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Wästerhed J, Ekenberg E, Hagiwara MA. Ambulance nurses' experiences as the sole caregiver with critical patients during long ambulance transports: an interview study. Scand J Trauma Resusc Emerg Med 2024; 32:6. [PMID: 38263118 PMCID: PMC10807097 DOI: 10.1186/s13049-024-01178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Working in rural areas involves tackling long distances and occasional lack of supportive resources. Ambulance nurses are faced with the responsibility of making immediate autonomous decisions and providing extended care to critically ill patients during prolonged ambulance transport to reach emergency medical facilities. This study aims to expose the experiences of ambulance nurses acting as primary caregivers for critically ill patients during lengthy ambulance transfers in rural regions. METHOD Fifteen nurses employed in an ambulance service within sparsely populated rural areas were subjected to semi-structured interviews. The collected data underwent qualitative content analysis. RESULT The analysis resulted in one overarching theme with two categories. The theme is 'Safety in the Professional Role,' and the two categories are 'Working in sparsely populated areas presents challenges' and 'Rare events: when routine cannot be established.' The findings suggest that working as an ambulance nurse in a rural setting poses various challenges that can be highly stressful. Delivering care to critically ill patients during extended ambulance transports requires the knowledge, experience, and careful planning of the healthcare provider in charge. CONCLUSIONS The findings underscore the necessity for thorough planning and adaptable thinking when attending to critically ill patients during extended transport scenarios. The absence of supporting resources can render the task demanding. Nevertheless, participants reported an inherent tranquility that aids them in maintaining focus amid their responsibilities.
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Affiliation(s)
- Jenny Wästerhed
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden
| | - Erika Ekenberg
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden.
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Zeymer U, Pöss J, Zahn R, Thiele H. [Prehospital resuscitation : Current status, results and strategies for improvement in Germany]. Herz 2023; 48:456-461. [PMID: 37831069 DOI: 10.1007/s00059-023-05214-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/14/2023]
Abstract
Out-of-hospital cardiac arrest (OHCA) is one of the most frequent causes of death in Europe and is associated with a dismal prognosis. The annual incidence in Germany is approximately 100-120 per 100,000 inhabitants (ca. 80,000-100,000 cases). With the use of cardiopulmonary resuscitation (CPR) about 40% of patients have a return of spontaneous circulation (ROSC); however, after OHCA only 15% of patients survive for 30 days and less than 10% survive with no or only minor neurological deficits. Data from the German Resuscitation Register demonstrate that there was no change in the results over the last 15 years, despite all medical innovations, higher rates of coronary interventions, higher use of mechanical support systems and improvement in intensive care treatment. A high proportion of patients with OHCA have a cardiac or coronary cause. As shown by the data from the German Cardiac Arrest Register (G-CAR) an early coronary angiography is often carried out after CPR in Germany; however, in randomized clinical studies an immediate coronary angiography in patients with non-ST segment elevation in the electrocardiogram (ECG) was not associated with an improvement in the prognosis. In large randomized studies the use of mechanical CPR systems and the implantation of mechanical circulatory support devices after OHCA also did not lead to a reduction in mortality. The most important impact factor for the success of CPR is the time interval between collapse and start of CPR, if possible also by bystander resuscitation. Therefore, the focus of efforts for improving CPR should be on increasing the rate of patients with early CPR. Experiences from Denmark and The Netherlands indicate that this can be successful by education and training of the general population, telephone resuscitation and apps for alerting lay persons.
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Affiliation(s)
- Uwe Zeymer
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland.
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Deutschland.
| | - Janine Pöss
- Herzzentrum Leipzig der Universität Leipzig und Leipzig Heart Science, Leipzig, Deutschland
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum Ludwigshafen, Bremserstr. 79, 67063, Ludwigshafen, Deutschland
| | - Holger Thiele
- Herzzentrum Leipzig der Universität Leipzig und Leipzig Heart Science, Leipzig, Deutschland
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Introduction Automated cardiac arrest diagnosis offers the possibility to significantly shorten the interval between onset of out-of-hospital cardiac arrest (OHCA) and notification of EMS, providing the opportunity for earlier resuscitation and possibly increased survival. Methods Automated cardiac arrest diagnosis was one of six focus topics for the Wolf Creek XVII Conference held on June 14-17 2023 in Ann Arbor, Michigan, USA. Conference invitees included international thought leaders and scientists in the field of cardiac arrest resuscitation from academia and industry. Participants submitted via online survey knowledge gaps, barriers to translation and research priorities for each focus topic. Expert panels used the survey results and their own perspectives and insights to create and present a preliminary unranked list for each category that was debated, revised and ranked by all attendees to identify the top 5 for each category. Results Top knowledge gaps include the accuracy of automated OHCA detection technologies and the feasibility and reliability of automated EMS activation. The main barriers to translation are the risk of false positives potentially overburdening EMS, development and application costs of technology and the challenge of integrating new technology in EMS IT systems. The top research priorities are large-scale evaluation studies to measure real world performance and user research regarding the willingness to adopt these technologies. Conclusion Automated cardiac arrest diagnosis has the potential to significantly impact time to resuscitation and survival of OHCA because it could convert unwitnessed events into witnessed events. Validation and feasibility studies are needed. The specificity of the technology must be high not to overburden limited EMS resources. If adequate event classification is achieved, future research could shift toward event prediction, focusing on identifying potential digital biomarkers and signatures of imminent cardiac arrest. Implementation could be challenging due to high costs of development, regulatory considerations and instantiation logistics.
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Affiliation(s)
| | - Michael R. Sayre
- Department of Emergency Medicine, University of Washington, Seattle, WA, United States
| | - Theresa M. Olasveengen
- Department of Anesthesia and Intensive Care, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Norway
| | - Jacob E. Sunshine
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, WA, United States
- Paul G Allen School of Computer Science and Engineering, University of Washington, Seattle, WA, United States
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Vera-López JD, Heredia-Pi IB, Pérez-Núñez R, Hijar M. [Indicators to measure the performance of emergency trauma care]. Rev Med Inst Mex Seguro Soc 2023; 61:819-840. [PMID: 37995348 PMCID: PMC10721338 DOI: 10.5281/zenodo.10064412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 06/28/2023] [Indexed: 11/25/2023]
Abstract
The objective of this paper was to identify the main indicators used to measure the performance in emergency trauma care. A literature review was carried out in the electronic databases: PubMEd, LILACS and Epistemónikos, including publications between January 2011 and December 31, 2021, in Spanish, English and Portuguese. A total of 962 publications were identified. When reviewing the full text, 48 articles were included. The indicators were classified in the dimensions of process and results. 100 different indicators were identified to analyze the performance of emergency trauma care. 71% were process indicators, including service time and triage. In the results dimension 29 indicators were identified; mortality was the indicator most analyzed as well as length of stay. Six indicators on the disability of injured people and 14 indicators related to satisfaction were identified, the most frequent being complaints. Various indicators have been used to assess the performance of emergency trauma care. In the results dimension, the indicators related to satisfaction and disability after injuries have been little explored. Decision-makers and those responsible for emergency care must promote performance evaluation exercises to learn about their current situation using appropriate and sensitive indicators with the available data.
