1
|
Wood FNR, Hicks J, Wilkinson R, Hartley R, Lowe J. Orientation affects the integrity of glass ampoules of 1 in 1000 adrenaline on exposure to very low temperatures. Int J Circumpolar Health 2024; 83:2309756. [PMID: 38290014 PMCID: PMC10829818 DOI: 10.1080/22423982.2024.2309756] [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] [Received: 07/13/2023] [Accepted: 01/19/2024] [Indexed: 02/01/2024] Open
Abstract
In very cold environments, it may be burdensome or impossible for the polar medic to prevent medicines from freezing. We sought to investigate whether orientation affected the risk that glass ampoules of 1 in 1000 adrenaline, an important emergency drug, would break during freezing and subsequent thawing. Ampoules of adrenaline were orientated either upright, horizontally or inverted. They were exposed to freezing temperatures (-25°C or -80°C) and then allowed to thaw. A crossover design was used whereby the orientation of unbroken ampoules was changed for the next trial. No ampoules broke when frozen at -25°C and then thawed. When this was repeated at -80°C, ampoules reliably broke unless they were upright with no liquid in the top part of the ampoule. Upright orientation prevents the breakage of glass ampoules of 1 in 1000 adrenaline rapidly frozen at -80°C. The polar medic may consider storing ampoules upright if they are to be exposed to very low temperatures.
Collapse
Affiliation(s)
- Felix N. R. Wood
- British Antarctic Survey Medical Unit, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Jason Hicks
- British Antarctic Survey Medical Unit, Plymouth, UK
| | | | | | - Jonathon Lowe
- British Antarctic Survey Medical Unit, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| |
Collapse
|
2
|
Adem MA, Tezera ZB, Agegnehu CD. The practice and determinants of ambulance service utilization in pre-hospital settings, Jimma City, Ethiopia. BMC Emerg Med 2024; 24:81. [PMID: 38735937 PMCID: PMC11089792 DOI: 10.1186/s12873-024-00999-8] [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: 07/23/2023] [Accepted: 05/03/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND In pre-hospital setting, ambulance provides emergency care and means of transport to arrive at appropriate health centers are as vital as in-hospital care, especially, in developing countries. Accordingly, Ethiopia has made several efforts to improve accessibility of ambulances services in prehospital care system that improves the quality of basic emergency care. Yet, being a recent phenomenon in Ethiopia, empirical studies are inadequate with regard to the practice and determinants of ambulance service utilization in pre-hospital settings. Hence, this study aimed to assess the ambulance service utilization and its determinants among patients admitted to the Emergency Departments (EDs) within the context of pre-hospital care system in public hospitals of Jimma City. METHOD A cross-sectional study design was used to capture quantitative data in the study area from June to July 2022. A systematic sampling technique was used to select 451 participants. Interviewer-administered questionnaire was used to collect data. Data analysis was done using SPSS version 26.0; descriptive and logistic regressions were done, where statistical significance was determined at p < 0.05. RESULTS Ambulance service was rendered to bring about 39.5% (of total sample, 451) patients to hospitals. The distribution of service by severity of illnesses was 48.7% among high, and 39.4% among moderately acute cases. The major determinants of ambulance service utilization were: service time (with AOR, 0.35, 95%CI, 0.2-0.6 for those admitted to ED in the morning, and AOR, 2.36, 95%CI, 1.3-4.4 for those at night); referral source (with AOR, 0.2, 95%CI, 0.1-0.4 among the self-referrals); mental status (with AOR, 1.9, 95%CI, 1-3.5 where change in the level of consciousness is observed); first responder (AOR, 6.3 95%CI, 1.5-26 where first responders were the police, and AOR, 3.4, 95%C1, 1.7-6.6 in case of bystanders); distance to hospital (with AOR,0.37, 95%CI, 0.2-0.7 among the patients within ≤15km radius); and prior experience in ambulance use (with AOR, 4.1,95%CI, 2.4-7). CONCLUSION Although the utilization of ambulance in pre-hospital settings was, generally, good in Jimma City; lower levels of service use among patients in more acute health conditions is problematic. Community-based emergency care should be enhanced to improve the knowledge and use of ambulance services.
Collapse
Affiliation(s)
- Mohammed Ahmed Adem
- Department of Emergency and Critical Care, School of Nursing, Faculty of Health Sciences, Institute of Health, Jimma University main campus, 378, Jimma, Ethiopia.
| | - Zewdu Baye Tezera
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
| | - Chilot Desta Agegnehu
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, 196, Gondar, Ethiopia
| |
Collapse
|
3
|
Tsuboi M, Hibiya M, Kawaura H, Seki N, Hasegawa K, Hayashi T, Matsuo K, Furuya S, Nakajima Y, Hitomi S, Ogawa K, Suzuki H, Yamamoto D, Asami M, Sakamoto S, Kamiyama J, Okuda Y, Minami K, Teshigahara K, Gokita M, Yasaka K, Taguchi S, Kiyota K. Impact of physician-staffed ground emergency medical services-administered pre-hospital trauma care on in-hospital survival outcomes in Japan. Eur J Trauma Emerg Surg 2024; 50:505-512. [PMID: 37999771 PMCID: PMC11035423 DOI: 10.1007/s00068-023-02383-w] [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] [Received: 08/11/2023] [Accepted: 10/17/2023] [Indexed: 11/25/2023]
Abstract
PURPOSE In Japan, the vehicle used in pre-hospital trauma care systems with physician-staffed ground emergency medical services (GEMS) is referred to as a "doctor car". Doctor cars are highly mobile physician-staffed GEMS that can provide complex pre-hospital trauma management using various treatment strategies. The number of doctor car operations for patients with severe trauma has increased. Considering facility factors, the association between doctor cars and patient outcomes remains unclear. Therefore, this study aimed to examine the relationship between doctor cars for patients with severe trauma and survival outcomes in Japan. METHODS A nationwide retrospective cohort study was conducted to compare the impact of the doctor car group with the non-physician-staffed GEMS group on in-hospital survival in adult patients with severe trauma. The data were analyzed using multivariable logistic regression models with generalized estimating equations. RESULTS This study included 372,365 patients registered in the Japan Trauma Data Bank between April 2009 and March 2019. Of the 49,144 eligible patients, 2361 and 46,783 were classified into the doctor car and non-physician staffed GEMS groups, respectively. The adjusted odds ratio (OR) for survival was significantly higher in the doctor car group than in the non-physician staffed GEMS group (adjusted OR = 1.228 [95% confidence interval 1.065-1.415]). CONCLUSION Using nationwide data, this novel study suggests that doctor cars improve the in-hospital survival rate of patients with severe trauma in Japan. Therefore, doctor cars could be an option for trauma strategies.
Collapse
Affiliation(s)
- Motohiro Tsuboi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan.
- International Cooperation for Disaster Medicine Lab., International Research Institute of Disaster Science (IRIDeS), Tohoku University, 468-1, Aramaki-aza-Aoba-Ku, Sendai, Miyagi, 980-8572, Japan.
| | - Manabu Hibiya
- Teikyo Academic Research Center, Teikyo University, 2-11-1, Kaga, Itabashi-Ku, Tokyo, 173-8605, Japan
| | - Hiroyuki Kawaura
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Nozomu Seki
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kazuki Hasegawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Tatsuhiko Hayashi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kentaro Matsuo
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Shintaro Furuya
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Yukiko Nakajima
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Suguru Hitomi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kaoru Ogawa
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Hajime Suzuki
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Daisuke Yamamoto
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Masahiro Asami
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Saki Sakamoto
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Jiro Kamiyama
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Yuko Okuda
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kazu Minami
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Katsunobu Teshigahara
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Masashi Gokita
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Koichi Yasaka
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Shigemasa Taguchi
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| | - Kazuya Kiyota
- Advanced Emergency and Critical Care Center, Saitama Red Cross Hospital, 1-5, Shintoshin, Chuo-Ku, Saitama, Saitama, 330-8553, Japan
| |
Collapse
|
4
|
Shafique MA, Haseeb A, Asghar B, Kumar A, Chaudhry ER, Mustafa MS. Assessing the impact of pre-hospital airway management on severe traumatic Brain injury: A systematic review and Meta-analysis. Am J Emerg Med 2024; 78:188-195. [PMID: 38301369 DOI: 10.1016/j.ajem.2024.01.030] [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] [Received: 10/13/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE This study aimed to assess the impact of establishing a pre-hospital definitive airway on mortality and morbidity compared with no prehospital airway in cases of severe traumatic brain injury (TBI). BACKGROUND Traumatic brain injury (TBI) is a global health concern that is associated with substantial morbidity and mortality. Prehospital intubation (PHI) has been proposed as a potential life-saving intervention for patients with severe TBI to mitigate secondary insults, such as hypoxemia and hypercapnia. However, their impact on patient outcomes remains controversial. METHODS A systematic review and meta-analysis were conducted to assess the effects of prehospital intubation versus no prehospital intubation on morbidity and mortality in patients with severe TBI, adhering to the PRISMA guidelines. RESULTS 24 studies, comprising 56,543 patients, indicated no significant difference in mortality between pre-hospital and In-hospital Intubation (OR 0.89, 95% CI 0.65-1.23, p = 0.48), although substantial heterogeneity was noted. Morbidity analysis also showed no significant difference (OR 0.83, 95% CI 0.43-1.63, p = 0.59). These findings underscore the need for cautious interpretation due to heterogeneity and the influence of specific studies on the results. CONCLUSION In summary, an initial assessment did not reveal any apparent disparity in mortality rates between individuals who received prehospital intubation and those who did not. However, subsequent analyses and randomized controlled trials (RCTs) demonstrated that patients who underwent prehospital intubation had a reduced risk of death and morbidity. The dependence on biased observational studies and the need for further replicated RCTs to validate these findings are evident. Despite the intricacy of the matter, it is crucial to intervene during severe airway impairment.
Collapse
Affiliation(s)
| | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Bushra Asghar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aashish Kumar
- Department of Medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | | | | |
Collapse
|
5
|
Krammel M, Frimmel N, Hamp T, Grassmann D, Widhalm H, Verdonck P, Reisinger C, Sulzgruber P, Schnaubelt S. Outcomes and potential for improvement in the prehospital treatment of penetrating chest injuries in a European metropolitan area: A retrospective analysis of 2009 - 2017. Injury 2024; 55:110971. [PMID: 37544864 DOI: 10.1016/j.injury.2023.110971] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 07/08/2023] [Accepted: 08/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Trauma is the leading cause of death in patients <45 years living in high-resource settings. However, penetrating chest injuries are still relatively rare in Europe - with an upwards trend. These cases are of particular interest to emergency medical services (EMS) due to available invasive treatment options like chest tube placement or resuscitative thoracotomy. To date, there is no sufficient data from Austria regarding penetrating chest trauma in a metropolitan area, and no reliable source to base decisions regarding further skill proficiency training on. METHODS For this retrospective observational study, we screened all trauma emergency responses of the Viennese EMS between 01/2009 and 12/2017 and included all those with a National Advisory Committee for Aeronautics (NACA) score ≥ IV (= potentially life-threatening). Data were derived from EMS mission documentations and hospital files, and for those cases with the injuries leading to cardiopulmonary resuscitation (CPR), we assessed the EMS cardiac arrest registry and consulted a forensic physician. RESULTS We included 480 cases of penetrating chest injuries of NACA IV-VII (83% male, 64% > 30 years old, 74% stab wounds, 16% cuts, 8% gunshot wounds, 56% inflicted by another party, 26% self-inflicted, 18% unknown). In the study period, the incidence rose from 1.4/100,000 to 3.5/100,000 capita, and overall, about one case was treated per week. In the cases with especially severe injury patterns (= NACA V-VII, 43% of total), (tension-)pneumothorax was the most common injury (29%). The highest mortality was seen in injuries to pulmonary vessels (100%) or the heart (94%). Fifty-eight patients (12% of total) deceased, whereas in 15 cases, the forensic physician stated survival could theoretically have been possible. However, only five of these CPR patients received at least unilateral thoracostomy. Regarding all penetrating chest injuries, thoracostomy had only been performed in eight patients. CONCLUSIONS Severe cases of penetrating chest trauma are rare in Vienna and happened about once a week between 2009 and 2017. Both incidence and case load increased over the years, and potentially life-saving invasive procedures were only reluctantly applied. Therefore, a structured educational and skill retention approach aimed at both paramedics and emergency physicians should be implemented. TRIAL REGISTRATION Retrospective analysis without intervention.
