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Jana A, Sarkar A, Parmar V, Saunik S. Examining district-level disparity and determinants of timeliness of emergency medical services in Maharashtra, India. Sci Rep 2023; 13:21239. [PMID: 38040797 PMCID: PMC10692338 DOI: 10.1038/s41598-023-48713-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 11/29/2023] [Indexed: 12/03/2023] Open
Abstract
The quality of emergency medical services remains a major public health issue in developing countries in terms of access, availability, or timely delivery, owing to high socio-economic and ethnic disparities. Particularly, the timeliness of EMS remains a drawback, leading to higher mortality and morbidity. The aim of the study is to assess the district-level differences and factors that influence ambulance travel time, as there was no study done in the Indian scenario. Sequential Explanatory Design was applied here, which involved a descriptive study and spatial analysis of the call volume and distribution to understand the operational challenges of MEMS, followed by in-depth interviews among medical officers and officials to explore the reasons for the challenges. The data, shared by the Department of Health, Government of Maharashtra, consisted of 38,823 records (emergency: 16,197 and hospital-to-hospital transfer: 22,626), including emergency and hospital-to-hospital transfer calls across 36 districts of Maharashtra for November 2022. Spatial analyses were performed to identify the districts with challenges of timeliness. The average ambulance response time (T) across the districts was reported at 134.5 min for emergency cases and 222.80 min for hospital-to-hospital transfer cases. The total ambulance response time, was classified as preparation time (t1:3.53 min for emergency, 3.69 min for hospital-to-hospital transfer), travel time from base to scene (t2: 23.15 min for emergency, 17.18 min for hospital-to-hospital transfer), time required at scene (t3: 12.12 min for emergency, 14.72 min for hospital-to-hospital transfer), travel time from scene to hospital (t4:39.41 min for emergency, 74.34 min for hospital-to-hospital transfer), patient handover time (t5: 10.85 min for emergency, 13.84 min for hospital-to-hospital transfer), and return from base to hospital (t6: 41.89 min for emergency, 94.72 min for hospital-to-hospital transfer). Multivariate linear regression was conducted to investigate the factors that influence ambulance travel time. The finding identifies that the ambulance travel time increased for the districts with lesser population density, lower road density, fewer hospitals, a higher district area served per ambulance, and a higher population served per ambulance. Additionally, socio-cultural reasons affecting health-seeking behaviour, early closing of healthcare centres, undercapacity and resource-deficit healthcare centres, and overloading of specialised tertiary hospitals were identified as determinants of delay in patient assessment and handover time in qualitative findings. A decisive and multi-sectoral approach is required to address the timeliness of EMS in the Indian context.
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Affiliation(s)
- Arnab Jana
- Centre for Urban Science and Engineering, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra, India.
| | - Ahana Sarkar
- Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra, India
| | - Vipul Parmar
- Centre for Urban Science and Engineering, Indian Institute of Technology Bombay, Powai, Mumbai, Maharashtra, India
| | - Sujata Saunik
- Administrative Reforms, Office and Management, Government of Maharashtra, Mumbai, India
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Heidet M, Benjamin Leung KH, Bougouin W, Alam R, Frattini B, Liang D, Jost D, Canon V, Deakin J, Hubert H, Christenson J, Vivien B, Chan T, Cariou A, Dumas F, Jouven X, Marijon E, Bennington S, Travers S, Souihi S, Mermet E, Freyssenge J, Arrouy L, Lecarpentier E, Derkenne C, Grunau B. Improving EMS response times for out-of-hospital cardiac arrest in urban areas using drone-like vertical take-off and landing air ambulances: An international, simulation-based cohort study. Resuscitation 2023; 193:109995. [PMID: 37813148 DOI: 10.1016/j.resuscitation.2023.109995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/12/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Advances in vertical take-off and landing (VTOL) technologies may enable drone-like crewed air ambulances to rapidly respond to out-of-hospital cardiac arrest (OHCA) in urban areas. We estimated the impact of incorporating VTOL air ambulances on OHCA response intervals in two large urban centres in France and Canada. METHODS We included adult OHCAs occurring between Jan. 2017-Dec. 2018 within Greater Paris in France and Metro Vancouver in Canada. Both regions utilize tiered OHCA response with basic (BLS)- and advanced life support (ALS)-capable units. We simulated incorporating 1-2 ALS-capable VTOL air ambulances dedicated to OHCA response in each study region, and computed time intervals from call reception by emergency medical services (EMS) to arrival of the: (1) first ALS unit ("call-to-ALS arrival interval"); and (2) first EMS unit ("call-to-first EMS arrival interval"). RESULTS There were 6,217 OHCAs included during the study period (3,760 in Greater Paris and 2,457 in Metro Vancouver). Historical median call-to-ALS arrival intervals were 21 min [IQR 16-29] in Greater Paris and 12 min [IQR 9-17] in Metro Vancouver, while median call-to-first EMS arrival intervals were 11 min [IQR 8-14] and 7 min [IQR 5-8] respectively. Incorporating 1-2 VTOL air ambulances improved median call-to-ALS arrival intervals to 7-9 min and call-to-first EMS arrival intervals to 6-8 min in both study regions (all P < 0.001). CONCLUSION VTOL air ambulances dedicated to OHCA response may improve EMS response intervals, with substantial improvements in ALS response metrics.
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Affiliation(s)
- Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France; Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France.
| | - K H Benjamin Leung
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | - Wulfran Bougouin
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Rejuana Alam
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | | | - Danny Liang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - Daniel Jost
- Paris Fire Brigade (BSPP), Paris, France; Paris Sudden Death Expertise Center, Paris, France
| | | | | | | | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada; Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Benoît Vivien
- AP-HP, SAMU 75, Necker University Hospital, Paris, France
| | - Timothy Chan
- Department of Mechanical and Industrial Engineering University of Toronto, Toronto, Canada
| | - Alain Cariou
- Paris Sudden Death Expertise Center, Paris, France; AP-HP, Medical Intensive Care Unit, Cochin University Hospital, Paris, France
| | - Florence Dumas
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Emergency Department, Cochin-Hotel-Dieu University Hospital, Paris, France
| | - Xavier Jouven
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges Pompidou University Hospital, Paris, France
| | - Eloi Marijon
- Université de Paris, INSERM U970, Paris Cardiovascular Research Center (PARCC), European Georges Pompidou Hospital, Paris, France; Paris Sudden Death Expertise Center, Paris, France; AP-HP, Cardiology Department, European Georges Pompidou University Hospital, Paris, France
| | - Steven Bennington
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France
| | | | - Sami Souihi
- Université Paris-Est Créteil (UPEC), CIR/TincNet (EA-3956), Créteil, France
| | - Eric Mermet
- Centre National pour la Recherche scientifique (CNRS), TSE-R, UMR 5314, Toulouse, France; Toulouse School of Economics (TSE), Toulouse, France
| | - Julie Freyssenge
- Université Claude Bernard Lyon 1, INSERME U1290, Research on Healthcare Performance (RESHAPE), Lyon, France; Urgences-ARA Network, ARS Auvergne Rhône-Alpes, Lyon, France
| | - Laurence Arrouy
- AP-HP, Emergency Department, Paris Ile-de-France Ouest University Hospitals, Ambroise Paré University Hospital, Boulogne-Billancourt, France
| | - Eric Lecarpentier
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94, Henri Mondor University Hospital, Créteil, France
| | - Clément Derkenne
- Medical Intensive Care Unit, Ramsay Générale de Santé, Hôpital Privé Jacques Cartier, Massy, France
| | - Brian Grunau
- Centre for Health Evaluation and Outcome Sciences (CHEOS), Vancouver, Canada; Department of Emergency Medicine, St Paul's Hospital and University of British Columbia, Vancouver, Canada
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Moens E, Degraeuwe E, Caputo Maria L, Cresta R, Arys R, Van Moorter N, Tackaert T, Benvenuti C, Auricchio A, Vercammen S. A roadmap to building first responder networks: Lessons learned and best practices from Belgium and Switzerland. Resusc Plus 2023; 16:100469. [PMID: 37779882 PMCID: PMC10539931 DOI: 10.1016/j.resplu.2023.100469] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023] Open
Abstract
Background/Aims Limited bystander assistance and delayed emergency medical service arrival reduce the chances of survival in cardiac arrest victims. Early basic life support through trained first responders (FR) and automatic external defibrillation both improve the outcome. Well-organized FR networks have shown promise, but guidance on effective implementation is lacking. This study evaluates two FR networks, in Belgium and in Switzerland, to identify main advancements in the development of such systems. Method Direct comparison is made of the barriers and facilitators in the development of both FR systems from 2006 up until December 2022, and summarized within a roadmap. Results The Roadmap comprises four integral steps: exploration, installation, initiation, and implementation. Exploration involves understanding the national legislation, engaging with advisory bodies, and establishing local steering committees. The installation phase focuses on FR recruitment, engaging specific professional groups such as firemen, registering public Automated External Defibrillators (AEDs), and requesting feedback. The initiation step includes implementing improvement cycles and fidelity measures. Finally, implementation expands the network, leading to increased survival rates and the integration of these practices into legislation. A significant focus is placed on FR's psychological wellbeing. Moreover, the roadmap highlights the use of efficient geo-mapping to simplify optimal AED placement and automatically assign FRs to tasks. Conclusion The importance of FR networks for early resuscitation is increasingly recognized and various systems are being developed. Key developmental strategies of the EVapp and Ticino Cuore app system may serve as a roadmap for other systems and implementations within Europe and beyond.
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Affiliation(s)
| | - Eva Degraeuwe
- Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | - Luce Caputo Maria
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Fondazione Ticino Cuore, Lugano, Switzerland
| | | | - Robin Arys
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | - Nina Van Moorter
- Emergency Volunteer Application (EVapp) NGO, Belgium
- OLVG Hospital, Amsterdam, The Netherlands
| | - Thomas Tackaert
- Ghent University, Ghent, Belgium
- Ghent University Hospital, Ghent, Belgium
- Emergency Volunteer Application (EVapp) NGO, Belgium
| | | | - Angelo Auricchio
- Cardiocentro Ticino Institute, Lugano, Switzerland
- Fondazione Ticino Cuore, Lugano, Switzerland
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Ahn JY, Ryoo HW, Moon S, Jung H, Park J, Lee WK, Kim JY, Lee DE, Kim JH, Lee SH. Prehospital factors associated with out-of-hospital cardiac arrest outcomes in a metropolitan city: a 4-year multicenter study. BMC Emerg Med 2023; 23:125. [PMID: 37880656 PMCID: PMC10601319 DOI: 10.1186/s12873-023-00899-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Prehospital factors play a vital role in out-of-hospital cardiac arrest (OHCA) survivability, and they vary between countries and regions. We investigated the prehospital factors associated with OHCA outcomes in a single metropolitan city in the Republic of Korea. METHODS This study included adult medical OHCA patients enrolled prospectively, using data from the citywide OHCA registry for patients registered between 2018 and 2021. The primary outcome was survival to hospital discharge. Multivariable logistic regression analysis was conducted to determine the factors associated with the study population's clinical outcomes, adjusting for covariates. We performed a sensitivity analysis for clinical outcomes only for patients without prehospital return of spontaneous circulation prior to emergency medical service departure from the scene. RESULTS In multivariable logistic regression analysis, older age (odds ratio [OR] 0.96; 95% confidence interval [CI] 0.95-0.97), endotracheal intubation (adjusted odds ratio [aOR] 0.29; 95% [CIs] 0.17-0.51), supraglottic airway (aOR 0.29; 95% CI 0.17-0.51), prehospital mechanical chest compression device use (OR 0.13; 95% CI 0.08-0.18), and longer scene time interval (OR 0.96; 95% CI 0.93-1.00) were negatively associated with survival. Shockable rhythm (OR 24.54; 95% CI 12.99-42.00), pulseless electrical activity (OR 3.11; 95% CI 1.74-5.67), and witnessed cardiac arrest (OR 1.59; 95% CI 1.07-2.38) were positively associated with survival. In the sensitivity analysis, endotracheal intubation, supraglottic airway, prehospital mechanical chest compression device use, and longer scene time intervals were associated with significantly lower survival to hospital discharge. CONCLUSIONS Regional resuscitation protocol should be revised based on the results of this study, and modifiable prehospital factors associated with lower survival of OHCA should be improved.
