Paramedic versus physician-staffed ambulances and prehospital delays in the management of patients with ST-segment elevation myocardial infarction

Telemedical support for prehospital emergency medical service in severe emergencies: an open-label randomised non-inferiority clinical trial

BACKGROUND

A tele-emergency medical service with a remote emergency physician for severe prehospital emergencies may overcome the increasing number of emergency calls and shortage of emergency medical service providers. We analysed whether routine use of a tele-emergency medical service is non-inferior to a conventional physician-based one in the occurrence of intervention-related adverse events.

METHODS

This open-label, randomised, controlled, parallel-group, non-inferiority trial included all routine severe emergency patients aged ≥ 18 years within the ground-based ambulance service of Aachen, Germany. Patients were randomised in a 1:1 allocation ratio to receive either tele-emergency medical service (n = 1764) or conventional physician-based emergency medical service (n = 1767). The primary outcome was the occurrence of intervention-related adverse events with suspected causality to the group assignment. The trial was registered with ClinicalTrials.gov (NCT02617875) on 30 November 2015 and is reported in accordance with the CONSORT statement for non-inferiority trials.

RESULTS

Among 3531 randomised patients, 3220 were included in the primary analysis (mean age, 61.3 years; 53.8% female); 1676 were randomised to the conventional physician-based emergency medical service (control) group and 1544 to the tele-emergency medical service group. A physician was not deemed necessary in 108 of 1676 cases (6.4%) and 893 of 1544 cases (57.8%) in the control and tele-emergency medical service groups, respectively. The primary endpoint occurred only once in the tele-emergency medical service group. The Newcombe hybrid score method confirmed the non-inferiority of the tele-emergency medical service, as the non-inferiority margin of - 0.015 was not covered by the 97.5% confidence interval of - 0.0046 to 0.0025.

CONCLUSIONS

Among severe emergency cases, tele-emergency medical service was non-inferior to conventional physician-based emergency medical service in terms of the occurrence of adverse events.

Factors affects the performance of red crescent paramedics, Bisha, Saudi Arabia

Context:

Saving lives is the ultimate purpose of the Red Crescent paramedics. It is crucial to enable safe, effective, and efficient performance of paramedics globally. In Saudi Arabia, the Red Crescent faces at least over 280,000 cases every year.

Aims:

Therefore, this study aims to address the factors affecting the performance of the Red Crescent paramedics.

Methods and Material:

Descriptive qualitative study and all data processed were analyzed using thematic analysis.

Settings and Design:

In total, 31 paramedic staff in Bisha city were invited to participate in this descriptive qualitative study. Among them, 11 paramedics agreed to participate in an in-depth semi-structured interview.

Results:

The findings of the research indicated three themes. The first theme was a lack of awareness in society, with three sub-themes: types of emergency calls, the crowd that gathers at the incident location, and people interruptions. Theme 2 was the long distance and road obstacles, and other factors that affect the paramedics were the third theme.

Conclusions:

Policymakers and the community should obtain a clear understanding of the Red Crescent paramedic interventions to help to create policies, legislation, and guidelines suitable for the needs of paramedics.