Collapse
Affiliation(s)
| | - Nikolaus Frimmel
- Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | - Thomas Hamp
- Emergency Medical Service Vienna, Vienna, Austria; Dept. of Anaesthesia, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Harald Widhalm
- Dept. of Orthopedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria
| | - Philip Verdonck
- Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium
| | | | - Patrick Sulzgruber
- Division of Cardiology, Dept. of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Sebastian Schnaubelt
- Dept. of Emergency Medicine, Antwerp University Hospital, Edegem, Belgium; Dept. of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
| |
Collapse
|
6
|
Rydlöv HS, Fjose LO, Heyerdahl F. Pain Management with Inhalation of Methoxyflurane Administrated by Non-Medical Ski Patrol: A Quality Assessment Study. Pain Ther 2023; 12:1455-1463. [PMID: 37578680 PMCID: PMC10616009 DOI: 10.1007/s40122-023-00547-5] [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: 05/11/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023] Open
Abstract
INTRODUCTION Pain management can be challenging, especially in remote locations where first responders are not certified health care personnel. In these settings, traditional intravenous administration of analgesics is not feasible. In this study, we explore the feasibility of using methoxyflurane as a first-line analgesic in ski-related traumas, administered by the ski patrol, acting as the municipality physician's aiding personnel. METHODS This is a quality assessment of a project aimed at improving pain management in trauma patients at the largest ski resort in Norway. Members of the ski patrol were trained and delegated administration of methoxyflurane on behalf of the municipality physician. Patients > 18 years with ski-related trauma and pain Numeric Rating Scale (NRS) of 6 or more were included. The patients received inhalational methoxyflurane on site, with continued administration during transport. Data were collected by the ski patrol and entered into a quality register. RESULTS In total, 53 patients (18 to 76 years, 32 (60%) males) accepted to be registered. The injuries were fractures in 35 (66%), joint luxation in seven (13%), combination of fracture and luxation in seven (13%), and blunt soft tissue damage in four (8%) cases. Median NRS before administration of methoxyflurane was 8 decreasing to median NRS 5 after 5-10 min. The median NRS reduction of 3 (25-75% percentiles 2-5) was significant, p < 0.001. Patients rated the perceived effect as good in 40 (80%) moderate in nine (18%) and no effect in 1 (2%). Side effects were mild: Six patients (11%) experienced dizziness, one patient (2%) was considered drowsy. CONCLUSIONS Methoxyflurane is feasible as a first-line analgesic administered by a non-medical ski patrol in a responsibly organized system. Early pain management with inhalation of methoxyflurane provides good perceived effect with mild adverse events and can be of great value in settings where few alternatives for pain management are available.
Collapse
Affiliation(s)
| | - Lars Olav Fjose
- Innlandet Health Trust, Division of Prehospital Services, Gjøvik, Norway
- Norwegian Air Ambulance Foundation, Oslo, Norway
| | - Fridtjof Heyerdahl
- Norwegian Air Ambulance Foundation, Oslo, Norway.
- Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway.
| |
Collapse
|
7
|
Sebakeng M, Cox M. Experiences and Interventions by Botswana police officers in providing emergency care in road traffic collisions in the greater Gaborone region. Afr J Emerg Med 2023; 13:230-234. [PMID: 37711767 PMCID: PMC10497991 DOI: 10.1016/j.afjem.2023.08.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 08/18/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
Background Close to 500 people die annually from Road Traffic Collisions in Botswana. The country's Emergency Medical Service is limited in capacity and coverage and greatest in the region of the capital city, Gaborone. Botswana Police Service officers are often first responders to the incidents and provide first aid, however the extent of their interventions and their experiences has not been studied. Methods A questionnaire based cross-sectional survey was conducted in January 2016 on a sample of 99 officers on past pre-hospital care training, attitudes towards providing pre-hospital care for accident victims, the number of road traffic collision related deaths and injuries encountered in the last 6 months, their interventions to the victims and limitations encountered in providing care. Results The officers self-reported attending to a median of 10 injured victims (IQR = 5 - 20) and a median of 2 deaths (IQR = 0 - 4) in the preceding 6 months. The officers generally acknowledged their role and responsibility to provide pre-hospital care to the victims. Officers frequently secured accident scenes and transported injured victims to health facilities. They rarely performed haemorrhage control on victims, performed any airway manoeuvres or splint injured limbs. The major limitations to providing care were lack of first aid supplies and personal protective equipment, lack of knowledge and skills to provide care and interference from onlookers at accident scenes. Conclusion Botswana Police officers in the greater Gaborone area attend to a considerable number of traffic related injuries and fatalities. These results support many opportunities for educational interventions to add value to pre-hospital care.
Collapse
Affiliation(s)
- M. Sebakeng
- Department of Emergency Medicine; Faculty of Medicine, University of Botswana
| | - M. Cox
- University of Sydney School of Medicine and Public Health
| |
Collapse
|
8
|
Newport R, Grey C, Dicker B, Brewer K, Amertunga S, Selak V, Hanchard S, Taueetia-Su'a T, Harwood M. Upholding te mana o te wā: Māori patients and their families' experiences of accessing care following an out-of-hospital cardiac event. Am Heart J Plus 2023; 36:100341. [PMID: 38510103 PMCID: PMC10945954 DOI: 10.1016/j.ahjo.2023.100341] [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] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 03/22/2024]
Abstract
Objective The purpose of this study was to explore the experiences of Māori patients and their families accessing care for an acute out-of-hospital cardiac event and to identify any barriers or enablers of timely access to care. Design Eleven interviews with patients and their families were conducted either face-to-face or using online conferencing. Interviews were audio-recorded and transcribed for thematic analysis using Kaupapa Māori methodology. Results Data analysis identified three themes: (1) me and the event, (2) the people (3) upholding te mana ō te wā or self-determined heart wellbeing. Knowledge of symptoms and a desire to maintain personal dignity at the time of the event affected emergency medical service initiation. Participants described relationships with health professionals, the importance of good quality information, having family support, and drawing on cultural practices as vital for their health care journey. Conclusion Systemic barriers including racism, discrimination, and inadequate resourcing exist for Māori journeying to and through care following an out of hospital cardiac event. Improving the cultural safety of health professionals, better access to community defibrillation, and improving understanding of the life-long impacts a cardiac event has on patients and whānau is recommended.
Collapse
Affiliation(s)
- Rochelle Newport
- Department of General Practice and Primary Health Care, The University of Auckland Faculty of Medical and Health Sciences, Private Bag 92019, Auckland 1142, New Zealand
| | - Corina Grey
- Te Whatu Ora |Health New Zealand - Counties Manukau, Auckland, New Zealand
| | - Bridget Dicker
- Hato Hone St John NZ & Auckland University of Technology Faculty of Health and Environmental Sciences, Auckland, New Zealand
| | - Karen Brewer
- The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Shanthi Amertunga
- The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Vanessa Selak
- The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Sandra Hanchard
- The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Tua Taueetia-Su'a
- The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Matire Harwood
- The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| |
Collapse
|
9
|
Odusola AO, Jeong D, Malolan C, Kim D, Venkatraman C, Kola-Korolo O, Idris O, Olaomi OO, Nwariaku FE. Spatial and temporal analysis of road traffic crashes and ambulance responses in Lagos state, Nigeria. BMC Public Health 2023; 23:2273. [PMID: 37978483 PMCID: PMC10656774 DOI: 10.1186/s12889-023-16996-8] [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: 05/25/2023] [Accepted: 10/15/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Sub-Saharan African countries, Nigeria inclusive, are constrained by grossly limited access to quality pre-hospital trauma care services (PTCS). Findings from pragmatic approaches that explore spatial and temporal trends of past road crashes can inform novel interventions. To improve access to PTCS and reduce burden of road traffic injuries we explored geospatial trends of past emergency responses to road traffic crashes (RTCs) by Lagos State Ambulance Service (LASAMBUS), assessed efficiency of responses, and outcomes of interventions by local government areas (LGAs) of crash. METHODS Using descriptive cross-sectional design and REDcap we explored pre-hospital care data of 1220 crash victims documented on LASAMBUS intervention forms from December 2017 to May 2018. We analyzed trends in days and times of calls, demographics of victims, locations of crashes and causes of delayed emergency responses. Assisted with STATA 16 and ArcGIS pro we conducted descriptive statistics and mapping of crash metrics including spatial and temporal relationships between times of the day, seasons of year, and crash LGA population density versus RTCs incidence. Descriptive analysis and mapping were used to assess relationships between 'Causes of Delayed response' and respective crash LGAs, and between Response Times and crash LGAs. RESULTS Incidences of RTCs were highest across peak commuting hours (07:00-12:59 and 13:00-18:59), rainy season and harmattan (foggy) months, and densely populated LGAs. Five urban LGAs accounted for over half of RTCs distributions: Eti-Osa (14.7%), Ikeja (14.4%), Kosofe (9.9%), Ikorodu (9.7%), and Alimosho (6.6%). On intervention forms with a Cause of Delay, Traffic Congestion (60%), and Poor Description (17.8%), had associations with LGA distribution. Two densely populated urban LGAs, Agege and Apapa were significantly associated with Traffic Congestion as a Cause of Delay. LASAMBUS was able to address crash in only 502 (36.8%) of the 1220 interventions. Other notable outcomes include: No Crash (false calls) (26.6%), and Crash Already Addressed (22.17%). CONCLUSIONS Geospatial analysis of past road crashes in Lagos state offered key insights into spatial and temporal trends of RTCs across LGAs, and identified operational constraints of state-organized PTCS and factors associated with delayed emergency responses. Findings can inform programmatic interventions to improve trauma care outcomes.