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Affiliation(s)
- Jae Yun Ahn
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Hyun Wook Ryoo
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.
| | - Sungbae Moon
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Haewon Jung
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jungbae Park
- Department of Emergency Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Won Kee Lee
- Department of Biostatistics, School of Medicine, Medical Research Collaboration Center, Kyungpook National University, Daegu, Republic of Korea
| | - Jong-Yeon Kim
- Department of Public Health, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Jung Ho Kim
- Department of Emergency Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea
| | - Sang-Hun Lee
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Republic of Korea
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Alaleit OD, Kajjimu J, Joseph K, Namirembe MS, Agaba PK, Kintu A. Description and analysis of the emergency obstetric interfacility ambulance transfers (IFTs) to Kawempe National Referral Hospital in Uganda. Afr J Emerg Med 2023; 13:183-190. [PMID: 37483678 PMCID: PMC10359711 DOI: 10.1016/j.afjem.2023.06.003] [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: 10/02/2022] [Revised: 02/28/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction In Uganda, 2% of women die from maternal causes with a mortality rate of 336 maternal deaths per 100,000 live births. According to the World Health Organization Uganda is one of the top three contributors to maternal mortality in sub-Saharan Africa. Uganda has parallel weak ambulance systems, government, and non-government-owned, that transport obstetric emergencies to higher-level facilities. These two operations lack standards of medical care and inter-facility transfer (IFT) protocols to direct care. Limited studies exist which assess the state of Emergency Care Services in Uganda and none has been performed to assess the ambulance referral services utilized to address obstetric emergencies. Objective The present study was performed to describe the ambulance transfer processes of obstetric emergencies by analyzing cases arriving at Kawempe National Referral Hospital (KNRH) from outlying health facilities. Methods The study was based at KNRH in Kampala, Uganda. It was a descriptive and analytic cross-sectional study. Trained research assistants enrolled participating patients who met the inclusion criteria consecutively on arrival by ambulance at the hospital. Utilizing a questionnaire, quantitative data was collected from the ambulance driver, the sending facility referral form, and the receiving hospital's ambulance log book for each case. The sample size was 215. Results The median age was 27 years and the majority of patients were referred because of hypertensive disorders (34.9%), obstructed labor (26.5%) and hemorrhage (20.9%). The median total response time for transfer of obstetric emergencies was 50 min, from ambulance activation until the mother was received at KNRH. Differences were identified between government and non-government-owned ambulances in regards to the method of activation, medical escort staffing, number of vital signs recorded, and ambulance onboard medical care. Ambulances parked at the facility took the shortest transfer time and EMT-supported ambulances had the greatest number of vital signs taken. Conclusions Recommendations are to develop an integrated ambulance system for both government and non-government ambulances with standards especially in regards to standardized scripted call-center calls analysis, dispatch activation time, response-to-patient time, and trained ambulance professional staffing and medical care whenever in patient transport mode.
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Affiliation(s)
- Okong Doreen Alaleit
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Jonathan Kajjimu
- Faculty of Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Kalanzi Joseph
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Magara Stella Namirembe
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Peter K. Agaba
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Andrew Kintu
- Department of Anesthesia critical care and Emergency Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Ahn C, Oh YT, Park Y, Kim JH, Hwang S, Won M. The Influence of Cardiac Arrest Floor-Level Location within a Building on Survival Outcomes. J Pers Med 2023; 13:1265. [PMID: 37623515 PMCID: PMC10455151 DOI: 10.3390/jpm13081265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
This nationwide, population-based observational study investigated the association between the floor level of out-of-hospital cardiac arrest (OHCA) incidence and survival outcomes in South Korea, notable for its significant high-rise apartment living. Data were collected retrospectively from OHCA patients through the South Korean Out-of-Hospital Cardiac Arrest Surveillance database. The study incorporated cases that included the OHCA's building floor information. The primary outcome assessed was survival to discharge, analyzed using multivariate logistic regression, and the secondary outcome was favorable neurological outcome. Among 36,977 patients, a total of 29,729 patients were included, and 1680 patients were survivors. A weak yet significant correlation between floor level and hospital arrival time was observed. Interestingly, elevated survival rates were noted among patients from higher floors despite extended emergency medical service response times. Multivariate analysis identified age, witnessed OHCA, shockable rhythm, and prehospital return of spontaneous circulation (ROSC) as primary determinants of survival to discharge. The floor level's impact on survival was less substantial than anticipated, suggesting residential emergency response enhancements should prioritize witness interventions, shockable rhythm management, and prehospital ROSC rates. The study underscores the importance of bespoke emergency response strategies in high-rise buildings, particularly in urban areas, and the potential of digital technologies to optimize response times and survival outcomes.
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Affiliation(s)
- Chiwon Ahn
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Young Taeck Oh
- Department of Emergency Medicine, Hallym University Dongtan Sacred Heart Hospital, Hwaseong 18450, Republic of Korea;
| | - Yeonkyung Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Veterans Health Service Medical Center, Seoul 05368, Republic of Korea
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul 04763, Republic of Korea
| | - Jae Hwan Kim
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Sojune Hwang
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
| | - Moonho Won
- Department of Emergency Medicine, College of Medicine, Chung-Ang University, Seoul 06974, Republic of Korea; (C.A.); (J.H.K.); (S.H.); (M.W.)
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Omatsu K, Uchiyama M, Shimizu U, Ling Y, Okuda S, Koyama Y. Impact of Heavy Snowfall on Emergency Transport and Prognosis of Out-of-Hospital Cardiac Arrest Patients: A Nation-Wide Cohort Study. Prehosp Disaster Med 2023; 38:436-443. [PMID: 37448197 PMCID: PMC10445114 DOI: 10.1017/s1049023x23006040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/31/2023] [Accepted: 06/08/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is a significant global cause of mortality, and Emergency Medical Services (EMS) response interval is critical for survival and a neurologically-favorable outcome. Currently, it is unclear whether EMS response interval, neurologically-intact survival, and overall survival differ between snowy and non-snowy periods at heavy snowfall areas. METHODS A nation-wide population-based cohort of OHCA patients, registered from 2017 through 2019 in the All-Japan Utstein Registry, was divided into four groups according to areas (heavy snowfall area or other area) and seasons (winter or non-winter): heavy snowfall-winter, heavy snowfall-non-winter, other area-winter, and other area-non-winter. The first coprimary outcome was EMS response interval, and the secondary coprimary outcome was one-month survival and a neurologically-favorable outcome at one month. RESULTS A total of 337,781 OHCA patients were divided into four groups: heavy snowfall-winter (N = 15,627), heavy snowfall-non-winter (N = 97,441), other area-winter (N = 32,955), and other area-non-winter (N = 191,758). Longer EMS response intervals (>13 minutes) were most likely in the heavy snowfall-winter group (OR = 1.86; 95% CI, 1.76 to 1.97), and also more likely in heavy snowfall areas in non-winter (OR = 1.44; 95% CI, 1.38 to 1.50). One-month survival in winter was worse not only in the heavy snowfall area (OR = 0.86; 95% CI, 0.78 to 0.94) but also in other areas (OR = 0.91; 95% CI, 0.87 to 0.94). One-month neurologically-favorable outcomes were also comparable between heavy snowfall-winter and other area-non-winter groups. CONCLUSIONS This study showed OHCA in heavy snowfall areas in winter resulted in longer EMS response intervals. However, heavy snowfall had little effect on one-month survival or neurologically-favorable outcome at one month.
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Affiliation(s)
- Kentaro Omatsu
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
- Department of Emergency Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - Mieko Uchiyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Utako Shimizu
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Yiwei Ling
- Bioinformatics Laboratory, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Shujiro Okuda
- Bioinformatics Laboratory, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yu Koyama
- Department of Nursing, Niigata University Graduate School of Health Sciences, Niigata, Japan
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Pin Pek P, Cheng Fan K, Eng Hock Ong M, Luo N, Østbye T, Lynn Lim S, Fuwah Ho A. Determinants of health-related quality of life after out-of-hospital cardiac arrest (OHCA): A systematic review. Resuscitation 2023; 188:109794. [PMID: 37059353 DOI: 10.1016/j.resuscitation.2023.109794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/31/2023] [Accepted: 04/01/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVE With a growing number of out-of-hospital cardiac arrest (OHCA) survivors globally, the focus of OHCA management has now broadened to survivorship. An outcome central to survivorship is health-related quality of life (HRQoL). This systematic review aimed to synthesise evidence related to the determinants of HRQoL of OHCA survivors. METHODS We systematically searched MEDLINE, Embase, and Scopus from inception to 15 August 2022 to identify studies investigating the association of at least one determinant and HRQoL in adult OHCA survivors. All articles were independently reviewed by two investigators. We abstracted data pertaining to determinants and classified them using a well-established HRQoL theoretical framework - the Wilson and Cleary (revised) model. RESULTS 31 articles assessing a total of 35 determinants were included. Determinants were classified into the five domains in the HRQoL model. 26 studies assessed determinants related to individual characteristics (n=3), 12 studied biological function (n=7), nine studied symptoms (n=3), 16 studied functioning (n=5), and 35 studied characteristics of the environment (n=17). In studies that included multivariable analyses, most reported that individual characteristics (older age, female sex), symptoms (anxiety, depression), and functioning (impaired neurocognitive function) were significantly associated with poorer HRQoL. CONCLUSIONS Individual characteristics, symptoms, and functioning played significant roles in explaining the variability in HRQoL. Significant non-modifiable determinants such as age and sex could be used to identify populations at risk of poorer HRQoL, while significant modifiable determinants such as psychological health and neurocognitive functioning could serve as targets for post-discharge screening and rehabilitation plans. PROSPERO registration number: CRD42022359303.
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Affiliation(s)
- Pin Pin Pek
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kai Cheng Fan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Marcus Eng Hock Ong
- Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Truls Østbye
- Health Services & Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Shir Lynn Lim
- Department of Cardiology, National University Heart Centre, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Pre-hospital & Emergency Research Centre, Health Services & Systems Research, Duke-NUS Medical School, Singapore
| | - Andrew Fuwah Ho
- Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Zou Y, Jia L, Chen S, Deng X, Chen Z, He Y, Wang Q, Xing D, Zhang Y. Spatial accessibility of emergency medical services in Chongqing, Southwest China. Front Public Health 2023; 10:959314. [PMID: 36684945 PMCID: PMC9853430 DOI: 10.3389/fpubh.2022.959314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 12/09/2022] [Indexed: 01/08/2023] Open
Abstract
Background Timely access to emergency medical services (EMS) can significantly reduce mortality. In China, the evidence of the accessibility of complete EMS which considers two related trips and involves large rural areas is insufficient. This study aimed to explore the accessibility of ambulance services and complete EMS in Chongqing and its regional differences, and to provide a reference for improving spatial accessibility of EMS in Chongqing and optimizing allocation of EMS resources. Methods The nearest neighbor method was used to measure spatial accessibility of ambulance services and complete EMS. Spatial aggregation patterns and influencing factors of spatial accessibility of complete EMS were analyzed using Moran's I index, Pearson correlation and multiple linear regression. Results The medians of shortest travel time for ambulance, monitoring ambulance, primary EMS and advanced EMS in Chongqing were 7.0, 18.6, 36.2, and 47.8 min. The shortest travel time for complete EMS showed significant spatial aggregation characteristics. The Low-Low types that referred to cluster of short EMS travel time mainly distributed in city proper. The High-High types that referred to cluster of long EMS travel time mainly distributed in northeast and southeast of Chongqing. Urbanization rate was a negative influencing factor on shortest travel time for primary EMS, while average elevation and the number of settlements were positive influencing factors. GDP per capita and urbanization rate were negative influencing factors on shortest travel time for advanced EMS, while the number of settlements was a positive influencing factor. Conclusion This study evaluated the accessibility of EMS which considers two related trips in Chongqing. Although the accessibility of ambulances in Chongqing was relatively high, the accessibility of monitoring ambulance was relatively low. Regional and urban-rural differences in the accessibility of complete EMS integrating two related trips were obvious. It was recommended to increase financial investment in economic backward areas, increase high-quality EMS resources, enhance EMS capacity of central township health centers, strengthen road construction in mountainous areas, and provide reasonable planning of rural settlements for improving the spatial accessibility of EMS, narrowing the urban-rural gap and improving equity in getting EMS for all the people.
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Affiliation(s)
- Yang Zou
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Ling Jia
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Saijuan Chen
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Xinyi Deng
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Zhiyi Chen
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Ying He
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Qiuting Wang
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
| | - Dianguo Xing
- Office of Health Emergency, Chongqing Municipal Health Commission, Chongqing, China
| | - Yan Zhang
- School of Public Health, Research Center for Medicine and Social Development, Innovation Center for Social Risk Governance in Health, Research Center for Public Health Security, Chongqing Medical University, Chongqing, China
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Garcia RA, Girotra S, Jones PG, McNally B, Spertus JA, Chan PS. Variation in Out-of-Hospital Cardiac Arrest Survival Across Emergency Medical Service Agencies. Circ Cardiovasc Qual Outcomes 2022; 15:e008755. [PMID: 35698973 PMCID: PMC9233095 DOI: 10.1161/circoutcomes.121.008755] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although studies have reported variation in out-of-hospital cardiac arrest (OHCA) survival by geographic location, little is known about variation in OHCA survival at the level of emergency medical service (EMS) agencies-which may have modifiable practices, unlike counties and regions. We quantified the variation in OHCA survival across EMS agencies and explored whether variation in 2 specific EMS resuscitation practices were associated with survival to hospital admission. METHODS Within the Cardiac Arrest Registry to Enhance Survival, a prospective registry representing ≈51% of the US population, we identified 258 342 OHCAs from 764 EMS agencies with >10 OHCA cases annually during 2015 to 2019. Using hierarchical logistic regression, risk-standardized rates of survival to hospital admission were computed for each EMS agency. We quantified inter-agency variation in survival with median odds ratios and assessed the association of 2 resuscitation practices (EMS response time and the proportion of OHCAs with termination of resuscitation without meeting futility criteria) with EMS agency survival rates to hospital admission. RESULTS Across 764 EMS agencies comprising 258 342 OHCAs, the median risk-standardized rate of survival to hospital admission was 27.3% (interquartile range, 24.5%-30.1%; range: 16.0%-45.6%). The adjusted median odds ratio was 1.35 (95% CI, 1.32-1.39), denoting that the odds of survival of 2 patients with identical covariates varied by 35% at 2 randomly selected EMS agencies. EMS agencies in the lowest quartile of risk-standardized survival had longer EMS response times when compared with the highest quartile (12.0±3.4 versus 9.0±2.6 minutes; P<0.001), and a higher proportion of OHCAs with termination of resuscitation without meeting futility criteria (27.9±16.1% versus 18.9±11.4%; P<0.001). CONCLUSIONS Survival after OHCA varies widely across EMS agencies. EMS response times and termination of resuscitation practices were associated with agency-level rates of survival to hospital admission, suggesting potentially modifiable practices which can improve OHCA survival.
