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Descriptive Analysis of Clinical Encounters by Emergency Medical Services Physicians Using the RE-AIM Framework. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:E58-E64. [PMID: 36214653 DOI: 10.1097/phh.0000000000001629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Emergency medical services (EMS) medicine continues to expand and mature as a recognized subspeciality within emergency medicine. In the United States, EMS physicians historically supported training, protocol development, and EMS clinician credentialing. In the past, only limited programs existed in which prehospital physicians were engaged in the direct and routine care of prehospital patients; however, a growing number of EMS programs are recognizing the value and impact of direct EMS physician involvement in prehospital patient care. PROGRAM A large suburban, volunteer-based EMS agency implemented a volunteer prehospital physician program where providers routinely responded to emergency calls for service. IMPLEMENTATION Beginning in November 2019, a cadre of board-certified physicians completed a field preceptorship and local protocol orientation. Once complete, the physicians were released to function and respond independently to high acuity emergency calls or any call at their discretion. Prehospital physicians were authorized to utilize their full scope of practice and expected to provide field mentorship to traditional prehospital clinicians. EVALUATION This study systematically evaluated a prehospital physician program for public health relevance, sustainability, and population health impact using the RE-AIM framework. A retrospective descriptive analysis was performed on the role and responses by a cohort of prehospital physicians using dispatch data and electronic medical records. DISCUSSION Over the 17-month study period, 9 prehospital physicians responded to 482 calls, predominately cardiac arrests, traumatic injuries, and cardiac/chest pain. The physicians performed 99 procedures and administered 113 medications. Ultimately, the program added physician-level care to the prehospital setting in an ongoing and sustainable way. The routine placement of physicians in the prehospital environment can help benefit patients by enhancing access to advanced clinical knowledge and skills, while also benefiting EMS clinicians through opportunities for enhanced patient-side training, education, and medical control.
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Kaim A, Bodas M, Bieler D, Radomislensky I, Matthes G, Givon A, Trentzsch H, Waydhas C, Lefering R. Severe trauma in Germany and Israel: are we speaking the same language? A trauma registry comparison. Front Public Health 2023; 11:1136159. [PMID: 37200993 PMCID: PMC10186152 DOI: 10.3389/fpubh.2023.1136159] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 04/04/2023] [Indexed: 05/20/2023] Open
Abstract
Background Trauma registries are a crucial component of trauma systems, as they could be utilized to perform a benchmarking of quality of care and enable research in a critical but important area of health care. The aim of this study is to compare the performance of two national trauma systems: Germany (TraumaRegister DGU®, TR-DGU) and Israel (Israeli National Trauma Registry, INTR). Methods The present study was a retrospective analysis of data from the described above trauma registries in Israel and Germany. Adult patients from both registries treated during 2015-2019 with an Injury Severity Score (ISS) ≥ 16 points were included. Patient demographics, type, distribution, mechanism, and severity of injury, treatment delivered and length of stay (LOS) in the ICU and in the hospital were included in the analysis. Results Data were available from 12,585 Israeli patients and 55,660 German patients. Age and sex distribution were comparable, and road traffic collisions were the most prevalent cause of injuries. The ISS of German patients was higher (ISS 24 vs. 20), more patients were treated on an intensive care unit (92 vs. 32%), and mortality was higher (19.4 vs. 9.5%) as well. Conclusion Despite similar inclusion criteria (ISS ≥ 16), remarkable differences between the two national datasets were observed. Most probably, this was caused by different recruitment strategies of both registries, like trauma team activation and need for intensive care in TR-DGU. More detailed analyses are needed to uncover similarities and differences of both trauma systems.
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Affiliation(s)
- Arielle Kaim
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Sackler Tel Aviv University, Tel Aviv, Israel
- *Correspondence: Arielle Kaim,
| | - Moran Bodas
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
- Department of Emergency and Disaster Management, Faculty of Medicine, School of Public Health, Sackler Tel Aviv University, Tel Aviv, Israel
| | - Dan Bieler
- Department of Trauma Surgery and Orthopedics, University Düsseldorf, Düsseldorf, Germany
- Department for Trauma Surgery and Orthopedics, Reconstructive Surgery, Hand Surgery, Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany
| | - Irina Radomislensky
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Gerrit Matthes
- Department of Trauma and Reconstructive Surgery, Hospital Ernst-von-Bergmann, Potsdam, Germany
| | - Adi Givon
- Israel National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat-Gan, Israel
| | - Heiko Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, LMU München, Munich, Germany
| | | | - Christian Waydhas
- Department of Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
- Medical Faculty of University Duisburg-Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, University Witten/Herdecke, Cologne, Germany
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Sonkin R, Jaffe E, Wacht O, Morse H, Bitan Y. Real-time video communication between ambulance paramedic and scene - a simulation-based study. BMC Health Serv Res 2022; 22:1049. [PMID: 35978429 PMCID: PMC9382790 DOI: 10.1186/s12913-022-08445-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Telemedicine has been widely used in various medical settings including in Emergency Medical Services (EMS). The goal of this study was to assess the possible roles of real-time video communication between paramedics and bystanders at scenes of emergency, in the analysis and treatment of patients. Methods 44 experienced paramedics participated in a simulation. Participants communicated with the experimenter presenting video clips showing patients that simulated three emergency scenarios: trauma, an unresponsive patient with cardiac arrest, and an opiate overdose. The simulation sessions were conducted through Zoom™, recorded, and then analyzed to document participants’ questions, requests, instructions, and their timings during each scenario. Results The trauma scenario was assessed most promptly, with instructions to handle the bleeding provided by all paramedics. In the unresponsive patient with cardiac arrest scenario, most of the participants achieved a correct initial diagnosis, and in the opiate overdose scenario over half of paramedics sought visual clinical clues for the differential diagnoses of loss of consciousness and their causes. Additional results show the type of assessment, treatment and diagnosis participants provided in each scenario, and their confidence about situation. Conclusions The findings show that direct video communication between paramedic and scene may facilitate correct diagnosis, provision of instructions for treatment, and early preparation of medications or equipment. These may decrease time to correct diagnosis and lifesaving treatment and impact patient morbidity and mortality. Moreover, the findings highlight the difference between incidents with higher visual clarity, such as trauma, and conditions that require an extended diagnosis to reveal, such as unresponsive patients. This may also increase the paramedics’ mental preparedness for what is expected at the scene.
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Affiliation(s)
- Roman Sonkin
- Community Division, Magen David Adom, Ha-Plada 5, 6021805, Or-Yehuda, Israel.
| | - Eli Jaffe
- Community Division, Magen David Adom, Ha-Plada 5, 6021805, Or-Yehuda, Israel.,Department of Emergency Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Helena Morse
- Community Division, Magen David Adom, Ha-Plada 5, 6021805, Or-Yehuda, Israel
| | - Yuval Bitan
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Howard I, Howland I, Castle N, Al Shaikh L, Owen R. Retrospective identification of medication related adverse events in the emergency medical services through the analysis of a patient safety register. Sci Rep 2022; 12:2622. [PMID: 35173222 PMCID: PMC8850606 DOI: 10.1038/s41598-022-06290-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/22/2021] [Indexed: 11/12/2022] Open
Abstract
Adverse drug events encompass a wide range of potential unintended and harmful events, from adverse drug reactions to medication errors, many of which in retrospect, are considered preventable. However, the primary challenge towards reducing their burden lies in consistently identifying and monitoring these occurrences, a challenge faced across the spectrum of healthcare, including the emergency medical services. The aim of this study was to identify and describe medication related adverse events (AEs) in the out-of-hospital setting. The medication components of a dedicated patient safety register were analysed and described for the period Jan 2017–Sept 2020. Univariate descriptive analysis was used to summarize and report on basic case and patient demographics, intervention related AEs, medication related AEs, and AE severity. Multivariable logistic regression was used to assess the odds of AE severity, by AE type. A total of 3475 patient records were assessed where 161 individual medication AEs were found in 150 (4.32%), 12 of which were categorised as harmful. Failure to provide a required medication was found to be the most common error (1.67%), followed by the administration of medications outside of prescribed practice guidelines (1.18%). There was evidence to suggest a 63% increase in crude odds of any AE severity [OR 1.63 (95% CI 1.03–2.6), p = 0.035] with the medication only AEs when compared to the intervention only AEs. Prehospital medication related adverse events remain a significant threat to patient safety in this setting and warrant greater widespread attention and future identification of strategies aimed at their reduction.
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Affiliation(s)
- Ian Howard
- Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar.
| | - Ian Howland
- Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Nicholas Castle
- Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Loua Al Shaikh
- Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar
| | - Robert Owen
- Hamad Medical Corporation Ambulance Service, Hamad Medical Corporation, Doha, Qatar
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Árnason B, Hertzberg D, Kornhall D, Günther M, Gellerfors M. Pre-hospital emergency anaesthesia in trauma patients treated by anaesthesiologist and nurse anaesthetist staffed critical care teams. Acta Anaesthesiol Scand 2021; 65:1329-1336. [PMID: 34152597 PMCID: PMC9291089 DOI: 10.1111/aas.13946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 05/06/2021] [Accepted: 05/08/2021] [Indexed: 12/05/2022]
Abstract
Background Pre‐hospital tracheal intubation in trauma patients has recently been questioned. However, not only the trauma and patient characteristics but also airway provider competence differ between systems making simplified statements difficult. Method The study is a subgroup analysis of trauma patients included in the PHAST study. PHAST was a prospective, observational, multicentre study on pre‐hospital advanced airway management by anaesthesiologist and nurse anaesthetist manned pre‐hospital critical care teams in the Nordic countries May 2015‐November 2016. Endpoints include intubation success rate, complication rate (airway‐related complication according to Utstein Airway Template by Sollid et al), scene time (time from arrival of the critical care team to departure of the patient) and pre‐hospital mortality. Result The critical care teams intubated 385 trauma patients, of which 65 were in shock (SBP <90 mm Hg), during the study. Of the trauma patients, 93% suffered from blunt trauma, the mean GCS was 6 and 75% were intubated by an experienced provider who had performed >2500 tracheal intubations. The pre‐hospital tracheal intubation overall success rate was 98.6% and the complication rate was 13.6%, with no difference between patients with or without shock. The mean scene time was significantly shorter in trauma patients with shock (21.4 min) compared to without shock (21.4 vs 25.1 min). Following pre‐hospital tracheal intubation, 97% of trauma patients without shock and 91% of the patients in shock with measurable blood pressure were alive upon arrival to the ED. Conclusion Pre‐hospital tracheal intubation success and complication rates in trauma patients were comparable with in‐hospital rates in a system with very experienced airway providers. Whether the short scene times contributed to a low pre‐hospital mortality needs further investigation in future studies.
