alpha reliability value was 0.867. Confirmatory factor analysis (CFA) confirmed the results of exploratory factor analysis. The Cronbach's Alpha reliability coefficient obtained through CTT was 0.868, and the marginal reliability coefficient within the scope of IRT was 0.877. The test-retest reliability coefficient was calculated as 0.832, which indicates that the scale is valid and reliable.
CONCLUSIONS
The study revealed that resilience has a positive effect for professional commitment while occupational anxiety has a negative effect for professional commitment. In addition, having a moderate seniority has a negative (reducing) effect for professional commitment. Other variables (gender, job, and working unit) was found to have no significant impact on professional commitment.
Topics: Humans; Female; Male; Ambulances; Adult; Resilience, Psychological; Turkey; Surveys and Questionnaires; Anxiety; Middle Aged; Psychometrics; Occupational Stress
PubMed: 38858687
DOI: 10.1186/s12913-024-11158-x -
International Journal of Emergency... Jun 2024Refractory out-of-hospital cardiac arrest (OHCA) has a very poor prognosis, with survival rates at around 10%. Extracorporeal membrane oxygenation (ECMO) for patients in...
Refractory out-of-hospital cardiac arrest (OHCA) has a very poor prognosis, with survival rates at around 10%. Extracorporeal membrane oxygenation (ECMO) for patients in refractory arrest, known as ECPR, aims to provide perfusion to the patient whilst the underlying cause of arrest can be addressed. ECPR use has increased substantially, with varying survival rates to hospital discharge. The best outcomes for ECPR occur when the time from cardiac arrest to implementation of ECPR is minimised. To reduce this time, systems must be in place to identify the correct patient, expedite transfer to hospital, facilitate rapid cannulation and ECMO circuit flows. We describe the process of activation of ECPR, patient selection, and the steps that emergency department clinicians can utilise to facilitate timely cannulation to ensure the best outcomes for patients in refractory cardiac arrest. With these processes in place our survival to hospital discharge for OHCA patients is 35%, with most patients having a good neurological function.
PubMed: 38858639
DOI: 10.1186/s12245-024-00652-y -
BMJ Open Jun 2024In the face of unprecedented demand, the Welsh Ambulance Services University NHS Trust developed 'Blue Light Hub': a new app to educate primary school-aged children...
"When you're hurt and you need serious help you call 999." Educating children about emergency services and appropriate use of 999: An evaluation study of the Blue Light Hub app.
OBJECTIVES
In the face of unprecedented demand, the Welsh Ambulance Services University NHS Trust developed 'Blue Light Hub': a new app to educate primary school-aged children about emergency services. Our overarching aim was to examine the effectiveness of the app.
DESIGN
Primary school-aged children from three schools in South Wales, UK, played with the app for 2 hours over 2 weeks in class time. Children completed quizzes to assess their knowledge and awareness of, and confidence in engaging with, emergency services before and after using the app.
PARTICIPANTS
Our evaluation focused on N=393 children who completed both the pre-test and post-test quizzes. On average, children were 8-9 years old (median school year, Year 4); 47.8% were male and 50.9% were female.
RESULTS
After using the app, there was a significant increase in the proportion of children who knew of appropriate actions to take in non-emergency scenarios, χ(1) = 26.01, and could provide a question a call handler would ask them if they called 999, χ(1) = 13.79. There was also an increase in the proportion of children who could identify an National Health Service (NHS) service that could help them if they were unwell, χ(1) = 33.31, name different roles in the NHS, χ(1) = 12.80 and knew how dialling 111 could help them χ(1) = 90.05 (all p values<0.001).
CONCLUSION
To our knowledge, Blue Light Hub is the first app of its kind designed to educate primary school-aged children about emergency services. Our findings provide preliminary evidence that the app supports children's knowledge and awareness of emergency services.