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Affiliation(s)
- Raul A Garcia
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (R.A.G., P.G.J., J.A.S., P.S.C.)
| | - Saket Girotra
- University of Iowa Carver College of Medicine (S.G.)
| | - Philip G Jones
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (R.A.G., P.G.J., J.A.S., P.S.C.)
| | - Bryan McNally
- Emory University Rollins School of Public Health and the Department of Emergency Medicine, Emory University School of Medicine (B.M.)
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (R.A.G., P.G.J., J.A.S., P.S.C.)
| | - Paul S Chan
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (R.A.G., P.G.J., J.A.S., P.S.C.)
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Performance of an Emergency Road Ambulance Service in Bhutan: Response Time, Utilization, and Outcomes. Trop Med Infect Dis 2022; 7:tropicalmed7060087. [PMID: 35736966 PMCID: PMC9227530 DOI: 10.3390/tropicalmed7060087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 05/25/2022] [Accepted: 05/29/2022] [Indexed: 02/04/2023] Open
Abstract
Background: An efficient ambulance service is a vital component of emergency medical services. We determined the emergency ambulance response and transport times and ambulance exit outcomes in Bhutan. Methods: A cross-sectional study involving real-time monitoring of emergency ambulance deployments managed by a central toll-free (112) hotline (20 October 2021 to 20 January 2022) was carried out. Results: Of 5092 ambulance deployments, 4291 (84%) were inter-facility transfers, and 801 (16%) were for emergencies. Of the latter, 703 (88%) were for non-pregnancy-related emergencies (i.e., medical, surgical, and accidents), while 98 (12%) were for pregnancy-related emergencies. The median ambulance response and patient transport times were 42 (IQR 3–271) and 41 (IQR 2–272) minutes, respectively. The median round-trip distance travelled by ambulances was 18 km (range 1–186 km). For ambulance exit outcomes that were pregnancy-related (n = 98), 89 (91%) reached the health facility successfully, 8 delivered prior to ambulance arrival at the scene or in the ambulance during transport, and 1 had no outcome record. For the remaining 703 non-pregnancy deployments, 29 (4.1%) deployments were deemed not required or refusals, and 656 (93.3%) reached the health facility successfully; 16 (2.3%) died before the ambulance’s arrival at the scene, and 2 (0.3%) were not recorded. Conclusions: This first countrywide real-time operational research showed acceptable ambulance exit outcomes. Improving ambulance response and transport times might reduce morbidities and mortalities further.
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Influence of advanced life support response time on out-of-hospital cardiac arrest patient outcomes in Taipei. PLoS One 2022; 17:e0266969. [PMID: 35421162 PMCID: PMC9009650 DOI: 10.1371/journal.pone.0266969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Background The association between out-of-hospital cardiac arrest patient survival and advanced life support response time remained controversial. We aimed to test the hypothesis that for adult, non-traumatic, out-of-hospital cardiac arrest patients, a shorter advanced life support response time is associated with a better chance of survival. We analyzed Utstein-based registry data on adult, non-traumatic, out-of-hospital cardiac arrest patients in Taipei from 2011 to 2015. Methods Patients without complete data, witnessed by emergency medical technicians, or with response times of ≥ 15 minutes, were excluded. We used logistic regression with an exposure of advanced life support response time. Primary and secondary outcomes were survival to hospital discharge and favorable neurological outcomes (cerebral performance category ≤ 2), respectively. Subgroup analyses were based on presenting rhythms of out-of-hospital cardiac arrest, bystander cardiopulmonary resuscitation, and witness status. Results A total of 4,278 cases were included in the final analysis. The median advanced life support response time was 9 minutes. For every minute delayed in advanced life support response time, the chance of survival to hospital discharge would reduce by 7% and chance of favorable neurological outcome by 9%. Subgroup analysis showed that a longer advanced life support response time was negatively associated with the chance of survival to hospital discharge among out-of-hospital cardiac arrest patients with shockable rhythm and pulse electrical activity groups. Conclusions In non-traumatic, adult, out-of-hospital cardiac arrest patients in Taipei, a longer advanced life support response time was associated with declining odds of survival to hospital discharge and favorable neurologic outcomes, especially in patients presenting with shockable rhythm and pulse electrical activity.
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Swan D, Baumstark L. Does Every Minute Really Count? Road Time as an Indicator for the Economic Value of Emergency Medical Services. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:400-408. [PMID: 35227452 DOI: 10.1016/j.jval.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 08/21/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES This article builds on the literature regarding the association between emergency medical service (EMS) response times and patient outcomes (death and severe injury). Three issues are addressed in this article with respect to the empirical estimation of this relationship: the endogeneity of response time (systematically quicker response for higher degrees of urgency), the nonlinearity of this relationship, and the variation between such estimations for different patient outcomes. METHODS Binomial and multinomial logistic regression models are used to estimate the impact of response time on the probabilities of death and severe injury using data from French Fire and Rescue Services. These models are developed with response time as an explanatory variable and then with road time (dispatch to arrival) hypothesized as representing the exogenous variation within response time. Both models are also applied to data subsets based on response time intervals. RESULTS The results show that road time yields a higher estimate for the impact of response time on patient outcomes than (total) response time. The impact of road time on patient outcomes is also shown to be nonlinear. These results are of both statistical significance (model coefficients are significant at the 95% confidence level) and economical significance (when taking into account the number of annual interventions performed). CONCLUSIONS When using heterogeneous data on EMS interventions where endogeneity is a clear issue, road time is a more reliable indicator to estimate the impact of EMS response time on patient outcomes than (total) response time.
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Affiliation(s)
- David Swan
- Univ Lyon, Université Lumière Lyon 2, GATE UMR 5824, Ecully, France; Centre d'Etudes et de Recherches Interdisciplinaires sur la Sécurité Civile, Aix-en-Provence, France.
| | - Luc Baumstark
- Univ Lyon, Université Lumière Lyon 2, GATE UMR 5824, Ecully, France
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Assessing Trauma Center Accessibility for Healthcare Equity Using an Anti-Covering Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031459. [PMID: 35162486 PMCID: PMC8835095 DOI: 10.3390/ijerph19031459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/12/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023]
Abstract
Motor vehicle accidents are one of the most prevalent causes of traumatic injury in patients needing transport to a trauma center. Arrival at a trauma center within an hour of the accident increases a patient's chances of survival and recovery. However, not all vehicle accidents in Tennessee are accessible to a trauma center within an hour by ground transportation. This study uses the anti-covering location problem (ACLP) to assess the current placement of trauma centers and explore optimal placements based on the population distribution and spatial pattern of motor vehicle accidents in 2015 through 2019 in Tennessee. The ACLP models seek to offer a method of exploring feasible scenarios for locating trauma centers that intend to provide accessibility to patients in underserved areas who suffer trauma as a result of vehicle accidents. The proposed ACLP approach also seeks to adjust the locations of trauma centers to reduce areas with excessive service coverage while improving coverage for less accessible areas of demand. In this study, three models are prescribed for finding optimal locations for trauma centers: (a) TraCt: ACLP model with a geometric approach and weighted models of population, fatalities, and spatial fatality clusters of vehicle accidents; (b) TraCt-ESC: an extended ACLP model mitigating excessive service supply among trauma center candidates, while expanding services to less served areas for more beneficiaries using fewer facilities; and (c) TraCt-ESCr: another extended ACLP model exploring the optimal location of additional trauma centers.
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Nord-Ljungquist H, Bohm K, Fridlund B, Elmqvist C, Engström Å. "Time that save lives" while waiting for ambulance in rural environments. Int Emerg Nurs 2021; 59:101100. [PMID: 34781156 DOI: 10.1016/j.ienj.2021.101100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 09/15/2021] [Accepted: 09/29/2021] [Indexed: 10/19/2022]
Abstract
AIM Firefighters perform first aid before the ambulance arrives in areas with a long response time in Sweden; this is called 'While Waiting for the Ambulance' (WWFA). The aim was to describe WWFA assignments in rural environments, focusing on frequency, event time, actions and survival >30 days after cardiopulmonary resuscitation (CPR) was performed. METHODS Retrospective descriptive and comparative design. RESULTS Firefighters in the northern part of Sweden were involved in 518 WWFA assignments between 2012 and 2016. From alarm call until ambulance dispatch, median time was 2:20 min; for firefighters, nearly four minutes. Median dispatch time at out-of-hospital cardiac arrests (OHCA) (n = 52) was 1:40 min for ambulance and three minutes for firefighters. Maximal dispatch time was nearly 10 min for ambulance and 44 min for firefighters. Firefighters arrived first at the scene, after 17 min' median, for 95 % of assignments, while the ambulance took nearly twice the amount of time. In OHCA situations, time for firefighters was over 19 min versus ambulance at nearly twice the time. CPR was terminated by ambulance staff at 83% (n = 43) of 52 when firefighters performed prolonged CPR. Return to spontaneous circulation after OHCA was 17%, and 9% were alive after >30 days. CONCLUSION The efficiency of incident time and utilisation rate for WWFA assignments can be increased for the benefit of affected persons, especially in OHCA.
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Affiliation(s)
- Helena Nord-Ljungquist
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Division of Nursing and Medical Technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
| | - Katarina Bohm
- Karolinska Institute, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden; Head of Research in County Council Kronoberg and Research Manager for the Centre of Interprofessional Collaboration within Emergency Care (CICE) at the Department of Health and Caring Science, Linnaeus University, Sweden.
| | - Åsa Engström
- Division of Nursing and Medical Technology, Department of Health Science, Luleå University of Technology, Luleå, Sweden.
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16
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Stoesser CE, Boutilier JJ, Sun CLF, Brooks SC, Cheskes S, Dainty KN, Feldman M, Ko DT, Lin S, Morrison LJ, Scales DC, Chan TCY. Moderating effects of out-of-hospital cardiac arrest characteristics on the association between EMS response time and survival. Resuscitation 2021; 169:31-38. [PMID: 34678334 DOI: 10.1016/j.resuscitation.2021.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/06/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Although several Utstein variables are known to independently improve survival, how they moderate the effect of emergency medical service (EMS) response times on survival is unknown. OBJECTIVES To quantify how public location, witnessed status, bystander CPR, and bystander AED shock individually and jointly moderate the effect of EMS response time delays on OHCA survival. METHODS This retrospective cohort study was a secondary analysis of the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest database (December 2005 to June 2015). We included all adult, non-traumatic, non-EMS witnessed, and EMS-treated OHCAs from eleven sites across the US and Canada. We trained a logistic regression model with standard Utstein control variables and interaction terms between EMS response time and the four aforementioned OHCA characteristics. RESULTS 102,216 patients were included. Three of the four characteristics - witnessed OHCAs (OR = 0.962), bystander CPR (OR = 0.968) and public location (OR = 0.980) - increased the negative effect of a one-minute delay on the odds of survival. In contrast, a bystander AED shock decreased the negative effect of a one-minute response time delay on the odds of survival (OR = 1.064). The magnitude of the effect of a one-minute delay in EMS response time on the odds of survival ranged from 1.3% to 9.8% (average: 5.3%), depending on the underlying OHCA characteristics. CONCLUSIONS Delays in EMS response time had the largest reduction in survival odds for OHCAs that did not receive a bystander AED shock but were witnessed, occurred in public, and/or received bystander CPR. A bystander AED shock appears to be protective against a delay in EMS response time.