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Affiliation(s)
- Bjarni Árnason
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Rapid Response CarCapio Stockholm Sweden
| | - Daniel Hertzberg
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Department of Physiology and PharmacologyKarolinska Institutet Stockholm Sweden
| | - Daniel Kornhall
- Swedish Air Ambulance (SLA) Mora Sweden
- East Anglian Air Ambulance Cambridge UK
| | - Mattias Günther
- Department of Clinical Research and Education Karolinska Institutet Stockholm Sweden
| | - Mikael Gellerfors
- Department of Perioperative Medicine and Intensive Care Karolinska University Hospital Stockholm Sweden
- Rapid Response CarCapio Stockholm Sweden
- Department of Physiology and PharmacologyKarolinska Institutet Stockholm Sweden
- Swedish Air Ambulance (SLA) Mora Sweden
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Neeki M, DuMontier S, Toy J, Archambeau B, Goralnick E, Pennington T, Inaba K, Hammesfahr R, Wong D, Plurad DS. Prehospital Trauma Care in Disasters and Other Mass Casualty Incidents - A Proposal for Hospital-Based Special Medical Response Teams. Cureus 2021; 13:e13657. [PMID: 33824808 PMCID: PMC8016499 DOI: 10.7759/cureus.13657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Current mass casualty incident (MCI) response in the United States calls for rapid deployment of first responders, such as law enforcement, fire, and emergency medical services personnel, to the incident and simultaneous activation of trauma center disaster protocols. Past investigations demonstrated that the incorporation of advanced trauma-trained physicians and paramedics into prehospital teams resulted in improved mortality during routine emergency medical care in Europe and in the combat setting. To date, limited research exists on the incorporation of advanced trauma-trained physicians and paramedics into prehospital teams for civilian MCIs. We proposed the concept of Special Medical Response Teams, which would rapidly deploy advanced trauma-trained physicians and paramedics to deliver a higher level of medical and surgical care in the prehospital setting during civilian mass casualty incidents.
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Affiliation(s)
- Michael Neeki
- Emergency Medicine, California University of Science and Medicine, Colton, USA.,Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Jake Toy
- Emergency Medicine, Harbor University of California Los Angeles Medical Center, Torrance, USA
| | | | | | - Troy Pennington
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Kenji Inaba
- Surgery, University of Southern California, Los Angeles, USA
| | - Rick Hammesfahr
- Tactical Emergency Support Team, Marietta Police and Fire Department, Marietta, USA
| | - David Wong
- Surgery, Arrowhead Regional Medical Center, Colton, USA.,Surgery, California University of Science and Medicine, Colton, USA
| | - David S Plurad
- Department of Surgery, Riverside Community Hospital, Riverside, USA
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Haugland H, Olkinuora A, Rognås L, Ohlén D, Krüger A. Mortality and quality of care in Nordic physician-staffed emergency medical services. Scand J Trauma Resusc Emerg Med 2020; 28:100. [PMID: 33054786 PMCID: PMC7556966 DOI: 10.1186/s13049-020-00796-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 10/07/2020] [Indexed: 11/11/2022] Open
Abstract
Background Quality indicators (QI) for physician staffed emergency medical services (P-EMS) are necessary to improve service quality. Mortality can be considered the ultimate outcome QI. The process quality of care in P-EMS can be described by 15 response-specific QIs developed for these services. The most critical patients in P-EMS are presumably found among patients who die within 30 days after the P-EMS response. Securing high quality care for these patients should be a prioritized task in P-EMS quality improvement. Thus, the first aim of this study was to describe the 30-days survival in Nordic P-EMS as an expression of the outcome quality of care. The second aim was to describe the process quality of care as assessed by the 15 QIs, for patients who die within 30 days after the P-EMS response. Methods In this prospective observational study, P-EMSs in Finland, Sweden, Denmark, and Norway registered 30-days survival and scored the 15 QIs for their patients. The QI performance for patients who died within 30 days after the P-EMS response was assessed using established benchmarks for the applied QIs. Further, mean QI performance for the 30-days survivors and the 30-days non-survivors were compared using Chi-Square test for categorical variables and Mann-Whitney U test for continuous variables. Results We recorded 2808 responses in the study period. 30-days survival varied significantly between the four participating countries; from 89.0 to 76.1%. When assessing the quality of care for patients who die within 30 days after the P-EMS response, five out of 15 QIs met the established benchmarks. For nine out of 15 QIs, there was significant difference in mean scores between the 30 days survivors and non-survivors. Conclusion In this study we have described 30-days survival as an outcome QI for P-EMS, and found significant differences between four Nordic countries. For patients who died within 30 days, the majority of the 15 QIs developed for P-EMS did not meet the benchmarks, indicating room for quality improvement. Finally, we found significant differences in QI performance between 30-days survivors and 30-days non-survivors which also might represent quality improvement opportunities.
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Affiliation(s)
- Helge Haugland
- Department for Research and Development, The Norwegian Air Ambulance Foundation, Postbox 414, Sentrum, 0103, Oslo, Norway. .,Department of Emergency Medicine and Pre-Hospital Services, St. Olav University Hospital, Trondheim, Norway.
| | - Anna Olkinuora
- Research and Development Unit, FinnHEMS Ltd, Vantaa, Finland
| | - Leif Rognås
- Department of Anaesthesia, Aarhus University Hospital, Aarhus, Denmark.,Danish Air Ambulance, Aarhus, Denmark
| | - David Ohlén
- Airborne Intensive Care Unit, Department of Anaesthesia, Perioperative Management and Intensive Care Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Andreas Krüger
- Department for Research and Development, The Norwegian Air Ambulance Foundation, Postbox 414, Sentrum, 0103, Oslo, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olav University Hospital, Trondheim, Norway
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8
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Tønsager K, Krüger AJ, Ringdal KG, Rehn M. Data quality of Glasgow Coma Scale and Systolic Blood Pressure in scientific studies involving physician-staffed emergency medical services: Systematic review. Acta Anaesthesiol Scand 2020; 64:888-909. [PMID: 32270473 DOI: 10.1111/aas.13596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Emergency physicians on-scene provide highly specialized care to severely sick or injured patients. High-quality research relies on the quality of data, but no commonly accepted definition of EMS data quality exits. Glasgow Coma Score (GCS) and Systolic Blood Pressure (SBP) are core physiological variables, but little is known about the quality of these data when reported in p-EMS research. This systematic review aims to describe the quality of pre-hospital reporting of GCS and SBP data in studies where emergency physicians are present on-scene. METHODS A systematic literature search was performed using CINAHL, Cochrane, Embase, Medline, Norart, Scopus, SweMed + and Web of Science, in accordance with the PRISMA guidelines. Reported data on accuracy of reporting, completeness and capture were extracted to describe the quality of documentation of GCS and SBP. External and internal validity assessment was performed by extracting a set of predefined variables. RESULTS We included 137 articles describing data collection for GCS, SBP or both. Most studies (81%) were conducted in Europe and 59% of studies reported trauma cases. Reporting of GCS and SBP data were not uniform and may be improved to enable comparisons. Of the predefined external and internal validity data items, 26%-45% of data were possible to extract from the included papers. CONCLUSIONS Reporting of GCS and SBP is variable in scientific papers. We recommend standardized reporting to enable comparisons of p-EMS.
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Affiliation(s)
- Kristin Tønsager
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Department of Anaesthesiology and Intensive Care Stavanger University Hospital Stavanger Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
| | - Andreas J. Krüger
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Department of Emergency Medicine and Pre-Hospital Services St. Olavs Hospital Trondheim Norway
| | - Kjetil G. Ringdal
- Department of Anaesthesiology Vestfold Hospital Trust Tønsberg Norway
- Norwegian Trauma Registry Oslo University Hospital Oslo Norway
| | - Marius Rehn
- Department of Research The Norwegian Air Ambulance Foundation Oslo Norway
- Faculty of Health Sciences University of Stavanger Stavanger Norway
- Pre-hospital Division Air Ambulance DepartmentOslo University Hospital Oslo Norway
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Influence of prehospital physician presence on survival after severe trauma: Systematic review and meta-analysis. J Trauma Acute Care Surg 2020; 87:978-989. [PMID: 31335754 DOI: 10.1097/ta.0000000000002444] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND As trauma is one of the leading causes of death worldwide, there is great potential for reducing mortality in trauma patients. However, there is continuing controversy over the benefit of deploying emergency medical systems (EMS) physicians in the prehospital setting. The objective of this systematic review and meta-analysis is to assess how out-of-hospital hospital management of severely injured patients by EMS teams with and without physicians affects mortality. METHODS PubMed and Google Scholar were searched for relevant articles, and the search was supplemented by a hand search. Injury severity in the group of patients treated by an EMS team including a physician had to be comparable to the group treated without a physician. Primary outcome parameter was mortality. Helicopter transport as a confounder was accounted for by subgroup analyses including only the studies with comparable modes of transport. Quality of all included studies was assessed according to the Cochrane handbook. RESULTS There were 2,249 publications found, 71 full-text articles assessed, and 22 studies included. Nine of these studies were matched or adjusted for injury severity. The odds ratio (OR) of mortality was significantly lower in the EMS physician-treated group of patients: 0.81; 95% confidence interval (CI): 0.71-0.92. When analysis was limited to the studies that were adjusted or matched for injury severity, the OR was 0.86 (95% CI, 0.73-1.01). Analyzing only studies published after 2005 yielded an OR for mortality of 0.75 (95% CI, 0.64-0.88) in the overall analysis and 0.81 (95% CI, 0.67-0.97) in the analysis of adjusted or matched studies. The OR was 0.80 (95% CI, 0.65-1.00) in the subgroup of studies with comparable modes of transport and 0.74 (95% CI, 0.53-1.03) in the more recent studies. CONCLUSION Prehospital management of severely injured patients by EMS teams including a physician seems to be associated with lower mortality. After excluding the confounder of helicopter transport we have shown a nonsignificant trend toward lower mortality. LEVEL OF EVIDENCE Systematic review and meta-analysis, level III.
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10
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Tønsager K, Krüger AJ, Ringdal KG, Rehn M. Template for documenting and reporting data in physician-staffed pre-hospital services: a consensus-based update. Scand J Trauma Resusc Emerg Med 2020; 28:25. [PMID: 32245496 PMCID: PMC7119287 DOI: 10.1186/s13049-020-0716-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 03/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physician-staffed emergency medical services (p-EMS) are resource demanding, and research is needed to evaluate any potential effects of p-EMS. Templates, designed through expert agreement, are valuable and feasible, but they need to be updated on a regular basis due to developments in available equipment and treatment options. In 2011, a consensus-based template documenting and reporting data in p-EMS was published. We aimed to revise and update the template for documenting and reporting in p-EMS. METHODS A Delphi method was applied to achieve a consensus from a panel of selected European experts. The experts were blinded to each other until a consensus was reached, and all responses were anonymized. The experts were asked to propose variables within five predefined sections. There was also an optional sixth section for variables that did not fit into the pre-defined sections. Experts were asked to review and rate all variables from 1 (totally disagree) to 5 (totally agree) based on relevance, and consensus was defined as variables rated ≥4 by more than 70% of the experts. RESULTS Eleven experts participated. The experts generated 194 unique variables in the first round. After five rounds, a consensus was reached. The updated dataset was an expanded version of the original dataset and the template was expanded from 45 to 73 main variables. The experts approved the final version of the template. CONCLUSIONS Using a Delphi method, we have updated the template for documenting and reporting in p-EMS. We recommend implementing the dataset for standard reporting in p-EMS.