Topics: Humans; Child; Female; Male; Mobile Applications; Wales; Emergency Medical Services; Health Knowledge, Attitudes, Practice; Health Education; Ambulances; Blue Light
PubMed: 38858135
DOI: 10.1136/bmjopen-2023-079214 -
BMC Emergency Medicine Jun 2024An injury is described as any damage to the body that impairs health, and its severity can span from mild to life-threatening. On a global scale, injuries account for... (Observational Study)
Observational Study
INTRODUCTION
An injury is described as any damage to the body that impairs health, and its severity can span from mild to life-threatening. On a global scale, injuries account for approximately 4.4 million deaths annually and are anticipated to become the seventh leading cause of death by 2030. In Ethiopia, injuries account for 7% of all deaths, with one of the world's highest rates of road traffic injuries. This study, undertaken at a primary trauma centre in the capital of Ethiopia, aimed to explore the characteristics of injured patients and emergency department mortality as the patient outcome. Understanding the patterns and outcomes of injuries helps to anticipate needs, prioritize patients, and allocate resources effectively.
METHODS
A retrospective single-center observational study utilised patient records from September 2020 to August 2021 at Addis Ababa Burn Emergency and Trauma Hospital, located in Ethiopia. A structured checklist facilitated the data collection. All patients arriving in the ED from September 2020 to August 2021 were eligible for the study while incomplete records (missing > 20% of wanted data elements) were excluded.
RESULT
Of the 3502 injured patients recorded during the study period, 317 were selected. The mean patient age was 30 years, with 78.5% being male. About 8% arrived the emergency department within an hour after the injury. Ambulances transported 38.8% of patients; 58.5% of these were referred from other facilities. The predominant mechanism of injury both in and outside Addis Ababa was pedestrian road traffic injuries (31.4% and 38%). The predominant injury type was fractures (33.8%). The mortality rate was 5%, of which half were pedestrian road traffic incidents.
CONCLUSION
Pedestrian road traffic injuries were the main cause of injury in and outside of Addis Ababa. A small proportion of patients arrived at the emergency department within the first hour after an injury event. A significant proportion of ambulance-transported patients were referred from other facilities rather than directly from the scene. The overall mortality rate was high, with pedestrian road traffic injury accounting for half of the proportion.
Topics: Humans; Ethiopia; Male; Female; Retrospective Studies; Adult; Emergency Service, Hospital; Middle Aged; Wounds and Injuries; Adolescent; Child; Accidents, Traffic; Young Adult; Hospital Mortality; Child, Preschool; Aged
PubMed: 38849745
DOI: 10.1186/s12873-024-01017-7 -
Frontiers in Veterinary Science 2024This case report describes a 17-month-old Pudelpointer with recurring motor impairment localized to the left thoracic limb. A neurological exam highlighted lameness in...
This case report describes a 17-month-old Pudelpointer with recurring motor impairment localized to the left thoracic limb. A neurological exam highlighted lameness in that limb, accompanied by pre-scapular swelling. Radiographs and magnetic resonance imaging detected an osseous structure in soft tissues close to the fifth cervical vertebra, and subsequent surgery uncovered adjacent cervical spinal nerve impingement. Histology of the bony structure revealed heterotopic ossification in paravertebral muscles. Mild bone re-formation at the operating site was detected after a 2-year period, but the patient was asymptomatic. This article reports the first case of heterotopic ossification with spinal nerve entrapment in a dog and adds a new differential diagnosis to the causes of neurogenic lameness in dogs.
PubMed: 38846781
DOI: 10.3389/fvets.2024.1335175 -
Medecine Tropicale Et Sante... Mar 2024To observe the evolution in malaria case-fatality rate among children under 5 years of age receiving care at the Bittou district hospital (CMA) after an improvement of...
