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PloS One 2016Heart rate variability (HRV) is a parameter of autonomic nervous system function. A decrease of HRV has been associated with disease severity, risk of complications and...
BACKGROUND
Heart rate variability (HRV) is a parameter of autonomic nervous system function. A decrease of HRV has been associated with disease severity, risk of complications and prognosis in several conditions.
OBJECTIVE
We aim to investigate the feasibility and the reliability of in-ambulance HRV registration during emergency interventions, and to evaluate the association between prehospital HRV parameters, patient characteristics, vital parameters and short-term outcome.
METHODS
We conducted a prospective study using a non-invasive 2-lead ECG registration device in 55 patients transported by the paramedic intervention team of the Universitair Ziekenhuis Brussel. HRV assessment included time domain parameters, frequency domain parameters, nonlinear analysis, and time-frequency analysis. The correlation between HRV parameters and patient and outcome characteristics was analyzed and compared to controls.
RESULTS
Artifact and ectopic detection rates were higher in patients during ambulance transportation compared to controls in resting conditions, yet technical reasons precluding in-ambulance HRV analysis occurred in only 9.6% of cases. HRV acquisition was possible without safety issues or interference with routine emergency care. Reliability of the results was considered sufficient for Sample entropy (SampEn), good for the ratio of low frequency and high frequency components (LF/HF ratio) in the frequency and the time frequency domain, and excellent for the triangular interpolation of the NN interval histogram (TINN), and for the short-term scaling exponent of the detrended fluctuation analysis (DFA α1). HRV indices were significantly reduced inpatients with unfavorable outcome compared to patients with favorable outcome and controls. Multivariate analysis identified lower DFA α1 as an independent predictor of unfavorable outcome (OR, 0.155; 95% CI 0.024-0.966; p = 0.049).
CONCLUSION
In-ambulance HRV registration is technically and operationally feasible and produces reliable results for parameters in the time, frequency, nonlinear and time frequency domain. Especially non-linear HRV analysis during emergency ambulance transportation may be a promising approach to predict patient outcome.
Topics: Aged; Aged, 80 and over; Ambulances; Electrocardiography, Ambulatory; Entropy; Female; Heart Rate; Humans; Male; Middle Aged; Nonlinear Dynamics; Prospective Studies; Reproducibility of Results
PubMed: 27144492
DOI: 10.1371/journal.pone.0154834 -
Journal of Religion and Health Apr 2022Chaplains are employed by ambulance services in many states across Australia as one element in a suite of initiatives to support the health and wellness of paramedics....
Chaplains are employed by ambulance services in many states across Australia as one element in a suite of initiatives to support the health and wellness of paramedics. The aim of this paper is to present key findings from a study that explored paramedic perspectives on the role and value of chaplains in the ambulance service. Seventeen paramedics participated in semi-structured interviews. Data were analysed using framework analysis. Two themes were identified: scope of the chaplain's role and organisational factors influencing the chaplain's role. Paramedics highly valued what they believed to be proactive and reactive support provided by ambulance chaplains, regardless of paramedics' personal spiritual or religious beliefs.
Topics: Allied Health Personnel; Ambulances; Australia; Clergy; Emergency Medical Technicians; Humans
PubMed: 34694550
DOI: 10.1007/s10943-021-01446-9 -
Scandinavian Journal of Trauma,... Oct 2018Not all patients where an ambulance is dispatched are conveyed to an emergency department. Although non-conveyance is a substantial part of ambulance care, there is...
BACKGROUND
Not all patients where an ambulance is dispatched are conveyed to an emergency department. Although non-conveyance is a substantial part of ambulance care, there is limited insight in the non-conveyance patient population. Therefore, the study aim was to compare demographics, initial on-scene reasons for care, and vital signs between conveyed and non-conveyed patients attended by an ambulance.
METHODS
A retrospective study of ambulance runs from 2 EMS regions in the Netherlands in 2016 was performed. For each ambulance run demographics (age, gender and geographical location), initial reasons for care categorised into the ICD-10 classification system, and vital functions or observational scales (according to the national ambulance care protocol) were collected and analyzed.