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Affiliation(s)
- Clara E Stoesser
- Departmentof Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
| | - Justin J Boutilier
- Departmentof Industrial and Systems Engineering, University of Wisconsin - Madison, Madison, WI, USA.
| | - Christopher L F Sun
- SloanSchool of Management, Massachusetts Institute of Technology, Cambridge, MA, USA; HealthcareSystems Engineering, Massachusetts General Hospital, Boston, MA, USA
| | - Steven C Brooks
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Departmentsof Emergency Medicine and Public Health Sciences, Queen's University, Kingston, ON, Canada
| | - Sheldon Cheskes
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Departmentof Family and Community Medicine, Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada; SunnybrookCenter for Prehospital Medicine, Toronto, ON, Canada
| | - Katie N Dainty
- Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; NorthYork General Hospital, Toronto, ON, Canada
| | - Michael Feldman
- SunnybrookCenter for Prehospital Medicine, Toronto, ON, Canada
| | - Dennis T Ko
- Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Institutefor Clinical Evaluation Sciences, Toronto, ON, Canada; SchulichHeart Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Departmentof Medicine, University of Toronto, Toronto, ON, Canada
| | - Steve Lin
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Departmentof Medicine, University of Toronto, Toronto, ON, Canada
| | - Laurie J Morrison
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Departmentof Medicine, University of Toronto, Toronto, ON, Canada
| | - Damon C Scales
- LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada; Instituteof Health Policy, Management and Evaluation (IHPME), University of Toronto, Toronto, ON, Canada; Institutefor Clinical Evaluation Sciences, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Timothy C Y Chan
- Departmentof Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada; LiKa Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
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Stassen W, Wylie C, Djärv T, Wallis LA. Out-of-hospital cardiac arrests in the city of Cape Town, South Africa: a retrospective, descriptive analysis of prehospital patient records. BMJ Open 2021; 11:e049141. [PMID: 34400458 PMCID: PMC8370552 DOI: 10.1136/bmjopen-2021-049141] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 08/04/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES While prospective epidemiological data for out-of-hospital cardiac arrest (OHCA) exists in many high-income settings, there is a dearth of such data for the African continent. The aim of this study was to describe OHCA in the Cape Town metropole, South Africa. DESIGN Observational study with a retrospective descriptive design. SETTING Cape Town metropole, Western Cape province, South Africa. PARTICIPANTS All patients with OHCA for the period 1 January 2018-31 December 2018 were extracted from public and private emergency medical services (EMS) and described. OUTCOME MEASURES Description of patients with OHCA in terms of demographics, treatment and short-term outcome. RESULTS A total of 929 patients with OHCA received an EMS response in the Cape Town metropole, corresponding to an annual prevalence of 23.2 per 100 000 persons. Most patients were adult (n=885; 96.5%) and male (n=526; 56.6%) with a median (IQR) age of 63 (26) years. The majority of cardiac arrests occurred in private residences (n=740; 79.7%) and presented with asystole (n=322; 34.6%). EMS resuscitation was only attempted in 7.4% (n=69) of cases and return of spontaneous circulation (ROSC) occurred in 1.3% (n=13) of cases. Almost all patients (n=909; 97.8%) were declared dead on the scene. CONCLUSION To our knowledge, this was the largest study investigating OHCA ever undertaken in Africa. We found that while the incidence of OHCA in Cape Town was similar to the literature, resuscitation is attempted in very few patients and ROSC-rates are negligible. This may be as a consequence of protracted response times, poor patient prognosis or an underdeveloped and under-resourced Chain of Survival in low- to middle-income countries, like South Africa. The development of contextual guidelines given resources and disease burden is essential.
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Affiliation(s)
- Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Craig Wylie
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
- Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Therese Djärv
- Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lee A Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
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Abstract
PURPOSE OF REVIEW Out-of-hospital cardiac arrest (OHCA) is the most devastating and time-critical medical emergency. Survival after OHCA requires an integrated system of care, of which transport by emergency medical services is an integral component. The transport system serves to commence and ensure uninterrupted high-quality resuscitation in suitable patients who would benefit, terminate resuscitation in those that do not, provide critical interventions, as well as convey patients to the next appropriate venue of care. We review recent evidence surrounding contemporary issues in the transport of OHCA, relating to who, where, when and how to transport these patients. RECENT FINDINGS We examine the clinical and systems-related evidence behind issues including: contemporary approaches to field termination of resuscitation in patients in whom continued resuscitation and transport to hospital would be medically futile, OHCA patients and organ donation, on-scene versus intra-transport resuscitation, significance of response time, intra-transport interventions (mechanical chest compression, targeted temperature management, ECMO-facilitated cardiopulmonary resuscitation), OHCA in high-rise locations and cardiac arrest centers. We highlight gaps in current knowledge and areas of active research. SUMMARY There remains limited evidence to guide some decisions in transporting the OHCA patient. Evidence is urgently needed to elucidate the roles of cardiac arrest centers and ECPR in OHCA.
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Heffernan E, Mc Sharry J, Murphy A, Barry T, Deasy C, Menzies D, Masterson S. Community first response and out-of-hospital cardiac arrest: a qualitative study of the views and experiences of international experts. BMJ Open 2021; 11:e042307. [PMID: 33757945 PMCID: PMC7993284 DOI: 10.1136/bmjopen-2020-042307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES This research aimed to examine the perspectives, experiences and practices of international experts in community first response: an intervention that entails the mobilisation of volunteers by the emergency medical services to respond to prehospital medical emergencies, particularly cardiac arrests, in their locality. DESIGN This was a qualitative study in which semistructured interviews were conducted via teleconferencing. The data were analysed in accordance with an established thematic analysis procedure. SETTING There were participants from 11 countries: UK, USA, Canada, Australia, New Zealand, Singapore, Ireland, Norway, Sweden, Denmark and the Netherlands. PARTICIPANTS Sixteen individuals who held academic, clinical or managerial roles in the field of community first response were recruited. Maximum variation sampling targeted individuals who varied in terms of gender, occupation and country of employment. There were eight men and eight women. They included ambulance service chief executives, community first response programme managers and cardiac arrest registry managers. RESULTS The findings provided insights on motivating and supporting community first response volunteers, as well as the impact of this intervention. First, volunteers can be motivated by 'bottom-up factors', particularly their characteristics or past experiences, as well as 'top-down factors', including culture and legislation. Second, providing ongoing support, especially feedback and psychological services, is considered important for maintaining volunteer well-being and engagement. Third, community first response can have a beneficial impact that extends not only to patients but also to their family, their community and to the volunteers themselves. CONCLUSIONS The findings can inform the future development of community first response programmes, especially in terms of volunteer recruitment, training and support. The results also have implications for future research by highlighting that this intervention has important outcomes, beyond response times and patient survival, which should be measured, including the benefits for families, communities and volunteers.
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Affiliation(s)
- Eithne Heffernan
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Jenny Mc Sharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Andrew Murphy
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Tomás Barry
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Cork, Ireland
- National Ambulance Service, Health Service Executive, Dublin, Ireland
| | - David Menzies
- National Ambulance Service, Health Service Executive, Dublin, Ireland
- St Vincent's University Hospital, Dublin, Ireland
- CFR Ireland, Dublin, Ireland
| | - Siobhan Masterson
- Discipline of General Practice, Clinical Science Institute, School of Medicine, National University of Ireland Galway, Galway, Ireland
- National Ambulance Service, Health Service Executive, Dublin, Ireland
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Azami-Aghdash S, Moosavi A, Gharaee H, Sadeghi G, Mousavi Isfahani H, Ghasemi Dastgerdi A, Mohseni M. Development of quality indicators to measure pre-hospital emergency medical services for road traffic injury. BMC Health Serv Res 2021; 21:235. [PMID: 33726709 PMCID: PMC7970773 DOI: 10.1186/s12913-021-06238-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 03/03/2021] [Indexed: 01/01/2023] Open
Abstract
Background Pre-Hospital Emergency Care (PEC) is a fundamental property of prevention of Road Traffic Injuries (RTIs). Thus, this sector requires a system for evaluation and performance improvement. This study aimed to develop quality indicators to measure PEC for RTIs. Methods Following the related literature review, 14 experts were interviewed through semi-structured interviews to identify Quality Measurement Indicators (QMIs). The extracted indicators were then categorized into three domains: structure, performance, and management. Finally, the identified QMIs were confirmed through two rounds of the Delphi technique. Results Using literature review 11 structural, 13 performance, and four managerial indicators (A total of 28 indicators) were identified. Also, four structural, four performance, and three managerial indicators (A total of 11indicators) were extracted from interviews with experts. Two indicators were excluded after two rounds of Delphi’s technics. Finally, 14 structural, 16 performance and, seven managerial indicators (A total of 37indicators) were finalized. Conclusion Due to the importance and high proportion of RTIs compared to other types of injuries, this study set out to design and evaluate the QMIs of PEC delivered for RTIs. The findings of this research contribute to measuring and planning aimed at improving the performance of PEC. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06238-1.
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Affiliation(s)
- Saber Azami-Aghdash
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.,Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ahmad Moosavi
- Department of Health and Community Medicine, Dezful University of Medical Sciences, Dezful, Iran
| | - Hojatolah Gharaee
- District Health Center of Hamadan City, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Ghader Sadeghi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Haleh Mousavi Isfahani
- School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Ghasemi Dastgerdi
- Disaster and Emergency Medical Management Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Mohseni
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
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21
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Luo W, Yao J, Mitchell R, Zhang X. Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals. Int J Health Geogr 2020; 19:52. [PMID: 33243272 PMCID: PMC7689650 DOI: 10.1186/s12942-020-00249-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Access as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades. Most previous studies considered one-way trips, either getting ambulances to patients or transporting patients to hospitals. This research assesses spatiotemporal access to EMS at the shequ (the smallest administrative unit) level in Wuhan, China, attempting to fill a gap in literature by considering and comparing both trips in the evaluation of EMS access. METHODS Two spatiotemporal access measures are adopted here: the proximity-based travel time obtained from online map services and the enhanced two-step floating catchment area (E-2SFCA) which is a gravity-based model. First, the travel time is calculated for the two trips involved in one EMS journey: one is from the nearest EMS station to the scene (i.e. scene time interval (STI)) and the other is from the scene to the nearest hospital (i.e. transport time interval (TTI)). Then, the predicted travel time is incorporated into the E-2SFCA model to calculate the access measure considering the availability of the service provider as well as the population in need. For both access measures, the calculation is implemented for peak hours and off-peak hours. RESULTS Both methods showed a marked decrease in EMS access during peak traffic hours, and differences in spatial patterns of ambulance and hospital access. About 73.9% of shequs can receive an ambulance or get to the nearest hospital within 10 min during off-peak periods, and this proportion decreases to about 45.5% for peak periods. Most shequs with good ambulance access but poor hospital access are in the south of the study area. In general, the central areas have better ambulance, hospital and overall access than peripheral areas, particularly during off-peak periods. CONCLUSIONS In addition to the impact of peak traffic periods on EMS access, we found that good ambulance access does not necessarily guarantee good hospital access nor the overall access, and vice versa.
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Affiliation(s)
- Weicong Luo
- Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods, University of Glasgow, Glasgow, UK
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK
| | - Jing Yao
- Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods, University of Glasgow, Glasgow, UK.
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Richard Mitchell
- Centre for Sustainable, Healthy and Learning Cities and Neighbourhoods, University of Glasgow, Glasgow, UK
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Xiaoxiang Zhang
- Urban Big Data Centre, School of Social & Political Sciences, University of Glasgow, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK
- Department of Geographic Information Science, College of Hydrology and Water Resources, Hohai University, Nanjing, China
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22
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Vercammen S, Moens E. Cost-effectiveness of a novel smartphone application to mobilize first responders after witnessed OHCA in Belgium. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2020; 18:52. [PMID: 33292296 PMCID: PMC7673090 DOI: 10.1186/s12962-020-00248-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 11/03/2020] [Indexed: 11/13/2022] Open
Abstract
Background EVapp (Emergency Volunteer Application) is a Belgian smartphone application that mobilizes volunteers to perform cardiopulmonary resuscitation (CPR) and defibrillation with publicly available automatic external defibrillators (AED) after an emergency call for suspected out of hospital cardiac arrest (OHCA). The aim is to bridge the time before the arrival of the emergency services. Methods An accessible model was developed, using literature data, to simulate survival and cost-effectiveness of nation-wide EVapp implementation. Initial validation was performed using field data from a first pilot study of EVapp implementation in a city in Flanders, covering 2.5 years of implementation. Results Simulation of nation-wide EVapp implementation resulted in an additional yearly 910 QALY gained over the current baseline case scenario (worst case 632; best case 3204). The cost per QALY associated with EVapp implementation was comparable to the baseline scenario, i.e., 17 vs 18 k€ QALY−1. Conclusions EVapp implementation was associated with a positive balance on amount of QALY gained and cost of QALY. This was a consequence of both the lower healthcare costs for patients with good neurological outcome and the more efficient use of yet available resources, which did not outweigh the costs of operation.
