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International Journal of Environmental... Mar 2021This study examines the statewide service coverage of emergency medical services (EMS) in view of public health planners, policy makers, and ambulance service managers....
This study examines the statewide service coverage of emergency medical services (EMS) in view of public health planners, policy makers, and ambulance service managers. The study investigates the statewide service coverage in a mixed region of urban, rural, and frontier regions to address the importance of ambulance service coverage at a large scale. The study incorporated statewide road networks for ambulance travel time, census blocks for population, and backup service coverage using geographic information systems (GIS). The catchment areas were delineated by the travel time after subtracting chute time for each Census Block as an analysis zone. Using the catchment areas from the ambulance base to the centroid of Census Block, the population and land coverage were calculated. The service shortage and multiple coverage areas were identified by the catchment areas. The study found that both reducing chute time and increasing the speed of emergency vehicles at the same time was significantly more effective than improving only one of two factors. The study shows that the service is improved significantly in frontier and urban areas by increasing driving time and chute time. However, in rural areas, the improvement is marginal owing to wider distribution than urban areas and shorter threshold response time than frontier areas. The public health planners and EMS managers benefit from the study to identify underserved areas and redistribute limited public resources.
Topics: Ambulances; Emergency Medical Services; Geographic Information Systems; Humans; Rural Population; Travel
PubMed: 33807955
DOI: 10.3390/ijerph18052638 -
Scandinavian Journal of Trauma,... Apr 2024In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke... (Review)
Review
BACKGROUND
In Finland, the yearly number of mechanical thrombectomies for acute stroke is increasing and more patients are transported over 100 km to the comprehensive stroke centre (CSC) for definitive care. This leaves the rural townships without immediate emergency medical services (EMS) for hours. In this study we compare the EMS' estimated return times to own station after the handover of a thrombectomy candidate between two transport methods: (1) using ground transportation with an ambulance to the CSC or (2) using a hydrid strategy starting the transportation with an ambulance and continuing by air with a helicopter emergency medical services unit (HEMS).
METHODS
We reviewed retrospectively all thrombectomy candidates' transportations from the hospital district of South Ostrobothnia to definitive care at the nearest CSC, Tampere University Hospital from June 2020 to October 2022. The dispatch protocol stated that a thrombectomy candidate's transport begins immediately with an ambulance and if the local HEMS unit is available the patient is handed over to them at a rendezvous. If not, the patient is transported to the CSC by ground. Transport times and locations of the patient handovers were reviewed from the CSC's EMS database and the driving time back to ambulance station was estimated using Google maps. The HEMS unit's pilot's log was reviewed to assess their mission engagement time.
RESULTS
The median distance from the CSC to the ambulances' stations was 188 km (IQR 149-204 km) and from the rendezvous with the HEMS unit 70 km (IQR 51-91 km, p < 0.001). The estimated median driving time back to station after the patient handover at the CSC was 145 min (IQR 117-153 min) compared to the patient handover to the HEMS unit 53 min (IQR 38-68 min, p < 0.001). The HEMS unit was occupied in thrombectomy candidate's transport mission for a median of 136 min (IQR 127-148 min).
CONCLUSION
A hybrid strategy to transport thrombectomy candidates with an ambulance and a helicopter reallocates the EMS resources markedly faster back to their own district.
Topics: Humans; Air Ambulances; Retrospective Studies; Emergency Medical Services; Thrombectomy; Stroke; Hospitals, University
PubMed: 38627852
DOI: 10.1186/s13049-024-01203-3 -
American Journal of Public Health Apr 2019To identify individuals at risk for behavioral health (BH)-involved encounters with police in Chicago, Illinois.
OBJECTIVES
To identify individuals at risk for behavioral health (BH)-involved encounters with police in Chicago, Illinois.
METHODS
We linked Chicago Police Department (CPD) arrest and Fire Department (CFD) BH-involved ambulance event data. We identified at-risk individuals who accumulated at least 1 BH-involved ambulance and at least 1 arrest event between May 2016 and April 2017. We identified a high-use subgroup displaying most intensive services use. We identified high-use locations with highest volume of ambulance events with only CFD data.