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Affiliation(s)
- Kristin Tønsager
- Department of Research, The Norwegian Air Ambulance Foundation, Post box 414, Sentrum, N-0103, Oslo, Norway. .,Department of Anaesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway. .,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
| | - Andreas Jørstad Krüger
- Department of Research, The Norwegian Air Ambulance Foundation, Post box 414, Sentrum, N-0103, Oslo, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway
| | - Kjetil Gorseth Ringdal
- Department of Anaesthesiology, Vestfold, Hospital Trust, Tønsberg, Norway.,Norwegian Trauma Registry, Oslo University Hospital, Oslo, Norway
| | - Marius Rehn
- Department of Research, The Norwegian Air Ambulance Foundation, Post box 414, Sentrum, N-0103, Oslo, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Pre-hospital Division, Air Ambulance Department, Oslo University Hospital, Oslo, Norway
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Bhandari D, Yadav NK. Developing an integrated emergency medical services in a low-income country like Nepal: a concept paper. Int J Emerg Med 2020; 13:7. [PMID: 32028893 PMCID: PMC7006070 DOI: 10.1186/s12245-020-0268-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/03/2020] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The main aim of emergency medical services (EMS) should be to provide universal emergency medical care which is EMS system available to all those who need it. Most of the developed countries have an integrated EMS system that is accessible by a single dial number in the whole country. Nepal does not have a proper EMS system. We conducted a literature review regarding methods of developing an integrated EMS system in Nepal. RESULT The fragmented system, high demand-low supply, inequity with the service, and inadequately trained responders are major problems associated with EMS in Nepal. Nepal too should develop an integrated single dial number EMS system to meet the current demand of EMS. Having a paramedic in ambulances as the first responders will prevent chaos and save critical time. Funding models have to be considered while developing an EMS considering the capital as well as operational cost. CONCLUSION Nepal can develop a public private partnership model of EMS where capital cost is provided by the government and operational cost by other methods. Community-based insurance system looks more feasible in a country like Nepal for generating operational cost.
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Affiliation(s)
- Deepak Bhandari
- Department of Anesthesia, Critical care and Pain, Nepal Mediciti Hospital, Bhainsepati, Kathmandu, Nepal
| | - Nabin Krishna Yadav
- Department of Anesthesiology And Critical Care, Chitwan Medical College, Bharatpur-10, Chitwan Nepal
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Nakao S, Katayama Y, Kitamura T, Hirose T, Sado J, Ishida K, Tachino J, Umemura Y, Kiguchi T, Matsuyama T, Kiyohara K, Shimazu T. Epidemiological profile of emergency medical services in Japan: a population-based descriptive study in 2016. Acute Med Surg 2020; 7:e485. [PMID: 32015883 PMCID: PMC6992505 DOI: 10.1002/ams2.485] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 12/13/2019] [Accepted: 12/25/2019] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of our study is to describe the characteristics of patients who use emergency medical services (EMS), EMS performance, and regional variations in Japan. Methods We undertook a nationwide, population‐based, descriptive review of anonymized ambulance transport records obtained from the Fire and Disaster Management Agency in Japan. All emergency patients transported to emergency medical institutions by EMS personnel from January to December 2016 were enrolled in this study, excluding patients who were not transported. Results During the study period, 5,097,838 patients were transported to a hospital. Their median age was 69 years, 51.4% were male, and 56.5% were over 65 years old. Median durations from EMS call to EMS arrival on scene were similar among the regions, ranging from 7 to 9 min. However, the longest median duration from EMS call to hospital arrival was 38 min, and the shortest was 31 min across the regions. Among all patients, 350,865 (6.9%) were assessed as being in a severe condition, 14,410 (0.3%) were in very severe condition, and 74,780 (1.5%) were confirmed to be dead at the time of initial medical examination in the emergency department. Conclusions We described the characteristics of emergency patients and EMS performance in Japan. This registry serves as a basis for providing relevant information to improve prehospital emergency medical systems.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan.,Emergency and Critical Care Center Osaka Police Hospital Osaka Japan
| | - Junya Sado
- Division of Environmental Medicine and Population Sciences Department of Social and Environmental Medicine Graduate School of Medicine Osaka University Suita Japan
| | - Kenichiro Ishida
- Department of Acute Medicine and Critical Care Medical Center Osaka National Hospital National Hospital Organization Osaka Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
| | - Yutaka Umemura
- Department of Emergency and Critical Care Osaka General Medical Center Osaka Japan
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine Kyoto Prefectural University of Medicine Kyoto Japan
| | - Kosuke Kiyohara
- Department of Food Science Faculty of Home Economics Otsuma Women's University Tokyo Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine Osaka University Graduate School of Medicine Suita Japan
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13
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Bashiri A, Alizadeh Savareh B, Ghazisaeedi M. Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges. Clin Exp Emerg Med 2019; 6:288-296. [PMID: 31910499 PMCID: PMC6952626 DOI: 10.15441/ceem.18.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/12/2018] [Indexed: 11/23/2022] Open
Abstract
Clinical decision support systems are interactive computer systems for situational decision making and can improve decision efficiency and safety of care. We investigated the role of these systems in enhancing prehospital care. This narrative review included full-text articles published since 2000 that were available in databases/e-journals including Web of Science, PubMed, Science Direct, and Google Scholar. Search keywords included "clinical decision support system," "decision support system," "decision support tools," "prehospital care," and "emergency medical services." Non-journal articles were excluded. We revealed 14 relevant studies that used such a support system in prehospital emergency medical service. Owing to the dynamic nature of emergency situations, decision timing is critical. Four key factors demonstrated the ability of clinical decision support systems to improve decision-making, reduce errors, and improve the safety of prehospital emergency activity: computer-based, offer support as a natural part of the workflow, provide decision support in the time and place of decision making, and offer practical advice. The use of clinical decision support systems in prehospital care resulted in accurate diagnoses, improved patient triage and patient outcomes, and reduction of prehospital time. By improving emergency management and rescue operations, the quality of prehospital care will be enhanced.
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Affiliation(s)
- Azadeh Bashiri
- Department of Health Information Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrouz Alizadeh Savareh
- Department of Medical Informatics, School of Management & Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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14
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Understanding system-focused barriers to the identification and reporting of medication errors and adverse drug events in emergency medical services. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00628-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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15
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Prehospital emergency care systems in Europe - EuSEM prehospital section survey 2016. Eur J Emerg Med 2019; 25:446-447. [PMID: 30379716 DOI: 10.1097/mej.0000000000000553] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Katayama Y, Kitamura T, Kiyohara K, Sado J, Hirose T, Matsuyama T, Kiguchi T, Izawa J, Nakagawa Y, Shimazu T. Prehospital factors associated with death on hospital arrival after traffic crash in Japan: a national observational study. BMJ Open 2019; 9:e025350. [PMID: 30700488 PMCID: PMC6352761 DOI: 10.1136/bmjopen-2018-025350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Although it is important to assess prehospital factors associated with traffic crash fatalities to decrease them as a matter of public health, such factors have not been fully revealed. METHODS Using data from the Japanese Trauma Data Bank, a large hospital-based trauma registry in Japan, we retrospectively analysed traffic crash patients transported to participating facilities that treated patients with severe trauma from 2004 to 2015. This study defined registered emergency patients whose systolic blood pressure was 0 mm Hg or heart rate was 0 bpm at hospital arrival as being in prehospital cardiopulmonary arrest (CPA). Prehospital factors associated with prehospital CPA due to traffic crash were assessed with multivariable logistic regression analysis. RESULTS In total, 66 243 patients were eligible for analysis. Of them, 3390 (5.1%) patients were in CPA at hospital arrival. A multivariable logistic regression model showed the following factors to be significantly associated with prehospital CPA: ages 60-74 years (adjusted OR (AOR) 1.256, 95% CI 1.142 to 1.382) and ≥75 years (AOR 1.487, 95% CI 1.336 to 1.654), male sex (AOR 1.234, 95% CI 1.139 to 1.338), night-time (AOR 1.575, 95% CI 1.458 to 1.702), weekend including holiday (AOR 1.078, 95% CI 1.001 to 1.161), rural area (AOR 1.181, 95% CI 1.097 to 1.271), back seat passenger (AOR 1.227, 95% CI 0.985 to 1.528) and pedestrian (AOR 1.754, 95% CI 1.580 to 1.947) as types of patients. CONCLUSION In this population, factors associated with prehospital CPA due to a traffic crash were elderly people, male sex, night-time, weekend/holiday, back seat passenger, pedestrian and rural area. These fundamental data may be of help in reducing and preventing traffic crash deaths.
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Affiliation(s)
- Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
| | - Junya Sado
- Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Medicine for Sports and Performing Arts, Suita, Japan
| | - Tomoya Hirose
- Emergency and Critical Care Center, Osaka Police Hospital, Osaka, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | | | - Junichi Izawa
- Intensive Care Unit, Department of Anesthesiology, The Jikei University School of Medicine, Tokyo, Japan
| | - Yuko Nakagawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan
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Straumann GSH, Austvoll-Dahlgren A, Holte HH, Wisborg T. Effect of requiring a general practitioner at scenes of serious injury: A systematic review. Acta Anaesthesiol Scand 2018; 62:1194-1199. [PMID: 29932207 DOI: 10.1111/aas.13174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 05/09/2018] [Accepted: 05/17/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND In Norway, each municipality is responsible for providing first line emergency healthcare, and it is mandatory to have a primary care physician/general practitioner on call continuously. This mandate ensures that a physician can assist patients and ambulance personnel at the site of severe injuries or illnesses. The compulsory presence of the general practitioner at the scene could affect different parts of patient treatment, and it might save resources by obviating resources from secondary healthcare, like pre-hospital anaesthesiologists and other specialized resources. This systematic review aimed to examine how survival, time spent at the scene, the choice of transport destination, assessment of urgency, the number of admissions, and the number of cancellations of specialized pre-hospital resources were affected by the presence of a general practitioner at the scene of a suspected severe injury. METHODS We searched for published and planned systematic reviews and primary studies in the Cochrane Library, Medline, Embase, OpenGrey, GreyLit and trial registries. The search was completed in December 2017. Two individuals independently screened the references and assessed the eligibility of all potentially relevant studies. RESULTS The search for systematic reviews and primary studies identified 5981 articles. However, no studies met the pre-defined inclusion criteria. CONCLUSION No studies met our inclusion criteria; consequently, it remains uncertain how the presence of a general practitioner at the injury scene might affect the selected outcomes.