Collapse
Affiliation(s)
- Aina Olufemi Odusola
- Department of Community Health & Primary Health Care, Lagos State University Teaching Hospital, 1-5, Oba Akinjobi Road, Ikeja, Lagos, Nigeria.
| | - Dohyo Jeong
- School of Economic, Political, and Policy Science, University of Texas at Dallas, Richardson, TX, USA
| | - Chenchita Malolan
- Department of Surgery, Office of Global Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Dohyeong Kim
- School of Economic, Political, and Policy Science, University of Texas at Dallas, Richardson, TX, USA
| | - Chinmayee Venkatraman
- Department of Surgery, Office of Global Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390, USA
| | - Olusegun Kola-Korolo
- Lagos State Ministry of Health, Block 4, The Lagos State Government Secretariat Complex, Alausa, Lagos, Ikeja, Nigeria
| | - Olajide Idris
- Lagos State Ministry of Health, Block 4, The Lagos State Government Secretariat Complex, Alausa, Lagos, Ikeja, Nigeria
| | - Oluwole Olayemi Olaomi
- Department of Surgery, Central Business District, FCT, National Trauma Centre, National Hospital Abuja, Plot 321, Abuja, Nigeria
| | - Fiemu E Nwariaku
- Department of Surgery, Center for Global Surgery, University of Utah, 30 N 1900 E, Salt Lake City, Utah, 3B110, USA
| |
Collapse
|
10
|
Roberts DR, McGeorge T, Abrams D, Hewitt R, LeBlanc D, Dennis W, Rosenberg M, Kasab SA, Holmstedt C, Spampinato MV, Torres-Rosado S, Ancrum R, Haschker M, Harvey J. Mobile point-of-care MRI demonstration of a normal volunteer in a telemedicine-equipped ambulance. J Stroke Cerebrovasc Dis 2023; 32:107301. [PMID: 37579637 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107301] [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] [Received: 05/27/2023] [Revised: 07/28/2023] [Accepted: 08/06/2023] [Indexed: 08/16/2023] Open
Abstract
OBJECTIVE Several centers have implemented ambulances equipped with CT scanners and telemedicine capabilities, known as mobile stroke units (MSU), to expedite acute stroke care delivery in the pre-hospital setting. While MSUs have been shown to improve outcomes compared with standard emergency medical management, there are limitations to incorporating CT, including radiation exposure to emergency medical services personnel. Recently, a portable, low-field strength MRI (Swoop®, Hyperfine, Inc., Guilford, CT) received FDA clearance for in-hospital use. Here, as proof-of-concept, we explore the possibility of performing MRI in a telemedicine-equipped ambulance during active transport. MATERIALS AND METHODS In this initial technical demonstration, we imaged an MR phantom and a normal human volunteer using a standard stroke protocol during active ambulance transport. RESULTS Images of the MR phantom and volunteer were successfully obtained and were immediately available for viewing in the hospital PACS system. The images were deemed of diagnostic quality by the radiologist. Active motion correction maintained superior image quality despite vehicle and scanner motion. In-plane, low contrast resolution of greater than 4 × 4 mm was achieved. Average transmit speeds were calculated to be 3.54 Megabits/second and upload data rates varied while in transit ranging from 8.54 to 4.13 Megabits/second. CONCLUSION While MRI is not yet ready for clinical use in the MSU setting, our initial experience suggests potential technological feasible of this approach following future technical and MRI sequence development. Additional studies, incorporating patients, would be required to determine clinical feasibility.
Collapse
Affiliation(s)
- Donna R Roberts
- Department of Radiology and Radiological Science, Medical University of South Carolina (MUSC), Charleston, SC.
| | | | | | | | | | - William Dennis
- Department of Radiology and Radiological Science, Medical University of South Carolina (MUSC), Charleston, SC.
| | | | | | | | - Maria V Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina (MUSC), Charleston, SC.
| | | | | | | | - Jillian Harvey
- Department of Healthcare Management and Leadership, MUSC.
| |
Collapse
|
11
|
Tern PJW, Vaswani A, Yeo KK. Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries. Korean Circ J 2023; 53:594-605. [PMID: 37653695 PMCID: PMC10475691 DOI: 10.4070/kcj.2023.0169] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 06/25/2023] [Indexed: 09/02/2023] Open
Abstract
Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.
Collapse
Affiliation(s)
- Paul Jie Wen Tern
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Amar Vaswani
- Department of Cardiology, National Heart Centre Singapore, Singapore
| | - Khung Keong Yeo
- Department of Cardiology, National Heart Centre Singapore, Singapore.
| |
Collapse
|
12
|
Belcher J, Finn J, Whiteside A, Ball S. Association between initial presenting level of consciousness and patient acuity - A potential application for secondary triage in emergency ambulance calls. Australas Emerg Care 2023; 26:199-204. [PMID: 36496330 DOI: 10.1016/j.auec.2022.11.002] [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] [Received: 06/20/2022] [Revised: 11/17/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Conscious state assessment is important for the triage of emergency patients. In this study, we measured the association between ambulance patients' conscious state and high versus lower acuity, with a view to informing telephone triage assessment of conscious state. METHODS Data were analysed from one year of emergency ambulance incidents in Perth, Western Australia. Patient conscious state at the time of paramedic arrival was compared to acuity (based on paramedic assessment and management). We determined the proportion of high-acuity patients across six levels of consciousness (Alert, Confused, Drowsy, Voice Response, Pain Response, Unresponsive) overall, and within individual protocols of the Medical Priority Dispatch System (MPDS). RESULTS The proportion of high acuity patients increased with each step across the consciousness scale. Applying conscious state as a binary predictor of acuity, the largest increases occurred moving the threshold from Alert to Confused (22.0-48.6% high acuity) and Drowsy to Voice Response (61.9-89.5% high acuity). The Area Under the Curve (AUC) of the Receiver Operating Characteristic was 0.65. Within individual protocols, the highest AUC was in Cardiac Arrest (0.89), Overdose/Poisoning (0.81), Unknown Problem (0.76), Diabetic Problem, (0.74) and Convulsions/Fitting (0.73); and lowest in Heart problems (0.55), Abdominal Pain (0.55), Breathing Problems (0.55), Back Pain (0.53), and Chest Pain (0.52). CONCLUSION Based on these proportions of high acuity patients, it is reasonable to consider patients with any altered conscious state a high priority. The value of conscious state assessment for predicting acuity varies markedly between MPDS protocols. These findings could help inform secondary triage of ambulance patients during the emergency call.
Collapse
Affiliation(s)
- Jason Belcher
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia; St John Western Australia, Australia.
| | - Judith Finn
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia; St John Western Australia, Australia
| | - Austin Whiteside
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia; St John Western Australia, Australia
| | - Stephen Ball
- Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing, Curtin University, Perth, Western Australia, Australia; St John Western Australia, Australia
| |
Collapse
|
13
|
Wang D, Deng L, Zhang R, Zhou Y, Zeng J, Jiang H. Efficacy of intraosseous access for trauma resuscitation: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:17. [PMID: 36918947 PMCID: PMC10012735 DOI: 10.1186/s13017-023-00487-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 02/11/2023] [Accepted: 02/28/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND During medical emergencies, intraosseous (IO) access and intravenous (IV) access are methods of administering therapies and medications to patients. Treating patients in emergency medical situations is a highly time sensitive practice; however, research into the optimal access method is limited and existing systematic reviews have only considered out-of-hospital cardiac arrest (OHCA) patients. We focused on severe trauma patients and conducted a systematic review to evaluate the efficacy and efficiency of intraosseous (IO) access compared to intravenous (IV) access for trauma resuscitation in prehospital care. MATERIALS AND METHOD PubMed, Web of Science, Cochrane Library, EMBASE, ScienceDirect, banque de données en santé publique and CNKI databases were searched for articles published between January 1, 2000, and January 31, 2023. Adult trauma patients were included, regardless of race, nationality, and region. OHCA patients and other types of patients were excluded. The experimental and control groups received IO and IV access, respectively, in the pre-hospital and emergency departments for salvage. The primary outcome was success rate on first attempt, which was defined as secure needle position in the marrow cavity or a peripheral vein, with normal fluid flow. Secondary outcomes included mean time to resuscitation, mean procedure time, and complications. RESULTS Three reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies; meta-analyses were then performed using Review Manager (Version 5.4; Cochrane, Oxford, UK). The success rate on first attempt was significant higher for IO access than for IV access (RR = 1.46, 95% CI [1.16, 1.85], P = 0.001). The mean procedure time was significantly reduced (MD = - 5.67, 95% CI [- 9.26, - 2.07], P = 0.002). There was no significant difference in mean time to resuscitation (MD = - 1.00, 95% CI [- 3.18, 1.17], P = 0.37) and complications (RR = 1.22, 95% CI [0.14, 10.62], P = 0.86) between the IO and IV groups. CONCLUSION The success rate on first attempt of IO access was much higher than that of IV access for trauma patients, and the mean procedure time of IO access was significantly less when compared to IV access. Therefore, IO access should be suggested as an urgent vascular access for hypotensive trauma patients, especially those who are under severe shock.
Collapse
Affiliation(s)
- Dong Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Lei Deng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.,Sichuan Province Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Ruipeng Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China
| | - Yiyue Zhou
- Department of Biology, Sorbonne University, 75005, Paris, France
| | - Jun Zeng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China.,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China.,Sichuan Province Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No. 32, Yi Huan Lu Xi Er Duan, Chengdu, 610072, Sichuan Province, China. .,Chinese Academy of Sciences, Sichuan Translational Medicine Research Hospital, Chengdu, 610072, China. .,Sichuan Province Clinical Research Center for Emergency and Critical Care Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| |
Collapse
|
14
|
Martín-Rodríguez F, Ortega GJ, Castro Villamor MA, Del Pozo Vegas C, Delgado Benito JF, Martín-Conty JL, Sanz-García A, López-Izquierdo R. Development of a prehospital lactic acidosis score for early-mortality. A prospective, multicenter, ambulance-based, cohort study. Am J Emerg Med 2023; 65:16-23. [PMID: 36580696 DOI: 10.1016/j.ajem.2022.12.030] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/02/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Lactic acidosis is a clinical status related to clinical worsening. Actually, higher levels of lactate is a well-established trigger of emergency situations. The aim of this work is to build-up a prehospital early warning score to predict 2-day mortality and intensive care unit (ICU) admission, constructed with other components of the lactic acidosis besides the lactate. METHODS Prospective, multicenter, observational, derivation-validation cohort study of adults evacuated by ambulance and admitted to emergency department with acute diseases, between January 1st, 2020 and December 31st, 2021. Including six advanced life support, thirty-eight basic life support units, referring to four hospitals (Spain). The primary and secondary outcome of the study were 2-day all-cause mortality and ICU-admission. The prehospital lactic acidosis (PLA) score was derived from the analysis of prehospital blood parameters associated with the outcome using a logistic regression. The calibration, clinical utility, and discrimination of PLA were determined and compared to the performance of each component of the score alone. RESULTS A total of 3334 patients were enrolled. The final PLA score included: lactate, pCO2, and pH. For 2-day mortality, the PLA showed an AUC of 0.941 (95%CI: 0.914-0.967), a better performance in calibration, and a higher net benefit as compared to the other score components alone. For the ICU admission, the PLA only showed a better performance for AUC: 0.75 (95%CI: 0.706-0.794). CONCLUSIONS Our results showed that PLA predicts 2-day mortality better than other lactic acidosis components alone. Including PLA score in prehospital setting could improve emergency services decision-making.
Collapse
Affiliation(s)
- Francisco Martín-Rodríguez
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain
| | - Guillermo J Ortega
- Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain; CONICET, Argentina
| | - Miguel A Castro Villamor
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain
| | - Carlos Del Pozo Vegas
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain; Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Juan F Delgado Benito
- Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain
| | - José L Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla la Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Prehospital early warning scoring-system investigation group, Valladolid, Spain; Health Research Institute, Hospital de la Princesa, Madrid (IIS-IP), Spain.
| | - Raúl López-Izquierdo
- Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain; Prehospital early warning scoring-system investigation group, Valladolid, Spain; Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| |
Collapse
|
15
|
Hilbert-Carius P, Schmalbach B, Wrigge H, Schmidt M, Abu-Zidan FM, Aschenbrenner U, Streibert F. Do we need pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) in the civilian helicopter emergency medical services (HEMS)? Intern Emerg Med 2023; 18:627-637. [PMID: 36463569 DOI: 10.1007/s11739-022-03158-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
Pre-hospital resuscitative endovascular balloon occlusion of the aorta (REBOA) can be a life-saving procedure for patients with non-compressible torso hemorrhage. We aimed to evaluate the potential eligibility for REBOA in trauma patients of a civilian helicopter emergency medical service (HEMS) using a stepwise approach. A retrospective analysis using the electronic database (HEMSDER) of "DRF Luftrettung" HEMS covering the period from January 2015 to June 2021 was performed. Trauma patients aged ≥ 16 years and with a National Advisory Committee for Aeronautics (NACA) score of ≥ 4 were assessed for potential REBOA eligibility using two different decision trees based on assumed severe bleeding due to injuries of the abdomen, pelvis, and/or lower extremities and different vital signs on the scene and at hospital handover. Non-parametric statistical methods were used for comparison. A total of 22.426 patients met the inclusion criteria for data analysis. Of these, 0.15-2.24% were possible candidates for pre-hospital REBOA. No significant differences between groups on scene and at hospital handover regarding demographics, assumed injuries, and pre-hospital interventions were found. In the on-scene group, 21.1% of the patients remained unstable even at hospital handover despite pre-hospital care. In the handover group, 42.8% of the patients seemed initially stable but then deteriorated during the pre-hospital course. The number of potential pre-hospital REBOA in severely injured patients with a NACA score of ≥ 4 is < 3% or can be even < 1% if more strict criteria are used. There are some patients who may benefit from pre-hospital REBOA as a life-saving procedure. Further research on earlier diagnosis of life-threatening bleeding and proper indications of REBOA in trauma patients is needed.