OBJECTIVE
To observe the evolution in malaria case-fatality rate among children under 5 years of age receiving care at the Bittou district hospital (CMA) after an improvement of the care practices. The management team implemented an emergency plan in 2016 with 5 components: i) health facilities staff sensitization to enable rapid referral of severe malaria cases to CMA; ii) reorganization of CMA paediatric emergencies to make a physician as the mainpoint of contact; iii) ensuring availability of supplies for severe malaria case management, including the availability of blood; iv) daily medical check-ups of hospitalized patients; v) reinforcement of clinical staff skills at all peripheral health facilities. At the same time were introduced i) free care for children under 5 years; ii) municipality involvement to finance ambulance fuel for the referrals of patients; iii) free blood collection in professional schools and soldiers; iv) a free telephone line between the health structures; v) presence of 5 medical doctors at the CMA.
MATERIAL AND METHODS
Analysis of data collected from the statistical yearbooks of the Ministry of Health of Burkina Faso from 2014 to 2021.
RESULTS
The malaria case-fatality rate (CFR) in under-five in the Bittou health district (1.39% and 1.52% in 2014 and 2015) was higher than the average for all districts in this region (1.08%). After implementation of the emergency plan, the malaria CFR in Bittou declined to 0% in 2016 and 2017, 0.2% in 2018, 0% in 2019, 0.07% in 2020 and 0.05% in 2021. The same trend was observed at the CMA level with 2.94% and 2.59% in 2014 and 2015, 0% in 2016 and 2017, 0.38% in 2018, 0% in 2019, then 0.17% and 0.47% in 2020 and 2021.
CONCLUSION
Malaria control remains a challenge in Burkina Faso. However, the improved malaria CFRs observed in Bittou show that effective involvement of health district teams could potentially contribute to substantial reductions in malaria case-fatality risk.
Topics: Humans; Burkina Faso; Malaria; Case Management; Child, Preschool; Infant; Emergency Medical Services; Quality Improvement
PubMed: 38846124
DOI: 10.48327/mtsi.v4i1.2024.495 -
Medical Education Online Dec 2024Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed...
The 2024 French guidelines for scenario design in simulation-based education: manikin-based immersive simulation, simulated participant-based immersive simulation and procedural simulation.
BACKGROUND
Simulation-based education in healthcare encompasses a wide array of modalities aimed at providing realistic clinical experiences supported by meticulously designed scenarios. The French-speaking Society for Simulation in Healthcare (SoFraSimS) has developed guidelines to assist educators in the design of scenarios for manikin- or simulated participant- based immersive simulation and procedural simulation, the three mainly used modalities.
METHODS
After establishing a French-speaking group of experts within the SoFraSimS network, we performed an extensive literature review with theory-informed practices and personal experiences. We used this approach identify the essential criteria for practice-based scenario design within the three simulation modalities.
RESULTS
We present three comprehensive templates for creating innovative scenarios and simulation sessions, each tailored to the specific characteristics of a simulation modality. The SoFraSimS templates include five sections distributed between the three modalities. The first section contextualizes the scenario by describing the practicalities of the setting, the instructors and learners, and its connection to the educational program. The second section outlines the learning objectives. The third lists all the elements necessary during the preparation phase, describing the educational method used for procedural simulation (such as demonstration, discovery, mastery learning, and deliberate practice). The fourth section addresses the simulation phase, detailing the behaviors the instructor aims to analyze, the embedded triggers, and the anticipated impact on simulation proceedings (natural feedback). This ensures maximum control over the learning experience. Finally, the fifth section compiles elements for post-simulation modifications to enhance future iterations.
CONCLUSION
We trust that these guidelines will prove valuable to educators seeking to implement simulation-based education and contribute to the standardization of scenarios for healthcare students and professionals. This standardization aims to facilitate communication, comparison of practices and collaboration across different learning and healthcare institutions.
Topics: Manikins; Humans; Simulation Training; France; Clinical Competence; Guidelines as Topic; Education, Medical
PubMed: 38845343
DOI: 10.1080/10872981.2024.2363006 -
Environmental Research Jun 2024As climate change increases the frequency and intensity of extreme heat events, there is an urgent need to quantify the heat-related health burden. However, most past...