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Affiliation(s)
| | | | - H. H. Holte
- Norwegian Institute of Public Health; Oslo Norway
| | - T. Wisborg
- Norwegian National Advisory Unit on Trauma; Division of Emergencies and Critical Care; Oslo University Hospital; Oslo Norway
- Anaesthesia and Critical Care Research Group; Faculty of Health Sciences; University of Tromsø; Tromsø Norway
- Department of Anaesthesiology and Intensive Care; Finnmark Health Trust; Hammerfest Hospital; Hammerfest Norway
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18
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Zargaran E, Spence R, Adolph L, Nicol A, Schuurman N, Navsaria P, Ramsey D, Hameed SM. Association Between Real-time Electronic Injury Surveillance Applications and Clinical Documentation and Data Acquisition in a South African Trauma Center. JAMA Surg 2018. [PMID: 29541765 DOI: 10.1001/jamasurg.2018.0087] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Collection and analysis of up-to-date and accurate injury surveillance data are a key step in the maturation of trauma systems. Trauma registries have proven to be difficult to establish in low- and middle-income countries owing to the burden of trauma volume, cost, and complexity. Objective To determine whether an electronic trauma health record (eTHR) used by physicians can serve as simultaneous clinical documentation and data acquisition tools. Design, Setting, and Participants This 2-part quality improvement study included (1) preimplementation and postimplementation eTHR study with assessments of satisfaction by 41 trauma physicians, time to completion, and quality of data collected comparing paper and electronic charting; and (2) prospective ecologic study describing the burden of trauma seen at a Level I trauma center, using real-time data collected by the eTHR on consecutive patients during a 12-month study period. The study was conducted from October 1, 2010, to September 30, 2011, at Groote Schuur Hospital, Cape Town, South Africa. Data analysis was performed from October 15, 2011, to January 15, 2013. Main Outcomes and Measures The primary outcome of part 1 was data field competition rates of pertinent trauma registry items obtained through electronic or paper documentation. The main measures of part 2 were to identify risk factors to trauma in Cape Town and quality indicators recommended for trauma system evaluation at Groote Schuur Hospital. Results The 41 physicians included in the study found the electronic patient documentation to be more efficient and preferable. A total of 11 612 trauma presentations were accurately documented and promptly analyzed. Fields relevant to injury surveillance in the eTHR (n = 11 612) had statistically significant higher completion rates compared with paper records (n = 9236) (for all comparisons, P < .001). The eTHR successfully captured quality indicators recommended for trauma system evaluation which were previously challenging to collect in a timely and accurate manner. Of the 11 612 patient admissions over the study period, injury location was captured 11 075 times (95.4%), injury mechanism 11 135 times (95.9%), systolic blood pressure 11 106 times (95.6%), and Glasgow Coma Scale 11 140 times (95.9%). These fields were successfully captured with statistically higher rates than previous paper documentation. Epidemiologic analysis confirmed a heavy burden of violence-related injury (51.8% of all injuries) and motor vehicle crash injuries (14.3% of all injuries). Mapping analysis demonstrated clusters of injuries originating mainly from vulnerable and low-income neighborhoods and their respective referring trauma facilities, Mitchell's Plain Hospital (734 [10.1%]), Guguletu Community Health Center (654 [9.0%]), and New Somerset Hospital (400 [5.5%]). Conclusions and Relevance Accurate capture and simultaneous analysis of trauma data in low-resource trauma settings are feasible through the integration of surveillance into clinical workflow and the timely analysis of electronic data.
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Affiliation(s)
- Eiman Zargaran
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Richard Spence
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Lauren Adolph
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andrew Nicol
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Nadine Schuurman
- Department of Geography, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Pradeep Navsaria
- Department of Surgery, University of Cape Town, Cape Town, South Africa
| | - Damon Ramsey
- Input Health, Vancouver, British Columbia, Canada
| | - S Morad Hameed
- Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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19
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Baert V, Escutnaire J, Nehme Z, Mols P, Lagadec S, Vilhelm C, Jacob L, Wiel E, Adnet F, Hubert H. Development of an online, universal, Utstein registry-based, care practice report card to improve out-of-hospital resuscitation practices. J Eval Clin Pract 2018; 24:431-438. [PMID: 29356255 DOI: 10.1111/jep.12880] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/20/2017] [Accepted: 12/21/2017] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Care quality is a primary concern in health field. In France, the care practice report card (CPRC) is compulsory for practitioners. It is the first step towards the culture of excellence. In this context, practitioners have to assess and improve their practices. Competent authorities define registries as reliable sources for CPRC. The first aim of this work is to describe how we designed and built a universally transposable CPRC model based on an Utstein-style cardiac arrest registry. The second aim is to measure the adherence of practitioners to this approach and to show how such a tool can be used in real situation. METHODS Our report card is adapted from in-hospital CA care quality and safety indicators. We built a 2-section grid. The first part described the quality and completeness of the analysed data. The second part distinguished medical and traumatic CA and assesses care practices. We analysed the practitioners' adherence thanks to a satisfaction survey. Finally, we presented a CPRC case study. RESULTS This tool was tested in 92 centres gathering 8433 patients. The satisfaction survey showed that this CPRC was well accepted by emergency professionals. We presented an implementation example of this tool in a centre in real-life situation. CONCLUSIONS We designed and implemented a fully automated CPRC tool routinely usable for Utstein-style CA registries. This CPRC is easily transferable in all other Utstein CA registries. The debriefing report source codes are freely distributed upon request. This tool enables the care assessment and improvement.
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Affiliation(s)
- Valentine Baert
- French National Out-of-Hospital Cardiac Arrest Registry (RéAC), Lille, France.,Public Health Department (EA 2694), Lille University, Lille, France
| | - Joséphine Escutnaire
- French National Out-of-Hospital Cardiac Arrest Registry (RéAC), Lille, France.,Public Health Department (EA 2694), Lille University, Lille, France
| | - Ziad Nehme
- Department of Research and Evaluation, Ambulance Victoria, Doncaster, and Department of Epidemiology and Preventive Medicine, Monash University, Prahran, Victoria, Australia
| | - Pierre Mols
- Saint-Pierre University Hospital, Université Libre de Bruxelles, Bruxelles, Belgium
| | - Steven Lagadec
- Centre Sud-Francilien Hospital, Corbeil Essonnes, France
| | - Christian Vilhelm
- French National Out-of-Hospital Cardiac Arrest Registry (RéAC), Lille, France.,Public Health Department (EA 2694), Lille University, Lille, France
| | - Line Jacob
- Department of Emergency Medicine, SAMU 77, Melun, France
| | - Eric Wiel
- Public Health Department (EA 2694), Lille University, Lille, France.,Department of Emergency Medicine, SAMU du Nord and Emergency Department for Adults, Lille, France
| | - Frédéric Adnet
- AP-HP, Department of Emergency Medicine, Hôpital Avicenne, Inserm U942, Paris 13 University, Bobigny, France
| | - Hervé Hubert
- French National Out-of-Hospital Cardiac Arrest Registry (RéAC), Lille, France.,Public Health Department (EA 2694), Lille University, Lille, France
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- French National Out-of-Hospital Cardiac Arrest Registry (RéAC), Lille, France
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20
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Katayama Y, Kitamura T, Kiyohara K, Iwami T, Kawamura T, Hayashida S, Ogura H, Shimazu T. Factors associated with prehospital death among traffic accident patients in Osaka City, Japan: A population-based study. TRAFFIC INJURY PREVENTION 2018; 19:49-53. [PMID: 28658590 DOI: 10.1080/15389588.2017.1347645] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2017] [Accepted: 06/22/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Although it is important to assess the factors associated with traffic accident fatalities to decrease them as a matter of public health, such factors have not been fully identified. METHODS Using a large-scale data set of ambulance records in Osaka City, Japan, we retrospectively analyzed all traffic accident patients transported to hospitals by emergency medical service personnel from 2013 to 2014. In this study, prehospital death was defined as that occurring at the scene or in the emergency department immediately after hospital arrival. We assessed prehospital factors associated with prehospital death due to traffic accidents by logistic regression models. RESULTS This study enrolled 28,903 emergency patients involved in traffic accidents, of whom 68 died prehospital. In a multivariate model, elderly patients aged ≥75 years (adjusted odds ratio [AOR] = 4.34; 95% confidence interval [CI], 2.29-8.23), nighttime (AOR = 2.75; 95% CI, 1.65-4.70), and type of injured person compared to bicyclists such as pedestrians (AOR = 9.58; 95% CI, 5.07-17.99), motorcyclists (AOR = 2.75; 95% CI, 1.21-6.24), and car occupants (AOR = 2.98; 95% CI, 1.39-6.40) were significantly associated with prehospital death due to traffic accidents. In addition, the AOR for automobile versus nonautomobile as the collision opponent was 4.76 (95% CI, 2.30-9.88). CONCLUSIONS In this population, the factors associated with prehospital death due to traffic accidents were elderly people, nighttime, and pedestrian as the type of patient. The proportion of prehospital deaths due to traffic accidents was also high when the collision component was an automobile.
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Affiliation(s)
- Yusuke Katayama
- a Department of Traumatology and Acute Critical Medicine , Osaka University Graduate School of Medicine , Suita , Japan
| | - Tetsuhisa Kitamura
- b Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine , Osaka University , Suita , Japan
| | - Kosuke Kiyohara
- c Department of Public Health , Tokyo Women's Medical University , Tokyo , Japan
| | - Taku Iwami
- d Kyoto University Health Services , Kyoto , Japan
| | | | | | - Hiroshi Ogura
- a Department of Traumatology and Acute Critical Medicine , Osaka University Graduate School of Medicine , Suita , Japan
| | - Takeshi Shimazu
- a Department of Traumatology and Acute Critical Medicine , Osaka University Graduate School of Medicine , Suita , Japan
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21
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Wilson SL, Gangathimmaiah V. Does prehospital management by doctors affect outcome in major trauma? A systematic review. J Trauma Acute Care Surg 2017; 83:965-974. [PMID: 28590350 DOI: 10.1097/ta.0000000000001559] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is substantial variation worldwide in prehospital management of trauma and the role of doctors is controversial. The objective of this review was to determine whether prehospital management by doctors affects outcomes in major trauma, including the prespecified subgroup of severe traumatic brain injuries when compared with management by other advanced life support providers. METHODS EMBASE, MEDLINE(R), PubMed, SciELO, Trip, Web of Science, and Zetoc were searched for published articles. HSRProj, OpenGrey, and the World Health Organization International Clinical Trials Registry Platform were searched for unpublished data. Relevant reference lists were hand-searched. There were no limits on publication year, but articles were limited to the English language. Authors were contacted for further information as required. Quality was assessed using the Downs and Black criteria. Mortality was the primary outcome, and disability was the secondary outcome of interest. Studies were subjected to a descriptive analysis alone without a meta-analysis due to significant study heterogeneity. All searches, quality assessment, data abstraction, and data analysis was performed by two reviewers independently. RESULTS Two thousand thirty-seven articles were identified, 49 full-text articles assessed and eight studies included. The included studies consisted of one randomized controlled trial with 375 participants and seven observational studies with over 4,451 participants. All included studies were at a moderate to high risk of bias. Six of the eight included studies showed an improved outcome with prehospital management by doctors, five in terms of mortality and one in terms of disability. Two studies found no significant difference. CONCLUSION There appears to be an association between prehospital management by doctors and improved survival in major trauma. There may also be an association with improved survival and better functional outcomes in severe traumatic brain injury. Further high-quality evidence is needed to confirm these findings. LEVEL OF EVIDENCE Systematic review, level III.