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Affiliation(s)
- Steven Vercammen
- EVapp vzw, AA Tower - 8th floor, Technologiepark 122 (zone C2a), 9052, Zwijnaarde, België.
| | - Esther Moens
- UGent, Sint-Pietersnieuwstraat 25, 9000, Gent, Belgium
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23
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Holmén J, Herlitz J, Ricksten SE, Strömsöe A, Hagberg E, Axelsson C, Rawshani A. Shortening Ambulance Response Time Increases Survival in Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2020; 9:e017048. [PMID: 33107394 PMCID: PMC7763420 DOI: 10.1161/jaha.120.017048] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background The ambulance response time in out‐of‐hospital cardiac arrest (OHCA) has doubled over the past 30 years in Sweden. At the same time, the chances of surviving an OHCA have increased substantially. A correct understanding of the effect of ambulance response time on the outcome after OHCA is fundamental for further advancement in cardiac arrest care. Methods and Results We used data from the SRCR (Swedish Registry of Cardiopulmonary Resuscitation) to determine the effect of ambulance response time on 30‐day survival after OHCA. We included 20 420 cases of OHCA occurring in Sweden between 2008 and 2017. Survival to 30 days was our primary outcome. Stratification and multiple logistic regression were used to control for confounding variables. In a model adjusted for age, sex, calendar year, and place of collapse, survival to 30 days is presented for 4 different groups of emergency medical services (EMS)‐crew response time: 0 to 6 minutes, 7 to 9 minutes, 10 to 15 minutes, and >15 minutes. Survival to 30 days after a witnessed OHCA decreased as ambulance response time increased. For EMS response times of >10 minutes, the overall survival among those receiving cardiopulmonary resuscitation before EMS arrival was slightly higher than survival for the sub‐group of patients treated with compressions‐only cardiopulmonary resuscitation. Conclusions Survival to 30 days after a witnessed OHCA decreases as ambulance response times increase. This correlation was seen independently of initial rhythm and whether cardiopulmonary resuscitation was performed before EMS‐crew arrival. Shortening EMS response times is likely to be a fast and effective way of increasing survival in OHCA.
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Affiliation(s)
- Johan Holmén
- Department of Anesthesiology and Intensive Care Queen Silvia's Children's Hospital Gothenburg Sweden.,Department of Prehospital and Emergency Care Sahlgrenska University Hospital Gothenburg Sweden
| | - Johan Herlitz
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska AcademyUniversity of GothenburgSahlgrenska University Hospital Gothenburg Sweden
| | - Anneli Strömsöe
- School of Education, Health and Social Studies Dalarna University Falun Sweden.,Centre for Clinical Research Dalarna Uppsala University Uppsala Sweden.,Department of Prehospital Care Region of Dalarna Falun Sweden
| | - Eva Hagberg
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska AcademyUniversity of GothenburgSahlgrenska University Hospital Gothenburg Sweden
| | - Christer Axelsson
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Araz Rawshani
- Department of Anesthesiology and Intensive Care Medicine Sahlgrenska AcademyUniversity of GothenburgSahlgrenska University Hospital Gothenburg Sweden
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24
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Svensson A, Elmqvist C, Fridlund B, Rask M, Andersson R, Stening K. Using firefighters as medical first responders to shorten response time in rural areas in Sweden. Aust J Rural Health 2020; 28:6-14. [PMID: 32105393 DOI: 10.1111/ajr.12599] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 12/20/2019] [Accepted: 12/22/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To map out and describe an earlier response by using firefighters as medical first responders on while waiting for the ambulance and first incident person assignments focusing on frequency, event time and survival >30 days after performed cardiopulmonary resuscitation. DESIGN Retrospective descriptive design. SETTING Ambulance service in a county of southern Sweden with a population of 200 000 inhabitants (23/km2 ). PARTICIPANTS Data were collected from four data systems within different organizations; emergency medical communication centre, fire deparment, ambulance services and conty hospital analysis unit. MAIN OUTCOME MEASURE(S) Data from 600 while waiting for the ambulance assignments, whereof 120 with first incident person present, collected between 1 January 2012 and 31 December 2016. Between 1 June 2014 and 1 October 2015, the two fire departments were dually dispatched on out-of-hospital cardiac arrests. RESULTS Three main findings were made: there was a prolonged process time for dispatching fire fighters on while waiting for the ambulance assignments. Dual dispatches did not shorten the process time for dispatching full-time firefighters, and, in a majority of while waiting for the ambulance assignments where cardiopulmonary resuscitation was performed, firefighters or first incident persons arrived first on the scene. CONCLUSION Minimising every minute that delays the performance of life-saving actions is crucial. By dispatching firefighters on while waiting for the ambulance assignments in rural areas, the response time in a majority of assignments was shortened. However, there was substantial delay in dispatching firefighters due to prolonged process time at the emergency medical communication centre. The emergency medical communication centre operator's ability to quickly assess the need for while waiting for the ambulance assignments plays a crucial role in the chain of survival.
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Affiliation(s)
- Anders Svensson
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Mikael Rask
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Richard Andersson
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Ambulance Services at Region Kronoberg, Växjö, Sweden
| | - Kent Stening
- Centre of Interprofessional Collaboration within Emergency care (CICE), Växjö, Sweden.,Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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25
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Moon S, Ryoo HW, Ahn JY, Lee DE, Shin SD, Park JH. Association of response time interval with neurological outcomes after out-of-hospital cardiac arrest according to bystander CPR. Am J Emerg Med 2020; 38:1760-1766. [DOI: 10.1016/j.ajem.2020.05.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/22/2020] [Accepted: 05/27/2020] [Indexed: 12/30/2022] Open
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26
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Kim TH, Sohn Y, Hong W, Song KJ, Shin SD. Association between hourly call volume in the emergency medical dispatch center and dispatcher-assisted cardiopulmonary resuscitation instruction time in out-of-hospital cardiac arrest. Resuscitation 2020; 153:136-142. [DOI: 10.1016/j.resuscitation.2020.05.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/17/2020] [Accepted: 05/20/2020] [Indexed: 11/27/2022]
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27
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Cheskes S, McLeod SL, Nolan M, Snobelen P, Vaillancourt C, Brooks SC, Dainty KN, Chan TCY, Drennan IR. Improving Access to Automated External Defibrillators in Rural and Remote Settings: A Drone Delivery Feasibility Study. J Am Heart Assoc 2020; 9:e016687. [PMID: 32627636 PMCID: PMC7660725 DOI: 10.1161/jaha.120.016687] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background Time to treatment is critical for survival from sudden cardiac arrest. Every minute delay in defibrillation results in a 7% to 10% reduction in survival. This is particularly problematic in rural and remote regions, where emergency medical service response is prolonged and automated external defibrillators (AEDs) are often not available. Our primary objective was to examine the feasibility of a novel AED drone delivery method for rural and remote sudden cardiac arrest. A secondary objective was to compare response times between AED drone delivery and ambulance to mock sudden cardiac arrest resuscitations. Methods and Results We conducted 6 simulations in 2 rural communities in southern Ontario, Canada. In the first 2 simulations, the drone and ambulance were dispatched from the same paramedic base. In simulations 3 and 4, the drone and ambulance were dispatched from separate paramedic bases; and in simulations 5 and 6, the drone was dispatched from an optimized location. During each simulation, a "mock" call was placed to 911 and a single AED drone and an ambulance were simultaneously dispatched to a predetermined destination. On scene, trained first responders retrieved the AED from the drone and initiated resuscitative efforts on a mannequin until paramedics arrived. No difficulties were encountered during drone activation by dispatch, ascent, landing, or bystander retrieval of the AED from the drone. During simulations 1 and 2, the distance to the scene was 6.6 km. For simulations 3 and 4, the ambulance response distance increased to 8.8 km while drone remained at 6.6 km; and in simulations 5 and 6, the ambulance response distance was 20 km compared with 9 km for the drone. During each flight, the AED drone arrived on scene before the ambulance, between 1.8 and 8.0 minutes faster. Conclusions This study suggests AED drone delivery is feasible, with the potential for improvements in response time during simulated sudden cardiac arrest scenarios. Further research is required to determine the appropriate system configuration for AED drone delivery in an integrated emergency medical service system as well as optimal strategies to simplify bystander application of a drone-delivered AED.
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Affiliation(s)
- Sheldon Cheskes
- Sunnybrook Centre for Prehospital Medicine Sunnybrook Health Sciences Centre Toronto Ontario Canada.,Division of Emergency Medicine Department of Family and Community Medicine University of Toronto Ontario Canada.,Sunnybrook Research Institute Sunnybrook Health Sciences Centre Toronto Ontario Canada.,Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada
| | - Shelley L McLeod
- Division of Emergency Medicine Department of Family and Community Medicine University of Toronto Ontario Canada.,Schwartz/Reisman Emergency Medicine Institute Sinai Health System Toronto Ontario Canada
| | - Michael Nolan
- County of Renfrew Paramedic Service Pembroke Ontario Canada
| | - Paul Snobelen
- Peel Regional Paramedic Services Brampton Ontario Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine Ottawa Hospital Research Institute University of Ottawa Ontario Canada
| | - Steven C Brooks
- Departments of Emergency Medicine and Public Health Sciences Queen's University Kingston Ontario Canada
| | - Katie N Dainty
- North York General Hospital Toronto Ontario Canada.,Institute of Health Policy Management and Evaluation University of Toronto Ontario Canada
| | - Timothy C Y Chan
- Li Ka Shing Knowledge Institute St. Michael's Hospital Toronto Ontario Canada.,Department of Mechanical and Industrial Engineering Faculty of Applied Science and Engineering University of Toronto Ontario Canada
| | - Ian R Drennan
- Sunnybrook Centre for Prehospital Medicine Sunnybrook Health Sciences Centre Toronto Ontario Canada.,Division of Emergency Medicine Department of Family and Community Medicine University of Toronto Ontario Canada.,Sunnybrook Research Institute Sunnybrook Health Sciences Centre Toronto Ontario Canada.,Institute of Health Policy Management and Evaluation University of Toronto Ontario Canada.,Institute of Medical Science Faculty of Medicine University of Toronto Ontario Canada
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28
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Al-Azzani MAK, Davari S, England TJ. An empirical investigation of forecasting methods for ambulance calls - a case study. Health Syst (Basingstoke) 2020; 10:268-285. [PMID: 34745589 DOI: 10.1080/20476965.2020.1783190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
A primary goal of emergency services is to minimise the response times to emergencies whilst managing operational costs. This paper is motivated by real data from the Welsh Ambulance Service which in recent years has been criticised for not meeting its eight-minute response target. In this study, four forecasting approaches (ARIMA, Holt Winters, Multiple Regression and Singular Spectrum Analysis (SSA)) are considered to investigate whether they can provide more accurate predictions to the call volume demand (total and by category) than the current approach on a selection of planning horizons (weekly, monthly and 3-monthly). Each method is applied to a training and test set and root mean square error (RMSE) and mean absolute percentage error (MAPE) error statistics are determined. Results showed that ARIMA is the best forecasting method for weekly and monthly prediction of demand and the long-term demand is best predicted using the SSA method.
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Affiliation(s)
| | - Soheil Davari
- Hertfordshire Business School, University of Hertfordshire, Hatfield, UK
| | - Tracey Jane England
- School of Mathematics, Cardiff University, Aneurin Bevan University Health Board, Newport, UK
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29
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Chichester K, Drawve G, Giménez-Santana A, Sisson M, McCleskey B, Dye DW, Walker J, Mrug S, Cropsey K. Pharmacies and features of the built environment associated with opioid overdose: A geospatial comparison of rural and urban regions in Alabama, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 79:102736. [PMID: 32278255 DOI: 10.1016/j.drugpo.2020.102736] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 02/20/2020] [Accepted: 03/17/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Elements of the physical environment have been shown to influence health behaviors including drug use and overdose mortality. Throughout the opioid epidemic in the United States, rural regions have been disproportionately affected by opioid overdose. Although the relationship between the urban built environment and opioid overdose has been established, little is known as to how trends may differ in rural areas. METHODS Risk terrain modeling was used as a spatial analytical approach to assess environmental features that significantly increase the risk of opioid overdose in Jefferson County, Alabama. Spatial risk assessments were conducted for urban and rural regions as well as for the county as a whole. Criminogenic, opioid-related, and community variables were included and compared across spatial risk models. RESULTS The geographic context, rural or urban, influenced the relationship between environmental features and opioid overdose. In rural areas, community features such as bus stops and public schools were related to the occurrence of opioid overdose. In urban areas, inpatient treatment centers, transitional living facilities, express loan establishments, and liquor vendors were significantly related to the locations of opioid overdose. CONCLUSION Risk terrain modeling can be used to locate high-risk areas for opioid overdose while identifying factors that are contributing to the risk of events occurring in communities. The patterns of overdose risk differ in rural and urban contexts and may be used to inform the placement of treatment and prevention resources.
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Affiliation(s)
- Keith Chichester
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Grant Drawve
- Department of Sociology & Criminology, University of Arkansas, 211 Old Main, Fayetteville, AR 72701, United States
| | | | - Michelle Sisson
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Brandi McCleskey
- Department of Pathology, University of Alabama at Birmingham, 1515 6th Ave S #220, Birmingham, AL 35233, United States
| | - Daniel W Dye
- Department of Pathology, University of Alabama at Birmingham, 1515 6th Ave S #220, Birmingham, AL 35233, United States
| | - Jeffery Walker
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Sylvie Mrug
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States
| | - Karen Cropsey
- University of Alabama at Birmingham, 1670 University Blvd, Volker Hall, Suite L107, Birmingham, AL 35233, United States.