Collapse
Affiliation(s)
- Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG Hospital, Merseburgerstr. 165, 06179, Halle (Saale), Germany.
- DRF Luftrettung (German Air Rescue) HEMS, Christoph 84 and 85, Halle (Saale), Germany.
| | - Bjarne Schmalbach
- Wissenschaftlicher Arbeitskreis (Scientific Working Group) of DRF Luftrettung, Filderstadt, Germany
| | - Hermann Wrigge
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG Hospital, Merseburgerstr. 165, 06179, Halle (Saale), Germany
- Medical Faculty, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Merve Schmidt
- Wissenschaftlicher Arbeitskreis (Scientific Working Group) of DRF Luftrettung, Filderstadt, Germany
| | - Fikri M Abu-Zidan
- Consultant of Statistics and Research Methodology, The Research Office, College of Medicine and Health Sciences, United Arab Emirates University, Al-Ain, United Arab Emirates
| | - Ulf Aschenbrenner
- Wissenschaftlicher Arbeitskreis (Scientific Working Group) of DRF Luftrettung, Filderstadt, Germany
- DRF Luftrettung (German Air Rescue) HEMS, Christoph Dortmund, Dortmund, Germany
| | - Fridolin Streibert
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bergmannstrost BG Hospital, Merseburgerstr. 165, 06179, Halle (Saale), Germany
- DRF Luftrettung (German Air Rescue) HEMS, Christoph 84 and 85, Halle (Saale), Germany
| |
Collapse
|
16
|
Magimel-Pelonnier E, Marjanovic N, Couvreur R, Drugeon B, Mimoz O, Guenezan J. Photography tele-transmission by regular ambulance staff for the management of mild traumatic injury: the NiCEPHORE randomised-controlled trial. Scand J Trauma Resusc Emerg Med 2022; 30:53. [PMID: 36242052 PMCID: PMC9569019 DOI: 10.1186/s13049-022-01026-0] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 05/23/2022] [Indexed: 11/18/2022] Open
Abstract
Background Handling emergency calls in French emergency medical call centres (EMCCs) can be challenging considering the frequent lack of relevant information. Tele-transmission device use in regular ambulances seems like a good solution to provide the EMCC physician with a more accurate assessment of the scene, particularly for mild traumatic injury (MTI). We measured the impact of ambulance staff tele-transmitted photography on prehospital dispatching optimisation for patients calling the EMCC with MTI. Methods We conducted a prospective, single-centre, randomised-controlled trial comparing two groups of patients calling the EMCC with MTI who were or were not allocated to photography tele-transmission by ambulance staff. The primary outcome was the proportion of patients referred away from the nearest hospital (left at home for outpatient care; referred to a higher-level hospital; handled by a medical intensive care ambulance for advanced pre-hospital care) used as a marker of better orientation. Results Between 29 April 2019 and 21 July 2020, 165 patients were randomised and 152 analysed. Photography tele-transmission resulted in better patient dispatching (24/73 [33%] patients in the intervention group vs 9/79 [11%] patients in the control group, OR 3.80 [1.63–8.90]; p = 0.03), without increasing the proportion of patients initially left at home for outpatient care and visiting an ED within 10 days for secondary trauma-related care (1/14 [7%] vs 1/4 [25%], OR 0.25 [0.01–24.1]; p = 0.41). The proportion of patients unnecessarily referred to an ED was 7% [4/59 patients] in the intervention group vs 16% [12/75 patients] in the control group (OR 0.38 [0.09–1.36]; p = 0.10). Conclusion Photography tele-transmission by regular ambulance staff could improve the dispatching of patients calling French EMCCs with MTI. Trial registration The study is registered with Clinicaltrials.gov (NCT04034797).
Collapse
Affiliation(s)
- E Magimel-Pelonnier
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France.
| | - N Marjanovic
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - R Couvreur
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - B Drugeon
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - O Mimoz
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| | - J Guenezan
- Emergency Department and Pre-Hospital Care, University Hospital of Poitiers, Service des Urgences, CHU de Poitiers, 2 rue de la Mileterie, 86000, Poitiers, France
| |
Collapse
|
17
|
Pule MS, Hodkinson P, Hardcastle T. A descriptive study of trauma patients transported by helicopter emergency medical services to a level one trauma centre. Afr J Emerg Med 2022; 12:183-190. [PMID: 35734545 PMCID: PMC9192815 DOI: 10.1016/j.afjem.2022.03.004] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 02/28/2022] [Accepted: 03/24/2022] [Indexed: 11/04/2022] Open
Abstract
Helicopter Emergency Medical Service (HEMS) remains an important option in Africa to address long distance transfers. There is insufficient evidence to assess the impact of HEMS on outcomes in the setting of Trauma in a LMIC Further evidence-based research is needed to evaluate Helicopter Emergency Medical Service in a LMIC as far as its impact on significantly shortening the time of transfer to definitive care for patients with time-sensitive medical or surgical conditions. Evidence-based research should evaluate the impact of HEMS in a LMIC regarding its role in providing specialized medical expertise or equipment to patients before and/or during transport, especially patients who are in inaccessible or obscure environments.
Background KwaZulu-Natal, the largest land mass province that is densely populated in SA has vast distances to referral centres and time to definitive treatment is key in trauma care. Helicopter Emergency Medical Service (HEMS) is still an invaluable prehospital asset for the transport of time sensitive trauma. This study reviews the impact of HEMS in the management of trauma at Inkosi Albert Luthuli hospital (IALCH) which is the only public accredited level one trauma centre in the province. Methods A retrospective descriptive study of polytrauma patients transported by HEMS in KZN to IALCH over a three-year period from 01 January 2014 to 31 December 2016. Data was collected around patient demographics, transfer details and patient outcomes. Results Over the three-year period, 117 HEMS transfers were reviewed, with the majority being male (90.6%). Just 26% of HEMS transfers were direct from the scene, with the balance being interhospital transfers largely from distant regional hospitals around the province. Some 60% of injuries were caused by vehicle crashes, and 31% by intentional injury. Mortality was 30% which is reflective of the high severity of injury of the cohort. The injury severity scores (ISS) (median 26 overall) of those who died was higher (median 38) (P-= .0002), and there were more interventions before and during transfer such as thoracostomy, ventilation and immobilization. Overall, 88% required admission to ICU at IACLH. Conclusions HEMS in the KwaZulu Natal province was mainly used for long-distance transfer of major trauma patients which is an appropriate use of this essential service, given the single major trauma centre in the province. The majority of patients that were transported by HEMS had severe injury, which was also associated with increased mortality outcomes. Rational use of this essential but expensive resource will require clear policy around the role of HEMS and call out criteria in each setting.
Collapse
Affiliation(s)
| | | | - Timothy Hardcastle
- Head Clinical Department: Trauma and Burns, Inkosi Albert Luthuli Central Hospital and DoH-KZN, Honorary Research Associate Professor in Health Sciences - DUT, Honorary Associate Professor of Trauma and Surgery - UKZN
| |
Collapse
|
18
|
Proios H, Baskini M, Keramydas C, Pourliaka T, Tsakpounidou K. Can We Learn from Our Children About stroke? Effectiveness of a School-Based Educational Programme in Greece. J Stroke Cerebrovasc Dis 2022; 31:106544. [PMID: 35576860 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106544] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES We describe new findings from the implementation of an educational school-based stroke awareness programme, FAST (Face, Arm, Speech, Time) 112 Heroes, that teaches kindergarten children about stroke symptomatology and the appropriate action plan. The goal of our study was to examine whether the population mostly affected by stroke, i.e. the elderly, can be educated by young children, who have attended the programme. MATERIALS AND METHODS The educational programme was implemented face-to-face in a kindergarten in Athens, Greece, once a week for five consecutive weeks for one hour per week. Preschoolers (n = 137, aged 4.1-7, mean age=5.3) were enrolled in the programme and nominated two elderly members of their extended family (grandparents) as their own superheroes. Family members received personalized stroke-related material. Stroke awareness of the grandparents was measured before programme implementation (phase 1), after (prior to receiving the printed personalized stroke-related material, phase 2) and three months after receiving the printed personalized stroke-related material (phase 3). RESULTS Data was obtained from 63 grandparents (48 women; aged 60-84, mean age=69.5 years). Family members demonstrated significant increases in stroke symptom knowledge (p < 0.001) and appropriate course of action (p ≤ 0.001) after participating in the program (phase 2) and receiving printed personalized stroke-related material (phase 3). The majority of the participants (86.84%) reported positive feedback about the received material, the programme, and their interaction with their grandchildren during the programme. CONCLUSIONS Elderly family members outside the nuclear family can be successfully educated about stroke through their grandchildren and the FAST 112 Heroes programme.
Collapse
Affiliation(s)
- Hariklia Proios
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece.
| | - Maria Baskini
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece.
| | - Christos Keramydas
- Department of Supply Chain Management, School of Economics and Business Administration, International Hellenic University, Thessaloniki, Greece.
| | - Tatiana Pourliaka
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece.
| | - Kalliopi Tsakpounidou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece.
| |
Collapse
|
19
|
Peran D, Sykora R, Vidunova J, Krsova I, Pekara J, Renza M, Brizgalova N, Cmorej PC. Non-technical skills in pre-hospital care in the Czech Republic: a prospective multicentric observational study (NTS study). BMC Emerg Med 2022; 22:83. [PMID: 35562664 PMCID: PMC9107236 DOI: 10.1186/s12873-022-00642-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 01/16/2022] [Accepted: 04/28/2022] [Indexed: 12/31/2022] Open
Abstract
Background Non-technical skills (NTS) are important for the proper functioning of emergency medical ambulance crews but have hardly been researched in the conditions of clinical pre-hospital care. The primary objective of this study, therefore, is to describe the use of NTS in practice. The secondary objective is to compare if the performance of NTS varies according to the type of case. Methods In this multicentric observational study the modified Team Emergency Assessment Measure (TEAM) score was used to assess the performed NTS of two or more crews on site. The evaluation consisted of leadership, teamwork and task management, rated by a field supervisor. The study observations took place in real clinical pre-hospital emergency medical cases when two or more crews were dispatched between October 2019 and August 2020. The sample size was determined by researchers prior to the study to at least 100 evaluated events per each of the three participating emergency medical services. The results are presented as median and interquartile range. The internal reliability, consistency and validity of test items and results were evaluated. The Kruskal–Wallis test and the post hoc Mann-Whitney U test with Bonferroni correction were used for multiple comparisons of three groups. Results A total of 359 events were evaluated. Surprisingly, the median value for all eight items was as high as 3.0 with a similar interquartile range of 1.0. There were no differences observed by case type (CPR vs. TRAUMA vs. MEDICAL) except from item 1. A post hoc analysis revealed that this difference is in favour of a higher rated performance of non-technical skills in CPR. Conclusions The overall result of the performance of non-technical skills can be regarded as very good and can serve for further evaluations. The crews achieved better parameters of NTS in leadership in resuscitation situations in comparison with general medical events. Trial Registration The study is registered at Clinical Trials under the ID: NCT04503369.