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Affiliation(s)
- Juan Daniel Vera-López
- Escuela de Salud Pública de México, Doctorado en Ciencias en Sistemas de Salud. Cuernavaca, Morelos, MéxicoEscuela de Salud Pública de MéxicoMéxico
| | - Ileana Beatriz Heredia-Pi
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud. Cuernavaca, Morelos, MéxicoInstituto Nacional de Salud PúblicaMéxico
| | - Ricardo Pérez-Núñez
- Organización Panamericana de la Salud, Seguridad vial y prevención de lesiones no intencionales. Washington D.C., Estados UnidosOrganización Panamericana de la SaludEstados Unidos
| | - Martha Hijar
- Instituto Nacional de Salud Pública, Centro de Investigación en Sistemas de Salud. Cuernavaca, Morelos, MéxicoInstituto Nacional de Salud PúblicaMéxico
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Strototte LM, May TW, Laker S, Latka E, Thaemel D, Thies KC, Rehberg SW, Jansen G. Efficacy of in-bed chest compressions depending on provider position during in-hospital cardiac arrest: a controlled manikin study. Minerva Anestesiol 2023; 89:1003-1012. [PMID: 37671538 DOI: 10.23736/s0375-9393.23.17390-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
BACKGROUND In contrast to the pre-hospital environment, patients with in-hospital cardiac arrest are usually lying in a hospital bed. Interestingly, there are no current recommendations for optimal provider positioning. The present study evaluates in bed chest compression quality in different provider positions during in-hospital-cardiac-arrest. METHODS Paramedics conducted four resuscitation scenarios: manikin lying on the floor with provider position kneeling next to the manikin (control group), manikin lying in a hospital bed with the provider kneeling astride, kneeling beside or standing next to the manikin. A resuscitation board was not used according to the current guideline recommendations. Quality of resuscitation, compression depth, compression rate and percentage of compressions with complete chest rebound were recorded. Afterwards, the paramedics were asked about subjective efficiency and fatigue. Data were analyzed using Generalized-Linear-Mixed-Models and, in addition, by non-parametric Friedman test. RESULTS A total of 60 participants were recruited. The total quality of chest compressions was significantly higher in floor-based control position compared to the standing (P<.001) and both kneeling positions (P<.05). Also, the compression depth was significantly more guideline compliant in the control (P<.001) and the kneeling position (P<.05) compared to the standing position. The compression frequency as well as the complete chest wall recoil did not differ significantly. The standing position was rated as more fatiguing than the other positions (p≤0.001), kneeling beside as subjectively more efficient than the standing position (P<0.001). CONCLUSIONS In case of an in-bed resuscitation, high quality chest compressions are possible. Kneeling astride or beside the patient should be preferred because these positions demonstrated a good chest compression quality and were more efficient and less exhausting.
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Affiliation(s)
- Lisa M Strototte
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany -
| | - Theodor W May
- Coordination Office for Studies in Biomedicine and Preclinical and Clinical Research, Protestant Hospital of the Bethel Foundation, University Hospital OWL, University of Bielefeld, Bielefeld, Germany
| | - Stefan Laker
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Eugen Latka
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Daniel Thaemel
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
| | - Karl-Christian Thies
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Sebastian W Rehberg
- Department of Anesthesiology, Intensive Care, Emergency Medicine, Transfusion Medicine, and Pain Therapy, Protestant Hospital of the Bethel Foundation, University Hospital of Bielefeld, Campus Bielefeld-Bethel, Bielefeld, Germany
| | - Gerrit Jansen
- Department of Medical and Emergency Services, Study Institute Westfalen-Lippe, Bielefeld, Germany
- University Department of Anesthesiology, Intensive Care Medicine and Emergency Medicine, Johannes Wesling Medical Center of Minden, Ruhr University of Bochum, Minden, Germany
- Medical School and University Medical Center East Westphalia-Lippe, University of Bielefeld, Bielefeld, Germany
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Monaco T, Fischer M, Michael M, Hubar I, Westenfeld R, Rauch S, Gräsner JT, Bernhard M. Impact of the route of adrenaline administration in patients suffering from out-of-hospital cardiac arrest on 30-day survival with good neurological outcome (ETIVIO study). Scand J Trauma Resusc Emerg Med 2023; 31:14. [PMID: 36997973 PMCID: PMC10061896 DOI: 10.1186/s13049-023-01079-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/21/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Over the past decades, international guidelines for cardiopulmonary resuscitation (CPR) have changed the recommendation for alternative routes for drug administration. Until now, evidence for the substantial superiority of one route with respect to treatment outcome after CPR has been lacking. The present study compares the effects of intravenous (IV), intraosseous (IO) and endotracheal (ET) adrenaline application during CPR in out-of-hospital cardiac arrest (OHCA) on clinical outcomes within the database of the German Resuscitation Registry (GRR). METHODS This registry analysis was based on the GRR cohort of 212,228 OHCA patients between 1989 and 2020. Inclusion criteria were: OHCA, application of adrenaline, and out-of-hospital CPR. Excluded from the study were patients younger than 18 years, those who had trauma or bleeding as suspected causes of cardiac arrest, and incomplete data sets. The clinical endpoint was hospital discharge with good neurological outcome [cerebral performance category (CPC) 1/2]. Four routes of adrenaline administration were compared: IV, IO, IO + IV, ET + IV. Group comparisons were done using matched-pair analysis and binary logistic regression. RESULTS In matched-pair group comparisons of the primary clinical outcome hospital discharge with CPC 1/2, the IV group (n = 2416) showed better results compared to IO (n = 1208), [odds ratio (OR): 2.43, 95% confidence interval (CI): 1.54-3.84, p < 0.01] and when comparing IV (n = 8706) to IO + IV (n = 4353), [OR: 1.33, 95% CI: 1.12-1.59, p < 0.01]. In contrast, no significant difference was found between IV (n = 532) and ET + IV (n = 266), [OR: 1.26, 95% CI: 0.55-2.90, p = 0.59]. Concurrently, binary logistic regression yielded a highly significant effect of vascular access type (χ² = 67.744(3), p < 0.001) on hospital discharge with CPC1/2, with negative effects for IO (regression coefficient (r.c.) = - 0.766, p = 0.001) and IO + IV (r.c. = - 0.201, p = 0,028) and no significant effect for ET + IV (r.c. = 0.117, p = 0.770) compared to IV. CONCLUSIONS The GRR data, collected over a period of 31 years, seem to emphasize the relevance of an IV access during out-of-hospital CPR, in the event that adrenaline had to be administered. IO administration of adrenaline might be less effective. ET application, though removed in 2010 from international guidelines, could gain importance as an alternative route again.
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Affiliation(s)
- Tobias Monaco
- Emergency Department, University Hospital of Düsseldorf, Heinrich Heine University, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Matthias Fischer
- Department of Anaesthesiology and Intensive Care, ALB FILS Kliniken, Eichertstraße 3, 73035, Göppingen, Germany
| | - Mark Michael
- Emergency Department, University Hospital of Düsseldorf, Heinrich Heine University, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Iryna Hubar
- Emergency Department, University Hospital of Düsseldorf, Heinrich Heine University, Moorenstrasse 5, D-40225, Düsseldorf, Germany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, University Hsopital of Düsseldorf, Heinrich Heine University, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Stefan Rauch
- Department of Anaesthesiology and Intensive Care, ALB FILS Kliniken, Eichertstraße 3, 73035, Göppingen, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, Department of Anesthesiology and Intensive Care Medicine, University-Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, 24105, Kiel, Germany
| | - Michael Bernhard
- Emergency Department, University Hospital of Düsseldorf, Heinrich Heine University, Moorenstrasse 5, D-40225, Düsseldorf, Germany.
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Huebinger R, Panczyk M, Villa N, Al-Araji R, Schulz K, Humphries A, Gill J, Persse D, J Bobrow B. First Responder CPR and Survival Differences in Texas Minority and Lower Socioeconomic Status Neighborhoods. PREHOSP EMERG CARE 2023; 27:1076-1082. [PMID: 36880880 DOI: 10.1080/10903127.2023.2188331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023]
Abstract
INTRODUCTION First responder (FR) cardiopulmonary resuscitation (CPR) is an important component of out-of-hospital cardiac arrest (OHCA) care. However, little is known about FR CPR disparities. METHODS We linked the 2014-2021 Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES) database to census tract data. We included non-traumatic OHCAs that were not witnessed by 9-1-1 responders and did not receive bystander CPR. We defined census tracts as having >50% of a race/ethnicity: White, Black, or Hispanic/Latino. We also stratified patients into quartiles based on socioeconomic status (SES): household income, high school graduation, and unemployment. We also combined race/ethnicity and income to create a total of five mixed strata, comparing lower income and minority census tracts to high income White census tracts. We created mixed model logistic regression models, adjusting for confounders and modeling census tract as a random intercept. Using the models, we compared FR CPR rates for census race/ethnicity (Black and Hispanic/Latino compared to White), and SES quartiles (2nd, 3rd, and 4th quartiles compared to 1st quartiles). Secondarily, we evaluated the association between FR CPR and survival for all strata. RESULTS We included 21,966 OHCAs, and 57.4% had FR CPR. Evaluating the association between census tract characteristic and FR CPR, majority Black (aOR 0.30, 95% CI 0.22-0.41) had a lower bystander CPR rate when compared to majority White. The lowest income quartile had a lower rate of bystander CPR (aOR 0.80, 95% CI 0.65-0.98). The worst unemployment quartile was also associated with a lower rate of FR CPR (aOR 0.75, 95% CI 0.61-0.92). Combining race/ethnicity and income, middle income majority Black (30.0%; aOR 0.27, 95% CI 0.17-0.46) and low income >80% Black (31.8%; aOR 0.27, 95% CI 0.10-0.68) had lower rates of FR CPR in comparison to high income majority White. There were no associations between Hispanic or lower high school graduation and lower rates of FR CPR. We found no association between FR CPR and survival for all three strata. CONCLUSION While we identified disparities in FR CPR in low SES and majority Black census tracts, we identified no association between FR CPR and survival in Texas.