RESULTS
54.797 ambulance runs met the inclusion criteria, of which 14.383/54.797 (26.2%) resulted in non-conveyance. There was no significant difference in gender, but the non-conveyance group was significantly younger (48.5 (±26.4) years) compared to the conveyance group (60.7 (±22.2) years) (p = .000). The most common initial reasons for care for the conveyance group could be classified into chapter-9 diseases of the circulatory system, chapter-19 injury, poisoning and certain other consequences of external causes, and chapter-10 diseases of the respiratory system. The most common reasons for care in the non-conveyance group could be classified into the chapter-9 diseases of the circulatory system, chapter-19 injury, poisoning and certain other consequences of external causes, and -chapter-5 mental, behavioral and neurodevelopmental disorders. The total percentage abnormal vital functions/observation scales between the conveyance (69.5%) and non-conveyance group (58.6%) was significantly different (p = .000). 15 out of 17 vital functions/observation scales are significantly different between the conveyance and non-conveyance group.
CONCLUSIONS
This study shows that non-conveyed patients are younger, are more likely to be in (highly) rural areas, and more often have initial reasons for care related to mental, behavioral and neurodevelopmental disorders (ICD-10 chapter 5). Although abnormal vital functions/observation scale were more prevalent in the conveyance group, 58.6% of the non-conveyed patients had at least one abnormal vital function/observation scale.
Topics: Ambulances; Emergencies; Emergency Medical Services; Female; Humans; Incidence; Male; Middle Aged; Netherlands; Patient Safety; Retrospective Studies
PubMed: 30373652
DOI: 10.1186/s13049-018-0557-3 -
Academic Emergency Medicine : Official... Jun 2013The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia.
OBJECTIVES
The objective was to study the role and effect of patients' perceptions on reasons for using ambulance services in Queensland, Australia.
METHODS
A cross-sectional survey was conducted of patients (n = 911) presenting via ambulance or self-transport at eight public hospital emergency departments (EDs). The survey included perceived illness severity, attitudes toward ambulance, and reasons for using ambulance. A theoretical framework was developed to inform this study.
RESULTS
Ambulance users had significantly higher self-rated perceived seriousness, urgency, and pain than self-transports. They were also more likely to agree that ambulance services are for everyone to use, regardless of the severity of their conditions. In compared to self-transports, likelihood of using an ambulance increased by 26% for every unit increase in perceived seriousness; and patients who had not used an ambulance in the 6 months prior to the survey were 66% less likely to arrive by ambulance. Patients who had presented via ambulance stated they considered the urgency (87%) or severity (84%) of their conditions as reasons for calling the ambulance. Other reasons included requiring special care (76%), getting higher priority at the ED (34%), not having a car (34%), and financial concerns (17%).
CONCLUSIONS
Understanding patients' perceptions is essential in explaining their actions and developing safe and effective health promotion programs. Individuals use ambulances for various reasons and justifications according to their beliefs, attitudes, and sociodemographic conditions. Policies to reduce and manage demand for such services need to address both general opinions and specific attitudes toward emergency health services to be effective.
Topics: Adult; Ambulances; Attitude to Health; Cross-Sectional Studies; Emergency Medical Services; Female; Health Knowledge, Attitudes, Practice; Humans; Male; Queensland; Self Report; Severity of Illness Index; Surveys and Questionnaires; Utilization Review
PubMed: 23758304
DOI: 10.1111/acem.12149 -
Scientific Reports Sep 2022Cost-effective on-demand computing resources can help to process the increasing number of large, diverse datasets generated from smart internet-enabled technology, such...
Cost-effective on-demand computing resources can help to process the increasing number of large, diverse datasets generated from smart internet-enabled technology, such as sensors, CCTV cameras, and mobile devices, with high temporal resolution. Category 1 emergency services (Ambulance, Fire and Rescue, and Police) can benefit from access to (near) real-time traffic- and weather data to coordinate multiple services, such as reassessing a route on the transport network affected by flooding or road incidents. However, there is a tendency not to utilise available smart city data sources, due to the heterogeneous data landscape, lack of real-time information, and communication inefficiencies. Using a systems engineering approach, we identify the current challenges faced by stakeholders involved in incident response and formulate future requirements for an improved system. Based on these initial findings, we develop a use case using Microsoft Azure cloud computing technology for analytical functionalities that can better support stakeholders in their response to an incident. Our prototype allows stakeholders to view available resources, send automatic updates and integrate location-based real-time weather and traffic data. We anticipate our study will provide a foundation for the future design of a data ontology for multi-agency incident response in smart cities of the future.