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30
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Wei Y, Pek P, Doble B, Finkelstein E, Wah W, Ng Y, Cheah S, Chia M, Leong B, Gan H, Mao D, Tham L, Fook-Chong S, Ong M. Strategies to improve survival outcomes of out-of-hospital cardiac arrest (OHCA) given a fixed budget: A simulation study. Resuscitation 2020; 149:39-46. [DOI: 10.1016/j.resuscitation.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 11/28/2022]
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31
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Cui Y, Ai S, Liu Y, Qian ZM, Wang C, Sun J, Sun X, Zhang S, Syberg KM, Howard S, Qin L, Lin H. Hourly associations between ambient temperature and emergency ambulance calls in one central Chinese city: Call for an immediate emergency plan. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 711:135046. [PMID: 31812379 DOI: 10.1016/j.scitotenv.2019.135046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 10/13/2019] [Accepted: 10/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Most studies examining the short-term effects of temperature on health were based on the daily scale, few were at the hourly level. Revealing the relationship between unfavorable temperatures on an hourly basis and health is conducive to the development of more accurate extreme temperature early warning systems and reasonable dispatch of ambulances. METHODS Hourly data on temperature, air pollution (including PM2.5, O3, SO2 and NO2) and emergency ambulance calls (EACs) for all-cause, cardiovascular and respiratory diseases from January 16, 2014 to December 31, 2016 were obtained from Luoyang, China. A distributed lag non-linear model (DLNM) was used to assess the association between hourly temperature and ambulance calls after adjusting for potential confounding factors. The fractions of EACs attributable to non-optimum temperatures were also estimated. RESULTS Hourly temperature was associated with increased ambulance calls with a varying lag pattern. Extreme hot temperature (>32.1 °C) was positively associated with all-cause, cardiovascular diseases at lag 0-30 h and lag 0-9 h, while no significant effects were found for respiratory morbidity. Extreme cold temperature (<-2.5 °C) was positively associated with all-cause, cardiovascular and respiratory morbidity at lag 56-157 h, 50-145 h and 123-170 h. An overall EACs fraction of 6.84% [Backward estimate, 95% confidence interval (CI): 5.01%, 8.59%] could be attributed to non-optimum temperatures, and more contributions were caused by cold [Backward estimate: 6.06% (95% CI: 5.10%, 8.48%)] than by heat [Backward estimate: 0.79% (95% CI: 0.12%, 1.45%)]. CONCLUSIONS Extreme hot temperature may lead to increased ambulance calls within a few hours, while extreme cold temperature may not increase ambulance calls until more than 2 days later. Effective measures, such as forming hourly temperature warning standards, optimizing ambulance services at extreme temperatures, etc., should be taken to reduce the unfavorable temperature - associated EACs burden.
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Affiliation(s)
- Yingjie Cui
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Siqi Ai
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yuying Liu
- Department of Cancer Prevention, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhengmin Min Qian
- Department of Epidemiology & Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Changke Wang
- National Climate Center, China Meteorological Administration, Beijing, China
| | - Jia Sun
- Department of Epidemiology & Biostatistics, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Xiangyan Sun
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Shiyu Zhang
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kevin M Syberg
- Department of Health Management & Policy, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Steven Howard
- Department of Health Management & Policy, College for Public Health & Social Justice, Saint Louis University, St. Louis, MO, USA
| | - Lijie Qin
- Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China.
| | - Hualiang Lin
- Department of Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China.
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Fang PH, Lin YY, Lu CH, Lee CC, Lin CH. Impacts of Emergency Medical Technician Configurations on Outcomes of Patients with Out-of-Hospital Cardiac Arrest. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17061930. [PMID: 32188024 PMCID: PMC7143305 DOI: 10.3390/ijerph17061930] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/14/2020] [Accepted: 03/15/2020] [Indexed: 11/22/2022]
Abstract
Paramedics can provide advanced life support (ALS) for patients with out-of-hospital cardiac arrest (OHCA). However, the impact of emergency medical technician (EMT) configuration on their outcomes remains debated. A three-year cohort study consisted of non-traumatic OHCA adults transported by ALS teams was retrospectively conducted in Tainan City using an Utstein-style population database. The EMT-paramedic (EMT-P) ratio was defined as the EMT-P proportion out of all on-scene EMTs. Among the 1357 eligible cases, the median (interquartile range) number of on-scene EMTs and the EMT-P ratio were 2 (2–2) persons and 50% (50–100%), respectively. The multivariate analysis identified five independent predictors of sustained return of spontaneous circulation (ROSC): younger adults, witnessed cardiac arrest, prehospital ROSC, prehospital defibrillation, and comorbid diabetes mellitus. After adjustment, every 10% increase in the EMT-P ratio was on average associated with an 8% increased chance (adjusted odds ratio [aOR], 1.08; p < 0.01) of sustained ROSC and a 12% increase change (aOR, 1.12; p = 0.048) of favorable neurologic status at discharge. However, increased number of on-scene EMTs was not linked to better outcomes. For nontraumatic OHCA adults, an increase in the on-scene EMT-P ratio resulted in a higher proportion of improved patient outcomes.
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Affiliation(s)
- Pin-Hui Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-H.F.); (Y.-Y.L.); (C.-H.L.)
| | - Yu-Yuan Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-H.F.); (Y.-Y.L.); (C.-H.L.)
| | - Chien-Hsin Lu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-H.F.); (Y.-Y.L.); (C.-H.L.)
| | - Ching-Chi Lee
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-H.F.); (Y.-Y.L.); (C.-H.L.)
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan
- Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan 71101, Taiwan
- Department of Adult Critical Care Medicine, Tainan Sin-Lau Hospital, Tainan 70142, Taiwan
- Correspondence: (C.-C.L.); (C.-H.L.)
| | - Chih-Hao Lin
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; (P.-H.F.); (Y.-Y.L.); (C.-H.L.)
- Correspondence: (C.-C.L.); (C.-H.L.)
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Sangkharat K, Mahmood MA, Thornes JE, Fisher PA, Pope FD. Impact of extreme temperatures on ambulance dispatches in London, UK. ENVIRONMENTAL RESEARCH 2020; 182:109100. [PMID: 31918315 DOI: 10.1016/j.envres.2019.109100] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 11/24/2019] [Accepted: 12/28/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Associations between extreme temperatures and health outcomes, such as mortality and morbidity, are often observed. However, relatively little research has investigated the role of extreme temperatures upon ambulance dispatches. METHODS A time series analysis using London Ambulance Service (LAS) incident data (2010-2014), consisting of 5,252,375 dispatches was conducted. A generalized linear model (GLM) with a quasi-likelihood Poisson regression was applied to analyse the associations between ambulance dispatches and temperature. The 99th (22.8°C) and 1st (0.0°C) percentiles of temperature were defined as extreme high and low temperature. Fourteen categories of ambulance dispatches were investigated, grouped into 'respiratory' (asthma, dyspnoea, respiratory chest infection, respiratory arrest and chronic obstructive pulmonary disease), 'cardiovascular' (cardiac arrest, chest pain, cardiac chest pain RCI, cardiac arrhythmia and other cardiac problems) and 'other' non-cardiorespiratory (dizzy, alcohol related, vomiting and 'generally unwell') categories. The effects of long-term trends, seasonality, day of the week, public holidays and air pollution were controlled for in the GLM. The lag effect of temperature was also investigated. The threshold temperatures for each category were identified and a distributed lag non-linear model (DLNM) was reported using relative risk (RR) values at 95% confidence intervals. RESULTS Many dispatch categories show significant associations with extreme temperature. Total calls from 999 dispatches and 'generally unwell' dispatch category show significant RRs at both low and high temperatures. Most respiratory categories (asthma, dyspnoea and RCI) have significant RRs at low temperatures represented by with estimated RRs ranging from 1.392 (95%CI: 1.161-1.699) for asthma to 2.075 (95%CI: 1.673-2.574) for RCI. The RRs for all other non-cardiorespiratory dispatches were often significant for high temperatures ranging from 1.280 (95% CI: 1.128-1.454) for 'generally unwell' to 1.985 (95%CI: 1.422-2.773) for alcohol-related. For the cardiovascular group, only chest pain dispatches reported a significant RR at high temperatures. CONCLUSIONS Ambulance dispatches can be associated with extreme temperatures, dependent on the dispatch category. It is recommended that meteorological factors are factored into ambulance forecast models and warning systems, allowing for improvements in ambulance and general health service efficiency.
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Affiliation(s)
- Kamolrat Sangkharat
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Marliyyah A Mahmood
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - John E Thornes
- Chemicals and Environmental Effects, Public Health England, Oxfordshire, UK
| | - Paul A Fisher
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Francis D Pope
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Birmingham, UK.
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Factors associated with return to work among survivors of out-of-hospital cardiac arrest. Resuscitation 2020; 146:203-212. [DOI: 10.1016/j.resuscitation.2019.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/21/2019] [Accepted: 09/08/2019] [Indexed: 11/18/2022]
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Effect of the Floor Level on the Probability of a Neurologically Favorable Discharge after Cardiac Arrest according to the Event Location. Emerg Med Int 2019; 2019:9761072. [PMID: 31737368 PMCID: PMC6815993 DOI: 10.1155/2019/9761072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 09/09/2019] [Indexed: 11/17/2022] Open
Abstract
As the number of people living in high-rise buildings increases, so does the incidence of cardiac arrest in these locations. Changes in cardiac arrest location affect the recognition of patients and emergency medical service (EMS) activation and response. This study aimed to compare the EMS response times and probability of a neurologically favorable discharge among patients who suffered an out-of-hospital cardiac arrest (OHCA) event while on a high or low floor at home or in a public place. This retrospective analysis was based on Smart Advanced Life Support registry data from January 2016 to December 2017. We included patients older than 18 years who suffered an OHCA due to medical causes. A high floor was defined as ≥3rd floor above ground. We compared the probability of a neurologically favorable discharge according to floor level and location (home vs. public place) of the OHCA event. Of the 6,335 included OHCA cases, 4,154 (65.6%) events occurred in homes. Rapid call-to-scene times were reported for high-floor events in both homes and public places. A longer call-to-patient time was observed for home events. The probability of a neurologically favorable discharge after a high-floor OHCA was significantly lower than that after a low-floor OHCA if the event occurred in a public place (adjusted odds ratio (aOR), 0.58; 95% confidence intervals (CI), 0.37-0.89) but was higher if the event occurred at home (aOR, 1.40; 95% CI, 0.96-2.03). Both the EMS response times to OHCA events in high-rise buildings and the probability of a neurologically favorable discharge differed between homes and public places. The results suggest that the prognosis of an OHCA patient is more likely to be affected by the building structure and use rather than the floor height.
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The Effect of All-Terrain Vehicle Crash Location on Emergency Medical Services Time Intervals. SAFETY 2019. [DOI: 10.3390/safety5040073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Over 100,000 all-terrain vehicle (ATV)-related injuries are evaluated in U.S. emergency departments each year. In this study, we analyzed the time intervals for emergency medical services (EMS) providers responding to ATV crashes in different location types. Data from the Iowa State Trauma Registry and a statewide ATV crash/injury database was matched with Iowa EMS Registry records from 2004–2014. Ground ambulance responses to 270 ATV crashes were identified, and response characteristics and time intervals were analyzed. Off-road crashes had a longer median patient access interval (p < 0.001) and total on scene interval (p = 0.002) than roadway crashes. Crashes in remote locations had a longer median patient access interval (p < 0.001) and total on scene interval (p < 0.001), but also a longer median on scene with patient interval (p = 0.004) than crashes in accessible locations. Fifteen percent of remote patient access times were >6 min as compared to 3% of accessible crashes (p = 0.0004). There were no differences in en route to scene or en route to hospital time. Comparisons by location type showed no differences in injury severity score or number of total procedures performed. We concluded that responding EMS providers had an increased length of time to get to the patient after arriving on scene for off-road and remote ATV crashes relative to roadway and accessible location crashes, respectively.
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Nord-Ljungquist H, Engström Å, Fridlund B, Elmqvist C. Lone and lonely in a double ambivalence situation as experienced by callers while waiting for the ambulance in a rural environment. Scand J Caring Sci 2019; 34:566-574. [PMID: 31614024 DOI: 10.1111/scs.12767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 09/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND In a rural environment where distances and access to ambulance resources in people's immediate area are limited, other responders like firefighters dispatched to perform a first aid before ambulance arrives in areas where a longer response time exists; an assignment called 'While Waiting for the Ambulance' (WWFA). Knowledge is limited about the experience from a caller's perspective when a person has a life-threatening condition needing emergency help and both firefighters in a WWFA assignment and ambulance staff are involved. AIM The aim of the study is to describe the emergency situation involving a WWFA assignment in a rural environment from the caller's perspective. METHOD A descriptive design using qualitative methodology with a reflective lifeworld research (RLR) approach was used for this study, including in-depth interviews with eight callers. RESULTS An emergency situation involving WWFA assignment in a rural environment mean a sense of being lone and lonely with a vulnerability in while waiting to hand over responsibility for the affected person. Ambivalence in several dimensions arises with simultaneous and conflicting emotions. A tension between powerlessness and power of action where the throw between doubt and hope are abrupt with a simultaneous pendulum between being in a chaos and in a calm. CONCLUSION A double ambivalence emerges between, on one hand feeling alone in the situation and having full control, on the other hand, with trust handing over the responsibility, thereby losing control. Contact with the emergency medical dispatcher becomes a saving lifeline to hold onto, and access to emergency help in the immediate area of WWFA is valuable and important. Trust and confidence are experienced when callers are met with empathy, regardless of personal acquaintance with arriving responders.