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Affiliation(s)
- Ryan Huebinger
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Micah Panczyk
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Normandy Villa
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Rabab Al-Araji
- Public Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Kevin Schulz
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
- Houston Fire Department, Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Amanda Humphries
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - Joseph Gill
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
| | - David Persse
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
- Houston Fire Department, Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, Texas
| | - Bentley J Bobrow
- Texas Emergency Medicine Research Center, McGovern Medical School, Houston, Texas
- Department of Emergency Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Houston, Texas
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Holm S. Some Problems with the 'It Has Been Decided That You Will Die and Are No Longer in Need of Your Organs Donor Rule'. Am J Bioeth 2023; 23:26-28. [PMID: 36681908 DOI: 10.1080/15265161.2022.2159095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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10
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Sonkin R, Jaffe E, Wacht O, Morse H, Bitan Y. Real-time video communication between ambulance paramedic and scene - a simulation-based study. BMC Health Serv Res 2022; 22:1049. [PMID: 35978429 PMCID: PMC9382790 DOI: 10.1186/s12913-022-08445-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction Telemedicine has been widely used in various medical settings including in Emergency Medical Services (EMS). The goal of this study was to assess the possible roles of real-time video communication between paramedics and bystanders at scenes of emergency, in the analysis and treatment of patients. Methods 44 experienced paramedics participated in a simulation. Participants communicated with the experimenter presenting video clips showing patients that simulated three emergency scenarios: trauma, an unresponsive patient with cardiac arrest, and an opiate overdose. The simulation sessions were conducted through Zoom™, recorded, and then analyzed to document participants’ questions, requests, instructions, and their timings during each scenario. Results The trauma scenario was assessed most promptly, with instructions to handle the bleeding provided by all paramedics. In the unresponsive patient with cardiac arrest scenario, most of the participants achieved a correct initial diagnosis, and in the opiate overdose scenario over half of paramedics sought visual clinical clues for the differential diagnoses of loss of consciousness and their causes. Additional results show the type of assessment, treatment and diagnosis participants provided in each scenario, and their confidence about situation. Conclusions The findings show that direct video communication between paramedic and scene may facilitate correct diagnosis, provision of instructions for treatment, and early preparation of medications or equipment. These may decrease time to correct diagnosis and lifesaving treatment and impact patient morbidity and mortality. Moreover, the findings highlight the difference between incidents with higher visual clarity, such as trauma, and conditions that require an extended diagnosis to reveal, such as unresponsive patients. This may also increase the paramedics’ mental preparedness for what is expected at the scene.
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Affiliation(s)
- Roman Sonkin
- Community Division, Magen David Adom, Ha-Plada 5, 6021805, Or-Yehuda, Israel.
| | - Eli Jaffe
- Community Division, Magen David Adom, Ha-Plada 5, 6021805, Or-Yehuda, Israel.,Department of Emergency Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Helena Morse
- Community Division, Magen David Adom, Ha-Plada 5, 6021805, Or-Yehuda, Israel
| | - Yuval Bitan
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Sirikul W, Piankusol C, Wittayachamnankul B, Riyapan S, Supasaovapak J, Wongtanasarasin W, McNally B. A retrospective multi-centre cohort study: Pre-hospital survival factors of out-of-hospital cardiac arrest (OHCA) patients in Thailand. Resusc Plus 2022; 9:100196. [PMID: 35036967 PMCID: PMC8749449 DOI: 10.1016/j.resplu.2021.100196] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/30/2021] [Accepted: 12/13/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE This study aimed to explore significant pre-hospital factors affecting the survivability of Out-of-Hospital Cardiac Arrest (OHCA) patients in countries with developing EMS systems. METHOD A retrospective cohort study was conducted examining data from January 1, 2017 to December 31, 2020 from Utstein Registry databases in Thailand, collected through Pan-Asian Resuscitation Outcomes Study (PAROS). Data were collected from three centres, including regional, suburban-capital, and urban-capital hospitals. The primary endpoint of this study was 30-day survival or discharged alive after an OHCA event. The multivariable risk regression was done by modified Poisson regression with robust error variance to explore the association between 30-day survival and pre-hospital factors with potential confounders adjustments. FINDINGS Of 1,240 OHCA cases transferred by Emergency Medical Services (EMS), 42 patients (3.4%) were discharged alive after 30 days, including 22 (8.6%), 8 (3.0%), and 12 (1.7%) from regional, suburban-capital, and urban-capital centres, respectively. The initial arrest rhythm was 89.7% unshockable, with no significant variations across the three centres. Overall, bystander Cardiopulmonary Resuscitation (CPR) was 40.4%. However, bystander CPR with Automated External Defibrillator (AED) application was 0.8%. Bystander CPR significantly increased 30-day survival probability (aRR 1.88, 95% CI 1.01 to 3.51; p 0.049). Additionally, reducing the EMS response time by one minute significantly increased OHCA survivability (aRR 1.12, 95% CI 1.04 to 1.20; p 0.001). CONCLUSIONS Response time and bystander CPR are the factors that improve the 30-day survival outcomes of OHCA patients. In contrast, scene time, transport time, and pre-hospital advanced airway management didn't improve 30-day OHCA survival.
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Affiliation(s)
| | - Chanodom Piankusol
- Faculty of Medicine, Chiang Mai University, Thailand
- Corresponding author at: Department of Community Medicine, Faculty of Medicine, Chiang Mai University, 110 Intawaroros, Muang, Chiang Mai 50200, Thailand.
| | | | - Sattha Riyapan
- Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | | | | | - Bryan McNally
- Emory University School of Medicine, Emory University, United States
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Metelmann C, Metelmann B, Müller MP, Böttiger BW, Trummer G, Thies KC. First responder systems can stay operational under pandemic conditions: results of a European survey during the COVID-19 pandemic. Scand J Trauma Resusc Emerg Med 2022; 30:10. [PMID: 35183230 PMCID: PMC8857892 DOI: 10.1186/s13049-022-00998-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
Background Dispatching first responders (FR) to out-of-hospital cardiac arrest in addition to the emergency medical service has shown to increase survival. The promising development of FR systems over the past years has been challenged by the outbreak of COVID-19. Whilst increased numbers and worse outcomes of cardiac arrests during the pandemic suggest a need for expansion of FR schemes, appropriate risk management is required to protect first responders and patients from contracting COVID-19. This study investigated how European FR schemes were affected by the pandemic and what measures were taken to protect patients and responders from COVID-19. Methods To identify FR schemes in Europe we conducted a literature search and a web search. The schemes were contacted and invited to answer an online questionnaire during the second wave of the pandemic (December 2020/ January 2021) in Europe. Results We have identified 135 FR schemes in 28 countries and included responses from 47 FR schemes in 16 countries. 25 schemes reported deactivation due to COVID-19 at some point, whilst 22 schemes continued to operate throughout the pandemic. 39 schemes communicated a pandemic-specific algorithm to their first responders. Before the COVID-19 outbreak 20 FR systems did not provide any personal protective equipment (PPE). After the outbreak 19 schemes still did not provide any PPE. The majority of schemes experienced falling numbers of accepted call outs and decreasing registrations of new volunteers. Six schemes reported of FR having contracted COVID-19 on a mission. Conclusions European FR schemes were considerably affected by the pandemic and exhibited a range of responses to protect patients and responders. Overall, FR schemes saw a decrease in activity, which was in stark contrast to the high demand caused by the increased incidence and mortality of OHCA during the pandemic. Given the important role FR play in the chain of survival, a balanced approach upholding the safety of patients and responders should be sought to keep FR schemes operational. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-022-00998-3.
