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Circulation Aug 2013Casinos are often exempted from legislation mandating smoke-free environments, potentially putting employees and patrons at risk for adverse events triggered by... (Comparative Study)
Comparative Study
BACKGROUND
Casinos are often exempted from legislation mandating smoke-free environments, potentially putting employees and patrons at risk for adverse events triggered by secondhand smoke exposure.
METHODS AND RESULTS
We used an interrupted time series analysis of ambulance calls not originating and originating from casinos in Gilpin County, Colorado, a rural Colorado county with a large casino presence, from January 2000 through December 2012 to determine whether there was a change in ambulance calls originating from casinos when a state smoke-free law was extended to include them. Initial implementation of the smoke-free law (which exempted casinos) was followed by a significant 22.8% drop in ambulance calls (incidence rate ratio, 0.772; 95% confidence interval, 0.685-0.871; P<0.001) from locations other than casinos but no significant change in calls from casinos (P>0.9). The law requiring smoke-free casinos taking effect was followed by a 19.1% (incidence rate ratio, 0.809; 95% confidence interval, 0.724-0.905; P<0.001) drop in ambulance calls from casinos but no change in calls originating outside casinos (P>0.1).
CONCLUSIONS
The observation that ambulance calls not coming from casinos dropped when the smoke-free law was initially implemented (excluding casinos) with no change in calls from casinos, followed by a comparable drop in calls originating from casinos (but not calls from elsewhere) when the law was extended to casinos, suggests that the important effects of secondhand smoke exposure occur acutely. These results also suggest that exempting casinos from smoke-free laws means that more people will suffer medical emergencies.
Topics: Ambulances; Cardiovascular Diseases; Colorado; Gambling; Humans; Retrospective Studies; Risk Factors; Smoke-Free Policy; Tobacco Smoke Pollution; Workplace
PubMed: 23918257
DOI: 10.1161/CIRCULATIONAHA.113.003455 -
Nursing Ethics Sep 2023Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness,... (Review)
Review
BACKGROUND
Even though the traditional focus in emergency care is on life-threatening medical crisis, ambulance clinicians frequently encounter patients with mental illness, including suicidal ideation. A suicide is preceded by a complex process where most of the suicidal ideation is invisible to others. However, as most patients seek healthcare in the year before suicide, ambulance clinicians could have an important part to play in preventing suicide, as they encounter patients in different phases of the suicidal process.
AIM
The aim of this study was to describe ambulance clinicians' conceptions of responsibility when encountering patients in a suicidal process.
RESEARCH DESIGN
A qualitative inductive design using a phenomenographic approach was used.
PARTICIPANTS AND RESEARCH CONTEXT
Twenty-seven ambulance clinicians from two regions in southern Sweden were interviewed.
ETHICAL CONSIDERATIONS
The study was approved by the Swedish Ethical Review Authority.
FINDINGS
Three categories of descriptions captured a movement from responding to a biological being to responding to a social being. Conventional responsibility was perceived as a primary responsibility for emergency care. In conditional responsibility, the patient's mental illness was given only limited importance and only if certain conditions were met. Ethical responsibility was perceived to have its primary focus on the encounter with the patient and listening to the patient's life story.
CONCLUSIONS
An ethical responsibility is favourable regarding suicide prevention in ambulance care, and competence development in mental illness and conversation skills could enable ambulance clinicians to have conversations with patients about suicidal ideation.
Topics: Humans; Ambulances; Suicidal Ideation; Emergency Medical Services; Suicide; Mental Disorders
PubMed: 37026403
DOI: 10.1177/09697330221149102 -
PloS One 2022Despite emergency ambulance services playing a pivotal role in accessibility to life-saving treatments in Malaysia, there are still numerous gaps in knowledge in terms...
BACKGROUND
Despite emergency ambulance services playing a pivotal role in accessibility to life-saving treatments in Malaysia, there are still numerous gaps in knowledge in terms of their utilization and cost. This leads to current policies on procurement, maintenance, and allocation being predicated on historical evidence and expert opinions. This study thus aims to analyse the cost and utilization of ambulance services in selected public health facilities in Malaysia.
METHODS
A cross-sectional study was employed involving 239 ambulances from selected hospitals and clinics. Ambulance service utilization was based on the number of trips, distance and duration of travel obtained from travel logbooks. A mixed top-down and activity-based costing approach was used to estimate the monthly cost of ambulance services. This constituted personnel, maintenance, fuel, overhead, consumables, ambulance, and medical equipment costs. The utilization and costs of ambulance services were further compared between settings and geographical locations.