Topics: Ambulances; Cities; Cloud Computing; Emergency Medical Services; Floods
PubMed: 36171329
DOI: 10.1038/s41598-022-20178-8 -
Health Services Research Dec 2017Out-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors...
OBJECTIVE
Out-of-network emergency department (ED) use, or use that occurs outside the contracted network, may lead to increased care fragmentation and cost. We examined factors associated with out-of-network ED use among Medicaid beneficiaries.
DATA SOURCES AND STUDY SETTING
Enrollment, claims, and encounter data for adult Medi-Cal health plan members with 1+ ED visits and complete Medicaid eligibility during the study period from 2013 to 2014.
STUDY DESIGN
We analyzed the data to identify factors associated with out-of-network ED use classified by mode of arrival (ambulance vs. nonambulance).
DATA EXTRACTION METHODS
We extracted encounter, ambulance, and ED census data and linked them together based on ED visit date.
PRINCIPAL FINDINGS
Of 11,143 ED visits, 6,808 (61.1 percent) were out-of-network. The number of hours the study ED was on ambulance diversion increased the odds of out-of-network visits for the 3,365 (30.2 percent) ED visits arriving by ambulance. For all visit types, assignment to a primary care clinic at the in-network hospital and having had any primary care visit during the study period decreased the odds of out-of-network ED care. Individuals were more likely to go out-of-network for ED care if they lived in neighborhoods containing out-of-network EDs.
CONCLUSIONS
There are a number of factors related to out-of-network ED use, including the proximity and density of out-of-network EDs, race and ethnicity, a prior history of out-of-network ED use, and individuals' connection to primary care. EDs that serve Medicaid beneficiaries may need to explore alternative sites and modalities of care as alternatives to the ED, and consider their ability to absorb large numbers of out-of-network visits given already limited capacity.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Ambulances; Cross-Sectional Studies; Emergency Service, Hospital; Female; Humans; Male; Medicaid; Middle Aged; Primary Health Care; Racial Groups; Residence Characteristics; San Francisco; Socioeconomic Factors; United States; Young Adult
PubMed: 27861836
DOI: 10.1111/1475-6773.12604 -
Academic Emergency Medicine : Official... Nov 2006To review the current literature on the effects of ambulance diversion (AD). (Review)
Review
OBJECTIVES
To review the current literature on the effects of ambulance diversion (AD).
METHODS
The authors performed a systematic review of AD and its effects. PubMed, EMBASE, the Cochrane database, societal meeting abstracts, and references from relevant articles were searched. All articles were screened for relevance to AD.
RESULTS
The authors examined 600 citations and reviewed the 107 articles relevant to AD. AD is a common occurrence that is increasing in frequency. AD is associated with periods of emergency department (ED) crowding (Mondays, mid-afternoon to early evening, influenza season, and when hospitals are at capacity). Interventions that redesign the AD process or that provide additional hospital or ED resources reduce diversion frequency. AD is associated with increased patient transport times and time to thrombolytics but not with mortality. AD is associated with loss of estimated hospital revenues. Short of anecdotal or case reports, no studies measured the effect of AD on ED crowding, morbidity, patient and provider satisfaction, or EMS resource utilization.
CONCLUSIONS
Despite its common use, there is a relative paucity of studies on the effects of AD. Further research into these effects should be performed so that we may understand the role of AD in the health system.
Topics: Ambulances; Crowding; Emergency Service, Hospital; Humans; Transportation of Patients
PubMed: 16946281
DOI: 10.1197/j.aem.2006.05.024 -
Air Medical Journal 2023Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging...