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Tjelmeland IBM, Alm-Kruse K, Grasner JT, Isern CB, Jakisch B, Kramer-Johansen J, Renzing N, Wnent J, Seewald S. Importance of reporting survival as incidence: a cross-sectional comparative study on out-of-hospital cardiac arrest registry data from Germany and Norway. BMJ Open 2022; 12:e058381. [PMID: 35177465 PMCID: PMC8860078 DOI: 10.1136/bmjopen-2021-058381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Health registries are a unique source of information about current practice and can describe disease burden in a population. We aimed to understand similarities and differences in the German Resuscitation Registry (GRR) and the Norwegian Cardiac Arrest Registry (NorCAR) and compare incidence and survival for patients resuscitated after out-of-hospital cardiac arrest. DESIGN A cross-sectional comparative analysis reporting incidence and outcome on a population level. SETTING We included data from the cardiac arrest registries in Germany and Norway. PARTICIPANTS Patients resuscitated between 1 January 2015 and 31 December 2019 were included, resulting in 29 222 cases from GRR and 16 406 cases from NorCAR. From GRR, only emergency medical services (EMS) reporting survival information for patients admitted to the hospital were included. PRIMARY AND SECONDARY OUTCOME MEASURES This study focused on the EMS systems, the registries and the patients included in both registries. The results compare the total incidence, incidence of patients resuscitated by EMS, and the incidence of survival. RESULTS We found an incidence of 68 per 100 000 inhabitants in GRR and 63 in NorCAR. The incidence of patients treated by EMS was 67 in GRR and 53 in NorCAR. The incidence of patients arriving at a hospital was higher in GRR (24.3) than in NorCAR (15.1), but survival was similar (8 in GRR and 7.8 in NorCAR). CONCLUSION GRR is a voluntary registry, and in-hospital information is not reported for all cases. NorCAR has mandatory reporting from all EMS and hospitals. EMS in Germany starts treatment on more patients and bring a higher number to hospital, but we found no difference in the incidence of survival. This study has improved our knowledge of both registries and highlighted the importance of reporting survival as incidence when comparing registries.
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Affiliation(s)
- Ingvild Beathe Myrhaugen Tjelmeland
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Alm-Kruse
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Jan-Thorsten Grasner
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Cecilie Benedicte Isern
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Barbara Jakisch
- Organization & Corporate Development, imland gGmbH, Rendsburg, Schleswig-Holstein, Germany
| | - Jo Kramer-Johansen
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Niels Renzing
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- University of Namibia School of Medicine, Windhoek, Namibia
| | - Stephan Seewald
- Institute for Emergency Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
- Department of Anaesthesiology and Intensive Care Medicine, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
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Neira-rodado D, Escobar-velasquez JW, Mcclean S. Ambulances Deployment Problems: Categorization, Evolution and Dynamic Problems Review. IJGI 2022; 11:109. [DOI: 10.3390/ijgi11020109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In this paper, an analytic review of the recent methodologies tackling the problem of dynamic allocation of ambulances was carried out. Considering that state-of-the-art is moving to deal with more extensive and dynamic problems to address in a better way real-life instances, this research looks to identify the evolution and recent applications of this kind of problem once the basic models are explored. This extensive review allowed us to identify the most recent developments in this problem and the most critical gaps to be addressed. In this sense, it is essential to point out that the dynamic location of emergency medical services (EMS) is nowadays a relevant topic considering its impact on the healthcare system outcomes. Issues related to forecasting, simulation, heterogeneous fleets, robustness, and solution speed for real-life problems, stand out in the identified gaps. Applications of machine learning the deployment challenges during epidemic outbreaks such as SARS and COVID-19 were also explored. At the same time, a proposed notation tries to tackle the fact that the word problem in this kind of work refers to a model on many occasions. The proposed notation eases the comparison between the different model proposals found in the literature.
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Kyriacou E, Antoniou Z, Hadjichristofi G, Fragkos P, Kronis C, Theodosiou T, Constantinou R. Operating an eHealth System for Prehospital and Emergency Health Care Support in Light of Covid-19. Front Digit Health 2021; 3:654234. [PMID: 34713128 PMCID: PMC8521915 DOI: 10.3389/fdgth.2021.654234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022] Open
Abstract
Introduction: The support of prehospital and emergency call handling and the impact of Covid-19 is discussed throughout this study. The initial purpose was to create an electronic system (eEmergency system) in order to support, improve, and help the procedure of handling emergency calls. This system was expanded to facilitate needed operation changes for Covid-19. Materials and Methods: An effort to reform the procedures followed for emergency call handling and Ambulance dispatch started on the Island of Cyprus in 2016; along that direction, a central call centre was created. The electronic system presented in this work was designed for this call centre and the new organization of the ambulance services. The main features are the support for ambulance fleet handling, the support for emergency call evaluation and triage procedure, and the improvement of communication between the call centre and the ambulance vehicles. This system started regular operation at the end of 2018. One year later, when Covid-19 period started, we expanded it with the addition of several new features in order to support the handling of patients infected with the new virus. Results: This system has handled 112,414 cases during the last 25 months out of which 4,254 were Covid-19 cases. These cases include the transfer of patients from their house to the reference hospital, or the transfer of critical patients from the reference hospital to another hospital with an intensive care unit or transfer of patients from one hospital to another one for other reasons, like the number of admissions. Conclusion: The main purpose of this study was to create an electronic system (eEmergency system) in order to support, improve, and help the procedure of handling emergency calls. The main components and the architecture of this system are outlined in this paper. This system is being successfully used for 25 months and has been a useful tool from the beginning of the pandemic period of Covid-19.
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Affiliation(s)
- Efthyvoulos Kyriacou
- Department of Electrical and Computer Engineering and Informatics, Cyprus University of Technology, Limassol, Cyprus
| | - Zinonas Antoniou
- eHealth Lab, Department of Computer Science, University of Cyprus, Nicosia, Cyprus
| | - George Hadjichristofi
- Department of Computer Science and Engineering, European University Cyprus, Nicosia, Cyprus
| | - Prokopios Fragkos
- eHealth Lab, Department of Electrical and Computer Engineering and Informatics, Frederick University, Limassol, Cyprus
| | - Chris Kronis
- eHealth Lab, Department of Electrical and Computer Engineering and Informatics, Frederick University, Limassol, Cyprus
| | - Theodosis Theodosiou
- Ambulance Department, State Health Services Organization, Ministry of Health, Nicosia, Cyprus
| | - Riana Constantinou
- Ambulance Department, State Health Services Organization, Ministry of Health, Nicosia, Cyprus
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Poth JM, Buschmann CM, Kappler J, Heister U, Ehrentraut SF, Muenster S, Diepenseifen CJ, Ellerkmann R, Schewe JC. Neurologisches Ergebnis und allgemeiner Gesundheitszustand bei Langzeitüberleben nach außerklinischer kardiopulmonaler Reanimation. Notf Rett Med 2021. [DOI: 10.1007/s10049-021-00929-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Zusammenfassung
Fragestellung
Für Deutschland liegen nur wenige Daten zum Gesundheitszustand und Langzeitüberleben nach außerklinischer Reanimation vor. Die vorliegende Studie untersucht den allgemeinen Gesundheitszustand und das neurologische Langzeitergebnis 2,5 bis 5 Jahre nach dem Reanimationsereignis sowie den Zusammenhang zwischen Behandlungsergebnis und präklinischen Patienten- und Behandlungsfaktoren.
Methodik
Alle über einen Zeitraum von 30 Monaten (2011–2013) durch den Rettungsdienst der Stadt Bonn durchgeführten Reanimationen wurden auf Grundlage der Notarzteinsatzprotokolle und des Deutschen Reanimationsregisters retrospektiv analysiert. Der allgemeine Gesundheitszustand wurde in Anlehnung an den SF-12 erfasst und das neurologische Langzeitergebnis kategorisiert (Cerebral Performance Category [CPC]). Die vorliegenden Daten wurden einer uni- und multivariaten logistischen Regressionsanalyse unterzogen.
Ergebnis
Von insgesamt 458 Patienten überlebten 17,9 % bis zur Krankenhausentlassung, 13,8 % mehr als 2,5 Jahre und 7,7 % bis zum Stichtag der Befragung. Von den noch lebenden Patienten hatten 85,3 % ein gutes neurologisches Ergebnis (CPC ≤ 2), welches durch ein geringeres Alter, einen beobachteten Kollaps, die Durchführung einer Defibrillation und das Ausbleiben einer Vasopressorgabe begünstigt wurde (multivariate Analyse). 74,2 % der Überlebenden beschrieben ihren Gesundheitszustand als gut.
Interpretation
Insgesamt überleben langfristig nur wenige Patienten einen außerklinischen Herz-Kreislauf-Stillstand. Die überlebenden Patienten beurteilen ihren Gesundheitszustand als gut und zeigen ein gutes neurologisches Ergebnis. Dabei hängt dieses Behandlungsergebnis von denselben Parametern wie der primäre Reanimationserfolg (Überleben bis Krankenhausaufnahme) ab. Die Etablierung klinischer Instrumente zur frühen Prognoseerstellung ist wünschenswert. Hierzu sind weitere Langzeituntersuchungen größerer Patientenkollektive mit Zugriff auf Routinedaten notwendig.
