Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study

Association of emergency intensive care unit occupancy due to brain-dead organ donors with ambulance diversion

Our study aims to explore how intensive care unit (ICU) occupancy by brain-dead organ donors affects emergency ambulance diversions. In this retrospective, single-center study at an emergency ICU (EICU), brain-dead organ donors were managed until organ procurement. We classified each day between August 1, 2021, and July 31, 2023, as either an exposure day (any day with a brain-dead organ donor in the EICU from admission to organ procurement) or a control day (all other days). The study compared these days and used multiple logistic regression analysis to assess the impact of EICU occupancy by brain-dead organ donors on ambulance diversions. Over two years, 6,058 emergency patients were transported by ambulance, with 1327 admitted to the EICU, including 13 brain-dead organ donors. Brain-dead donors had longer EICU stays (17 vs. 2 days, P < 0.001). With 168 exposure and 562 control days, EICU occupancy was higher on exposure days (75% vs. 67%, P = 0.003), leading to more ambulance diversions. Logistic regression showed exposure days significantly increased ambulance diversions, with an odds ratio of 1.79 (95% CIs 1.10-2.88). This study shows that managing brain-dead organ donors in the EICU leads to longer stays and higher occupancy, resulting in more frequent ambulance diversions. These findings highlight the critical need for policies that optimize ICU resource allocation while maintaining the infrastructure necessary to support organ donation programs and ensuring continued care for brain-dead donors, who play an essential role in addressing the organ shortage crisis.

Exploring Saudi paramedics' experiences in managing adult trauma cases: a qualitative study

BACKGROUND

Saudi paramedics face numerous challenges while providing care for adult trauma patients affecting their care but little is known about these specific challenges.

METHODS

A qualitative study was conducted using a purposive sample of Saudi paramedics from the Saudi Red Crescent Authority (SRCA) across various cities. Data were collected through online semi-structured interviews and analyzed using the framework method.

RESULTS

A total of 20 paramedics were recruited and interviewed. They identified challenges in trauma response, including coordinating care, ensuring the accuracy and accessibility of patient information, and maintaining confidence and readiness. Participants emphasized the need for independent knowledge acquisition through courses, simulations, and peer discussions. They also highlighted the need for more paramedics, strategies to reduce burnout, and the importance of accurately assessing patient conditions. Additionally, they also stressed the importance of raising public awareness to enhance trauma care.

CONCLUSION

This study explored Saudi paramedics' experiences in managing adult trauma patients. standardized handovers, more staff, and greater public awareness are the main key needs to improve daily practice.

On-scene time delays for epileptic seizures in developed community-based integrated care system regions

BACKGROUND

Delayed on-scene time by emergency medical services (EMS) can have detrimental effects on critical cases for people with epilepsy (PWE). In preparation for a super-aged society, a Community-based Integrated Care System is crucial to manage healthcare costs. However, sufficient coordination irrespective of sociomedical changes among medical providers is challenging.

AIM

This study aimed to evaluate on-scene time delays in the treatment of PWE, identify factors associated with such delays, and clarify regional differences. The focus was on the volume of acute care beds in regions with a developed Community-based Integrated Care System.

METHODS

This population-based observational study evaluated on-scene time delays in the treatment of PWE across six major cities in western Japan between 2017 and 2021. In addition, we also evaluated the association between regional differences focusing on volume of acute care beds ("Reduced region" and "Preserved region", as cities with numbers of acute care beds per 1,000 people below and above the national average, respectively) along with sociomedical factors associated with on-scene time delays.

RESULTS

This study included 8,737 PWE transported by EMS, with a mean on-scene time for EMS ranging from 12.9 ± 6.8 min to 21.7 ± 10.6 min. On-scene time delays were evident in Reduced regions, with an increase of 1.45 min (95 % confidence interval 0.86-2.03 min, p < 0.001). A high total EMS call volume independently influenced on-scene time delays during the middle period of the pandemic in Reduced regions.

CONCLUSION

Optimal coordination must be facilitated to ensure the effective functioning of the Community-based Integrated Care System, particularly during unusual circumstances.

Factors associated with prolonged on-scene time in ambulance transportation among patients with minor diseases or injuries in Japan: a population-based observational study

BACKGROUND

Prolonged prehospital time is a major global problem in the emergency medical system (EMS). Although factors related to prolonged on-scene times (OSTs) have been reported in patients with trauma and critical medical conditions, those in patients with minor diseases or injuries remain unclear. We examined factors associated with prolonged OSTs in patients with minor diseases or injuries.

METHODS

This population-based observational study used the ambulance transportation and request call record databases of the Higashihiroshima Fire Department, Japan, between January 1, 2016, and December 31, 2022. The participants were patients with minor diseases or injuries during the study period. We performed a multivariable logistic regression analysis with robust error variance to examine the association between patient age, sex, severity, accident type, date and time of ambulance call, and the coronavirus disease 2019 (COVID-19) pandemic with prolonged OSTs. Prolonged OST was defined as ≥ 30 min from the ambulance arrival at the scene to departure.

RESULTS

Of the 60,309 people transported by ambulance during the study period, 20,069 with minor diseases or injuries were included in the analysis. A total of 1,241 patients (6.2%) experienced prolonged OSTs. Fire accidents (adjusted odds ratio [aOR]: 7.77, 95% confidence interval [CI]: 3.82-15.79), natural disasters (aOR: 28.52, 95% CI: 2.09-389.76), motor vehicle accidents (aOR: 1.63, 95% CI: 1.30-2.06), assaults (aOR: 2.91, 95% CI: 1.86-4.53), self-injuries (aOR: 5.60, 95% CI: 3.37-9.32), number of hospital inquiries ≥ 4 (aOR: 77.34, 95% CI: 53.55-111.69), and the COVID-19 pandemic (aOR: 2.01, 95% CI: 1.62-2.50) were associated with prolonged OSTs. Moreover, older and female patients had prolonged OSTs (aOR: 1.18, 95% CI: 1.01-1.36 and aOR: 1.12, 95% CI: 1.08-1.18, respectively).

CONCLUSIONS

Older age, female sex, fire accidents, natural disasters, motor vehicle accidents, assaults, self-injuries, number of hospital inquiries ≥ 4, and the COVID-19 pandemic influenced prolonged OSTs among patients with minor diseases or injuries. To improve community EMS, we should reconsider how to intervene with potentially modifiable factors, such as EMS personnel performance, the impact of the presence of allied services, hospital patient acceptance systems, and cooperation between general emergency and psychiatric hospitals.