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Affiliation(s)
- Stephanie Laura Wilson
- From the Emergency Department (S.W.), The Townsville Hospital; and Lifeflight Retrieval Medicine (V.G.), Townsville Base, Queensland, Australia
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23
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Haugland H, Rehn M, Klepstad P, Krüger A. Developing quality indicators for physician-staffed emergency medical services: a consensus process. Scand J Trauma Resusc Emerg Med 2017; 25:14. [PMID: 28202076 PMCID: PMC5311851 DOI: 10.1186/s13049-017-0362-4] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 02/10/2017] [Indexed: 12/24/2022] Open
Abstract
Background There is increasing interest for quality measurement in health care services; pre-hospital emergency medical services (EMS) included. However, attempts of measuring the quality of physician-staffed EMS (P-EMS) are scarce. The aim of this study was to develop a set of quality indicators for international P-EMS to allow quality improvement initiatives. Methods A four-step modified nominal group technique process (expert panel method) was used. Results The expert panel reached consensus on 26 quality indicators for P-EMS. Fifteen quality indicators measure quality of P-EMS responses (response-specific quality indicators), whereas eleven quality indicators measure quality of P-EMS system structures (system-specific quality indicators). Discussion When measuring quality, the six quality dimensions defined by The Institute of Medicine should be appraised. We argue that this multidimensional approach to quality measurement seems particularly reasonable for services with a highly heterogenic patient population and complex operational contexts, like P-EMS. The quality indicators in this study were developed to represent a broad and comprehensive approach to quality measurement of P-EMS. Conclusions The expert panel successfully developed a set of quality indicators for international P-EMS. The quality indicators should be prospectively tested for feasibility, validity and reliability in clinical datasets. The quality indicators should then allow for adjusted quality measurement across different P-EMS systems. Electronic supplementary material The online version of this article (doi:10.1186/s13049-017-0362-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Helge Haugland
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway. .,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway. .,Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marius Rehn
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Health Studies, University of Stavanger, Stavanger, Norway.,Division of Emergencies and Critical Care. Department of Anaesthesia, Oslo University Hospital, Oslo, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Anaesthesiology and Intensive Care, St. Olav University Hospital, Trondheim, Norway
| | - Andreas Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.,Department of Emergency Medicine and Pre-Hospital Services, St. Olavs Hospital, Trondheim, Norway.,Department of Circulation and Medical Imaging, Medical Faculty, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
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24
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Bieler D, Franke A, Lefering R, Hentsch S, Willms A, Kulla M, Kollig E. Does the presence of an emergency physician influence pre-hospital time, pre-hospital interventions and the mortality of severely injured patients? A matched-pair analysis based on the trauma registry of the German Trauma Society (TraumaRegister DGU ®). Injury 2017; 48:32-40. [PMID: 27586065 DOI: 10.1016/j.injury.2016.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE The role of emergency physicians in the pre-hospital management of severely injured patients remains controversial. In Germany and Austria, an emergency physician is present at the scene of an emergency situation or is called to such a scene in order to provide pre-hospital care to severely injured patients in approximately 95% of all cases. By contrast, in the United States and the United Kingdom, paramedics, i.e. non-physician teams, usually provide care to an injured person both at the scene of an incident and en route to an appropriate hospital. We investigated whether physician or non-physician care offers more benefits and what type of on-site care improves outcome. MATERIAL AND METHODS In a matched-pair analysis using data from the trauma registry of the German Trauma Society, we retrospectively (2002-2011) analysed the pre-hospital management of severely injured patients (ISS ≥16) by physician and non-physician teams. Matching criteria were age, overall injury severity, the presence of relevant injuries to the head, chest, abdomen or extremities, the cause of trauma, the level of consciousness, and the presence of shock. RESULTS Each of the two groups, i.e. patients who were attended by an emergency physician and those who received non-physician care, consisted of 1235 subjects. There was no significant difference between the two groups in pre-hospital time (61.1 [SD 28.9] minutes for the physician group and 61.9 [SD 30.9] minutes for non-physician group). Significant differences were found in the number of pre-hospital procedures such as fluid administration, analgosedation and intubation. There was a highly significant difference (p<0.001) in the number of patients who received no intervention at all applying to 348 patients (28.2%) treated by non-physician teams and to only 31 patients (2.5%) in the physician-treated group. By contrast, there was no significant difference in mortality within the first 24h and in mortality during hospitalisation. CONCLUSION This retrospective analysis does not allow definitive conclusions to be drawn about the optimal model of pre-hospital care. It shows, however, that there was no significant difference in mortality although patients who were attended by non-physician teams received fewer pre-hospital interventions with similar scene times.
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Affiliation(s)
- Dan Bieler
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany.
| | - Axel Franke
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany.
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), Witten/Herdecke University, Ostmerheimer Strasse 200, 51109 Cologne, Germany
| | - Sebastian Hentsch
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany
| | - Arnulf Willms
- Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany
| | - Martin Kulla
- Department of Anaesthesiology and Intensive Care, German Armed Forces Hospital of Ulm, Oberer Eselsberg 40, 89081 Ulm, Germany
| | - Erwin Kollig
- Department of Trauma Surgery and Orthopaedics, Reconstructive Surgery, Hand Surgery and Burn Medicine, German Armed Forces Central Hospital of Koblenz, Ruebenacher Strasse 170, 56072 Koblenz, Germany
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- Committee on Emergency Medicine, Intensive Care and Trauma Management (Sektion NIS) of the German Trauma Society (DGU), Germany
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Sun KM, Song KJ, Shin SD, Tanaka H, Shaun GE, Chiang WC, Kajino K, Jamaluddin SF, Kimura A, Ro YS, Wi DH, Park JO, Moon SW, Jung YH, Kim MJ, Holmes JF. Comparison of Emergency Medical Services and Trauma Care Systems Among Pan-Asian Countries: An International, Multicenter, Population-Based Survey. PREHOSP EMERG CARE 2016; 21:242-251. [DOI: 10.1080/10903127.2016.1241325] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Campbell OMR, Calvert C, Testa A, Strehlow M, Benova L, Keyes E, Donnay F, Macleod D, Gabrysch S, Rong L, Ronsmans C, Sadruddin S, Koblinsky M, Bailey P. The scale, scope, coverage, and capability of childbirth care. Lancet 2016; 388:2193-2208. [PMID: 27642023 DOI: 10.1016/s0140-6736(16)31528-8] [Citation(s) in RCA: 188] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 05/23/2016] [Accepted: 06/17/2016] [Indexed: 12/15/2022]
Abstract
All women should have access to high quality maternity services-but what do we know about the health care available to and used by women? With a focus on low-income and middle-income countries, we present data that policy makers and planners can use to evaluate whether maternal health services are functioning to meet needs of women nationally, and potentially subnationally. We describe configurations of intrapartum care systems, and focus in particular on where, and with whom, deliveries take place. The necessity of ascertaining actual facility capability and providers' skills is highlighted, as is the paucity of information on maternity waiting homes and transport as mechanisms to link women to care. Furthermore, we stress the importance of assessment of routine provision of care (not just emergency care), and contextualise this importance within geographic circumstances (eg, in sparsely-populated regions vs dense urban areas). Although no single model-of-care fits all contexts, we discuss implications of the models we observe, and consider changes that might improve services and accelerate response to future challenges. Areas that need attention include minimisation of overintervention while responding to the changing disease burden. Conceptualisation, systematic measurement, and effective tackling of coverage and configuration challenges to implement high quality, respectful maternal health-care services are key to ensure that every woman can give birth without risk to her life, or that of her baby.
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Affiliation(s)
| | - Clara Calvert
- London School of Hygiene & Tropical Medicine, London, UK
| | - Adrienne Testa
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lenka Benova
- London School of Hygiene & Tropical Medicine, London, UK
| | | | - France Donnay
- Tulane University School of Public Health, New Orleans, LA, USA
| | - David Macleod
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sabine Gabrysch
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
| | - Luo Rong
- National Center for Women and Children Health, Chinese Disease Prevention Control Center, Beijing, China
| | - Carine Ronsmans
- London School of Hygiene & Tropical Medicine, London, UK; West China School of Public Health, Sichuan University, Chengdu, China
| | | | - Marge Koblinsky
- USAID, Office of Health, Infectious Diseases and Nutrition, Maternal and Child Health, Washington, DC, USA
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Bahadori M, Ghardashi F, Izadi AR, Ravangard R, Mirhashemi S, Hosseini SM. Pre-Hospital Emergency in Iran: A Systematic Review. Trauma Mon 2016; 21:e31382. [PMID: 27626016 PMCID: PMC5003496 DOI: 10.5812/traumamon.31382] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 12/15/2015] [Accepted: 02/07/2016] [Indexed: 11/26/2022] Open
Abstract
CONTEXT Pre-hospital care plays a vital role in saving trauma patients. OBJECTIVES This study aims to review studies conducted on the pre-hospital emergency status in Iran. DATA SOURCES Data were sourced from Iranian electronic databases, including SID, IranMedex, IranDoc, Magiran, and non-Iranian electronic databases, such as Medline, Embase, Cochrane Library, Scopus, and Google Scholar. In addition, available data and statistics for the country were used. DATA SELECTION All Persian-language articles published in Iranian scientific journals and related English-language articles published in Iranian and non-Iranian journals indexed on valid sites for September 2005 - 2014 were systematically reviewed. DATA EXTRACTION To review the selected articles, a data extraction form developed by the researchers as per the study's objective was adopted. The articles were examined under two categories: structure and function of pre-hospital emergency. RESULTS A total of 19 articles were selected, including six descriptive studies (42%), four descriptive-analytical studies (21%), five review articles (16%), two qualitative studies (10.5%), and two interventional (experimental) studies (10.5%). In addition, of these, 14 articles (73.5%) had been published in the English language. The focus of these selected articles were experts (31.5%), bases of emergency medical services (26%), injured (16%), data reviews (16%), and employees (10.5%). A majority of the studies (68%) investigated pre-hospital emergency functions and 32% reviewed the pre-hospital emergency structure. CONCLUSIONS The number of studies conducted on pre-hospital emergency services in Iran is limited. To promote public health, consideration of prevention areas, processes to provide pre-hospital emergency services, policymaking, foresight, systemic view, comprehensive research programs and roadmaps, and assessments of research needs in pre-hospital emergency seem necessary.
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Affiliation(s)
- Mohammadkarim Bahadori
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Fatemeh Ghardashi
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ahmad Reza Izadi
- Health Management Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Ramin Ravangard
- School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Sedigheh Mirhashemi
- Trauma Research Centre, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Seyed Mojtaba Hosseini
- Department of Health Services Management, Tehran North Branch, Islamic Azad University, Tehran, IR Iran
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Kuzma K, Lim AG, Kepha B, Nalitolela NE, Reynolds TA. The Tanzanian trauma patients' prehospital experience: a qualitative interview-based study. BMJ Open 2015; 5:e006921. [PMID: 25916487 PMCID: PMC4420946 DOI: 10.1136/bmjopen-2014-006921] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVES We sought to characterise the prehospital experience of Tanzanian trauma patients, and identify barriers and facilitators to implement community-based emergency medical systems (EMS). SETTINGS Our study was conducted in the emergency department of an urban national referral hospital in Tanzania. PARTICIPANTS A convenience sample of 34 adult trauma patients, or surrogate family members, presenting or referred to an urban referral emergency department in Tanzania for treatment of injury, participated in the study. INTERVENTIONS Participation in semistructured, iteratively developed interviews until saturation of responses was reached. OUTCOMES A grounded theory-based approach to qualitative analysis was used to identify recurrent themes. RESULTS We characterised numerous deficiencies within the existing clinic-to-hospital referral network, including missed/delayed diagnoses, limited management capabilities at pre-referral facilities and interfacility transfer delays. Potential barriers to EMS implementation include patient financial limitations and lack of insurance, limited public infrastructure and resources, and the credibility of potential first aid responders. Potential facilitators of EMS include communities' tendency to pool resources, individuals' trust of other community members to be first aid responders, and faith in community leaders to organise EMS response. Participants expressed a strong desire to learn first aid. CONCLUSIONS The composite themes generated by the data suggest that there are myriad structural, financial, institutional and cultural barriers to the implementation of a formal prehospital system. However, our analysis also revealed potential facilitators to a first-responder system that takes advantage of close-knit local communities and the trust of recognised leaders in society. The results suggest favourable acceptability for community-based response by trained lay people. There is significant opportunity for care improvements with short trainings and low-cost supply planning. Further research looking at the effects of delay on outcomes in this population is needed.
