Pre-Hospital Emergency Medical Services in Developing Countries: A Case Study about EMS Response Time in Yazd, Iran

BACKGROUND

Prehospital emergency medical services, a subsystem of Emergency Medical Services (EMS),provides early care to critically ill and injured patients in the field. Time is an important factor in pre-hospital care and the length of time it takes to reach care, has a significant impact on patient outcome. This study aims to calculate the response time in EMS stations of Yazd, Iran.

METHODS

During 2008-2009, 11961 run report forms from all 7 EMS stations in Yazd that had been submitted to central station were surveyed. By using Excell statistical software and descriptive statistics (percent, cumulative distribution and standard deviation), we calculated fractile response times for Yazd EMS.

RESULTS

81.15 percent of response times were within 8 minutes as a referenced standard for EMS.

CONCLUSION

The majority of call services in Yazd EMS have been responded in a suitable time interval comparing with reference standards and country's approved EMS response time goal, but there are still rooms for improvement.

Predictors of outcome in 100 consecutive laparoscopic antireflux procedures

BACKGROUND

Published success rates for surgical intervention in gastroesophageal reflux disease exceed 90%. The goal of this study was to determine if any preoperative factors could accurately predict postoperative symptom relief.

METHODS

One hundred consecutive patients undergoing laparoscopic antireflux surgery completed a detailed preoperative questionnaire, and underwent endoscopy, manometry, and 24-hour esophageal pH monitoring. Two surgeons performed all procedures in a standardized fashion. At least 2 months following operative intervention, a single interviewer, blinded to all preoperative information and procedure performed, recorded Visick and Gastroesophageal Reflux Disease-Health-Related Quality of Life scores for all patients. All follow-up was performed within 3 years of antireflux procedure.

RESULTS

The surgical success rate, as defined by Visick scores of 1-2, was 91%. Three variables were predictive of postoperative success: age <50, presence of typical symptoms at presentation, and complete resolution of symptoms with acid suppression therapy.

CONCLUSION

The study shows that surgical strategies can reproducibly control gastroesophageal reflux disease symptoms in more than 90% of patients. The optimal surgical candidate is a patient under the age of 50 whose typical symptoms completely resolve with acid suppression therapy.