RESULTS
Of 83 392 individuals and 116 105 events in the linked emergency events data, 1842 at-risk individuals accounted for 2.2% of individuals, 5.6% of all events, and 16% of BH-involved CFD events with police involvement. A total of 330 high-use individuals accounted for 0.4% of individuals, 2% of events, and 4.7% of CFD events with police involvement. Top-100 high-use locations accounted for 9% of CFD events, and individuals of high-use location events are largely distinct from high-use individuals.
CONCLUSIONS
Integrated police and ambulance data hold promise to identify individuals at risk for BH-involved encounters with police and to support proactive interventions to prevent or improve response at these encounters.
Topics: Adult; Ambulances; Chicago; Crisis Intervention; Emergency Medical Services; Female; Humans; Male; Mental Disorders; Police
PubMed: 30789767
DOI: 10.2105/AJPH.2018.304923 -
Ideggyogyaszati Szemle May 2018The therapeutic time window of acute stroke is short. Decision on the use of intravenous thrombolysis is based on well-defined criteria. Any delay in the transport to a...
BACKGROUND AND PURPOSE
The therapeutic time window of acute stroke is short. Decision on the use of intravenous thrombolysis is based on well-defined criteria. Any delay in the transport to a designated stroke centre decreases the odds of therapeutic success. In Hungary, the admission rate of stroke patients peaks on Monday, the number gradually decreasing by the end of the week. This phenomenon has long been suggested to be due to the lack of emergency care approach. According to the literature, however, returning to work following a holiday is a risk factor for acute stroke. A similar phenomenon is well-known in veterinary medicine, a condition in horses referred to as 'Monday morning disease'. In our study, we analysed the distribution of admissions due to acute stroke by the day of the week in 4 independent data sources.
METHODS
The number of patients admitted to the Szent János Hospital, Budapest, Hungary with stroke and that of emergency ambulance transports in the whole city of Budapest due to acute stroke were analysed in the period between January 1 and March 31, 2009. The distribution of thrombolytic interventions reflecting hospitalizations for hyperacute stroke was analysed based on data of the Szent János Hospital in 2009-2012, and on national data from 2006-2012. Descriptive statistics was used to present the data. The variation between daily admission was compared by chi-square test.
RESULTS
The proportion of daily admission of stroke patients admitted to the Szent János Hospital was the highest at the beginning of the week (18% on Monday, and 21% on Tuesday) and the lowest on the weekend (9% and 9% on Saturday and Sunday, respectively). The distribution of ambulance transports in Budapest due to acute stroke tended to be similar (15% and 15% on Monday and Tuesday, whereas 13% and 12% on Saturday and Sunday, respectively) on different days of the week. No such Monday peak could be observed in a single centre regarding thrombolytic interventions: 18% and 19% of the total of 80 thrombolytic interventions in the Szent János Hospital were performed on Monday and Sunday, respectively. At the national level the higher Monday rate is obvious: during a 7-year period 16.0%, 12.7%, and 13.5% of all thrombolytic interventions in Hungary were performed on Monday, Saturday and Sunday, respectively.
CONCLUSION
Monday preference of stroke is not exclusively caused by the lack of emergency care approach, and the phenomenon is not consistent at the individual hospital level in cases undergoing thrombolysis.
Topics: Ambulances; Humans; Hungary; Patient Admission; Periodicity; Stroke; Thrombolytic Therapy; Time Factors
PubMed: 29889458
DOI: 10.18071/isz.71.0161 -
Hong Kong Medical Journal = Xianggang... Aug 2018For acute ischaemic stroke patients, treatment with intravenous tissue plasminogen activator within a 4.5-hour therapeutic window is essential. We aimed to assess the...
INTRODUCTION
For acute ischaemic stroke patients, treatment with intravenous tissue plasminogen activator within a 4.5-hour therapeutic window is essential. We aimed to assess the time delays experienced by stroke patients arriving at the emergency department and to compare ambulance users and non-ambulance users.
METHODS
We performed a prospective cohort study in a tertiary hospital in Hong Kong. All acute stroke patients attending the emergency department from January to June 2017 were recruited. Patients who were in hospital at the time of stroke onset and those who transferred from other hospitals were excluded. Three phases were compared between ambulance users and non-ambulance users: phase I, between stroke onset and calling for help; phase II, between calling for help and arriving at the emergency department; and phase III, between arriving and receiving medical assessment.
