-
BMC Medical Education Oct 2022Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides...
CONTEXT
Medical Student First Responders (MSFRs) are volunteers who respond to emergency calls, managing patients before ambulance staff attend. The MSFR role provides opportunities to manage acutely unwell patients in the prehospital environment, not usually offered as part of formal undergraduate medical education. There are few previous studies describing activities or experiences of MSFRs or exploring the potential educational benefits. We aimed to investigate the activity of MSFRs and explore their experiences, particularly from an educational perspective.
METHODS
We used a mixed methods design, combining quantitative analysis of ambulance dispatch data with qualitative semi-structured interviews of MSFRs. Dispatch data were from South Central and East Midlands Ambulance Service NHS Trusts from 1st January to 31st December 2019. Using propensity score matching, we compared incidents attended by MSFRs with those attended by other Community First Responders (CFRs) and ambulance staff. We interviewed MSFRs from five English (UK) medical schools in those regions about their experiences and perceptions and undertook thematic analysis supported by NVivo 12.
RESULTS
We included 1,939 patients (median age 58.0 years, 51% female) attended by MSFRs. Incidents attended were more urgent category calls (category 1 n = 299, 14.9% and category 2 n = 1,504, 77.6%), most commonly for chest pain (n = 275, 14.2%) and shortness of breath (n = 273, 14.1%). MSFRs were less likely to attend patients of white ethnicity compared to CFRs and ambulance staff, and more likely to attend incidents in areas of higher socioeconomic deprivation (IMD - index of multiple deprivation) (p < 0.05). Interviewees (n = 16) consistently described positive experiences which improved their clinical and communication skills.
CONCLUSION
MSFRs' attendance at serious medical emergencies provide a range of reported educational experiences and benefits. Further studies are needed to explore whether MSFR work confers demonstrable improvements in educational or clinical performance.
Topics: Ambulances; Emergency Responders; Female; Humans; Male; Middle Aged; Students, Medical
PubMed: 36242030
DOI: 10.1186/s12909-022-03791-z -
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 -
Journal of Ayub Medical College,... 2021To improve morbidity and mortality outcomes in mass casualty victims it is pertinent that a system of prehospital triage be implemented. The objectives of this study are...
BACKGROUND
To improve morbidity and mortality outcomes in mass casualty victims it is pertinent that a system of prehospital triage be implemented. The objectives of this study are to determine the knowledge, attitude and practices of emergency care transporters and ambulance personnel towards onsite triage, pre-hospital management and transportation to hospital of critically injured and wounded patients in mass casualty incidents and other emergencies in Karachi, Pakistan.
METHODS
All ambulance personnel and emergency care transporters who transported patients to the hospital were included in the study. Pre-tested questionnaire was selfadministered after obtaining written consent.
RESULTS
Among 250 emergency care transporters (ambulance personnel), mostly belonged to age group 21-25 years 73 (29.2%). Most of emergency transport provider teams were composed of only 1 person who was the driver of ambulance 22 (80%) and only 44 (17.6%) had the facility of paramedics. Regarding lifesaving equipment facilities in ambulance, 188 (75.2%) ambulances did not have these and only 62 (24.8%) were equipped. Predominantly, the ambulance personnel performed the 'scoop and run' practice and the ambulance works as a transport vehicle 188(75.2%), while facilities of basic life support were available in only 45 (18%) and advance life support facility in 17 (6.8%). Among all 203 (81.2%) did not think they are able to decide who is severely injured and 183(73.2%) believe they are unable to do triage in mass causalities.
CONCLUSION
Our study showed significant gaps in the knowledge of the emergency care providers regarding triage of patients especially in mass casualty incidents. Though the response time and time to the hospital center is comparable, no prehospital lifesaving interventions are attempted en-route. A coordinated effort by the ambulance services, hospitals and the government are detrimental for a swift functioning of a trauma system.