RESULTS
The average total cost of ambulance services was MYR 11,410.44 (US$ 2,756.14) for hospitals and MYR 9,574.39 (US$ 2,312.65) for clinics, albeit not significantly different. Personnel cost was found to be the main contributor to the total cost, at around 44% and 42% in hospitals and clinics, respectively. There was however a significant difference in the total cost in terms of the type and age of ambulances, in addition to their location. In terms of service utilization, the median number of trips and duration of ambulance usage was significantly higher in clinics (31.88 trips and 58.58 hours) compared to hospitals (16.25 trips and 39.25 hours).
CONCLUSIONS
The total cost of ambulance services was higher in hospitals compared to clinics, while its utilization showed a converse trend. The current findings evidence that despite the ambulance services being all under the MOH, their operating process and utilization reflected an inherent difference by setting.
Topics: Ambulances; Cross-Sectional Studies; Malaysia; Health Facilities; Emergency Medical Services
PubMed: 36331901
DOI: 10.1371/journal.pone.0276632 -
BMC Emergency Medicine May 2024In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially,...
BACKGROUND
In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City.
METHOD
A cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05.
RESULTS
Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7).
CONCLUSION
Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.
Topics: Humans; Ethiopia; Ambulances; Cross-Sectional Studies; Male; Female; Adult; Middle Aged; Emergency Medical Services; Adolescent; Surveys and Questionnaires; Young Adult; Emergency Service, Hospital; Aged
PubMed: 38735937
DOI: 10.1186/s12873-024-00999-8 -
Laeknabladid
Topics: Air Ambulances; Delivery of Health Care; Humans; Iceland
PubMed: 28497763
DOI: 10.17992/lbl.2017.01.113 -
Scandinavian Journal of Trauma,... Jul 2017This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed... (Review)
Review
BACKGROUND
This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process.
METHODS
We systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction.
RESULTS
We included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%-93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h-48 h after non-conveyance, 2.5%-6.1% of the patients have EMS representations, and 4.6-19.0% present themselves at the ED. Mortality rates vary from 0.2%-3.5% after 24 h, up to 0.3%-6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card).
CONCLUSIONS
Non-conveyance rates for general and specific patient populations vary. Patients in the non-conveyance population present themselves with a variety of initial complaints and conditions, common initial complaints or conditions are related to trauma and neurology. After non-conveyance, a proportion of patients re-enters the emergency healthcare system within 2 days. For ambulance professionals the non-conveyance decision-making process is complex and multifactorial. Competencies needed to perform non-conveyance are marginally described, and there is a limited amount of supportive tools is available for general and specific non-conveyance populations. This may compromise patient-safety.
Topics: Air Ambulances; Clinical Decision-Making; Humans; Patient Safety; Patient Selection
PubMed: 28716132
DOI: 10.1186/s13049-017-0409-6 -
Italian Journal of Pediatrics Aug 2019This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European...
OBJECTIVES
This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European Community rules specify requirements for the design, testing, performance, and equipping of road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport.
METHODS
The project consisted of electric and gas supply planning, interior design taking into account ergonomic and occupant protection principles, both during travel and during medical care performances.
RESULTS
A detailed project is presented. Main differences between European Type C ambulance and the new proposed Type D neonatal ground ambulance are the presence on board of air compressed cylinder, iNO cylinders and delivery system, phototheraphy, shock adsorbing stretcher support, cooling device, patient's placenta (refrigeration box), and transcutaneous gas analyzer.
CONCLUSION
The European Community rules specify requirements for road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. This study describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service. This study demonstrated that it is not possible simply to adapt the currently dedicated ambulance for mobile intensive care and resuscitation services (actual type C European Community) in a modern dedicated NETS ambulance; it is of paramount importance suggesting to European Community to introduce a further ambulance type, to be identified type D, strictly reserved to neonatal transport activities.
Topics: Ambulances; Equipment Design; Europe; Humans; Infant, Newborn; Italy
PubMed: 31391074
DOI: 10.1186/s13052-019-0686-y -
BMC Health Services Research Nov 2023Providing health care in a moving vehicle requires different considerations regarding safety than in other settings. Use of seatbelts are mandatory, and during ambulance...