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Affiliation(s)
- Kristin Kuzma
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - Andrew George Lim
- Division of Emergency Medicine, University of Washington—Harborview Medical Center, Seattle, Washington, USA
| | - Bernard Kepha
- Emergency Medicine, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | | | - Teri A Reynolds
- Emergency Medicine, University of California San Francisco, San Francisco, California, USA
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Rahman NH, Tanaka H, Shin SD, Ng YY, Piyasuwankul T, Lin CH, Ong MEH. Emergency medical services key performance measurement in Asian cities. Int J Emerg Med 2015; 8:12. [PMID: 25932052 PMCID: PMC4412872 DOI: 10.1186/s12245-015-0062-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 04/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background One of the key principles in the recommended standards is that emergency medical service (EMS) providers should continuously monitor the quality and safety of their services. This requires service providers to implement performance monitoring using appropriate and relevant measures including key performance indicators. In Asia, EMS systems are at different developmental phases and maturity. This will create difficultly in benchmarking or assessing the quality of EMS performance across the region. An attempt was made to compare the EMS performance index based on the structure, process, and outcome analysis. Findings The data was collected from the Pan-Asian Resuscitation Outcome Study (PAROS) data among few Asian cities, namely, Tokyo, Osaka, Singapore, Bangkok, Kuala Lumpur, Taipei, and Seoul. The parameters of inclusions were broadly divided into structure, process, and outcome measurements. The data was collected by the site investigators from each city and keyed into the electronic web-based data form which is secured strictly by username and passwords. Generally, there seems to be a more uniformity for EMS performance parameters among the more developed EMS systems. The major problem with the EMS agencies in the cities of developing countries like Bangkok and Kuala Lumpur is inadequate or unavailable data pertaining to EMS performance. Conclusions There is non-uniformity in the EMS performance measurement across the Asian cities. This creates difficulty for EMS performance index comparison and benchmarking. Hopefully, in the future, collaborative efforts such as the PAROS networking group will further enhance the standardization in EMS performance reporting across the region.
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Affiliation(s)
- Nik Hisamuddin Rahman
- Department of Emergency Medicine, School of Medical Sciences, University Sains Malaysia, Kota Bharu, 16150 Malaysia
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Chih-Hao Lin
- Department of Emergency Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
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Haner A, Örninge P, Khorram-Manesh A. The role of physician–staffed ambulances: the outcome of a pilot study. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(14)60086-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Brinck T, Handolin L, Paffrath T, Lefering R. Trauma registry comparison: six-year results in trauma care in Southern Finland and Germany. Eur J Trauma Emerg Surg 2014; 41:509-16. [PMID: 26037999 DOI: 10.1007/s00068-014-0470-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the treatment and survival of trauma patients in Germany and Southern Finland. METHODS Data from Helsinki University Hospital trauma registry (TR-THEL) and TraumaRegister DGU(®) (TR-DGU) were compared in a period from 2006 until 2011. From TR-DGU level-one trauma centers treating annually >50 injury severity score (ISS) >15 patients were included. The inclusion criterion was ISS >15. Patients under 16 years with penetrating trauma without head injury and transferred in with isolated head injury were excluded. The compared parameters were age, sex, pre-injury ASA, injury scoring, injury pattern, mechanism of injury, injury distribution, pre-hospital timings, transportation method, pre-hospital intubation, treatment at hospital, discharge destination, and 30-day hospital mortality. Expected mortality was defined with the Revised Injury Severity Classification score (RISC). RESULTS Eighty-five German level-one trauma centers were included. A total of 15,306 and 1,274 patients were included in the outcome analysis from TR-DGU and TR-THEL, respectively. The difference between the observed and expected mortality of all patients was -4.1% (standardized mortality ratio [SMR] 0.82) at German hospitals and -4.0% (SMR 0.79) in Helsinki. Differences in the pre- and in-hospital treatment between the two countries were noted (transportation method, intubation rate, intensive care unit treatment, ventilation time, length of stay). CONCLUSION The overall outcome results of the Helsinki University Hospital trauma unit were similar to those of the German level-one trauma centers. Registry comparison is a feasible method of quality control in a trauma centre.
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Affiliation(s)
- T Brinck
- Department of Orthopaedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital, Topeliuksenkatu 5, PB 266, FI-00029 HUS, Helsinki, Finland.
| | - L Handolin
- Department of Orthopaedics and Traumatology, Trauma Unit, Töölö Hospital, Helsinki University Hospital, Topeliuksenkatu 5, PB 266, FI-00029 HUS, Helsinki, Finland
| | - T Paffrath
- Department for Trauma Surgery and Orthopaedics, Faculty of Health, Cologne Merheim Medical Center, University of Witten/Herdecke, Cologne, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
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Wutzler S, Maegele M, Wafaisade A, Wyen H, Marzi I, Lefering R. Risk stratification in trauma and haemorrhagic shock: scoring systems derived from the TraumaRegister DGU(®). Injury 2014; 45 Suppl 3:S29-34. [PMID: 25284230 DOI: 10.1016/j.injury.2014.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Scoring systems commonly attempt to reduce complex clinical situations into one-dimensional values by objectively valuing and combining a variety of clinical aspects. The aim is to allow for a comparison of selected patients or cohorts. To appreciate the true value of scoring systems in patients with multiple injuries it is necessary to understand the different purposes of quantifying the severity of specific injuries and overall trauma load, being: (1) clinical decision making; (2) triage; (3) planning of trauma systems and resources; (4) epidemiological and clinical research; (5) evaluation of outcome and trauma systems, including quality assessment; and (6) estimation of costs and allocation of resources. For the first two, easy-to estimate scores with immediate availability are necessary, mainly based on initial physiology. More sophisticated scores considering age, gender, injury pattern/severity and more are usually used for research and outcome evaluation, once the diagnostic and therapeutic process has been completed. For score development large numbers of data are necessary and thus, it appears as a logical consequence that large registries as the TraumaRegister DGU(®) of the German Trauma Society (TR-DGU) are used to derive and validate clinical scoring systems. A variety of scoring systems have been derived from this registry, the majority of them with focus on hospital mortality. The most important among these systems is probably the RISC score, which is currently used for quality assessment and outcome adjustment in the annual audit reports. This report summarizes the various scoring systems derived from the TraumaRegister DGU(®) over the recent years.
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Affiliation(s)
- Sebastian Wutzler
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany.
| | - Marc Maegele
- Institute for Research in Operative Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany; Department of Orthopedics, Trauma and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Arasch Wafaisade
- Institute for Research in Operative Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany; Department of Orthopedics, Trauma and Sports Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
| | - Hendrik Wyen
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, Hospital of the Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine, Cologne Merheim Medical Center (CMMC), University of Witten/Herdecke, Cologne, Germany
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Alghnam S, Palta M, Hamedani A, Remington PL, Alkelya M, Albedah K, Durkin MS. In-hospital mortality among patients injured in motor vehicle crashes in a Saudi Arabian hospital relative to large U.S. trauma centers. Inj Epidemiol 2014; 1:21. [PMID: 26613073 PMCID: PMC4648961 DOI: 10.1186/s40621-014-0021-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 07/23/2014] [Indexed: 11/10/2022] Open
Abstract
Background Traffic-related fatalities are a leading cause of premature death worldwide. According to the 2012 report the Global Burden of Disease 2010, traffic injuries ranked 8th as a cause of death in 2010, compared to 10th in 1990. Saudi Arabia is estimated to have an overall traffic fatality rate more than double that of the U.S., but it is unknown whether mortality differences also exist for injured patients seeking medical care. We aim to compare in-hospital mortality between Saudi Arabia and the United States, adjusting for severity and demographic variables. Methods The analysis included 485,611 patients from the U.S. National Trauma Data Bank (NTDB) and 5,290 patients from a trauma registry at King Abdulaziz Medical City (KAMC) in Riyadh, Saudi Arabia. For comparability, we restricted our sample to NTDB data from level-I public trauma centers (≥400 beds) in the U.S. Multiple logistic regression analyses were performed to evaluate the effect of setting (KAMC vs. NTDB) on in-hospital mortality after adjusting for age, sex, Triage-Revised Scale (T-RTS), Injury Severity Score (ISS), mechanism of injury, hypotension, surgery and head injuries. Interactions between setting and ISS, and predictors were also evaluated. Results Injured patients in the Saudi registry were more likely to be males, and younger than those from the NTDB. Patients at the Saudi hospital were at higher risk of in-hospital death than their U.S. counterparts. In the highest severity group (ISSs, 25–75), the odds ratio of in-hospital death in KAMC versus NTDB was 5.0 (95% CI 4.3-5.8). There were no differences in mortality between KAMC and NTDB among patients from lower ISS groups (ISSs, 1–8, 9–15, and 16–24). Conclusions Patients who are severely injured following traffic crash injuries in Saudi Arabia are significantly more likely to die in the hospital than comparable patients admitted to large U.S. trauma centers. Further research is needed to identify reasons for this disparity and strategies for improving the care of patients severely injured in traffic crashes in Saudi Arabia. Electronic supplementary material The online version of this article (doi:10.1186/s40621-014-0021-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Suliman Alghnam
- Postdoctoral Researcher, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Mari Palta
- Population Health Sciences, University of Wisconsin-Madison, Madison, WI USA
| | - Azita Hamedani
- Emergency Medicine, University of Wisconsin-Madison, Madison, WI USA
| | - Patrick L Remington
- Population Health Sciences, University of Wisconsin-Madison, Madison, WI USA
| | - Mohamed Alkelya
- Research Scientist, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, KAIMRC, KSAU-HS, Riyadh, Saudi Arabia
| | - Khalid Albedah
- Consultant Surgeon, Department of Surgery, King Abdulaziz Medical City, Riyadh Saudi Arabia
| | - Maureen S Durkin
- Population Health Sciences, University of Wisconsin-Madison, Madison, WI USA
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Metelmann C, Metelmann B, Wendt M, Meissner K, von der Heyden M. LiveCity. INTERNATIONAL JOURNAL OF ELECTRONIC GOVERNMENT RESEARCH 2014. [DOI: 10.4018/ijegr.2014070104] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The goal of emergency medicine is to treat time-critical diseases and conditions to reduce morbidity and mortality. The improvement of emergency medicine is an important topic for governments worldwide. A common problem is the inevitable lack of support by emergency doctors, when paramedics need their assistance at the emergency site but are without an emergency doctor. Video-communication in real time from the emergency site to an emergency doctor, offers an opportunity to enhance the quality of emergency medicine. The core piece of this study is a video camera system called “LiveCity camera”, enabling real-time high quality video connection of paramedics and emergency doctors. The impact of video communication on emergency medicine is clearly appreciated among providers, based upon the extent of agreement that has been stated in this study´s questionnaire by doctors and paramedics. This study is part of the FP7-European Union funded research project “LiveCity” (Grant Agreement No. 297291).
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Affiliation(s)
- Camilla Metelmann
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bibiana Metelmann
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Michael Wendt
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Konrad Meissner
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Martin von der Heyden
- Klinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerzmedizin, Universitätsmedizin Greifswald, Greifswald, Germany
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Adib-Hajbaghery M, Maghaminejad F. Epidemiology of patients with multiple trauma and the quality of their prehospital respiration management in kashan, iran: six months assessment. ARCHIVES OF TRAUMA RESEARCH 2014; 3:e17150. [PMID: 25147774 PMCID: PMC4139695 DOI: 10.5812/atr.17150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/25/2013] [Revised: 06/21/2014] [Accepted: 06/22/2014] [Indexed: 11/16/2022]
Abstract
Background: Respiration management is an important and critical issue in prehospital transportation phase of multiple trauma patients. However, the quality of this important care has not been assessed in Iran Emergency Medical Services’ (EMS). Objectives: This study was conducted to investigate the quality of prehospital respiration management in patients with multiple trauma, referred to the Shahid Beheshti Trauma Center, Kashan, Iran. Patients and Methods: This cross-sectional study was conducted in the first six months of 2013. All the 400 patients with multiple trauma, transferred by EMS to the Shahid Beheshti Medical Center, were recruited. The study instrument was a checklist, which was completed through observation. Descriptive statistics were presented. Results: Out of all included individuals, 301 were males (75.2%) and 99 were females (24.8%). The most common mechanism of trauma was traffic accident (87.25%). Furthermore, 71.7% of the patients were injured in head and neck and chest areas. The quality of consciousness monitoring and airway management was desirable in 95% of the cases. However, the quality of monitoring patients’ respiration was only desirable in 42% of the cases. Only 18.6% of the patients received oxygen therapy during prehospital transportation. Conclusions: The quality of monitoring patients’ respiration and oxygen therapy was undesirable in most patients with multiple trauma. Therefore, the EMS workers should be retrained to apply proper respiration management in patients with multiple trauma.