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Arcolezi H, Cerna S, Guyeux C, Couchot J. Preserving Geo-Indistinguishability of the Emergency Scene to Predict Ambulance Response Time. MCA 2021; 26:56. [DOI: 10.3390/mca26030056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Emergency medical services (EMS) provide crucial emergency assistance and ambulatory services. One key measurement of EMS’s quality of service is their ambulances’ response time (ART), which generally refers to the period between EMS notification and the moment an ambulance arrives on the scene. Due to many victims requiring care within adequate time (e.g., cardiac arrest), improving ARTs is vital. This paper proposes to predict ARTs using machine-learning (ML) techniques, which could be used as a decision-support system by EMS to allow a dynamic selection of ambulance dispatch centers. However, one well-known predictor of ART is the location of the emergency (e.g., if it is urban or rural areas), which is sensitive data because it can reveal who received care and for which reason. Thus, we considered the ‘input perturbation’ setting in the privacy-preserving ML literature, which allows EMS to sanitize each location data independently and, hence, ML models are trained only with sanitized data. In this paper, geo-indistinguishability was applied to sanitize each emergency location data, which is a state-of-the-art formal notion based on differential privacy. To validate our proposals, we used retrospective data of an EMS in France, namely Departmental Fire and Rescue Service of Doubs, and publicly available data (e.g., weather and traffic data). As shown in the results, the sanitization of location data and the perturbation of its associated features (e.g., city, distance) had no considerable impact on predicting ARTs. With these findings, EMSs may prefer using and/or sharing sanitized datasets to avoid possible data leakages, membership inference attacks, or data reconstructions, for example.
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Finlay E, Palmer S, Abes B, Abo B, Fishe JN. Clinical, Operational, and Socioeconomic Analysis of EMS Bypass of the Closest Facility for Pediatric Asthma Patients. West J Emerg Med 2021; 22:972-978. [PMID: 35353998 PMCID: PMC8328167 DOI: 10.5811/westjem.2021.4.50382] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/13/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Pediatric hospital care is becoming increasingly regionalized, with fewer facilities providing inpatient care for common conditions such as asthma. That trend has major implications for emergency medical services (EMS) medical care and operations because EMS historically transports patients to the closest facility. This study describes EMS transport patterns of pediatric asthma patients in greater depth, including an analysis of facility bypass rates and the association of bypass with demographics and clinical outcomes. Methods This was a retrospective study of pediatric asthma patients ages 2–18 years transported by Lee County, FL EMS between March 1, 2018 – December 31, 2019. A priori, we defined bypass as greater than five minutes extra transport time. We performed geospatial analysis and mapping of EMS pediatric asthma encounters. We used the Pediatric Destination Tree (PDTree) project’s tiered approach to characterize receiving hospital facility pediatric capability. We analyzed incidence and characteristics of bypass, and bypass and non-bypass patient characteristics including demographics, emergency department (ED) clinical outcomes, and socioeconomic disadvantage (SED). Results From the study period, there were a total of 262 encounters meeting inclusion criteria, 254 (96.9%) of which could be geocoded to EMS incident and destination locations. Most encounters (72.8%) bypassed at least one facility, and the average number of facilities bypassed per encounter was 1.52. For all 185 bypass encounters, there was a median additional travel time of 13.5 minutes (interquartile range 7.5 – 17.5). Using the PDTree’s classification of pediatric capability of destination facilities, 172 of the 185 bypasses (93%) went to a Level I facility. Bypass incidence varied significantly by age, but not by minority status, asthma severity, or by the area deprivation index of the patient’s home address. Overall, the highest concentrations of EMS incidents tended to occur in areas of greater SED. With regard to ED outcomes, ED length of stay did not vary between bypass and non-bypass patients (P = 0.54), and neither did hospitalization (P = 0.80). Conclusion We found high rates of bypass for pediatric EMS encounters for asthma exacerbations, and that bypass frequency was significantly higher in younger age groups. With national trends pointing toward increasing pediatric healthcare regionalization, bypass has significant implications for EMS operations.
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Affiliation(s)
- Erik Finlay
- University of Florida Geoplan Center, Gainesville, Florida
| | - Sam Palmer
- University of Florida Geoplan Center, Gainesville, Florida
| | - Benjamin Abes
- Lee County Emergency Medical Services, Fort Myers, Florida
| | - Benjamin Abo
- Lee County Emergency Medical Services, Fort Myers, Florida
| | - Jennifer N Fishe
- University of Florida College of Medicine - Jacksonville, Pediatric Emergency Department, Jacksonville, Florida
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Schehadat MS, Scherer G, Groneberg DA, Kaps M, Bendels MHK. Outpatient care in acute and prehospital emergency medicine by emergency medical and patient transport service over a 10-year period: a retrospective study based on dispatch data from a German emergency medical dispatch centre (OFF-RESCUE). BMC Emerg Med 2021; 21:29. [PMID: 33750317 PMCID: PMC7941891 DOI: 10.1186/s12873-021-00424-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/24/2021] [Indexed: 11/10/2022] Open
Abstract
Background The number of operations by the German emergency medical service almost doubled between 1994 and 2016. The associated expenses increased by 380% in a similar period. Operations with treatment on-site, which retrospectively proved to be misallocated (OFF-Missions), have a substantial proportion of the assignment of the emergency medical service (EMS). Besides OFF-Missions, operations with patient transport play a dominant role (named as ON-Missions). The aim of this study is to work out the medical and economic relevance of both operation types. Methods This analysis examined N = 819,780 missions of the EMS and patient transport service (PTS) in the catchment area of the emergency medical dispatch centre (EMDC) Bad Kreuznach over the period from 01/01/2007 to 12/31/2016 in terms of triage and disposition, urban-rural distribution, duration of operations and economic relevance (p < .01). Results 53.4% of ON-Missions are triaged with the indication non-life-threatening patient transport; however, 63.7% are processed by the devices of the EMS. Within the OFF-Mission cohort, 78.2 and 85.8% are triaged or dispatched for the EMS. 74% of all ON-Missions are located in urban areas, 26% in rural areas; 81.3% of rural operations are performed by the EMS. 66% of OFF-Missions are in cities. 93.2% of the remaining 34% of operations in rural locations are also performed by the EMS. The odds for both ON- and OFF-Missions in rural areas are significantly higher than for PTS (ORON 3.6, 95% CI 3.21–3.30; OROFF 3.18, 95% CI 3.04–3.32). OFF-Missions last 47.2 min (SD 42.3; CI 46.9–47.4), while ON-Missions are processed after 79.7 min on average (SD 47.6; CI 79.6–79.9). ON-Missions generated a turnover of more than € 114 million, while OFF-Missions made a loss of almost € 13 million. Conclusions This study particularly highlights the increasing utilization of emergency devices; especially in OFF-Missions, the resources of the EMS have a higher number of operations than PTS. OFF-Missions cause immensely high costs due to misallocations from an economic point of view. Appropriate patient management appears necessary from both medical and economic perspective, which requires multiple solution approaches.
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Affiliation(s)
- Marc S Schehadat
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany. .,Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany.