Topics: Adult; Ambulances; Emergency Medical Services; Hospitals; Humans; Mass Casualty Incidents; Triage; Young Adult
PubMed: 35077629
DOI: No ID Found -
Scandinavian Journal of Trauma,... Jan 2021The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who... (Review)
Review
BACKGROUND
The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known.
METHODS
This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent "intermediate" patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages.
RESULTS
Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood.
CONCLUSIONS
This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.
Topics: Ambulances; Emergency Medical Services; Emergency Service, Hospital; Humans; Referral and Consultation
PubMed: 33407771
DOI: 10.1186/s13049-020-00821-x -
Scandinavian Journal of Trauma,... Jun 2017Community First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK.... (Review)
Review
BACKGROUND
Community First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK. There has been no previous review of UK literature on these schemes. This is the first systematic scoping review of UK literature on CFR schemes, which identifies the reasons for becoming a CFR, requirements for training and feedback and confusion between the CFR role and that of ambulance service staff. This study also reveals gaps in the evidence base for CFR schemes.
METHODS
We conducted a systematic scoping review of the published literature, in the English language from 2000 onwards using specific search terms in six databases. Narrative synthesis was used to analyse article content.
RESULTS
Nine articles remained from the initial search of 15,969 articles after removing duplicates, title and abstract and then full text review. People were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. There were concerns about the possible emotional impact on CFRs responding to incidents. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low, patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles. There was support for local autonomy of CFR schemes but with greater sharing of best practice.
DISCUSSION
Most studies dated from 2005 and were descriptive rather than analytical. In the UK and Australia CFRs are usually lay volunteers equipped with basic skills for responding to medical emergencies, whereas in the US they include other emergency staff as well as lay people.
CONCLUSION
Opportunities for future research include exploring experiences and perceptions of patients who have been treated by CFRs and other stakeholders, while also evaluating the effectiveness and costs of CFR schemes.
Topics: Ambulances; Australia; Community Health Services; Community Health Workers; Emergency Responders; Emotions; Humans; Motivation; United Kingdom
PubMed: 28629382
DOI: 10.1186/s13049-017-0403-z -
Journal of Medical Ethics Oct 2021Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and...
Here we present the personal perspectives of two authors on the important and unfortunately frequent scenario of ambulance clinicians facing a deceased individual and family members who do not wish them to attempt cardiopulmonary resuscitation. We examine the professional guidance and the protection provided to clinicians, which is not matched by guidance to protect family members. We look at the legal framework in which these scenarios are taking place, and the ethical issues which are presented. We consider the interaction between ethics, clinical practice and the law, and offer suggested changes to policy and guidance which we believe will protect ambulance clinicians, relatives and the patient.
Topics: Ambulances; Cardiopulmonary Resuscitation; Consensus; Family; Humans; Morals
PubMed: 33060185
DOI: 10.1136/medethics-2020-106490 -
Tidsskrift For Den Norske Laegeforening... Mar 2001
Topics: Ambulances; Emergency Medical Services; Humans; Norway
PubMed: 11332373
DOI: No ID Found -
A Psychological Resilience Briefing Intervention for Helicopter Emergency Medical Service Observers.Air Medical Journal 2022Helicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This...
OBJECTIVE
Helicopter emergency medical services (HEMS) observers may be at risk of negative psychological effects associated with exposure to traumatic events during shifts. This article describes a quality improvement project for HEMS observers at Essex & Herts Air Ambulance.
METHODS
A psychological resilience briefing intervention (PRBi) was developed and delivered during induction training with 60 HEMS observers. The PRBi aimed to raise awareness of traumatic events that observers may experience and provided basic education on 5 domains, including likely forms of trauma exposure, possible psychological reactions, advice on coping strategies and supporting colleagues, and resources that they could use if required. The intervention was intended to bolster resilience and reduce posttraumatic stress disorder symptoms, and to encourage adaptive coping styles in observers.
RESULTS
Observers learned from and valued the PRBi; statistically significant increases were observed in awareness of the 5 domains from pre- to post-delivery, and free-text responses cited a variety of benefits to the observers. There was no indication that the PRBi caused harm.