RESULTS
Of 102 consecutive patients recruited, 48 (47%) patients arrived at the emergency department by ambulance. The percentage of stroke patients attending emergency department within the therapeutic window was significantly higher for ambulance users than for non-ambulance users (64.6% vs 29.6%; P<0.001). For phases I, II and III, the median times were significantly shorter for ambulance users (77.5, 32 and 8 min, respectively) than for non-ambulance users (720, 44.5 and 15 min, respectively; all P<0.001).
CONCLUSION
Transport of patients to the emergency department by ambulance is important for timely and effective stroke treatment.
Topics: Aged; Ambulances; Emergency Treatment; Female; Hong Kong; Humans; Male; Middle Aged; Prospective Studies; Stroke; Tertiary Care Centers; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator; Treatment Outcome
PubMed: 30065119
DOI: 10.12809/hkmj177025 -
Pre-hospital Care to Trauma Patients in Addis Ababa, Ethiopia: Hospital-based Cross-sectional Study.Ethiopian Journal of Health Sciences Sep 2021Trauma is a major cause of morbidity and mortality worldwide. Prompt use of pre-hospital care is associated with reduced early and late morbidity and mortality from...
BACKGROUND
Trauma is a major cause of morbidity and mortality worldwide. Prompt use of pre-hospital care is associated with reduced early and late morbidity and mortality from trauma. This study aimed to assess the time to reach the facility and the pattern of pre-hospital care provided for trauma patients.
METHODS
A cross-sectional study design with a structured interview questioner was used for patients presenting to Addis Ababa Burn Emergency and Trauma Hospital Emergency Department from April 1 to May 30, 2020.
RESULT
Out of 238 interviewed patients, the most common means of transportation from the scene to the initial health facility were taxi 77(32.4%) and ambulance 54(22.7%). The time of arrival from the scene to the initial health care facility was within one hour, 133(56.1%) and in 1-3 hours 84(35.5%). Some form of care was provided at the scene in 110(46.2%) of cases. The care provided was bleeding arrest 74(31.1 %), removing from wreck 51(21.4%), splinting/immobilizing injured area 38(16%), position for patient comfort 19(8%), and others. Relatives were the most common care provider 49(45%) followed by bystanders 37(33.9%), trained ambulance staff 19(17.4%), and police 2 (1.8%). The main reasons for not providing care were lack of knowledge 79(61.2%), and lack of equipment 25 (19.4%).
CONCLUSION
The study showed relatives and bystanders were the first responders during trauma care. However, ambulance utilization for pre-hospital care was low. There was trauma patients delay to arrive to hospital. Only half of the patients presented to the health facility within Golden hour.
Topics: Ambulances; Cross-Sectional Studies; Ethiopia; Hospitals; Humans; Police
PubMed: 35221619
DOI: 10.4314/ejhs.v31i5.14 -
Annals of Emergency Medicine Nov 2020
Topics: Air Ambulances; Emergencies; Humans; United States
PubMed: 34842164
DOI: 10.1016/j.annemergmed.2020.09.447 -
Palliative Medicine Oct 2018Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients...
BACKGROUND
Hospital admissions for end-of-life patients, particularly those who die shortly after being admitted, are recognised to be an international policy problem. How patients come to be transferred to hospital for care, and the central role of decisions made by ambulance staff in facilitating transfer, are under-explored.
AIM
To understand the role of ambulance staff in the admission to hospital of patients close to the end of life.
DESIGN
Qualitative interviews, using particular patient cases as a basis for discussion, analysed thematically.
PARTICIPANTS/SETTING
Ambulance staff ( n = 6) and other healthcare staff (total staff n = 30), involved in the transfer of patients (the case-patients) aged more than 65 years to a large English hospital who died within 3 days of admission with either cancer, chronic obstructive pulmonary disease or dementia.
RESULTS
Ambulance interviewees were broadly positive about enabling people to die at home, provided they could be sure that they would not benefit from treatment available in hospital. Barriers for non-conveyance included difficulties arranging care particularly out-of-hours, limited available patient information and service emphasis on emergency care.
CONCLUSION
Ambulance interviewees fulfilled an important role in the admission of end-of-life patients to hospital, frequently having to decide whether to leave a patient at home or to instigate transfer to hospital. Their difficulty in facilitating non-hospital care at the end of life challenges the negative view of near end-of-life hospital admissions as failures. Hospital provision was sought for dying patients in need of care which was inaccessible in the community.