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Affiliation(s)
- Helena Nord-Ljungquist
- Department of Health and Caring Science, Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
| | - Åsa Engström
- Division of Nursing, Department of Health Science, Luleå University of Technology, Luleå, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency care (CICE), Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency care (CICE), Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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Courtemanche C, Friedson A, Koller AP, Rees DI. The affordable care act and ambulance response times. JOURNAL OF HEALTH ECONOMICS 2019; 67:102213. [PMID: 31362143 DOI: 10.1016/j.jhealeco.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 11/18/2018] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
This study contributes to the literature on the capacity challenges faced by health care providers after insurance expansions by examining the Affordable Care Act (ACA) and ambulance response times. Exploiting temporal and geographic variation in the implementation of the ACA as well as pre-treatment differences in uninsured rates, we estimate that the expansions of private and Medicaid coverage under the ACA combined to slow ambulance response times by an average of 24%. We conclude that, through extending coverage to individuals who, in its absence, would not have availed themselves of emergency medical services, the ACA added strain to emergency response systems.
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Affiliation(s)
| | | | | | - Daniel I Rees
- University of Colorado Denver, NBER and IZA, United States
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Turner J, Siriwardena AN, Coster J, Jacques R, Irving A, Crum A, Gorrod HB, Nicholl J, Phung VH, Togher F, Wilson R, O’Cathain A, Booth A, Bradbury D, Goodacre S, Spaight A, Shewan J, Pilbery R, Fall D, Marsh M, Broadway-Parkinson A, Lyons R, Snooks H, Campbell M. Developing new ways of measuring the quality and impact of ambulance service care: the PhOEBE mixed-methods research programme. PROGRAMME GRANTS FOR APPLIED RESEARCH 2019. [DOI: 10.3310/pgfar07030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BackgroundAmbulance service quality measures have focused on response times and a small number of emergency conditions, such as cardiac arrest. These quality measures do not reflect the care for the wide range of problems that ambulance services respond to and the Prehospital Outcomes for Evidence Based Evaluation (PhOEBE) programme sought to address this.ObjectivesThe aim was to develop new ways of measuring the impact of ambulance service care by reviewing and synthesising literature on prehospital ambulance outcome measures and using consensus methods to identify measures for further development; creating a data set linking routinely collected ambulance service, hospital and mortality data; and using the linked data to explore the development of case-mix adjustment models to assess differences or changes in processes and outcomes resulting from ambulance service care.DesignA mixed-methods study using a systematic review and synthesis of performance and outcome measures reported in policy and research literature; qualitative interviews with ambulance service users; a three-stage consensus process to identify candidate indicators; the creation of a data set linking ambulance, hospital and mortality data; and statistical modelling of the linked data set to produce novel case-mix adjustment measures of ambulance service quality.SettingEast Midlands and Yorkshire, England.ParticipantsAmbulance services, patients, public, emergency care clinical academics, commissioners and policy-makers between 2011 and 2015.InterventionsNone.Main outcome measuresAmbulance performance and quality measures.Data sourcesAmbulance call-and-dispatch and electronic patient report forms, Hospital Episode Statistics, accident and emergency and inpatient data, and Office for National Statistics mortality data.ResultsSeventy-two candidate measures were generated from systematic reviews in four categories: (1) ambulance service operations (n = 14), (2) clinical management of patients (n = 20), (3) impact of care on patients (n = 9) and (4) time measures (n = 29). The most common operations measures were call triage accuracy; clinical management was adherence to care protocols, and for patient outcome it was survival measures. Excluding time measures, nine measures were highly prioritised by participants taking part in the consensus event, including measures relating to pain, patient experience, accuracy of dispatch decisions and patient safety. Twenty experts participated in two Delphi rounds to refine and prioritise measures and 20 measures scored ≥ 8/9 points, which indicated good consensus. Eighteen patient and public representatives attending a consensus workshop identified six measures as important: time to definitive care, response time, reduction in pain score, calls correctly prioritised to appropriate levels of response, proportion of patients with a specific condition who are treated in accordance with established guidelines, and survival to hospital discharge for treatable emergency conditions. From this we developed six new potential indicators using the linked data set, of which five were constructed using case-mix-adjusted predictive models: (1) mean change in pain score; (2) proportion of serious emergency conditions correctly identified at the time of the 999 call; (3) response time (unadjusted); (4) proportion of decisions to leave a patient at scene that were potentially inappropriate; (5) proportion of patients transported to the emergency department by 999 emergency ambulance who did not require treatment or investigation(s); and (6) proportion of ambulance patients with a serious emergency condition who survive to admission, and to 7 days post admission. Two indicators (pain score and response times) did not need case-mix adjustment. Among the four adjusted indicators, we found that accuracy of call triage was 61%, rate of potentially inappropriate decisions to leave at home was 5–10%, unnecessary transport to hospital was 1.7–19.2% and survival to hospital admission was 89.5–96.4% depending on Clinical Commissioning Group area. We were unable to complete a fourth objective to test the indicators in use because of delays in obtaining data. An economic analysis using indicators (4) and (5) showed that incorrect decisions resulted in higher costs.LimitationsCreation of a linked data set was complex and time-consuming and data quality was variable. Construction of the indicators was also complex and revealed the effects of other services on outcome, which limits comparisons between services.ConclusionsWe identified and prioritised, through consensus processes, a set of potential ambulance service quality measures that reflected preferences of services and users. Together, these encompass a broad range of domains relevant to the population using the emergency ambulance service. The quality measures can be used to compare ambulance services or regions or measure performance over time if there are improvements in mechanisms for linking data across services.Future workThe new measures can be used to assess different dimensions of ambulance service delivery but current data challenges prohibit routine use. There are opportunities to improve data linkage processes and to further develop, validate and simplify these measures.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Janette Turner
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - A Niroshan Siriwardena
- Community and Health Research Unit (CaHRU), University of Lincoln, Lincoln, UK
- East Midlands Ambulance Service NHS Trust, Nottingham, UK
| | - Joanne Coster
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Richard Jacques
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andy Irving
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Annabel Crum
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Helen Bell Gorrod
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Jon Nicholl
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Viet-Hai Phung
- Community and Health Research Unit (CaHRU), University of Lincoln, Lincoln, UK
| | - Fiona Togher
- Community and Health Research Unit (CaHRU), University of Lincoln, Lincoln, UK
| | - Richard Wilson
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Alicia O’Cathain
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Daniel Bradbury
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Anne Spaight
- East Midlands Ambulance Service NHS Trust, Nottingham, UK
| | - Jane Shewan
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | | | - Daniel Fall
- Patient and public involvement, Sheffield, UK
| | | | | | - Ronan Lyons
- College of Medicine, Swansea University, Swansea, UK
| | - Helen Snooks
- College of Medicine, Swansea University, Swansea, UK
| | - Mike Campbell
- School of Health and Related Research, University of Sheffield, Sheffield, UK
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Lee DW, Moon HJ, Heo NH. Association between ambulance response time and neurologic outcome in patients with cardiac arrest. Am J Emerg Med 2019; 37:1999-2003. [PMID: 30795948 DOI: 10.1016/j.ajem.2019.02.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE Emergency medical services (EMS) response time is one of prehospital factors associated with survival rate of patients with out-of-hospital cardiac arrest (OHCA). The objective of this study was to determine whether short EMS response time was associated with improved neurologic outcome of patients with OHCA through prospective analysis. METHODS We performed a prospective observational analysis of collected data from KoCARC registry between October 2015 and December 2016. OHCA patients aged 18 years or older with presumed cardiac etiology by emergency physicians in emergency department were included in this study. RESULTS Of 3187 cardiac arrest patients enrolled in the KoCARC registry, 2309 patients were included in the final analysis. Response time threshold was 11.5 min for prehospital return of spontaneous circulation and 7.5 min for survival to discharge and favorable neurologic outcome. Patients in the ≤7.5 min response time group showed increased odds of survival to discharge (OR: 1.54, 95% CI: 1.13-2.10, p = .006) and favorable neurologic recovery (OR: 2.01, 95% CI: 1.36-2.99, p = .001). When response time was decreased by 1 min, all outcomes were improved (survival to discharge, OR: 1.08; 95% CI: 1.04-1.12, p < .001; favorable neurological outcome, OR: 1.14, 95% CI: 1.07-1.21, p < .001). CONCLUSION We found that shorter EMS response time could lead to favorable neurologic outcome in patients with OHCA of presumed cardiac origin. EMS response time threshold associated with improved favorable outcome was ≤7.5 min.
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Affiliation(s)
- Dong Wook Lee
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Hyung Jun Moon
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea.
| | - Nam Hun Heo
- Clinical Trial Center, Soonchunhyang University Cheonan Hospital, Republic of Korea
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Khanna VA, Chidambaram S, Goh EL. Prehospital Advanced Life Support for Out-of-Hospital Cardiac Arrest in Blunt Trauma Patients. JAMA Surg 2019; 154:95-96. [DOI: 10.1001/jamasurg.2018.4291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - En Lin Goh
- School of Medicine, Imperial College London, London, United Kingdom
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Sultan M, Abebe Y, Tsadik AW, Jennings CA, Mould-Millman NK. Epidemiology of ambulance utilized patients in Addis Ababa, Ethiopia. BMC Health Serv Res 2018; 18:997. [PMID: 30587188 PMCID: PMC6307284 DOI: 10.1186/s12913-018-3820-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/16/2018] [Indexed: 11/10/2022] Open
Abstract
Background Well organized and appropriately utilized pre-hospital emergency services play a critical role in augmenting emergency care systems. The primary objective of this study was to understand the demographic and clinical profile of patients who used ambulances in Addis Ababa. The secondary objectives were to assess ambulance response time, transport time and reasons for referral amongst inter-facility transported patients in Addis Ababa. Methods The study was designed as a cross-sectional retrospective chart review of ambulance transported patients using ambulance station records from Addis Ababa Fire and Emergency Prevention and Control Authority. With IRB approval, simple random sampling and manual review of six months of clinical records was performed. Data were collected by trained data collectors and descriptive analysis was done using SPSS version 20. Results Female patients used ambulance services more often than males (female to male ratio of 3:1) and the mean age of the patients was 26 years. The most commonly transported age group was 16–30 years, followed by 31–50 years and neonatal patients (i.e. < 1 month). The majority of the patients had pregnancy related illnesses (n = 492, 61.4%), followed by general medical issues (n = 210, 26.2%) and injury secondary to trauma (n = 99, 12.3%). Most patients (n = 702, 87.6%) were transported for inter-facility transfers, while only 12.4% (n = 99) were primary responses (i.e. from the scene). Prolonged labor was the most common reason (n = 103, 23.4%) for inter-facility transfer of pregnant patients, followed by premature rupture of the amniotic membrane (n = 60, 13.6%). The mean dispatch to scene time interval was 10.1 min, and mean scene to facility time interval was 17.2 min. Conclusion Inter-facility transfers accounted for the largest proportion of ambulance utilization and dispatch in Addis Ababa. Ambulance transport time was twice as long compared to international recommendations of less than eight minutes for emergent transports. The most common reasons for ambulance dispatch were Obstetric. We recommend urgent action to decrease the transport times and to dedicate further pre-hospital resources to address the high burden of inter-facility transfers.
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Affiliation(s)
- Menbeu Sultan
- Department of Emergency Medicine and Critical Care, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
| | - Yonas Abebe
- Department of Emergency Medicine and Critical Care Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Assefu Welde Tsadik
- Federal Ministry of Health Ethiopia, Emergency and Critical Care Directorate, Addis Ababa, Ethiopia
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Lee J, Abdel-Aty M, Cai Q, Wang L. Effects of emergency medical services times on traffic injury severity: A random effects ordered probit approach. TRAFFIC INJURY PREVENTION 2018; 19:577-581. [PMID: 29693416 DOI: 10.1080/15389588.2018.1468889] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/20/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Emergency medical services (EMS) play a vital role in the postcrash effort to reduce fatalities by providing first aid treatment and transportation to medical facilities. This study aims to analyze the time required for crash reporting and EMS arrival in fatal traffic crashes and to explore the effects of EMS time on the traffic injury severity. METHODS The time required for EMS reporting, arrival, and transport to hospital was calculated by location type and roadway functional classification using 2016 Fatality Analysis Reporting System (FARS) data. Subsequently, an ordered probit model was developed to identify factors contributing to injury severity considering EMS time. RESULTS The average time for the crash-reporting duration is 5.38 min, the reporting-scene arrival interval is 10.52 min, and the scene-hospital interval is 34.72 min. The average crash reporting and reporting-scene arrival intervals were the longest on conventional roads in rural areas and the shortest on conventional roads in urban areas. The average scene-hospital interval was longest in conventional rural areas and the shortest on freeways/expressways in urban areas. The developed random effects ordered probit model shows that prolonged reporting-scene arrival and scene-hospital intervals result in more severe injuries. The result also presents that crash type, violation, age, location, lighting condition, and alcohol/drug involvement have significant effects on injury severity. CONCLUSIONS The key findings from this study indicate that EMS times differ according to urban/rural location and road functional classification and that reporting-scene arrival and scene-hospital intervals have significant effects on injury severity along with various factors. It is expected that the findings from this study can be used to develop effective and practical strategic plans to minimize EMS reporting, arrival time, and transport to hospital and therefore decrease the traffic injury severity.