CONCLUSION
The PRBi has now been included in the routine induction of observers at Essex & Herts Air Ambulance and has the potential to be repurposed for use in other settings, including medical schools.
Topics: Humans; Resilience, Psychological; Air Ambulances; Emergency Medical Services; Aircraft; Retrospective Studies
PubMed: 36494171
DOI: 10.1016/j.amj.2022.07.010 -
Sensors (Basel, Switzerland) Apr 2021Acute Coronary Syndrome (ACS) and other heart emergency events require immediate chest pain identification in the ambulance. Specifically, early identification and...
Acute Coronary Syndrome (ACS) and other heart emergency events require immediate chest pain identification in the ambulance. Specifically, early identification and triage is required so that patients with chest pain can be quickly sent to a hospital with appropriate care facilities for treatment. In the traditional approach, ambulance personnel often use symptom checklists to examine the patient and make a quick decision for the target hospital. However, not every hospital has specialist facilities to handle such emergency cases. If the result of the subsequent cardiac enzyme test performed at the target hospital strongly suggests the occurrence of myocardial infarction, the patient may need to be sent to another hospital with specialist facilities, such as Percutaneous Coronary Intervention. The standard procedure is time consuming, which may result in delayed treatment and reduce patent survival rate. To resolve this issue, we propose AMBtalk (Ambulance Talk) for accurate, early ACS identification in an ambulance. AMBtalk provides real-time connection to hospital resources, which reduces the elapsed time for treatment, and therefore, improves the patient survival rate. The key to success for AMBtalk is the development of the AllCheck Internet of Things (IoT) device, which can accurately and quickly provide cardiovascular parameter values for early ACS identification. The interactions between the AllCheck IoT device, the emergency medical service center, the ambulance personnel and the hospital are achieved through the AMBtalk IoT server in the cloud network. AllCheck outperforms the existing cardiovascular IoT device solutions for ambulance applications. The testing results of the AllCheck device show 99% correlation with the results of the hospital reports. Due to its excellent performance in quick ACS identification, the AllCheck device was awarded the 17th Taiwan Innovators Award in 2020.
Topics: Ambulances; Chest Pain; Emergency Medical Services; Humans; Internet of Things; Taiwan
PubMed: 33920835
DOI: 10.3390/s21082781 -
Health Expectations : An International... Feb 2018Patient and public involvement (PPI) is recognized as an important component of high-quality health services research. PPI is integral to the Pre-hospital Outcomes for...
BACKGROUND
Patient and public involvement (PPI) is recognized as an important component of high-quality health services research. PPI is integral to the Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. The PPI event described in detail in this article focusses on the process of involving patients and public representatives in identifying, prioritizing and refining a set of outcome measures that can be used to support ambulance service performance measurement.
OBJECTIVE
To obtain public feedback on little known, complex aspects of ambulance service performance measurement.
DESIGN
The event was codesigned and coproduced with the PhOEBE PPI reference group and PhOEBE research team. The event consisted of brief researcher-led presentations, group discussions facilitated by the PPI reference group members and electronic voting.
SETTING AND PARTICIPANTS
Data were collected from eighteen patient and public representatives who attended an event venue in Yorkshire.
RESULTS
The results of the PPI event showed that this interactive format and mode of delivery was an effective method to obtain public feedback and produced a clear indication of which ambulance performance measures were most highly favoured by event participants.
DISCUSSION AND CONCLUSIONS
The event highlighted valuable contributions the PPI reference group made to the design process, supporting participant recruitment and facilitation of group discussions. In addition, the positive team working experience of the event proved a catalyst for further improvements in PPI within the PhOEBE project.
Topics: Ambulances; Community Participation; Emergency Medical Services; Health Services Research; Humans; Patient Participation; Qualitative Research; Quality Indicators, Health Care; United Kingdom
PubMed: 28841272
DOI: 10.1111/hex.12606