Topics: Ambulances; Hospitalization; Humans; Interviews as Topic; Qualitative Research; Retrospective Studies; Terminal Care
PubMed: 29886792
DOI: 10.1177/0269216318779238 -
BMC Emergency Medicine Apr 2019The increasing burdens of trauma and time sensitive non-communicable disease in Addis Ababa necessitate a robust emergency medical care system. The objectives of this...
BACKGROUND
The increasing burdens of trauma and time sensitive non-communicable disease in Addis Ababa necessitate a robust emergency medical care system. The objectives of this study were to assess the proportion of patients who used emergency medical services (EMS) and to quantitatively and qualitatively assess barriers to EMS utilization in Addis Ababa.
METHODS
A cross-sectional quantitative and qualitative study was conducted on patients who visited five selected public hospitals in Addis Ababa with specific emergency conditions. Data were collected by trained nurses using a standardized questionnaire. Descriptive statistics and logistic regression was done on cleaned and coded quantitative data using SPSS version 20. Thematic analysis was performed on the qualitative data. Ethical approval was obtained prior to the study.
RESULTS
A total of 429 participants completed the survey with a non-response rate of 5.1%. The most common emergency scene was the home (n = 222, 51.8%) followed by road side (n = 159, 37.1%). Only 87(20.3%) patients arrived by ambulance, though a majority (53.4%) of participants recalled at least one access number for an ambulance service and 96.3% stated that ambulances were an important part of the continuum of care for their emergency condition. A higher proportion of participants believed that ambulance transportation is generally safer (n = 341, 78.5%) and faster (n = 298, 69.5%) than emergency transport by taxi or private car. Patients who were non-Amharic speaking had a negative association with arriving by ambulance (P = 0.001, OR 0.47; C.I, 0.31, 0.71). The median acceptable time to get the ambulance (according to respondent's perception) was 16 min but actually perceived ambulance waiting time was 40 min.
CONCLUSION
EMS utilization in Addis Ababa is relatively low and emergency patients are instead being transported by taxi or private car. Perceived longer ambulance waiting time and language barriers may have contributed for low utilization. Findings of this study suggest an action to improve access by improving ambulance availability while simultaneously enhancing the public's knowledge and perception of EMS in Addis Ababa.
Topics: Adult; Ambulances; Cross-Sectional Studies; Emergency Medical Services; Ethiopia; Female; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Hospitals, Public; Humans; Logistic Models; Male; Middle Aged; Surveys and Questionnaires; Transportation of Patients; Young Adult
PubMed: 30999840
DOI: 10.1186/s12873-019-0242-5 -
BMC Medical Education Mar 2022Compared to other road users, ambulance drivers are at a higher accident risk while driving with warning lights and sirens. No standard exists for training or education...
BACKGROUND
Compared to other road users, ambulance drivers are at a higher accident risk while driving with warning lights and sirens. No standard exists for training or education for emergency medical service employees driving ambulances. Training programs should positively influence knowledge. However, knowledge gain can be influenced by several different factors. This study developed a knowledge test for ambulance drivers to determine influencing factors on knowledge and its gain by simulator-based training.
METHODS
Two parallel knowledge test forms with 20 questions each were designed in several steps and tested on up to 174 participants. Questionnaires were used to study associated and influencing factors, such as objective experience, subjective attitudes, personality, motivation and demographic data.
RESULTS
Test construction showed good overall parallelism of the two tests as well as reliability and sensitivity. There was no correlation between subjective and objective knowledge gain, but participants with higher subjective knowledge gain showed a higher variation in objective knowledge. Younger age, higher qualification, higher number of license classes, fewer traffic violations, and more traffic safety trainings were positively associated with knowledge, whereas less yearly driving mileage, more traffic safety trainings, and higher risk sensitivity positively influenced knowledge gain through the training.
CONCLUSION
Knowledge and its gain through training are very low. Reasons for the lack of predictive power of some variables, such as motivation, personality and attitudes, are discussed. This study presents a new tool for testing knowledge on driving with warning lights and sirens. It shows the need for objective testing and for further research in this special area.
Topics: Accidents, Traffic; Ambulances; Automobile Driving; Humans; Licensure; Reproducibility of Results
PubMed: 35354466
DOI: 10.1186/s12909-022-03279-w