Collapse
Affiliation(s)
- David Peran
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic.,Prague Emergency Medical Services, Prague, Czech Republic.,Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic.,Medical College, Prague, Czech Republic
| | - Roman Sykora
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic. .,Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic. .,Medical College, Prague, Czech Republic.
| | - Jana Vidunova
- Emergency Medical Services of the Pilsen Region, Pilsen, Czech Republic
| | - Ivana Krsova
- Emergency Medical Services of the Pilsen Region, Pilsen, Czech Republic
| | - Jaroslav Pekara
- Prague Emergency Medical Services, Prague, Czech Republic.,Medical College, Prague, Czech Republic
| | - Metodej Renza
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic.,Department of Anaesthesia and Intensive Care, Third Faculty of Medicine, Charles University and FNKV University Hospital, Prague, Czech Republic
| | - Nikola Brizgalova
- Emergency Medical Services of the Karlovy Vary Region, Karlovy Vary, Czech Republic
| | - Patrik Ch Cmorej
- Jan Evangelista Purkyne University, Faculty of Health Studies, Usti nad Labem, Czech Republic.,Emergency Medical Services of the Usti nad Labem Region, Usti nad Labem, Czech Republic
| |
Collapse
|
20
|
Moore C, Clover J, Gibson L. Evaluating parental knowledge of pediatric burns first aid in Ireland and the effectiveness of an educational intervention improving knowledge. Burns 2022; 48:672-682. [PMID: 34696953 DOI: 10.1016/j.burns.2021.05.022] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/15/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
AIM Burns represent a large portion of injuries attending emergency departments each year, with children accounting for the biggest proportion. Appropriate first aid has been shown to help improve the outcome of burns, and decrease the need for surgical intervention. Several studies outside of Ireland demonstrate inadequate parental knowledge of burns first aid, but few evaluated interventions to improve knowledge. Consequently our aim was to assess parental/caregiver knowledge in Ireland, and determine if knowledge levels could be raised following a short educational video intervention. METHODS An educational video based on current European and British best practice guidelines was produced and shown to parents/caregivers waiting in the Pediatric Outpatients Department after a previously validated pre-intervention questionnaire was completed. A post intervention questionnaire was completed following the video. Questionnaires assessed demographics, previous experience and included scenarios to test parental knowledge. RESULTS 112 parents/caregivers (81.3% female (n = 91), 18.8% male (n = 21)) were questioned. Baseline knowledge was found to be poor overall, however this significantly improved with a simple educational video (pre-score 31.9%, post-test mean score knowledge 92.1%). Pre- and post-test scores showed a statistical significance (x2 = 71.117, P < 0.001, 95% CI).No other variables analysed were shown to be statistically significant predictors of pre- or post-test scores (all p > 0.05). CONCLUSION The study found poor parental knowledge of burns first aid in Ireland and shows the use of an educational video was effective in raising knowledge levels.
Collapse
Affiliation(s)
| | - James Clover
- University College Cork, Ireland; Cork University Hospital, Cork, Ireland.
| | - Louise Gibson
- University College Cork, Ireland; Cork University Hospital, Cork, Ireland.
| |
Collapse
|
21
|
Peran D, Uhlir M, Pekara J, Kolouch P, Loucka M. Approaching the End of Their Lives Under Blue Lights and Sirens - Scoping Review. J Pain Symptom Manage 2021; 62:1308-1318. [PMID: 33989706 DOI: 10.1016/j.jpainsymman.2021.04.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/19/2021] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
CONTEXT Emergency medical services (EMS) are frequently responding to calls involving patients in advanced stages of incurable diseases. Despite the competencies and potential of EMS in supporting patients and their families facing symptoms of advanced progressive illnesses, the role of EMS in providing palliative care remains unclear. OBJECTIVE The following research question was formulated: What is the role of ambulance EMS, EMS dispatch centres, paramedics and emergency medical physicians in the provision of palliative care to terminally ill patients? METHODS Following PRISMA-ScR guidelines, online bibliographic databases CINAHL Complete, MEDLINE Complete (EBSCO), PubMed and MEDLINE (Ovid) were searched from the initial year of database to September 2019. No language restrictions were applied. RESULTS 31 articles were included in the qualitative synthesis and 3 main roles and one contextual factor were identified: (1) Providing complex care; (2) Adjusting patient's trajectory; (3) Being able to make decisions in a time and information limited environment; (4) Health care professionals are insufficiently supported in palliative care. CONCLUSION There are limited data on the incidence of EMS calls to the patients at the end-of-life and no data focusing on the EMS dispatch centres. Both paramedics and emergency physicians are aware of their role in the end-of-life care. EMS personnel are lacking special training and education in the palliative care. Cooperation between palliative care providers, the EMS providers and other out-of-hours services might improve the responsiveness of the health care system to needs and expectations of patients and their families, and possibly improve the overall health care system efficiency.
Collapse
Affiliation(s)
- David Peran
- Prague Emergency Medical Services, Prague, Czech Republic; Divisions of Public Health, 3rd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic; Medical College, Prague, Czech Republic.
| | - Marek Uhlir
- Prague Emergency Medical Services, Prague, Czech Republic; Centre for Palliative Care, Prague, Czech Republic
| | - Jaroslav Pekara
- Prague Emergency Medical Services, Prague, Czech Republic; Medical College, Prague, Czech Republic
| | - Petr Kolouch
- Prague Emergency Medical Services, Prague, Czech Republic
| | | |
Collapse
|
22
|
Do SN, Luong CQ, Pham DT, Nguyen MH, Ton TT, Hoang QTA, Nguyen DT, Pham TTN, Hoang HT, Khuong DQ, Nguyen QH, Nguyen TA, Tran TT, Vu LD, Van Nguyen C, McNally BF, Ong MEH, Nguyen AD. Survival after traumatic out-of-hospital cardiac arrest in Vietnam: a multicenter prospective cohort study. BMC Emerg Med 2021; 21:148. [PMID: 34814830 PMCID: PMC8609736 DOI: 10.1186/s12873-021-00542-z] [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: 06/04/2021] [Accepted: 11/12/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country. METHODS We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital. RESULTS Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively). CONCLUSION In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.
Collapse
Affiliation(s)
- Son Ngoc Do
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Chinh Quoc Luong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam. .,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam. .,Faculty of Medicine, University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam.
| | - Dung Thi Pham
- Department of Nutrition and Food Safety, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - My Ha Nguyen
- Department of Health Organization and Management, Faculty of Public Health, Thai Binh University of Medicine and Pharmacy, Thai Binh, Vietnam
| | - Tra Thanh Ton
- Emergency Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam
| | - Quoc Trong Ai Hoang
- Emergency Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam
| | - Dat Tuan Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Thao Thi Ngoc Pham
- Intensive Care Department, Cho Ray Hospital, Ho Chi Minh City, Vietnam.,Department of Critical Care, Emergency Medicine and Clinical Toxicology, Faculty of Medicine, Ho Chi Minh City University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Hanh Trong Hoang
- Intensive Care Department, Hue Central General Hospital, Hue City, Thua Thien Hue, Vietnam.,Department of Emergency and Critical Care Medicine, Faculty of Medicine, University of Medicine and Pharmacy, Hue City, Thua Thien Hue, Vietnam
| | - Dai Quoc Khuong
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Quan Huu Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tuan Anh Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Tung Thanh Tran
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Long Duc Vu
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam
| | - Chi Van Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| | - Bryan Francis McNally
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Anh Dat Nguyen
- Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.,Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam
| |
Collapse
|
23
|
Aitavaara-Anttila MK, Pernu HH, Rumpunen TK, Similä JPO, Liisanantti JH, Kaakinen TI, Erkinaro TM, Raatiniemi LV. Factors associated with time delay to angiography in acute ST-elevation myocardial infarction - A retrospective cohort study in Northern Finland. Australas Emerg Care 2021; 25:213-218. [PMID: 34782298 DOI: 10.1016/j.auec.2021.11.003] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The delay of percutaneous coronary intervention increases the risk of heart failure and mortality in STEMI. The aim of this study was to examine the time intervals of EMS and the factors associated with the time delay to angiography in patients with STEMI. METHODS The present study was conducted in Northern Ostrobothnia, Finland in 2014-2016. All patients transported to the hospital by EMS who were diagnosed with STEMI and underwent a primary angiography within 24 h of arrival were included. Angiography was defined as delayed if it was performed over 120 min of the first medical contact (FMC). RESULTS 310 patients met the inclusion criteria during the study period. Time from the FMC to angiography was less than 120 min in 231 patients (74.5%). In multivariate analysis, the factors associated with delayed angiography were the absence of chest pain (OR 2.46 (1.18-5.13),p = 0.016), dyspnea (OR 3.11 (1.54-6.28),p = 0.002), the treatment protocol violations by EMS (OR 2.41 (0.99-5.80),p = 0.050), treatment initiation at a primary health care center (OR 3.64 (1.39-9.48),p = 0.008), and the distance to hospital of over 100 km (OR 11.87 (6.14-22.93),p < 0.001). CONCLUSION In our study, treatment protocol violations, non-specific symptoms, and the distance to hospital of over 100 km were associated with primary angiography in patients with STEMI transported to the hospital by EMS.
Collapse
Affiliation(s)
- Mia K Aitavaara-Anttila
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Rovaniemi Health Center, Rovaniemi, Finland.
| | | | | | - Jani P O Similä
- Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| | - Janne H Liisanantti
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Timo I Kaakinen
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Tiina M Erkinaro
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Department of Anesthesia and Intensive Care, Oulu University Hospital, Oulu, Finland
| | - Lasse V Raatiniemi
- Research Group of Surgery, Anesthesiology and Intensive Care, Division of Anesthesiology Oulu University Hospital, Medical Research Centre, University of Oulu, Oulu, Finland; Centre for Pre-Hospital Emergency Care, Oulu University Hospital, Oulu, Finland
| |
Collapse
|
24
|
G/Ananya T, Sultan M, Zemede B, Zewdie A. Pre-hospital Care to Trauma Patients in Addis Ababa, Ethiopia: Hospital-based Cross-sectional Study. Ethiop J Health Sci 2021; 31:1019-1024. [PMID: 35221619 PMCID: PMC8843143 DOI: 10.4314/ejhs.v31i5.14] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Trauma is a major cause of morbidity and mortality worldwide. Prompt use of pre-hospital care is associated with reduced early and late morbidity and mortality from trauma. This study aimed to assess the time to reach the facility and the pattern of pre-hospital care provided for trauma patients. METHODS A cross-sectional study design with a structured interview questioner was used for patients presenting to Addis Ababa Burn Emergency and Trauma Hospital Emergency Department from April 1 to May 30, 2020. RESULT Out of 238 interviewed patients, the most common means of transportation from the scene to the initial health facility were taxi 77(32.4%) and ambulance 54(22.7%). The time of arrival from the scene to the initial health care facility was within one hour, 133(56.1%) and in 1-3 hours 84(35.5%). Some form of care was provided at the scene in 110(46.2%) of cases. The care provided was bleeding arrest 74(31.1 %), removing from wreck 51(21.4%), splinting/immobilizing injured area 38(16%), position for patient comfort 19(8%), and others. Relatives were the most common care provider 49(45%) followed by bystanders 37(33.9%), trained ambulance staff 19(17.4%), and police 2 (1.8%). The main reasons for not providing care were lack of knowledge 79(61.2%), and lack of equipment 25 (19.4%). CONCLUSION The study showed relatives and bystanders were the first responders during trauma care. However, ambulance utilization for pre-hospital care was low. There was trauma patients delay to arrive to hospital. Only half of the patients presented to the health facility within Golden hour.