BACKGROUND
As climate change increases the frequency and intensity of extreme heat events, there is an urgent need to quantify the heat-related health burden. However, most past studies have focussed on a single health outcome (mainly mortality) or on specific heatwaves, thus providing limited knowledge of the total pressure heat exerts on health services.
OBJECTIVES
This study aims to quantify the heat-related mortality and morbidity burden for five different health outcomes including all-cause mortality, hospitalizations, emergency department (ED) visits, ambulance transports and calls to a health hotline, using the province of Quebec (Canada) as a case study.
METHODS
A two-step statistical analysis was employed to estimate regional heat-health relationships using Distributed Lag Non-Linear Models (DLNM) and pooled estimates using a multivariate meta-regression. Heat burden was quantified by attributable fraction (AF) and attributable number (AN) for two temperature ranges: all heat (above the minimum mortality/morbidity temperature) and extreme heat (above the 95th percentile of temperature).
RESULTS
Higher temperatures were associated with greater risk ratios for all health outcomes studied, but at different levels. Significant AF ranging from 2 to 3% for the all heat effect and 0.4-1.0% for extreme heat were found for all health outcomes, except for hospitalizations that had an AF of 0.1% for both heat exposures. The estimated burden of all heat (and extreme heat) every summer across the province was 470 (200) deaths, 225 (170) hospitalizations, 36 000 (6 200) ED visits, 7 200 (1 500) ambulance transports and 15 000 (3 300) calls to a health hotline, all figures significant.
DISCUSSION
This new knowledge on the total heat load will help public health authorities to target appropriate actions to reduce its burden now and in the future. The proposed state-of-the-art framework can easily be applied to other regions also experiencing the adverse effects of extreme heat.
PubMed: 38844034
DOI: 10.1016/j.envres.2024.119347 -
Scandinavian Journal of Trauma,... Jun 2024Pediatric trauma patients constitute a significant portion of the trauma population treated by Swedish Emergency Medical Services (EMS), and trauma remains a notable... (Observational Study)
Observational Study
BACKGROUND
Pediatric trauma patients constitute a significant portion of the trauma population treated by Swedish Emergency Medical Services (EMS), and trauma remains a notable cause of death among Swedish children. Previous research has identified potential challenges in prehospital assessments and interventions for pediatric patients. In Sweden, there is limited information available regarding pediatric trauma patients in the EMS. The aim of this study was to investigate the prevalence of pediatric trauma patients within the Swedish EMS and describe the prehospital assessments, interventions, and clinical outcomes.
METHODS
This retrospective observational study was conducted in a region of Southwestern Sweden. A random sample from ambulance and hospital records from the year 2019 was selected. Inclusion criteria were children aged 0-16 years who were involved in trauma and assessed by EMS clinicians.
RESULTS
A total of 440 children were included in the study, representing 8.4% of the overall trauma cases. The median age was 9 years (IQR 3-12), and 60.5% were male. The leading causes of injury were low (34.8%) and high energy falls (21%), followed by traffic accidents. The children were assessed as severely injured in 4.5% of cases. A quarter of the children remained at the scene after assessment. Complete vital signs were assessed in 29.3% of children, and 81.8% of children were assessed according to the ABCDE structure. The most common intervention performed by prehospital professionals was the administration of medication. The mortality rate was 0.2%.
CONCLUSIONS
Pediatric trauma cases accounted for 8.4% of the overall trauma population with a variations in injury mechanisms and types. Vital sign assessments were incomplete for a significant proportion of children. The adherence to the ABCDE structure, however, was higher. The children remained at the scene after assessment requires further investigation for patient safety.
Topics: Humans; Sweden; Retrospective Studies; Child; Male; Female; Ambulances; Child, Preschool; Wounds and Injuries; Emergency Medical Services; Adolescent; Infant; Infant, Newborn
PubMed: 38840226
DOI: 10.1186/s13049-024-01222-0