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Affiliation(s)
- Mohsen Adib-Hajbaghery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Farzaneh Maghaminejad
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
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Nutbeam T, Fenwick R, Hobson C, Holland V, Palmer M. Extrication time prediction tool. Emerg Med J 2014; 32:401-3. [PMID: 24743587 DOI: 10.1136/emermed-2013-202864] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 03/29/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for extrication or the factors which affect this time. OBJECTIVE To derive a tool to predict the time taken to extricate patients from MVCs. METHODS A prospective, observational derivation study was carried out in the West Midland Fire Service's metropolitan area. An expert group identified factors that may predict extrication time-the presence and absence of these factors was prospectively recorded at eligible extrications for the study period. A step-down multiple regression method was used to identify important contributing factors. RESULTS Factors that increased extrication times by a statistically significant extent were: a physical obstruction (10 min), patients medically trapped (10 min per patient) and any patient physically trapped (7 min). Factors that shortened extrication time were rapid access (-7 min) and the car being on its roof (-12 min). All these times were calculated from an arbitrary time (which assumes zero patients) of 8 min. CONCLUSIONS This paper describes the development of a tool to predict extrication time for a trapped patient. A number of factors were identified which significantly contributed to the overall extrication time.
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Affiliation(s)
- Tim Nutbeam
- The Emergency Department, Derriford Hospital Plymouth, UK
| | - Rob Fenwick
- Emergency Department, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK
| | | | - Vikki Holland
- Integrated Risk Management, West Midlands Fire Service, Birmingham, UK
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Adib-Hajbaghery M, Maghaminejad F, Paravar M. The quality of pre-hospital oxygen therapy in patients with multiple trauma: a cross-sectional study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2014; 16:e14274. [PMID: 24829770 PMCID: PMC4005432 DOI: 10.5812/ircmj.14274] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 12/24/2013] [Accepted: 01/11/2014] [Indexed: 11/16/2022]
Abstract
Background: Trauma is a major healthcare challenge worldwide. In developing countries, most road deaths happen during the pre-hospital phase; consequently, pre-hospital trauma care has received considerable attention during the past decades. Objectives: The aim of this study was to investigate the quality of pre-hospital oxygen therapy in patients with multiple trauma. Patients and Methods: This cross-sectional study was conducted in the year 2013. The study population consisted of all patients with multiple trauma who had been transferred by emergency medical services to the central trauma department in Shahid Beheshti Medical Center, Kashan, Iran. The data collection instrument had three parts including demographic, a trauma assessment, and an oxygen therapy quality assessment questionnaires that were designed by the researchers. In total, 350 patients with multiple trauma were recruited from March through July 2013. Data were described by using frequency tables, central tendency measures, and variability indices. Moreover, we analyzed data by using the Chi-square test, Mann-Whitney U test, and the logistic regression analysis. Results: The study sample consisted of 263 (75.1%) male and 87 (24.9%) female patients. Overall, 211 patients needed oxygen therapy during the pre-hospital phase; however, only 35 (16.60%) patients had received oxygen. The quality of oxygen therapy was undesirable in 92.42% of cases. In addition, 83.4% of patients, whose pre-hospital records indicated the administration of oxygen, reported that they had not received oxygen therapy. Logistic regression analysis revealed that the place of accident and the level of patients' education were significant predictors for administration of oxygen during the pre-hospital phase (P < 0.001). Conclusions: The quality of pre-hospital oxygen therapy had been provided for the patients with multiple trauma was poor while these patients, particularly patients with chest traumas and head injuries, were in urgent need of oxygen therapy. Consequently, developing and implementing standard evidence-based oxygen therapy protocols and administrating continuous education programs are recommended.
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Affiliation(s)
- Mohsen Adib-Hajbaghery
- Trauma Nursing Research Centre, Kashan University of Medical Sciences, Kashan, IR Iran
- Corresponding Author: Mohsen Adib-Hajbaghery, Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, IR Iran. Tel.: +98-3615550021, Fax: +98-3615556633, E-mail:
| | - Farzaneh Maghaminejad
- Trauma Nursing Research Centre , Medical Surgical Nursing Department, Faculty of Nursing and Midwifery, Kashan University of Medical Sciences, Kashan, IR Iran
| | - Mohammad Paravar
- Trauma Nursing Research Centre, Kashan University of Medical Sciences, Kashan, IR Iran
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Blom MC, Aspelin L, Ivarsson K. Propensity for performing interventions in pre-hospital trauma management - a comparison between physicians and non-physicians. J Trauma Manag Outcomes 2014; 8:3. [PMID: 24502224 PMCID: PMC3942262 DOI: 10.1186/1752-2897-8-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 02/04/2014] [Indexed: 11/26/2022]
Abstract
Background In 2005, the Advanced Life Support (ALS) teams delivering pre-hospital care in RegionSkane in southern Sweden received additional support by physicians, who were part of “Pre-hospital acute teams” (PHAT). The study objective is to compare the incidence of pre-hospital medical interventions for trauma-patients cared for by conventional ALS teams and patients who received additional support by PHAT. Methods Trauma patients with Injury Severity Score (ISS) >9 were identified retrospectively in the national quality registry KVITTRA at three hospitals in RegionSkane, for the time period October 2005 to December 2008. Interventions include e.g. tracheal intubation, administration of i.v. fluids, neck immobilization and spine board usage. Confounding effects from trauma severity, trauma mechanism, vital parameters, age and sex were addressed in multivariate models. Results Data from 202 cases was included. 9 pre-hospital interventions were assessed. The incidence of endotracheal intubation and immobilisation of extremities was higher among patients in the PHAT-group compared to the ALS-only group (16.3% vs. 6.9%, p = 0.034) and (12.8% vs. 4.3%, p = 0.027) respectively. PHATs presence remained a significant predictor of these interventions also after taking confounding factors into account (OR 5.5, CL 1.5-19.7) and (OR 3.2 CI 1.0-9.8). PHAT was involved in a greater proportion of cases with <50.0% of survival (19.8% vs. 12.1%, p = 0.134). The average ISS was higher among cases receiving PHAT support in strata ISS 16-24 and ISS > 24 than cases in corresponding strata cared for by ALS teams alone (ISS 20.0 vs. 17.0, p = 0.048 and ISS 34.0 vs. 29.0, p = 0.019). Conclusions The incidence of endotracheal intubation and immobilization of extremities was greater among patients supported by PHAT, compared to patients cared for by ALS teams alone. This finding has to be interpreted in the light of a selection-bias where PHAT support was directed to more severely injured patients.
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Affiliation(s)
- Mathias C Blom
- IKVL, Medicine, Lund University, IKVL/Avd för medicin, Hs 32, EA-blocket, plan 2, Universitetssjukhuset, Lund SE 221 85, Sweden.
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Nutbeam T, Fenwick R, Hobson C, Holland V, Palmer M. The stages of extrication: a prospective study. Emerg Med J 2013; 31:1006-8. [PMID: 24005643 DOI: 10.1136/emermed-2013-202668] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Many patients will require extrication following a motor vehicle collision (MVC). Little information exists on the time taken for the various stages of extrication. OBJECTIVE To report the time taken for the various stages of extrication. METHODS A prospective, observational study carried out in the West Midland Fire Service's metropolitan area. Time points related to extrication were collected 'live' by two-way radio broadcast. Any missing data were actively gathered by fire control within 1 h of completion of extrication. This paper reports an interim analysis conducted after 1 year of data collection following a 3-month run-in and training period: data were analysed from 1 January 2011 to 31 December 2011 inclusive. RESULTS During the study period 228 incidents were identified. Seventy-nine were excluded as they met the predetermined exclusion criteria or had incomplete data collection. This left 158 extrications that were suitable for analysis. The median time for extrication was 30 min, IQR 24-38 min. CONCLUSIONS In patients requiring extrication following an MVC a median time of 8 min is typically required before initial limited patient assessment and intervention. A further 22 min is typically required before full extrication. Prehospital personnel should be aware of these times when planning their approach to a trapped patient.
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Affiliation(s)
- Tim Nutbeam
- Department of Emergency Medicine, Derriford Hospital, Plymouth, Devon, UK
| | - Rob Fenwick
- Shrewsbury and Telford Hospitals NHS Trust, UK
| | | | - Vikki Holland
- Integrated Risk Management, West Midlands Fire Service, Birmingham, UK
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Al-Shaqsi S, Al-Kashmiri A, Al-Hajri H, Al-Harthy A. Emergency medical services versus private transport of trauma patients in the Sultanate of Oman: a retrospective audit at the Sultan Qaboos University Hospital. Emerg Med J 2013; 31:754-7. [PMID: 23825061 DOI: 10.1136/emermed-2013-202779] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS This study aims to assess the differences in the outcome of road traffic trauma patients between those transported by emergency medical services (EMS) and those privately transported to the Sultan Qaboos University Hospital in the Sultanate of Oman in 2011. METHODS This is a retrospective study of road traffic trauma patients admitted to the Sultan Qaboos University Hospital between January to December 2011. Data for all cases were retrieved from the emergency department database. The general linear multivariate regression analysis model was performed to test the differences in outcome. The analysis controlled for age, gender, ethnicity, weekend injury, time of injury, triage status, Injury Severity Score, existence of head injury, need for intensive care unit admission and need for surgical management. RESULTS There were 821 trauma cases in 2011. 66.7% were transported by EMS. Male patients represented 65.7% of the cases. There was no significant difference in the characteristics of EMS and non-EMS trauma patients. In terms of inhospital mortality, the relative ratio of inhospital mortality between EMS and non-EMS groups was 0.64 (0.36-1.13), and p value 0.13. There is no significant difference in all other secondary outcomes tested. CONCLUSIONS EMS transported trauma patients had a statistically non-significant 36% reduction in mortality compared with privately transported patients admitted to the Sultan Qaboos University Hospital in 2011. Further, research that incorporates prehospital factors such as crash to arrival of EMS services and transport time to definitive healthcare facility should be conducted to evaluate the effectiveness of such a system in trauma care. Since non-EMS transport is likely to continue, public first aid training is critical to reduce mortality and morbidity of road traffic trauma in Oman.