Collapse
Affiliation(s)
| | - Menbeu Sultan
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Biruktawit Zemede
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Ayalew Zewdie
- St Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| |
Collapse
|
25
|
Hilbert-Carius P, Struck MF, Rudolph M, Knapp J, Rognås L, Adler J, Slagt C, Jacobsen L, Pich H, Christian MD, Dandrifosse D, Abu-Zidan FM. Point-of-care ultrasound (POCUS) practices in the helicopter emergency medical services in Europe: results of an online survey. Scand J Trauma Resusc Emerg Med 2021; 29:124. [PMID: 34446076 PMCID: PMC8390051 DOI: 10.1186/s13049-021-00933-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 12/23/2022] Open
Abstract
Background The extent to which Point-of-care of ultrasound (POCUS) is used in different European helicopter EMS (HEMS) is unknown. We aimed to study the availability, perception, and future aspects of POCUS in the European HEMS using an online survey. Method A survey about the use of POCUS in HEMS was conducted by a multinational steering expert committee and was carried out from November 30, 2020 to December 30, 2020 via an online web portal. Invitations for participation were sent via email to the medical directors of the European HEMS organizations including two reminding notes. Results During the study period, 69 participants from 25 countries and 41 different HEMS providers took part in the survey. 96% (n = 66) completed the survey. POCUS was available in 75% (56% always when needed and 19% occasionally) of the responding HEMS organizations. 17% were planning to establish POCUS in the near future. Responders who provided POCUS used it in approximately 15% of the patients. Participants thought that POCUS is important in both trauma and non-trauma-patients (73%, n = 46). The extended focused assessment sonography for trauma (eFAST) protocol (77%) was the most common protocol used. A POCUS credentialing process including documented examinations was requested in less than one third of the HEMS organizations. Conclusions The majority of the HEMS organizations in Europe are able to provide different POCUS protocols in their services. The most used POCUS protocols were eFAST, FATE and RUSH. Despite the enthusiasm for POCUS, comprehensive training and clear credentialing processes are not available in about two thirds of the European HEMS organizations. Due to several limitations of this survey further studies are needed to evaluate POCUS in HEMS. Supplementary Information The online version contains supplementary material available at 10.1186/s13049-021-00933-y.
Collapse
Affiliation(s)
- Peter Hilbert-Carius
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, BG Klinikum Bergmannstrost Halle gGmbH, and HEMS, Christoph 84" and "Christoph 85", DRF-Luftrettung, Halle (Saale), Germany
| | - Manuel F Struck
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, and HEMS "Christoph 33"and "Christoph 71, Senftenberg, Germany
| | - Marcus Rudolph
- DRF Stiftung Luftrettung Gemeinnützige AG, Filderstadt, Germany
| | - Jürgen Knapp
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Jörn Adler
- Luxembourg Air Rescue A.S.B.L, Sandweiler, Luxembourg
| | - Cor Slagt
- Department of Anesthesiology, Pain and Palliative Medicine and Helicopter Emergency Medical Service, Lifeliner 3" and "Lifeliner 5", Radboudumc, Nijmegen, The Netherlands
| | - Lars Jacobsen
- Sørlandet Hospital, Air Ambulance dpt, Arendal, Norway.,The Norwegian Air Ambulance Foundation, Arendal, Norway
| | - Henryk Pich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Augsburg, Augsburg, Germany.,HEMS "Christoph 33"and "Christoph 71", Senftenberg, Germany
| | | | | | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Science, UAE University, Al-Ain, United Arab Emirates.
| | | |
Collapse
|
26
|
Jindal R, Dhillon M, Mittal N, Aggarwal A, Malhotra A, Garg SK. Gaps in the Care of Open Fractures: An Indian Scenario. Indian J Orthop 2021; 56:280-288. [PMID: 35140859 PMCID: PMC8789999 DOI: 10.1007/s43465-021-00476-5] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/02/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND/PURPOSE There is a distinct lack of published studies evaluating the reasons for delay in definitive treatment of open fractures. This study aimed to determine the specific factors causing delay in the timely treatment of open fractures from the time of injury and to analyse the quality of treatment performed at the pre-hospital level. METHODS In total, 250 consecutive patients with open fractures were assessed for time to surgery from injury and admission. The referred patients were analysed for distance of travel, level of referring hospital and appropriateness of care. The reasons for delay in terms of infrastructural- and patient-related factors were analysed individually and in combination. RESULTS There were 37 direct patients (Group A) and 213 referred patients (Group B). Inappropriate care was present in 172 out of 213 (80.8%) referred patients. In total, 84% patients travelled more than 50 kms. The definitive surgery in referred patients was likely to be significantly delayed with regard to time from injury (29.84 vs 44.84 h, p ≤ 0.02). After admission, the time to surgery was greater than 24 h in 102 patients. Multivariate regression analysis determined that associated injuries and lack of fitness for surgery caused greater delay than non-availability of operation theatre or intensive care unit bed. CONCLUSION Delayed referral, inadequate pre-hospital care and delay in surgery due to patient- and infrastructural-related issues at tertiary centre were identified as critical gaps in open fracture care in India. The importance of appropriate basic knowledge about management of open fractures should be emphasized at all structural level of care.
Collapse
Affiliation(s)
- Rohit Jindal
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Sector-32, Chandigarh, 160030 India
| | - Mehar Dhillon
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Sector-32, Chandigarh, 160030 India
| | - Naveen Mittal
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Sector-32, Chandigarh, 160030 India
| | - Arushi Aggarwal
- Government Medical College Hospital Chandigarh, Chandigarh, India
| | | | - Sudhir Kumar Garg
- Department of Orthopaedics, Government Medical College Hospital Chandigarh, Sector-32, Chandigarh, 160030 India
| |
Collapse
|
27
|
Zhou J, Wang T, Belenkiy I, Hardcastle TC, Rouby JJ, Jiang B. Management of severe trauma worldwide: implementation of trauma systems in emerging countries: China, Russia and South Africa. Crit Care 2021; 25:286. [PMID: 34372903 PMCID: PMC8352140 DOI: 10.1186/s13054-021-03681-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/06/2021] [Indexed: 12/04/2022]
Abstract
As emerging countries, China, Russia, and South Africa are establishing and/or improving their trauma systems. China has recently established a trauma system named “the Chinese Regional Trauma Care System” and covered over 200 million populations. It includes paramedic-staffed pre-hospital care, in-hospital care in certified trauma centers, trauma registry, quality assurance, continuous improvement and ongoing coverage of the entire Chinese territory. The Russian trauma system was formed in the first decade of the twenty-first century. Pre-hospital care is region-based, with a regional coordination center that determines which team will go to the scene and the nearest hospital where the victim should be transported. Physician-staffed ambulances are organized according to three levels of trauma severity corresponding to three levels of trauma centers where in-hospital care is managed by a trauma team. No national trauma registry exists in Russia. Improvements to the Russian trauma system have been scheduled. There is no unified trauma system in South Africa, and trauma care is organized by public and private emergency medical service in each province. During the pre-hospital care, paramedics provide basic or advanced life support services and transport the patients to the nearest hospital because of the limited number of trauma centers. In-hospital care is inclusive with a limited number of accredited trauma centers. In-hospital care is managed by emergency medicine with multidisciplinary care by the various specialties. There is no national trauma registry in South Africa. The South African trauma system is facing multiple challenges. An increase in financial support, training for primary emergency trauma care, and coordination of private sector, need to be planned.
Collapse
Affiliation(s)
- Jing Zhou
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Tianbing Wang
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China
| | - Igor Belenkiy
- Department of the Trauma and Orthopedics, Pavlov First Saint-Petersburg State Medical University, St. Petersburg, Russia.,Department of Trauma and Orthopedics , St. Petersburg I. I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
| | - Timothy Craig Hardcastle
- Trauma and Burns Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa.,Department of Surgery, Nelson R Mandela School of Clinical Medicine, UKZN, Durban, South Africa
| | - Jean-Jacques Rouby
- Multidisciplinary Intensive Care Unit, Department of Anesthesiology and Critical Care Medicine, Sorbonne University, La Pitié-Salpêtrière Hospital, Assistance-Publique-Hôpitaux-de-Paris, Paris, France.
| | - Baoguo Jiang
- National Center for Trauma Medicine, Trauma Center, Department of Orthopedics and Traumatology, Peking University People's Hospital, Beijing, China.
| | | |
Collapse
|
28
|
Forsell L, Forsberg A, Kisch A, Rantala A. Inequalities and short-term outcome among patients assessed as non-urgent in a Swedish ambulance service setting. Int Emerg Nurs 2021; 57:101018. [PMID: 34147876 DOI: 10.1016/j.ienj.2021.101018] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 05/07/2021] [Accepted: 05/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Within the ambulance service, assessment and referral of patients, especially those with non-urgent conditions, is a difficult and complicated task. Studies indicate that 12 to 20 percent of all patients are subjected to non-conveyance and discharged at the scene. There is lack of knowledge of what characterizes conveyed and non-conveyed patients. The aim of this study was to explore non-urgent patients who are conveyed or not conveyed to hospital and the short-term outcome of non-conveyance in a Swedish Ambulance Service setting. METHODS This study has a descriptive, cross-sectional design. All patients who were prioritized as non-urgent were eligible for the study and 1,048 patients were followed-up in an administrative data system that stores information about the patients' trajectory in both primary and hospital care. RESULTS More women than men were subjected to non-conveyance and most of the non-conveyed patients were left at home out-of-hours. 53% sought care again within 72 h. A large proportion of the non-conveyed patients were assessed as having unspecific symptoms. CONCLUSIONS There are prominent gender differences in the context of non-conveyance where unspecific symptoms seem to be the main reason for being left at home. As many of the non-conveyed patients who did not receive any advice about further investigation or intervention sought care again within 72 h, the assessments may be insufficient or inaccurate.
Collapse
Affiliation(s)
- Lena Forsell
- Department of Health Sciences, Lund University, Lund, Sweden; Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden
| | - Anna Forsberg
- Department of Health Sciences, Lund University, Lund, Sweden; Department of Cardiothoracic Surgery, Skåne University Hospital, Lund, Sweden
| | - Annika Kisch
- Department of Health Sciences, Lund University, Lund, Sweden; Department of Haematology, Skåne University Hospital, Lund, Sweden
| | - Andreas Rantala
- Department of Health Sciences, Lund University, Lund, Sweden; Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden.
| |
Collapse
|
29
|
Jacobson CL, Basnet S, Bhatt A, Parajuli S, Shrestha SK. Emergency medical dispatcher training as a strategy to improve pre-hospital care in low- and middle-income countries: the case study of Nepal. Int J Emerg Med 2021; 14:28. [PMID: 33957859 PMCID: PMC8100927 DOI: 10.1186/s12245-021-00355-8] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) often face significant challenges related to providing effective pre-hospital care services. Barriers to providing care include lack of financial resources, poor road infrastructure, lack of trained first responders and ambulance staff, and issues regarding coordination/communication between different entities involved in Emergency Medical Services. Prior initiatives to characterize and improve the state of pre-hospital care in LMICs have largely focused on improving access to high-quality ambulance services by providing training programs to community first responders and ambulance staff on how to recognize and manage key emergency conditions. In this article, we discuss an alternative strategy for improving pre-hospital care: the creation of a context-specific Emergency Medical Dispatcher (EMD) training curriculum and program. Methods We describe the current pre-hospital care setting in Nepal, the process of creating and piloting the Nepal-specific EMD training manual, and the early impact of its implementation. Results The 30-h EMD training was designed, piloted, and revised in collaboration with the three largest EMS organizations in Nepal. The training is now required for all dispatchers at the Dhulikhel Hospital Dispatch Center, one of the largest ambulance dispatch networks in Nepal. Dispatchers are trained in the following knowledge and skill areas: telecommunication guidelines, triaging and documentation procedures, delivery of Basic Life Support instructions to callers, other medical and trauma-condition specific instructions, and limited resource management. The short-term positive impacts of the training’s implementation include improved documentation procedures, better prioritization of ambulance resources, delivery of Basic Life Support instructions to callers, and improved communication between dispatch, responders, and healthcare facilities. Conclusions Context-specific Emergency Medical Dispatch training programs, which aim to optimize the emergency resources available in resource-limited settings, present a promising low-cost, high-impact interventional strategy to strengthen the pre-hospital care systems in low- and middle-income countries.