| | - Guido Scherer
- District Administration Mainz-Bingen, Department of Civil Protection, Ingelheim/Rhein, Germany
| | - David A Groneberg
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
| | - Manfred Kaps
- Department of Neurology, University Hospital Giessen and Marburg, Giessen, Germany
| | - Michael H K Bendels
- Institute for Occupational Medicine, Social Medicine and Environmental Medicine, University Hospital Frankfurt, Theodor-Stern-Kai 7, House 9b, 60590, Frankfurt/Main, Germany
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Gässler H, Helm M, Hossfeld B, Fischer M. Survival Following Lay Resuscitation. Dtsch Arztebl Int 2021; 117:871-877. [PMID: 33637167 DOI: 10.3238/arztebl.2020.0871] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 03/10/2020] [Accepted: 08/03/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Resuscitation by laypersons is important in bridging the time between the occurrence of an out-of-hospital cardiac arrest (OHCA) and the arrival of emergency rescue service personnel. Depending on the reason for the cardiac arrest, however, the effectiveness of chest compressions is uncertain. The aim of this study was to explore the impact of lay resuscitation on survival following OHCA of different causes. METHODS The data set for analysis comprised all cases of cardiac arrest before the arrival of emergency rescue service personnel that were fully documented in the German Resuscitation Registry in the period 2007-2019. The following endpoints related to resuscitation by bystanders were evaluated-separately for each cause-descriptively and by means of multivariate logistic regression analysis: return of spontaneous circulation (ROSC), 30 days' survival/discharged alive from the hospital, and good neurological function at discharge. RESULTS Altogether, 40 604 cases of cardiac arrest were included. Resuscitation by laypersons was carried out in 35.1% of these cases. The rate of ROSC was statistically significantly higher after lay resuscitation for OHCA caused by cardiac events, drowning, intoxication, or central nervous system disorders (overall 48.1% versus 41.0%). For all causes-with the exception of trauma/bleeding to death and sepsis- the endpoint 30 days' survival/discharged alive was better with lay resuscitation (overall 17.0% versus 9.5%). In multivariate regression analysis, lay resuscitation was associated with improvement of the endpoint 30 days' survival/discharged alive only for OHCA caused by cardiac events (odds ratio [OR] 1.16) or intoxication (OR 1.81). For all other causes-except hypoxia-lay resuscitation tended to yield better results. Neurological function at discharge was also significantly better (overall 11.5% versus 6.1%) after lay resuscitation for OHCA of all causes except trauma/ bleeding to death, hypoxia, and sepsis. CONCLUSION Resuscitation by laypersons is associated with an improved result regarding the endpoint 30 days' survival/discharged alive in cases of OHCA caused by cardiac events and intoxication. These two groups account for 81% of the resuscitation patients in the study. Because there was also a tendency towards higher survival rates following OHCA of other causes (except hypoxia), laypersons should continue to be encouraged to attempt resuscitation in all cases of OHCA, whatever the cause.
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Affiliation(s)
- Holger Gässler
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, German Armed Forces Hospital Ulm; Department of Anesthesiology and Intensive Care Medicine, Alb-Fils Hospitals, Göppingen
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Strauss C, Bildstein G, Efe J, Flacher T, Hofmann K, Huggler M, Stämpfli A, Schmid M, Schmid E, Gehring C, Häske D, Prückner S, Stock JP, Trentzsch H. Optimizing Emergency Medical Service Structures Using a Rule-Based Discrete Event Simulation-A Practitioner's Point of View. Int J Environ Res Public Health 2021; 18:2649. [PMID: 33808033 DOI: 10.3390/ijerph18052649] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/05/2021] [Accepted: 02/24/2021] [Indexed: 11/21/2022]
Abstract
Many studies in research deal with optimizing emergency medical services (EMS) on both the operational and the strategic level. It is the purpose of this method-oriented article to explain the major features of “rule-based discrete event simulation” (rule-based DES), which we developed independently in Germany and Switzerland. Our rule-based DES addresses questions concerning the location and relocation of ambulances, dispatching and routing policies, and EMS interplay with other players in prehospital care. We highlight three typical use cases from a practitioner’s perspective and go into different countries’ peculiarities. We show how research results are applied to EMS and healthcare organizations to simulate and optimize specific regions in Germany and Switzerland with their strong federal structures. The rule-based DES serves as basis for decision support to improve regional emergency services’ efficiency without increasing cost. Finally, all simulation-based methods suggest normative solutions and optimize EMS’ performance within given healthcare system structures. We argue that interactions between EMS, emergency departments, and public healthcare agencies are crucial to further improving effectiveness, efficiency, and quality.
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Deák MS, Csató G, Pápai G, Dombrádi V, Nagy A, Nagy C, Juhász A, Bíró K. Investigating the Geographic Disparities of Amenable Mortality and Related Ambulance Services in Hungary. Int J Environ Res Public Health 2021; 18:1065. [PMID: 33504113 DOI: 10.3390/ijerph18031065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates and ambulance services could identify counties where stronger ambulance services are needed. The datasets for 2018 consisted of county level aggregated data of citizens between the ages 15–64. The study examined how both the mortality rates and the ambulance rescue deliveries differ from the national average. The analyses were narrowed down to disease groups, such as acute myocardial infarction, hemorrhagic and ischemic stroke. Inequalities were identified regarding the distribution of number of ambulance deliveries, several counties had rates more than double that of the national average. For both mortality and ambulance services some of the counties had significantly better results and others had significantly worse compared to the national average. In Borsod-Abaúj-Zemplén county’s case, hemorrhagic stroke mortality was significantly higher (1.73 [1.35–2.11]), while ambulance deliveries were significantly lower (0.58 [0.40–0.76]) compared to the national average. The research has shown that regarding the investigated mortality rates and ambulance services there are considerable differences between the counties in Hungary. In this regard policy makers should implement policies to tackle these discrepancies.
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Bauer J, Moormann D, Strametz R, Groneberg DA. Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study. BMJ Open 2021; 11:e043791. [PMID: 33483448 PMCID: PMC7825255 DOI: 10.1136/bmjopen-2020-043791] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES This study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA. PARTICIPANTS 3296 emergency medical stations in Germany. SETTING Rural areas in Germany. PRIMARY AND SECONDARY OUTCOME MEASURES Three UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS. RESULTS Current EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158). CONCLUSION These results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.
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Affiliation(s)
- Jan Bauer
- Division of Health Services Research, Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt, Germany
| | - Dieter Moormann
- Institute for Flight System Dynamics, RWTH Aachen University, Aachen, Nordrhein-Westfalen, Germany
| | - Reinhard Strametz
- Wiesbaden Business School, RheinMain University of Applied Sciences, Wiesbaden, Hessen, Germany
| | - David A Groneberg
- Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe-Universitat Frankfurt am Main, Frankfurt am Main, Hessen, Germany
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Günther A, Schildmann J, in der Schmitten J, Schmid S, Weidlich-Wichmann U, Fischer M. Opportunities and Risks of Resuscitation Attempts in Nursing Homes. Dtsch Arztebl Int 2020; 117:757-763. [PMID: 33533330 PMCID: PMC7898050 DOI: 10.3238/arztebl.2020.0757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 02/19/2020] [Accepted: 06/03/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND Data supporting decision-making regarding cardiopulmonary resuscitation (CPR) in German nursing homes is insufficient. METHODS A retrospective evaluation of pre-hospital CPR was carried out with data from the German Resuscitation Registry (Deutsches Reanimationsregister) for the years 2011-2018. Patients under age 65 were excluded, as were patients from districts in which long-term data was available for less than 60% of patients. Subgroups were analyzed based on age and certain prehospital situations; patients treated outside nursing homes were used for comparison. RESULTS The study group consisted of 2900 patients, whose mean age was 83.7 years (standard deviation, 7.5 years). 1766 (60.9%) were women and 1134 (39.1%) were men. 118 patients (4.0%) were discharged alive, including 64 (2.2%) with a cerebral performance category (CPC) of 1 or 2, 30 (1.0%) with an unknown CPC, and 24 (0.8%) with a CPC of 3 or 4. 902 patients (31.1%) died in the hospital, including five (0.2%) who died more than 30 days after resuscitation, 279 (9.6%) between 24 hours and 30 days, and 618 (21.3%) within 24 hours. 1880 patients (64.8%) died at the site of attempted resuscitation. In 1056 cases (36.4%), CPR was initiated before the arrival of the emergency medical services. In the "initially shockable" subgroup, 13 of 208 patients (6.3%) were discharged alive with a CPC of 1 or 2. CONCLUSION CPR can lead to a good neurological outcome in rare cases even when carried out in a nursing home. The large percentage of CPR attempts that were initiated only after a delay indicates that nursing home staff may often be uncertain how to proceed. Uncertainty among caregivers points to a potential for advance care planning.
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Affiliation(s)
- Andreas Günther
- Fire Department,City of Braunschweig and Department of Anesthesiology, Braunschweig Hospitals gGmbH
| | - Jan Schildmann
- Institute for the History and Ethics of Medicine, Medical Faculty, University of Halle-Wittenberg (Saale)
| | - Jürgen in der Schmitten
- Fire Department,City of Braunschweig and Department of Anesthesiology, Braunschweig Hospitals gGmbH
| | | | - Uta Weidlich-Wichmann
- Faculty of Public Health Services, Ostfalia University of Applied Sciences, Campus Wolfsburg
| | - Matthias Fischer
- Department of Anesthesiology, Intensive Care Medicine, Emergency Medicine, and Pain Therapy, Klinik am Eichert, Alb Fils Hospitals, Göppingen
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Moafa HN, van Kuijk SMJ, Alqahtani DM, Moukhyer ME, Haak HR. Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services. Int J Environ Res Public Health 2020; 17:ijerph17217944. [PMID: 33138091 PMCID: PMC7663470 DOI: 10.3390/ijerph17217944] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/27/2020] [Indexed: 12/29/2022]
Abstract
The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20' target, reorganizing the lowest urgent cases in the rural areas seems necessary.