BACKGROUND
Providing health care in a moving vehicle requires different considerations regarding safety than in other settings. Use of seatbelts are mandatory, and during ambulance transport patients are fastened to the stretcher with safety straps. However, patients who wriggle out of, or unfasten, their safety straps pose a threat to him/herself and escorting personnel in the ambulance compartment in case of an accident. To prevent harm, ambulance personnel sometimes restrain the patient or unfasten their own seatbelts to keep the patient safe on the stretcher. The prevalence of coercive measures, and the relationship between the use of mechanical restraints comparable to coercion and seatbelt use, are scarcely investigated. Use of coercion normally requires a specific statutory basis. However, coercive measures needed to ensure safety in a moving vehicle while providing healthcare is hardly discussed in the literature. The aim of this study is to explore the use of coercion in ambulance services, the use of safety belts among escorts in situations where they need to keep the patient calm during transportation, and to analyse the relationship between safety belt non-compliance and coercion in these situations.
METHODS
This is a retrospective, cross-sectional study using a self-administered, online survey aiming to investigate the use of coercion and use of seatbelts during ambulance transport. Approximately 3,400 ambulance personnel from all 18 Health Trusts in Norway were invited to participate between Oct 2021 and Nov 2022. Descriptive analyses were used to describe the sample and the prevalence of findings, while multiple linear regressions were used to investigate associations.
RESULTS
Altogether, 681 (20%) ambulance personnel completed the survey where 488 (72.4%) stated that they had used coercion during the last six months and 375 (55.7%) had experienced ambulance personnel or escorting personnel working with unfastened seatbelts during transport. The majority of respondents experienced coercion as being unpleasant and more negative feelings were associated with less use of seatbelts.
CONCLUSIONS
Coercion seems to be used by ambulance personnel frequently. For the study participants, keeping the patient securely fastened was prioritized above escorting personnel's traffic safety, despite feeling uncomfortable doing so. Because coercive measures have negative consequences for patients, is associated with negative feelings for health personnel, and is not discussed ethically and legally in relation to the prehospital context, there is an urgent need for more research on the topic, and for legal preparatory work to address the unique perspectives of the prehospital context in which traffic safety also is an important factor.
Topics: Humans; Male; Ambulances; Coercion; Cross-Sectional Studies; Retrospective Studies; Norway
PubMed: 38012723
DOI: 10.1186/s12913-023-10332-x -
International Journal of Environmental... Jul 2022This paper describes how the profession of paramedics has evolved in Switzerland and takes the perspective of public health. Ambulance drivers play an important role in...
This paper describes how the profession of paramedics has evolved in Switzerland and takes the perspective of public health. Ambulance drivers play an important role in the health system, not only as a response to emergencies, but also by working in an interprofessional and interdisciplinary manner in response to other public health needs, such as home care, triage, telemedicine and interhospital transfers. This pre-hospital system is rapidly evolving and relies on the work of paramedics.
Topics: Allied Health Personnel; Ambulances; Emergency Medical Services; Humans; Switzerland; Triage
PubMed: 35886281
DOI: 10.3390/ijerph19148429 -
Public Health Reports (Washington, D.C.... 2021Studies describing linkage of ambulance trips and emergency department (ED) visits of patients with opioid-related overdose (ORO) are limited. We linked records of...
OBJECTIVES
Studies describing linkage of ambulance trips and emergency department (ED) visits of patients with opioid-related overdose (ORO) are limited. We linked records of patients experiencing ORO from ambulance trip and ED visit records in Massachusetts during April 1-June 30, 2017.
METHODS
We estimated the positive predictive value of ORO-capturing definitions by examining the narratives and triage notes of a sample of OROs from each data source. Because of a lack of common unique identifiers, we deterministically linked OROs to records in the counter data set on date of birth, incident date, facility, and sex. To validate the linkage strategy, we compared ambulance trip narratives with ED triage notes and chief complaints for a sample of pairs.
RESULTS
Of 3203 ambulance trips for ORO and 3046 ED visits for ORO, 82% and 63%, respectively, matched a record in the counter data set on date of birth, incident date, facility, and sex. In 200 randomly selected linked pairs from a final linked data set of 3006 paired records, only 5 (3%) appeared to be false matches.
PRACTICE IMPLICATIONS
This exercise demonstrated the feasibility of linking ORO records between 2 data sets without a unique identifier. Future analyses of the linked data could produce insights not available from analyzing either data set alone. Linkage using 2 rapidly available data sets can actively inform the state's public health opioid overdose response and allow for de-duplicating counts of OROs treated by ambulance, in an ED, or both.
Topics: Ambulances; Emergency Service, Hospital; Humans; Massachusetts; Opiate Overdose; Population Surveillance
PubMed: 34726977
DOI: 10.1177/00333549211011626