Collapse
Affiliation(s)
| | - Samjhana Basnet
- Dhulikhel Hospital, Kathmandu University, Dhulikhel, 45200, Nepal
| | - Ajay Bhatt
- University of Hawaii, John A. Burns School of Medicine, 651 Ilalo St, Honolulu, HI, 96813, USA
| | | | | |
Collapse
|
30
|
Jakob DA, Minneti M, Benjamin ER, Lam L, Schellenberg M, Matsushima K, Demetriades D, Inaba K. Practical assessment of different saw types for field amputation: A cadaver-based study. Am J Emerg Med 2021; 45:11-6. [PMID: 33647756 DOI: 10.1016/j.ajem.2021.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/10/2021] [Accepted: 02/15/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Field amputation can be life-saving for entrapped patients requiring surgical extrication. Under these austere conditions, the procedure must be performed as rapidly as possible with limited equipment, often in a confined space, while minimizing provider risk. The aim of this study was to determine the ideal saw, and optimal approach, through bone or joint, for a field amputation. METHODS This was a prospective cadaver-based study. Four saws (Gigli, manual pruning, electric oscillating and electric reciprocating) were tested in human cadavers. Each saw was used to transect four separate long bones (humerus, ulna/radius, femur and tibia/fibula), previously exposed at a standardized location. The time required for each saw to cut through the bone, the number of attempts required to seat the saw when transecting the bone, slippage, quality of proximal bone cut and extent of body fluid splatter as well as the physical space required by each device during the amputation were recorded. Additionally, the most effective saw in the through bone assessment was compared to limb amputation using scalpel and scissors for a through joint amputation at the elbow, wrist, knee and ankle. Univariate analysis was used to compare the outcomes between the different saws. RESULTS The fastest saw for the through bone amputation was the reciprocating followed by oscillating (2.1 [1.4-3.7] seconds vs 3.0 [1.6-4.9] seconds). The manual pruning (58.8 [25-121] seconds) was the slowest (p = 0.007). Overall, the oscillating saw was superior or equivalent to the other devices in number of attempts (1), slippage (0), quality of bone cut (100% good) and physical space requirements (4500 cm3), and was the second fastest. In comparison, a through joint amputation (125.0 [50-147] seconds for scalpel and scissor; 125.5 [86-217] seconds for the oscillating saw) was significantly slower than through bone with the Gigli (p = 0.029), the oscillating (p = 0.029) and the reciprocal saw (p = 0.029). CONCLUSIONS The speed, precision, safety, space required, as well as the adjustable blade of the oscillating saw make it ideal for a field amputation. A Gigli saw is an excellent backup for when electrical tools cannot be used. Through bone amputation is faster than a through joint amputation.
Collapse
|
31
|
Veldhuis LI, Hollmann MW, Kooij FO, Ridderikhof ML. A pre-hospital risk score predicts critical illness in non-trauma patients transported by ambulance to a Dutch tertiary referral hospital. Scand J Trauma Resusc Emerg Med 2021; 29:32. [PMID: 33579335 PMCID: PMC7881659 DOI: 10.1186/s13049-021-00843-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Background Early pre-hospital identification of critically ill patients reduces morbidity and mortality. To identify critically ill non-traumatic and non-cardiac arrest patients, a pre-hospital risk stratification tool was previously developed in the United States. The aim of this study was to investigate the accuracy of this tool in a Dutch Emergency Department. Methods This retrospective study included all patients of 18 years and older transported by ambulance to the Emergency Department of a tertiary referral hospital between January 1st 2017 and December 31st 2017. Documentation of pre-hospital vital parameters had to be available. The tool included a full set of vital parameters, which were categorized by predetermined thresholds. Study outcome was the accuracy of the tool in predicting critical illness, defined as admittance to the Intensive Care Unit for delivery of vital organ support or death within 28 days. Accuracy of the risk stratification tool was measured with the Area Under the Receiver Operating Characteristics (AUROC) curve. Results Nearly 3000 patients were included in the study, of whom 356 patients (12.2%) developed critical illness. We observed moderate discrimination of the pre-hospital risk score with an AUROC of 0.74 (95%-CI 0.71–0.77). Using a threshold of 3 to identify critical illness, we observed a sensitivity of 45.0% (95%-CI 44.8–45.2) and a specificity of 86.0% (95%-CI 85.9–86.0). Conclusion These data show that this pre-hospital risk stratification tool is a moderately effective tool to predict which patients are likely to become critically ill in a Dutch non-trauma and non-cardiac arrest population.
Collapse
Affiliation(s)
- Lars I Veldhuis
- Amsterdam UMC, Location AMC, Department of Emergency Medicine, Meibergdreef 9, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Amsterdam UMC, Location AMC, Department of Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Fabian O Kooij
- Amsterdam UMC, Location AMC, Department of Anesthesiology, Meibergdreef 9, Amsterdam, The Netherlands.,Amsterdam UMC, Location VUmc, Lifeliner 1 HEMS, De Boelelaan, 1117, Amsterdam, The Netherlands
| | - Milan L Ridderikhof
- Amsterdam UMC, Location AMC, Department of Emergency Medicine, Meibergdreef 9, Amsterdam, The Netherlands.
| |
Collapse
|
32
|
Andersen SK, Hustveit R, Frøland E, Uleberg O, Krüger A, Klepstad P, Nordseth T. Improper monitoring and deviations from physiologic treatment goals in patients with brain injury in the early phases of emergency care. J Clin Monit Comput 2021; 35:147-153. [PMID: 31938998 PMCID: PMC7889683 DOI: 10.1007/s10877-019-00455-0] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 12/28/2019] [Indexed: 12/05/2022]
Abstract
Severe traumatic brain injury (TBI), out-of-hospital cardiac arrest (OHCA) and intracerebral- and subarachnoid hemorrhage (ICH/SAH) are conditions associated with high mortality and morbidity. The aim of this study was to investigate the feasibility of obtaining continuous physiologic data and to identify possible harmful physiological deviations in these patients, in the early phases of emergency care. Patients with ICH/SAH, OHCA and severe TBI treated by the Physician-staffed Emergency Medical Service (P-EMS) between September and December 2016 were included. Physiological data were obtained from site of injury/illness, during transport, in the emergency department (ED) and until 3 h after admittance to the intensive care unit. Physiological deviations were based on predefined target values within each 5-min interval. 13 patients were included in the study, of which 38% survived. All patients experienced one or more episodes of hypoxia, 38% experienced episodes of hypercapnia and 46% experienced episodes of hypotension. The mean proportion of time without any monitoring in the pre-hospital phase was 29%, 47% and 56% for SpO2, end-tidal CO2 and systolic blood pressure, respectively. For the ED these proportions were 57%, 71% and 56%, respectively. Continuous physiological data was not possible to obtain in this study of critically ill and injured patients with brain injury. The patients had frequent deviations in blood pressure, SpO2 and end tidal CO2-levels, and measurements were frequently missing. There is a potential for improved monitoring as a tool for quality improvement in pre-hospital critical care.
Collapse
Affiliation(s)
- Siri Kojen Andersen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
| | - Ragnhild Hustveit
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
| | - Erlend Frøland
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
| | - Oddvar Uleberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
- Department of Emergency Medicine and Pre-hospital Services, St. Olav`s University Hospital, 7006, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, P.O.Box 6770, 0130, Oslo, Norway
| | - Andreas Krüger
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
- Department of Emergency Medicine and Pre-hospital Services, St. Olav`s University Hospital, 7006, Trondheim, Norway
- Department of Research and Development, Norwegian Air Ambulance Foundation, P.O.Box 6770, 0130, Oslo, Norway
| | - Pål Klepstad
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway
- Department of Anaesthesia and Intensive Care Medicine, St. Olav University Hospital, 7006, Trondheim, Norway
| | - Trond Nordseth
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, P.O. box 3250, Sluppen, 7006, Trondheim, Norway.
- Department of Emergency Medicine and Pre-hospital Services, St. Olav`s University Hospital, 7006, Trondheim, Norway.
- Regional Centre for Health Care Research, St. Olav University Hospital, 7006, Trondheim, Norway.
- Department of Anesthesia Molde Hospital, Møre og Romsdal Hospital Trust, 6412, Molde, Norway.
| |
Collapse
|
33
|
Dulf D, Coman MA, Tadevosyan A, Chikhladze N, Cebanu S, Peek-Asa C. A 3-Country Assessment of Traumatic Brain Injury Practices and Capacity. World Neurosurg 2021; 146:e517-e526. [PMID: 33127569 PMCID: PMC7897235 DOI: 10.1016/j.wneu.2020.10.115] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 08/24/2020] [Revised: 10/22/2020] [Accepted: 10/23/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The World Health Organization predicts a striking rise in the burden of traumatic brain injury (TBI) burden in the next decades. A disproportionately large increase is predicted in low- and middle-income countries, which have brain injury rates 3 times higher than high-income countries. The aim of this study was to identify current TBI practices and treatment capacity in 3 low- and middle-income countries: Republic of Armenia, Georgia, and Republic of Moldova. METHODS After a national inventory of hospitals treating TBI, a situational analysis was conducted in the highest volume adult and pediatric hospital in each country. The situational analysis included key informant interviews with content analysis and a quantitative checklist of treatment resources. RESULTS All 3 countries follow international, national, and hospital protocols for TBI treatment, and the in-hospital management of patients with TBI is similar to international standards in all 3 countries. Although health care specialists were well trained, however, lack of proper equipment, a scant number of hospitals outside the capital region, lack of specialized personnel in regional areas, and lack of rehabilitation services were mentioned as difficulties in interviews from all 3 countries. CONCLUSIONS Particular gaps were found in pre-hospital and rehabilitative care, as well as national leadership and data collection. Surveillance and standardized data collection are important measures to fill treatment gaps and reduce the burden of TBI.