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Affiliation(s)
- Jaeyoung Lee
- a Department of Civil, Environmental and Construction Engineering , University of Central Florida , Orlando , Florida , USA
| | - Mohamed Abdel-Aty
- a Department of Civil, Environmental and Construction Engineering , University of Central Florida , Orlando , Florida , USA
| | - Qing Cai
- a Department of Civil, Environmental and Construction Engineering , University of Central Florida , Orlando , Florida , USA
| | - Ling Wang
- b College of Transportation Engineering , Tongji University , Shanghai , China
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Kim TH, Lee K, Shin SD, Ro YS, Tanaka H, Yap S, Wong KD, Ng YY, Piyasuwankul T, Leong B. Association of the Emergency Medical Services-Related Time Interval with Survival Outcomes of Out-of-Hospital Cardiac Arrest Cases in Four Asian Metropolitan Cities Using the Scoop-and-Run Emergency Medical Services Model. J Emerg Med 2018; 53:688-696.e1. [PMID: 29128033 DOI: 10.1016/j.jemermed.2017.08.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Response time interval (RTI) and scene time interval (STI) are key time variables in the out-of-hospital cardiac arrest (OHCA) cases treated and transported via emergency medical services (EMS). OBJECTIVE We evaluated distribution and interactive association of RTI and STI with survival outcomes of OHCA in four Asian metropolitan cities. METHODS An OHCA cohort from Pan-Asian Resuscitation Outcome Study (PAROS) conducted between January 2009 and December 2011 was analyzed. Adult EMS-treated cardiac arrests with presumed cardiac origin were included. A multivariable logistic regression model with an interaction term was used to evaluate the effect of STI according to different RTI categories on survival outcomes. Risk-adjusted predicted rates of survival outcomes were calculated and compared with observed rate. RESULTS A total of 16,974 OHCA cases were analyzed after serial exclusion. Median RTI was 6.0 min (interquartile range [IQR] 5.0-8.0 min) and median STI was 12.0 min (IQR 8.0-16.1). The prolonged STI in the longest RTI group was associated with a lower rate of survival to discharge or of survival 30 days after arrest (adjusted odds ratio [aOR] 0.59; 95% confidence interval [CI] 0.42-0.81), as well as a poorer neurologic outcome (aOR 0.63; 95% CI 0.41-0.97) without an increasing chance of prehospital return of spontaneous circulation (aOR 1.12; 95% CI 0.88-1.45). CONCLUSIONS Prolonged STI in OHCA with a delayed response time had a negative association with survival outcomes in four Asian metropolitan cities using the scoop-and-run EMS model. Establishing an optimal STI based on the response time could be considered.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyungwon Lee
- Department of Emergency Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Biomedical Research Institute Seoul National University Hospital, Seoul, Republic of Korea
| | - Hideharu Tanaka
- Department of Emergency Medical System, Graduate School of Kokushikan University, Tokyo, Japan
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Benjamin Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
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Heidari M, Aryankhesal A, Khorasani-Zavareh D. Laypeople roles at road traffic crash scenes: a systematic review. Int J Inj Contr Saf Promot 2018; 26:82-91. [PMID: 29939119 DOI: 10.1080/17457300.2018.1481869] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
This study aimed to identify the roles of laypeople at road traffic injuries (RTIs). A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The key words of 'laypeople', 'layman', 'layperson', 'bystander', 'first responder', 'lay first responder', 'road traffic', 'road traffic injury', 'crash injury', 'crash scene', 'emergency', 'trauma care', and 'prehospital trauma care' were used in combination with the Boolean operators OR and AND. We did electronic search on Google Scholar, PubMed, ISI Web of Science, CINAHL, Science Direct, Scopus, ProQuest. Based on the reviewed studies, some factors such as cultural conditions, knowledge, relief agencies, and demographic factors affect the interventions of laypeople at the crash scene in functional areas. Regarding the permanent presence of people at the crash scene, the present study can provide an opportunity to reduce different side effects of RTIs imposed on the society.
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Affiliation(s)
- Mohammad Heidari
- a Health Management and Economics Research Center, Iran University of Medical Sciences , Tehran , Iran.,b Department of Health in Emergency and Disaster, School of Health Management and Information Sciences , Iran University of Medical Sciences , Tehran , Iran
| | - Aidin Aryankhesal
- c Department of Health Services Management, School of Health Management and Information Sciences , Iran University of Medical Sciences , Tehran , Iran
| | - Davoud Khorasani-Zavareh
- d Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences , Tehran , Iran.,e Department of Health in Disaster and Emergency, School of Health, Safety and Environment , Shahid Beheshti University of Medical Sciences , Tehran , Iran.,f Department of Clinical Science and Education , Karolinska Institute , Stockholm , Sweden
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The care of patients assessed as not in need of emergency ambulance care – Registered nurses’ lived experiences. Int Emerg Nurs 2018; 38:10-14. [DOI: 10.1016/j.ienj.2018.01.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/08/2018] [Accepted: 01/28/2018] [Indexed: 11/19/2022]
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Goto Y, Funada A, Goto Y. Relationship Between Emergency Medical Services Response Time and Bystander Intervention in Patients With Out-of-Hospital Cardiac Arrest. J Am Heart Assoc 2018; 7:JAHA.117.007568. [PMID: 29703811 PMCID: PMC6015296 DOI: 10.1161/jaha.117.007568] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background The response time of emergency medical services (EMS) is an important determinant of survival after out‐of‐hospital cardiac arrest. We sought to identify upper limits of EMS response times and bystander interventions associated with neurologically intact survival. Methods and Results We analyzed the records of 553 426 patients with out‐of‐hospital cardiac arrest in a Japanese registry between 2010 and 2014. The primary study end point was 1‐month neurologically intact survival (Cerebral Performance Category scale 1 or 2). Increased EMS response time was associated with significantly decreased adjusted odds of 1‐month neurologically intact survival (adjusted odds ratio [aOR] for each 1‐minute increase, 0.89; 95% confidence interval [CI], 0.89–0.90), although this relationship was modified by bystander interventions. The bystander interventions and the ranges of EMS response times that were associated with increased adjusted 1‐month neurologically intact survival were as follows: bystander defibrillation, from ≤2 minutes (aOR, 3.10 [95% CI, 1.25–7.31]) to 13 minutes (aOR, 5.55 [95% CI, 2.66–11.2]); bystander conventional cardiopulmonary resuscitation, from 3 minutes (aOR 1.48 [95% CI, 1.02–2.12]) to 11 minutes (aOR 2.41 [95% CI, 1.61–3.56]); and bystander chest‐compression‐only cardiopulmonary resuscitation, from ≤2 minutes (aOR 1.57 [95% CI, 1.01–2.25]) to 11 minutes (aOR 1.92 [95% CI, 1.45–2.56]). However, the increase in neurologically intact survival of those receiving bystander interventions became statistically insignificant compared with no bystander interventions when the EMS response time was outside these ranges. Conclusions The upper limits of the EMS response times associated with improved 1‐month neurologically intact survival were 13 minutes when bystanders provided defibrillation (typically with cardiopulmonary resuscitation) and 11 minutes when bystanders provided cardiopulmonary resuscitation without defibrillation.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
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Tsai LH, Chen CB, Liu PH, Chaou CH, Huang CH, Kuo CW, Lin CC, Wang KC, Weng YM, Chien CY. Significance of blood pH value and automated external defibrillator shock in determining the outcomes of out-of-hospital cardiac arrest patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917749480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The prognosis of out-of-hospital cardiac arrest is generally poor. It is known that the survival of out-of-hospital cardiac arrest patients depends on treatments delivered in a very short time frame. Identifying outcome-associated factors may provide valuable information for decision-making in clinical practices. Aim: The objective of the present study was to assess the associations between various factors (e.g. serum biomarker levels and prehospital factors) and outcomes in adult, non-traumatic out-of-hospital cardiac arrest patients. Methods: Data from 386 consecutive out-of-hospital cardiac arrest patients treated from January 2012 to December 2015 at Taoyuan Chang Gung Memorial Hospital (Taiwan, ROC) were collected. While performing cardiopulmonary resuscitation in the emergency room, the levels of creatinine, aspartate aminotransferase, sodium, potassium, troponin-I, hydrogen bicarbonate and haemoglobin were determined, blood pH and pCO2 were measured and the white blood cell count was calculated. The response time and scene time interval were also recorded. Results: Here we found that out-of-hospital cardiac arrest patients with blood pH values of <7.34 had a lower chance of survival to 24 h (Odds Ratio (OR) = 2.77), survival to discharge (OR = 7.06) and a good neurological outcome (OR = 64.59). Moreover, patients without an automated external defibrillator shock had a lower chance of being discharged (OR = 4.27) and enjoying good neurological outcomes (OR = 25.09). Conclusion: Our data suggest that the blood pH and an automated external defibrillator shockable rhythm are two easily measurable factors strongly associated with the outcomes of out-of-hospital cardiac arrest patients.
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Affiliation(s)
- Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
| | - Kuo-Cheng Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
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Defibrillation for Ventricular Fibrillation: A Shocking Update. J Am Coll Cardiol 2017; 70:1496-1509. [PMID: 28911514 DOI: 10.1016/j.jacc.2017.07.778] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/24/2017] [Indexed: 01/09/2023]
Abstract
Cardiac arrest is defined as the termination of cardiac activity associated with loss of consciousness, of spontaneous breathing, and of circulation. Sudden cardiac arrest and sudden cardiac death (SCD) are terms often used interchangeably. Most patients with out-of-hospital cardiac arrest have shown coronary artery disease or symptoms during the hour before the event. Cardiac arrest is potentially reversible by cardiopulmonary resuscitation, defibrillation, cardioversion, cardiac pacing, or treatments targeted at the underlying disease (e.g., acute coronary occlusion). We restrict SCD hereafter to cardiac arrest due to ventricular fibrillation, including rhythms shockable by an automatic external defibrillator (AED), implantable cardioverter-defibrillator (ICD), or wearable cardioverter-defibrillator (WCD). We summarize the state of the art related to defibrillation in treating SCD, including a brief history of the evolution of defibrillation, technical characteristics of modern AEDs, strategies to improve AED access and increase survival, ancillary treatments, and use of ICDs or WCDs.
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Holmberg MJ, Vognsen M, Andersen MS, Donnino MW, Andersen LW. Bystander automated external defibrillator use and clinical outcomes after out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2017; 120:77-87. [PMID: 28888810 DOI: 10.1016/j.resuscitation.2017.09.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/23/2017] [Accepted: 09/05/2017] [Indexed: 10/18/2022]
Abstract
AIM To systematically review studies comparing bystander automated external defibrillator (AED) use to no AED use in regard to clinical outcomes in out-of-hospital cardiac arrest (OHCA), and to provide a descriptive summary of studies on the cost-effectiveness of bystander AED use. METHODS We searched Medline, Embase, the Web of Science, and the Cochrane Library for randomized trials and observational studies published before June 1, 2017. Meta-analyses were performed for patients with all rhythms, shockable rhythms, and non-shockable rhythms. RESULTS Forty-four observational studies, 3 randomized trials, and 13 cost-effectiveness studies were included. Meta-analysis of 6 observational studies without critical risk of bias showed that bystander AED use was associated with survival to hospital discharge (all rhythms OR: 1.73 [95%CI: 1.36, 2.18], shockable rhythms OR: 1.66 [95%CI: 1.54, 1.79]) and favorable neurological outcome (all rhythms OR: 2.12 [95%CI: 1.36, 3.29], shockable rhythms OR: 2.37 [95%CI: 1.58, 3.57]). There was no association between bystander AED use and neurological outcome for non-shockable rhythms (OR: 0.76 [95%CI: 0.10, 5.87]). The Public-Access Defibrillation trial found higher survival rates when volunteers were equipped with AEDs. The other trials found no survival difference, although their study settings differed. The quality of evidence was low for randomized trials and very low for observational studies. AEDs were cost-effective in settings with high cardiac arrest incidence, with most studies reporting ratios < $100,000 per quality-adjusted life years. CONCLUSIONS The evidence supports the association between bystander AED use and improved clinical outcomes, although the quality of evidence was low to very low.
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Affiliation(s)
- Mathias J Holmberg
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA
| | - Mikael Vognsen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark
| | - Mikkel S Andersen
- Department of Emergency Medicine, Odense University Hospital, 5000 Odense C, Denmark
| | - Michael W Donnino
- Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA; Department of Internal Medicine, Division of Pulmonary and Critical Care, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA
| | - Lars W Andersen
- Research Center for Emergency Medicine, Department of Clinical Medicine, Aarhus University Hospital, 8000 Aarhus C, Denmark; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, 02215 MA, USA.
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