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Affiliation(s)
- Hassan N. Moafa
- Department of Health Services Management, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 82817 2820, Saudi Arabia
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
- Correspondence: or ; Tel.: +31-615-373-733
| | - Sander Martijn Job van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Dhafer M. Alqahtani
- Department of Quality Management, Saudi Red Crescent Authority, Ministry of Health, Riyadh 13251-8261, Saudi Arabia;
| | - Mohammed E. Moukhyer
- Department of Academic Development and Quality, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia;
| | - Harm R. Haak
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Internal Medicine, Maxima Medisch Centre, 5631 BM Eindhoven, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Czapla M, Zielińska M, Kubica-Cielińska A, Diakowska D, Quinn T, Karniej P. Factors associated with return of spontaneous circulation after out-of-hospital cardiac arrest in Poland: a one-year retrospective study. BMC Cardiovasc Disord 2020; 20:288. [PMID: 32532201 PMCID: PMC7291476 DOI: 10.1186/s12872-020-01571-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Accepted: 06/03/2020] [Indexed: 12/26/2022] Open
Abstract
Background Out-of-hospital cardiac arrest (OHCA) is a common reason for calls for intervention by emergency medical teams (EMTs) in Poland. Regardless of the mechanism, OHCA is a state in which the chance of survival is dependent on rapid action from bystanders and responding health professionals in emergency medical services (EMS). We aimed to identify factors associated with return of spontaneous circulation (ROSC). Methods The medical records of 2137 EMS responses to OHCA in the city of Wroclaw, Poland between July 2017 and June 2018 were analyzed. Results The OHCA incidence rate for the year studied was 102 cases per 100,000 inhabitants. EMS were called to 2317 OHCA events of which 1167 (50.4%) did not have resuscitation attempted on EMS arrival. The difference between the number of successful and failed cardiopulmonary resuscitations (CPRs) was statistically significant (p < 0.001). Of 1150 patients in whom resuscitation was attempted, ROSC was achieved in 250 (27.8%). Rate of ROSC was significantly higher when CPR was initiated by bystanders (p < 0.001). Patients presenting with asystole or pulseless electrical activity (PEA) had a higher risk of CPR failure (86%) than those with ventricular fibrillation/ventricular tachycardia (VF/VT). Patients with VF/VT had a higher chance of ROSC (OR 2.68, 1.86–3.85) than those with asystole (p < 0.001). The chance of ROSC was 1.78 times higher when the event occurred in a public place (p < 0.001). Conclusions The factors associated with ROSC were occurrence in a public place, CPR initiation by witnesses, and presence of a shockable rhythm. Gender, age, and the type of EMT did not influence ROSC. Low bystander CPR rates reinforce the need for further efforts to train the public in CPR.
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Affiliation(s)
- Michał Czapla
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Marzena Zielińska
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland.
| | - Anna Kubica-Cielińska
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Diakowska
- Department of Nervous System Diseases, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
| | - Tom Quinn
- Faculty of Health, Social Care and Education Kingston University and St George's, University of London, London, UK
| | - Piotr Karniej
- Department of Public Health, Faculty of Health Sciences, Wroclaw Medical University, Wroclaw, Poland
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Slabe D, Oven A. Evaluation of Slovenian Occupational Therapists' Theoretical Knowledge and Stress Levels Connected With Providing Cardiopulmonary Resuscitation. Inquiry 2020; 57:46958020963683. [PMID: 33124486 PMCID: PMC7607753 DOI: 10.1177/0046958020963683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 08/12/2020] [Accepted: 09/04/2020] [Indexed: 06/11/2023]
Abstract
This was the first study that evaluated cardiopulmonary resuscitation (CPR) knowledge in a sample of occupational therapists and investigated whether the knowledge of CPR parameters affected their perceived stress levels related to providing CPR. A questionnaire, consisting of 4 clusters of questions, was pretested and used in an online survey of Slovenian occupational therapists. The survey was sent to all electronic addresses obtained from the Association of Occupational Therapists of Slovenia and the Faculty of Health Sciences at the University of Ljubljana. It was completed by 201 occupational therapists, which represented about 40% of all Slovenian occupational therapists. Data were analyzed using independent-samples t-test, 1-way ANOVA, and Pearson's correlation coefficient. On average, the participants scored 5.44 points (SD = 2.96) on the CPR knowledge test that had a maximum of 9 points. A weak negative correlation existed between the perceived level of stress and scores on the knowledge test (r = -0.151; P = .05). Scores on the knowledge test were also negatively correlated with age (r = -0.409; P < .001) and work experience (r = -0.388; P < .001) and positively correlated with self-evaluation of knowledge of CPR (r = 0.366; P < .001). The majority of the participants (92.3%) felt that they needed to update their CPR knowledge. There was no statistically significant difference in the CPR knowledge between occupational therapists working in different clinical areas (P = .85). Our sample of occupational therapists was not optimally prepared to apply CPR. Older and more experienced therapists demonstrated less theoretical knowledge and were particularly vulnerable to stress. To improve knowledge and confidence, regular CPR training is recommended for this group of health professionals.
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Affiliation(s)
- Damjan Slabe
- Faculty of Health Sciences, University of Ljubljana, Slovenia
| | - Alenka Oven
- Faculty of Health Sciences, University of Ljubljana, Slovenia
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Alqahtani SE, Alhajeri AS, Ahmed AA, Mashal SY. Characteristics of Out of Hospital Cardiac Arrest in the United Arab Emirates. Heart Views 2019; 20:146-151. [PMID: 31803370 PMCID: PMC6881873 DOI: 10.4103/heartviews.heartviews_80_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 09/16/2019] [Indexed: 11/17/2022] Open
Abstract
Background: Out of hospital cardiac arrest is one of the leading causes of death globally. This study aimed to identify the characteristics of out of hospital cardiac arrest patients who were attended and treated by the National Ambulance crew. A lot of studies reported the importance of implementing chain of survival to increase survival rates from cardiac arrest. To be implemented in United Arab Emirates (UAE), it required a detailed study of the community engagement. The study aimed to explore the demography of the incidences, location, age, gender epidemiology of the patients who had their cardiac arrest witnessed along with their Bystander cardiopulmonary resuscitation (CPR) performed prior to the arrival of National Ambulance and public access to an automated external defibrillator. The return of spontaneous circulation was also explored prior to their arrival to the emergency department. Methods: The research is a prospective descriptive cohort study of out of hospital cardiac arrest patients attended by National Ambulance between July 2017 and June 2018. The National Ambulance provides emergency medical services for public and private hospitals in the Emirates of Sharjah, Ajman, Ras-al-Khaimah, Fujairah, and Umm Al-Quwain and its clients in Abu Dhabi in UAE. Data for the study were collected by the National Ambulance crew attending the OHCA patients, using a structured questionnaire. Results: In this 1-year period, a total of 715 out of hospital cardiac arrest cases were attended by the National Ambulance with higher percentage (77%) of male patients. Resuscitation and transportation were attempted for 95% whereas 5% were pronounced dead on the spot. In this study, the median age of the patients was 50 years. Majority of the patients were Asians 55% (n = 395) followed by Arabs non-UAE citizens 19.4% (n = 139) and UAE citizens 16% (n = 113). Patients facing sudden cardiac arrest in their homes or residences represented 69.9% (n = 500), street and public places 22.5% (n = 161), and workplace 6.8% (n = 49). The percentage of patients who had witnessed cardiac arrest was 51.7% (n = 370) only 197 had CPR performed on them prior to the arrival of National Ambulance. Low public access to AED was found in this population that is 1.8% (n = 13). A majority of the participants in this study had nonshockable rhythms 84.3% (n = 603) whereas shockable rhythms presented on 11% (n = 80). The percentage of patients who had ROSC at the scene or en route to the hospitals was found 9.2% (n = 66). Conclusion: In this 1-year study, the result showed that cardiac arrest was recognized and witnessed in about half of the cases, but low bystander CPR was performed. Low public access and use of AED were found. Data on hospitalized and discharged OHCA patients were not available and required further linkage and corporation between ambulance services and hospitals to ensure data continuity of OHCA cases. This study is essential for the implementation of proper chain of survival and reduction in mortality rates in UAE.