Patient Satisfaction and Utilization of Ambulance Services in Prehospital Services at a Tertiary Care Hospital: A Cross-Sectional Study in Peshawar, Khyber Pakhtunkhwa, Pakistan.
OBJECTIVE
Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services.
METHODS
This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378. The patients reporting to the emergency department using any ambulance service were included in this study. Different types of ambulance services were used as an outcome variable. Proportions were compared for the categoric variables using the chi-square test, whereas the 1-way analysis of variance test was used to determine the mean response time and age. Results were considered significant at a P value ≤ .050. All analyses were completed using SPSS version 20 (IBM Corp, Armonk, NY).
RESULTS
Of the total 378 study participants, approximately 166 (43.9%) used Rescue 1122 services, 99 (26.2%) used private ambulance services, and 44 (11.6%) used public ambulance services. Road traffic accidents were the most common complaint by 98 (25.9%, P < .003) participants. The mean response time for Rescue 1122 was 13.2 ± 18 minutes followed by the Chippa Foundation (private) at 17.8 ± 20 minutes (P < .005). Males (n = 254) were the predominant users of all services. Participants from the urban region (n = 112) used Rescue 1122, whereas the public ambulance service was used only by 31 patients (P < .005). Among all the ambulance services, 19 (61.3%) participants were not satisfied with the Chippa service regarding vehicle cleanliness, whereas participants were highly satisfied with Rescue 1122.
CONCLUSION
Overall, the patients were more satisfied with the services provided by the Rescue 1122 ambulances compared with all other ambulance services.
Topics: Male; Humans; Ambulances; Patient Satisfaction; Cross-Sectional Studies; Tertiary Care Centers; Pakistan; Emergency Medical Services
PubMed: 37356883
DOI: 10.1016/j.amj.2023.03.002 -
Scandinavian Journal of Trauma,... Sep 2023Healthcare laws allow for exceptions from the consent requirement when patients are not competent to consent or pose a danger to themselves or others. In these cases,...
BACKGROUND
Healthcare laws allow for exceptions from the consent requirement when patients are not competent to consent or pose a danger to themselves or others. In these cases, the use of coercion may be an alternative to voluntary health care. Ambulance personnel are regularly confronted with patients who need healthcare but refuse it and/or refuse to cooperate. This study aimed to explore ambulance personnel`s experience with use of coercion and factors influencing the use of coercion in the ambulance service in Norway.
METHOD
We conducted two focus group interviews with a total of eight informants, all ambulance personnel from a large Norwegian ambulance service. Digital recordings of the interviews were transcribed verbatim and analysed using systematic text condensation.
RESULTS
The informants` stories revealed several methods of coercion used by the ambulance personnel; physical coercion, pragmatic coercion, pharmacological coercion and coercion used to ensure the patient is secured during transportation. The main reasons for using coercion were preventing patients from harming themselves or others and to ensure that patients unable to consent receive healthcare considered necessary. Systemic factors as difficulty of applying the law to real-life situations, and organizational factors as fear of breaching guidelines, experienced lack of support from the management, fear of charges of misconduct, and lack of training in assessing patients´ competence to consent seem to influence ambulance personnels use of coercion.
CONCLUSION
Ethical grey areas in clinical practice emphasize the need for clinical discretion. Despite the fact that regulatory provisions allow for exceptions from the requirement to obtain consent, transferring these regulations to real life prehospital settings can be difficult. Consequently, the decisions made by ambulance personnel in clinical situations are highly influenced by organizational ethos and guidelines. The informants describe the coercive interventions they have employed to manage patients who are deemed to require healthcare but refuse it and/or refuse to cooperate.
Topics: Humans; Ambulances; Coercion; Qualitative Research; Focus Groups; Norway
PubMed: 37667365
DOI: 10.1186/s13049-023-01104-x -
International Journal of Qualitative... Dec 2021This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and...
PURPOSE
This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel.
METHODS
The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon.
RESULTS
The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated.
CONCLUSIONS
The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.
Topics: Ambulances; Decision Making; Health Personnel; Humans
PubMed: 34427535
DOI: 10.1080/17482631.2021.1970095