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Affiliation(s)
- Sultan Al-Shaqsi
- Preventive and Social Medicine, University of Otago, Dunedin School of Medicine, Dunedin, New Zealand
| | - Ammar Al-Kashmiri
- Emergency Department, Khoula Hospital, Ministry of Health, Muscat, Sultanate of Oman
| | - Hamood Al-Hajri
- Emergency Medicine Resident, Oman Medical Speciality Board, Muscat, Sultanate of Oman
| | - Abdullah Al-Harthy
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Sultanate of Oman
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Totten V, Bellou A. Development of emergency medicine in Europe. Acad Emerg Med 2013; 20:514-21. [PMID: 23672367 DOI: 10.1111/acem.12126] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 11/26/2012] [Accepted: 11/30/2012] [Indexed: 11/28/2022]
Abstract
Emergency medicine (EM) is emerging worldwide. Its development as a recognized specialty is proceeding at difference rates in different countries. Europe is a region with complex political affiliations and is composed of countries both within and outside the European Union (EU). Europe is seeking greater standardization (harmonization) for mutually improved economic development. Medicine in general, and EM in particular, is no exception. In Europe, as in other regions, EM is struggling for acceptance as a valid field of specialization. The European Union of Medical Specialists requires that once two-fifths of countries acknowledge a specialty, all EU countries must address the question. EM had achieved the needed majority by 2011. This article briefly describes the European road to specialty acceptance.
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Affiliation(s)
- Vicken Totten
- University Hospitals Case Medical Center; Case School of Medicine ; Cleveland; OH
| | - Abdelouahab Bellou
- President of the European Society for Emergency Medicine; Faculty of Medicine; University Hospital ; Rennes; France
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Mand C, Müller T, Lefering R, Ruchholtz S, Kühne CA. A comparison of the treatment of severe injuries between the former East and West German States. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:203-10. [PMID: 23589743 DOI: 10.3238/arztebl.2013.0203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 12/10/2012] [Indexed: 11/27/2022]
Abstract
BACKGROUND The annual number of persons killed in road-traffic accidents in Germany declined by 36% from 2001 to 2008, yet official traffic statistics still reveal a marked difference in fatalities between the federal states of the former East and West Germany twenty years after German reunification. METHODS We retrospectively analyzed data from the Trauma Registry of the German Trauma Society (Deutsche Gesellschaft für Unfallchirurgie; TR-DGU). Patients receiving primary treatment that had an Injury Severity Score (ISS) of 9 or above were analyzed separately depending on whether they were treated in the former East Germany or the former West Germany. RESULTS Data were obtained from a total of 26 866 road-accident trauma cases. With Berlin excluded, 2597 cases (10.2%) were from the former East Germany (EG), and 22 966 (89.9%) were from the former West Germany (WG). The percentage of the population living in these two parts of the country is 16.7% and 83.3%, respectively. The two groups did not differ significantly in either the mortality of injuries (EG 15.8%, WG 15.7%) or in the standardized mortality rate (0.89 [EG] vs. 0.88 [WG]). Over the years 2002-2008, the mean time to arrival of the emergency medical services on the scene was 19 minutes (EG) vs. 17 minutes (WG), and the mean time to arrival in hospital was 76 minutes (EG) vs. 69 minutes (WG). CONCLUSION Among the hospitals whose cases are included in the TR-DGU, there is no significant difference between the former East and West Germany with respect to mortality or any other clinically relevant variable. Hypothetically, the higher rate of death from road-traffic accidents in the former East Germany, as revealed by national traffic statistics, might be attributable to a difference in the quality of care received by trauma patients, but no such difference was found. Other potential reasons for it might be poorer road conditions, more initially fatal accidents, and lower accessibility of medical care in less densely populated areas.
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Affiliation(s)
- Carsten Mand
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Giessen and Marburg GmbH, Campus Marburg, Germany
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Hoogervorst EM, van Beeck EF, Goslings JC, Bezemer PD, Bierens JJLM. Developing process guidelines for trauma care in the Netherlands for severely injured patients: results from a Delphi study. BMC Health Serv Res 2013; 13:79. [PMID: 23452394 PMCID: PMC3621215 DOI: 10.1186/1472-6963-13-79] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 02/14/2013] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In organised trauma systems the process of care is the key to quality. Nevertheless, the optimal process of trauma care remains unclear due to lack of or inconclusive evidence. Because monitoring and improving the performance of a trauma system is complex, this study aimed to develop consensus-based process guidelines for trauma care in the Netherlands for severely injured patients. METHODS A five-round Delphi study was conducted with 141 participants that represent all professions involved in trauma care. Sensitivity analyses were carried out to evaluate whether consensus extended across all professions and to detect possible bias. RESULTS Consensus was reached on 21 guidelines within 4 categories: timeliness, actions, competent teams and interdisciplinary process. Timeliness guidelines set specific critical limits and definitions for 10 time intervals in the time period from an emergency call until the patient leaves the trauma room. Action guidelines reflect aspects of appropriate care and strongly rely on the international Advanced Trauma Life Support principles. Competence guidelines include flow charts to assess the competence of prehospital and emergency department teams. Essential to competent teams are education and experience of all team members. The interdisciplinary process guideline focuses on cooperation, communication and feedback within and between all professions involved. Consensus was extended across all professions and no bias was detected. CONCLUSIONS In this Delphi study, a large expert panel agreed on a set of guidelines describing the optimal process of care for severely injured trauma patients in the Netherlands. In addition to time intervals and appropriate actions, these guidelines emphasise the importance of team competence and interdisciplinary processes in trauma care. The guidelines can be seen as a description of a best practice and a new field standard in the Netherlands. The next step is to implement the guidelines and monitor the performance of the Dutch trauma system based on the guidelines.
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Sakran JV, Greer SE, Werlin E, McCunn M. Care of the injured worldwide: trauma still the neglected disease of modern society. Scand J Trauma Resusc Emerg Med 2012; 20:64. [PMID: 22980446 PMCID: PMC3518175 DOI: 10.1186/1757-7241-20-64] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 09/11/2012] [Indexed: 11/10/2022] Open
Abstract
Traditionally, surgical diseases including emergency and injury care have garnered less attention and support internationally when compared to other medical specialties. Over the past decade however, healthcare professionals have increasingly advocated for the need to address the global burden of non-communicable diseases. Surgical disease, including traumatic injury, is among the top causes of death and disability worldwide and the subsequent economic burden is substantial, falling disproportionately on low- and middle-income countries (LMICs). The future of global health in these regions depends on a redirection of attention to diseases managed within surgical, anesthesia and emergency specialties. Increasing awareness of these disparities, as well as increasing focus in the realms of policy and advocacy, is crucial. While the barriers to providing quality trauma and emergency care worldwide are not insurmountable, we must work together across disciplines and across boundaries in order to negotiate change and reduce the global burden of surgical disease.
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Affiliation(s)
- Joseph V Sakran
- Department of Surgery, Medical University of South Carolina, 96 Jonathan Lucas Street (MSC 613/CSB 420), Charleston, SC 29425-6130, USA.
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Willenberg L, Curtis K, Taylor C, Jan S, Glass P, Myburgh J. The variation of acute treatment costs of trauma in high-income countries. BMC Health Serv Res 2012; 12:267. [PMID: 22909225 PMCID: PMC3523961 DOI: 10.1186/1472-6963-12-267] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 08/14/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND In order to assist health service planning, understanding factors that influence higher trauma treatment costs is essential. The majority of trauma costing research reports the cost of trauma from the perspective of the receiving hospital. There has been no comprehensive synthesis and little assessment of the drivers of cost variation, such as country, trauma, subgroups and methods. The aim of this review is to provide a synthesis of research reporting the trauma treatment costs and factors associated with higher treatment costs in high income countries. METHODS A systematic search for articles relating to the cost of acute trauma care was performed and included studies reporting injury severity scores (ISS), per patient cost/charge estimates; and costing methods. Cost and charge values were indexed to 2011 cost equivalents and converted to US dollars using purchasing power parities. RESULTS A total of twenty-seven studies were reviewed. Eighty-one percent of these studies were conducted in high income countries including USA, Australia, Europe and UK. Studies either reported a cost (74.1%) or charge estimate (25.9%) for the acute treatment of trauma. Across studies, the median per patient cost of acute trauma treatment was $22,448 (IQR: $11,819-$33,701). However, there was variability in costing methods used with 18% of studies providing comprehensive cost methods. Sixty-three percent of studies reported cost or charge items incorporated in their cost analysis and 52% reported items excluded in their analysis. In all publications reviewed, predictors of cost included Injury Severity Score (ISS), surgical intervention, hospital and intensive care, length of stay, polytrauma and age. CONCLUSION The acute treatment cost of trauma is higher than other disease groups. Research has been largely conducted in high income countries and variability exists in reporting costing methods as well as the actual costs. Patient populations studied and the cost methods employed are the primary drivers for the treatment costs. Targeted research into the costs of trauma care is required to facilitate informed health service planning.
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Affiliation(s)
| | - Kate Curtis
- Sydney nursing school, University of Sydney, 88 Mallet St, Camperdown, Australia
- St George Hospital, Gray St, Kogarah, Australia
| | - Colman Taylor
- The George Institute for Global Health, Kent St, Sydney, Australia
| | - Stephen Jan
- The George Institute for Global Health, Kent St, Sydney, Australia
| | - Parisa Glass
- The George Institute for Global Health, Kent St, Sydney, Australia
| | - John Myburgh
- The George Institute for Global Health, Kent St, Sydney, Australia
- St George Hospital, Gray St, Kogarah, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Ogilvie R, McCloughen A, Curtis K, Foster K. The experience of surviving life-threatening injury: a qualitative synthesis. Int Nurs Rev 2012; 59:312-20. [DOI: 10.1111/j.1466-7657.2012.00993.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Krüger AJ, Lockey D, Kurola J, Di Bartolomeo S, Castrén M, Mikkelsen S, Lossius HM. A consensus-based template for documenting and reporting in physician-staffed pre-hospital services. Scand J Trauma Resusc Emerg Med 2011; 19:71. [PMID: 22107787 PMCID: PMC3282653 DOI: 10.1186/1757-7241-19-71] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Accepted: 11/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background Physician-staffed pre-hospital units are employed in many Western emergency medical services (EMS) systems. Although these services usually integrate well within their EMS, little is known about the quality of care delivered, the precision of dispatch, and whether the services deliver a higher quality of care to pre-hospital patients. There is no common data set collected to document the activity of physician pre-hospital activity which makes shared research efforts difficult. The aim of this study was to develop a core data set for routine documentation and reporting in physician-staffed pre-hospital services in Europe. Methods Using predefined criteria, we recruited sixteen European experts in the field of pre-hospital care. These experts were guided through a four-step modified nominal group technique. The process was carried out using both e-mail-based communication and a plenary meeting in Stavanger, Norway. Results The core data set was divided into 5 sections: "fixed system variables", "event operational descriptors", " patient descriptors", "process mapping", and "outcome measures and quality indicators". After the initial round, a total of 361 variables were proposed by the experts. Subsequent rounds reduced the number of core variables to 45. These constituted the final core data set. Emphasis was placed on the standardisation of reporting time variables, chief complaints and diagnostic and therapeutic procedures. Conclusions Using a modified nominal group technique, we have established a core data set for documenting and reporting in physician-staffed pre-hospital services. We believe that this template could facilitate future studies within the field and facilitate standardised reporting and future shared research efforts in advanced pre-hospital care.
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Affiliation(s)
- Andreas J Krüger
- Department of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway.
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Al-Shaqsi S. Models of International Emergency Medical Service (EMS) Systems. Oman Med J 2011; 25:320-3. [PMID: 22043368 DOI: 10.5001/omj.2010.92] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/27/2010] [Indexed: 11/03/2022] Open
Affiliation(s)
- Sultan Al-Shaqsi
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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