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Affiliation(s)
- Saad Essa Alqahtani
- Department of Research and Development, National Ambulance, Abu Dhabi, United Arab Emirates
| | - Ahmed Saleh Alhajeri
- Department of Research and Development, National Ambulance, Abu Dhabi, United Arab Emirates.,Department of Clinical Services, National Ambulance, Abu Dhabi, United Arab Emirates
| | - Ayman Adel Ahmed
- Department of Clinical Services, National Ambulance, Abu Dhabi, United Arab Emirates
| | - Sahar Yousef Mashal
- Department of Clinical Services, National Ambulance, Abu Dhabi, United Arab Emirates
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Abstract
Thermal burn injury methodologies are inconsistently described within the current literature. To permit the advancement of new treatments there is an urgent need for the development and standardisation of an acute rat model. We describe a rat thermal burn model that involves: anaesthesia, chronic catheterisation, skin preparation, baseline hemodynamic and physiological monitoring, and a quantifiable method to reproduce a severe full-thickness burns injury affecting ∼30% percent of the total body surface area (%TBSA). Following a 15 min post-burn period, treatment commences with an acute monitoring phase lasting up to 8 h, which can be modified according to individual protocols. This model reflects the clinical continuum-of-care from point-of-injury, a 15 min ambulance response time, a 60 min prehospital phase and hospital treatment monitoring phase. The model is validated with histological evidence of full-thickness injury, evidence of the hypermetabolic response (K+, Base Excess, lactate) and changes in complete blood counts. •It has been 50 years since Walker and Mason published their widely popular "A Standard Animal Burn Model".•The model, however, lacks quantifiable methodology for the assessment of burn thickness, surface area burnt and physiological status.•We present a new standardised method for evaluation of drug and interventional therapies that mimic the clinical scenario including ambulance response, pre-hospital and hospital phases after burn.
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Affiliation(s)
- Lisa Davenport
- Heart, Trauma & Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, 4811, Australia
| | - Geoffrey Dobson
- Heart, Trauma & Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, 4811, Australia
| | - Hayley Letson
- Heart, Trauma & Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook University, Townsville, Queensland, 4811, Australia
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Lichtenhahn A, Kruse M, Büsing J, Vogel M, Konrad C. [Analysis of a first responder system for emergency medical care in rural areas: first results and experiences]. Anaesthesist 2019; 68:618-625. [PMID: 31420707 DOI: 10.1007/s00101-019-00635-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In emergency situations it is essential to get access to medical treatment as early as possible. In Germany, the time interval from alarm to arrival should be less than 10-15 min. The emergency medical service (EMS) cannot comply with this recommendation in approximately 10% of the emergencies in Baden-Württemberg. In addition to the traditional EMS system, a voluntary system of first responders has been developed over the last years to reduce this interval. They are incorporated into the alarm system of the traditional EMS and are alarmed as soon as an emergency call arrives. Data on process times (from alarm to begin of treatment or duration of treatment until arrival of EMS) and quality are rare. In Baden-Württemberg, the emergency aid "Deutsche Lebens-Rettungs-Gesellschaft e.V. (DLRG)" Nordhardt can only estimate times and quality of primary care. The objective of this analysis was to describe and evaluate such a first responder system. METHODS The presented study investigated the emergency responses of a first responder system in Nordhardt, close to Karlsruhe, Germany. A total of 367 emergency data sets from 2017 containing information on operating time, medical history, suspected diagnosis and medical treatment, were evaluated. Of these, 363 anonymized emergency records including the complete information (concerning process time and medical treatment) were analyzed. The focus was on different time intervals from alarm to treatment and until arrival of the EMS. Additionally, the quality of medical treatment and the measured vital data were examined. RESULTS The median response time and time to access to the patient was 2 min in both. The patient was reached within approximately 4 min and treated for another 5 min until the EMS arrived. In two thirds of the patients, the vital parameters were measured, 5 patients were resuscitated, 23 received supplementary oxygen, 4 patients were ventilated and 11 patients suffering from hypoglycemia showed a clinical benefit from the early treatment. A total of 50 trauma patients were treated, 5 with cervical spine stabilization and 38 received a body check. CONCLUSION The first responders from Nordhardt received an emergency call nearly every day. In two thirds of the calls they were faster than the EMS as they usually have local sites with a shorter distance to the emergency scene where they are able to deal with critical medical cases until the EMS arrives. Despite the small case numbers, it could be concluded that the early medical treatment with respect to resuscitation based on earlier arrival on site may help to increase the survival rate of patients. The first responders were also able to manage airway problems with additional oxygen or other airway devices. Other medical treatment performed by the first responders, such as administration of glucose in hypoglycemic patients positively affected the patient's condition. There is a tactical advantage to include first responders in traditional EMS services. Further studies are needed to examine these questions in larger samples also over a longer time period. Standardization and digitalization of the records could help to gain more data in this field.
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Affiliation(s)
- A Lichtenhahn
- Klinik für Anästhesie, Kantonsspital Luzern, 6000, Luzern, Schweiz.
| | - M Kruse
- Klinik für Anästhesie, Kantonsspital Luzern, 6000, Luzern, Schweiz
| | - J Büsing
- Nordhardt, Bezirk Karlsruhe, Deutsche Lebens-Rettungs-Gesellschaft e.V. (DLRG), Karlsruhe, Deutschland
| | - M Vogel
- Nordhardt, Bezirk Karlsruhe, Deutsche Lebens-Rettungs-Gesellschaft e.V. (DLRG), Karlsruhe, Deutschland
| | - C Konrad
- Klinik für Anästhesie, Kantonsspital Luzern, 6000, Luzern, Schweiz.,Nordhardt, Bezirk Karlsruhe, Deutsche Lebens-Rettungs-Gesellschaft e.V. (DLRG), Karlsruhe, Deutschland
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Navab E, Esmaeili M, Poorkhorshidi N, Salimi R, Khazaei A, Moghimbeigi A. Predictors of Out of Hospital Cardiac Arrest Outcomes in Pre-Hospital Settings; a Retrospective Cross-sectional Study. Arch Acad Emerg Med 2019; 7:36. [PMID: 31555766 PMCID: PMC6732204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Different potential factors can affect the outcomes of Out of Hospital Cardiac Arrest (OHCA). The present study aimed to identify important factors contributing to the Return of Spontaneous Circulation (ROSC) and Survival to Hospital Discharge (SHD) in these patients. METHODS This cross-sectional study was conducted on all the OHCA patients who underwent Cardiopulmonary Resuscitation (CPR) in emergency medical service (EMS) of Hamedan province during 2016-2017. All the relevant data were retrieved from three sources, according to Utstein's style. In addition, univariate and multivariate logistic regressions were employed to identify predictive factors of ROSC and SHD using SPSS software, version 20. RESULTS Among the 3214 eligible patients whose data were collected, most OHCA patients were female (59.7%) with the mean age of 58 years. Moreover, the majority of OHCAs (77.8%) occurred at home during 8pm-8am (65.1%) and about 26.3% of OHCAs were witnessed, with only 5.1% bystander-initiated CPR. Furthermore, the median ambulance response time and CPR duration were 6.0 and 20 minutes, respectively. Overall, ROSC and SHD success rates were 8.3 and 4.1%, respectively. Bystander CPR was found to be the most effective predicting factor for the success rate of ROSC (AOR=3.26, P<0.001) and SHD (AOR=3.04, P<0.001) after adjusting for the Utstein variables including the patients' age, gender, cardiac disease history, arrest time, CPR duration, response time, being witnessed, bystander CPR, and endotracheal intubation (ETI). CONCLUSION The overall success rates of ROSC and SHD were 8.3% and 4.1%, respectively. The age, ambulance response time, CPR duration, and cardiac disease history were negatively associated with the outcomes of ROSC and SHD, while being witnessed, bystander CPR, ETI, and initial shockable rhythm were positively related to both of the above-mentioned outcomes.
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Affiliation(s)
- Elham Navab
- Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Maryam Esmaeili
- Critical Care and Geriatric Nursing Department, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nastaran Poorkhorshidi
- Student Research Committee, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Rasoul Salimi
- Emergency Department, Besat Hospital, Hamedan University of Medical Sciences, Hamedan, Iran.
| | - Afshin Khazaei
- Intensive Care and Management Nursing Department, School of Nursing and Midwifery, Hamedan University of Medical Sciences, Hamedan, Iran. ,Corresponding author: Afshin Khazaei; School of Nursing and Midwifery, Shahid Fahmideh Blvd, Hamedan, Iran. Postal code: 141973317. , Tel: 00989183143075
| | - Abbas Moghimbeigi
- Professor of Epidemiology and Biostatistics, Department of Biostatistics and Epidemiology, School of Public Health, Hamedan University of Medical Sciences, Hamedan, Iran.
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