Collapse
Affiliation(s)
- Diana Dulf
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Madalina-Adina Coman
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania.
| | - Artashes Tadevosyan
- Department of Public Health and Healthcare Organization, Yerevan State Medical University, Yerevan, Republic of Armenia
| | - Nino Chikhladze
- Department of Public Health, Faculty of Medicine, Tbilisi State University, Tbilisi, Georgia
| | - Serghei Cebanu
- Department of Hygiene, Nicolae Testemitanu State University of Medicine and Pharmacy, Chisinau, Republic of Moldova
| | - Corinne Peek-Asa
- Department of Occupational and Environmental Health, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| |
Collapse
|
34
|
Nutbeam T, Fenwick R, Smith J, Bouamra O, Wallis L, Stassen W. A comparison of the demographics, injury patterns and outcome data for patients injured in motor vehicle collisions who are trapped compared to those patients who are not trapped. Scand J Trauma Resusc Emerg Med 2021; 29:17. [PMID: 33446210 PMCID: PMC7807688 DOI: 10.1186/s13049-020-00818-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background Motor vehicle collisions (MVCs) are a common cause of major trauma and death. Following an MVC, up to 40% of patients will be trapped in their vehicle. Extrication methods are focused on the prevention of secondary spinal injury through movement minimisation and mitigation. This approach is time consuming and patients may have time-critical injuries. The purpose of this study is to describe the outcomes and injuries of those trapped following an MVC: this will help guide meaningful patient-focused interventions and future extrication strategies. Methods We undertook a retrospective database study using the Trauma Audit and Research Network database. Patients were included if they were admitted to an English hospital following an MVC from 2012 to 2018. Patients were excluded when their outcomes were not known or if they were secondary transfers. Results This analysis identified 426,135 cases of which 63,625 patients were included: 6983 trapped and 56,642 not trapped. Trapped patients had a higher mortality (8.9% vs 5.0%, p < 0.001). Spinal cord injuries were rare (0.71% of all extrications) but frequently (50.1%) associated with other severe injuries. Spinal cord injuries were more common in patients who were trapped (p < 0.001). Injury Severity Score (ISS) was higher in the trapped group 18 (IQR 10–29) vs 13 (IQR 9–22). Trapped patients had more deranged physiology with lower blood pressures, lower oxygen saturations and lower Glasgow Coma Scale, GCS (all p < 0.001). Trapped patients had more significant injuries of the head chest, abdomen and spine (all p < 0.001) and an increased rate of pelvic injures with significant blood loss, blood loss from other areas or tension pneumothorax (all p < 0.001). Conclusion Trapped patients are more likely to die than those who are not trapped. The frequency of spinal cord injuries is low, accounting for < 0.7% of all patients extricated. Patients who are trapped are more likely to have time-critical injuries requiring intervention. Extrication takes time and when considering the frequency, type and severity of injuries reported here, the benefit of movement minimisation may be outweighed by the additional time taken. Improved extrication strategies should be developed which are evidence-based and allow for the expedient management of other life-threatening injuries.
Collapse
Affiliation(s)
- Tim Nutbeam
- Emergency Department, University Hospitals Plymouth NHSTrust, Plymouth, UK. .,Devon Air Ambulance Trust, Exeter, UK.
| | - Rob Fenwick
- University Hospitals Birmingham, Birmingham, UK
| | - Jason Smith
- Emergency Department, University Hospitals Plymouth NHSTrust, Plymouth, UK.,Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, UK
| | - Omar Bouamra
- Trauma Audit Research Network, University of Manchester, Manchester, UK
| | - Lee Wallis
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| | - Willem Stassen
- Division of Emergency Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
35
|
Sy E, Amram O, Baer HJ, Hameed SM, Griesdale DEG. Transport Time and Mortality in Critically Ill Patients with Severe Traumatic Brain Injury. Can J Neurol Sci 2021;:1-9. [PMID: 33431101 DOI: 10.1017/cjn.2021.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE Severe traumatic brain injury (TBI) is a major cause of morbidity and mortality in critically ill patients. Pre-hospital care and transportation time may impact their outcomes. METHODS Using the British Columbia Trauma Registry, we included 2,860 adult (≥18 years) patients with severe TBI (abbreviated injury scale head score ≥4), who were admitted to an intensive care unit (ICU) in a centre with neurosurgical services from January 1, 2000 to March 31, 2013. We evaluated the impact of transportation time (time of injury to time of arrival at a neurosurgical trauma centre) on in-hospital mortality and discharge disposition, adjusting for age, sex, year of injury, injury severity score (ISS), revised trauma score at the scene, location of injury, socio-economic status and direct versus indirect transfer. RESULTS Patients had a median age of 43 years (interquartile range [IQR] 26-59) and 676 (23.6%) were female. They had a median ISS of 33 (IQR 26-43). Median transportation time was 80 minutes (IQR 40-315). ICU and hospital length of stay were 6 days (IQR 2-12) and 20 days (IQR 7-42), respectively. Six hundred and ninety-six (24.3%) patients died in hospital. After adjustment, there was no significant impact of transportation time on in-hospital mortality (odds ratio 0.98, 95% confidence interval 0.95-1.01). There was also no significant effect on discharge disposition. CONCLUSIONS No association was found between pre-hospital transportation time and in-hospital mortality in critically ill patients with severe TBI.
Collapse
|
36
|
Curtis K, Ellwood J, Walker A, Qian S, Delamont P, Yu P, Stojic J, Phang SM. Implementation evaluation of pre-hospital blood collection in regional Australia: a mixed methods study. Australas Emerg Care 2020:S2588-994X(20)30084-1. [PMID: 32981863 DOI: 10.1016/j.auec.2020.08.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/20/2020] [Accepted: 08/30/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND In response to increasing emergency department presentations and wait times in Australia, multiple strategies and models of care have been implemented with varying results. One effective strategy has been the implementation of pre-hospital blood collection by paramedics when they insert an intravenous cannula. This research aims to determine the efficiency of and barriers to wider implementation of a pre-hospital blood collection trial in a regional context. In particular, to evaluate the impact of the pre-hospital blood collection on time to pathology results and error rates, and paramedic opinion. METHODS This retrospective controlled cohort study was conducted over 12 months from August 2018. Emergency and pathology data were used to determine the haemolysis and error rates, as well as the time to result availability of pre-hospital blood collection samples compared to in hospital samples arrived by ambulance. To determine the facilitators and barriers to wider implementation a survey of 48 paramedics was conducted following completion of the 12-month trial. The survey was informed by the Theoretical Domains Framework, a behavior change theory associated with improved uptake when applied. FINDINGS Overall 237 samples were collected. There was a 65% (51 min) reduction in time taken for samples to be received at pathology and a 38% (50 min) improvement in time taken for results to return from pathology for patients arrived by ambulance. There were no labelling errors in the pre-hospital blood collection group or change in haemolysis rates. The majority (79%) of paramedics who completed the survey were optimistic about the protocol improving patient outcomes and 89% regarded the change in practice as acceptable. Three main themes emerged: 1. Training, environmental challenges and adequate equipment; 2. increased efficiency and improved patient care and 3. Prerequisites to implementing a new practice. Integration of Quantitative and Qualitative data resulted in 10 key influencers of behavior that need to be addressed in any future implementation. CONCLUSION AND IMPLICATIONS FOR PRACTICE The introduction of pre-hospital phlebotomy reduced the time to blood results availability by 38% and resulted in fewer labelling errors. Wider implementation is supported by paramedics, but more training is required.
Collapse
|
37
|
Ningwa A, Muni K, Oporia F, Kalanzi J, Zziwa EB, Biribawa C, Kobusingye O. The state of emergency medical services and acute health facility care in Uganda: findings from a National Cross-Sectional Survey. BMC Health Serv Res 2020; 20:634. [PMID: 32646519 PMCID: PMC7346654 DOI: 10.1186/s12913-020-05508-8] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited information on the state of emergency medical services (EMS) in Uganda. The available evidence is from studies that focused on either assessing EMS capacity and gaps at the national level especially in Kampala or identifying risk factors for specific emergency medical conditions (e.g., injuries). In this study, we sought to provide a snapshot of the state of EMS in Uganda by assessing the pre-hospital and hospital emergency care capacity at both national and sub-national (district) levels. METHODS We conducted a cross-sectional national survey administering structured questionnaires to EMS providers and policy makers from 38 randomly selected districts across seven of the 14 health regions of Uganda. This resulted in a study sample of 111 health facilities and 52 pre-hospital service providers. We collected data on six pillars of EMS whose frequencies and percentages were calculated and qualitatively compared for different levels of the health care system. RESULTS At the time of this study, Uganda did not have any EMS policy or guidelines. In addition, there was no functional toll-free number for emergency response in the country. However, Ministry of Health reported that a taskforce had been set up to lead development of EMS policy, guidelines, and standards including establishment of a toll-free emergency number. At the sub-national level, ambulances lacked the products and supplies needed to provide pre-hospital care, and mainly functioned as emergency transport vehicles, with no capacity for medical care. Only 16 (30.8%) of the 52 pre-hospital providers assessed had standard ambulances with required equipment, medicines, and personnel. The rest of the service providers had improvised ambulances that were not equipped to provide pre-hospital care. Traffic police and bystanders were the first responders to the majority (> 90%) of the emergency cases. CONCLUSION Our findings reveal weaknesses at every level of what should be a critical component in the health care system - one that deals with the ability to treat life-threatening conditions in a time sensitive manner. The Ministry of Health needs to speed up efforts to provide policies and guidelines, and to increase investments for the creation of a functional EMS in Uganda.
Collapse
Affiliation(s)
- Albert Ningwa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda.
| | - Kennedy Muni
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Frederick Oporia
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Joseph Kalanzi
- Department of Emergency Medical Services, Ministry of Health, Kampala, Uganda
| | - Esther Bayiga Zziwa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Claire Biribawa
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| | - Olive Kobusingye
- Department of Disease Control and Environmental Health, Makerere University School of Public Health, Kampala, Uganda
| |
Collapse
|
38
|
Medina-Lozano E, Martín-Rodríguez F, Castro-Villamor MÁ, Escudero-Cuadrillero C, Vegas CDP, López-Izquierdo R. Accuracy of early warning scores for predicting serious adverse events in pre-hospital traumatic injury. Injury 2020; 51:1554-60. [PMID: 32430198 DOI: 10.1016/j.injury.2020.04.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 04/25/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Traumatically injured patients are at higher risk of serious adverse events. Numerous physiological scoring systems are employed as diagnostic and/or prognostic tools. The objective of this study was to evaluate the scales most commonly used by emergency medical services for the early detection of prehospital serious adverse events. METHODS Design. Preliminary longitudinal prospective observational study without intervention study in adults with prehospital traumatic injury. SETTING The study was carried out in the public health system of Castile and León (Spain), from April 1, 2018 to October 31, 2019, involving seven advanced life support units and five hospitals. PARTICIPANTS Traumatically injured patients over 18 years of age who were stabilized and transferred in advanced life support units to their referral hospital. MAIN OUTCOME MEASURES Appearance of serious adverse events at the prehospital level at the scene or during the transfer to the emergency department. RESULTS A total of 346 patients were included in the study. The median age was 50 years (IQR: 38-65). 32 cases (7.8%) presented serious adverse events at the prehospital level. Areas under the curve for the detection of serious adverse events were obtained with the Prehospital Index (0.979; 95% CI: 0.94-1.00) and National Early Warning Score 2 (0.956; 95% CI: 0.90-1.00); p <0.001 for all scores. The Prehospital Index had a positive probability coefficient of 78.4 (95% CI: 62.8-68.6) and the National Early Warning Score 2 obtained 52.9 (95% CI: 39.7-65.6). A comparison of the curves was not significant for any of the scores studied (p> 0.05). CONCLUSIONS All scoring systems were able to detect prehospital serious adverse events early in traumatic injury; therefore, any of the scoring systems could be useful and represent an ideal tool for routine use by emergency medical services in cases of traumatic injury.
Collapse
|
39
|
Ventura C, Gibson C, Collier GD. Emergency Medical Services resource capacity and competency amid COVID-19 in the United States: preliminary findings from a national survey. Heliyon 2020; 6:e03900. [PMID: 32368629 PMCID: PMC7196380 DOI: 10.1016/j.heliyon.2020.e03900] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 04/13/2020] [Revised: 04/17/2020] [Accepted: 04/28/2020] [Indexed: 12/20/2022] Open
Abstract
Objective This study aimed to investigate available resources, Personal Protective Equipment (PPE) availability, sanitation practices, institutional policies, and opinions among EMS professionals in the United States amid the COVID-19 pandemic using a self-report survey questionnaire. Methods An online 42-question multiple choice survey was randomly distributed between April 1, 2020, and April 16, 2020 to various active Emergency Medical Services (EMS) paid personnel in all 50 U.S. states including the District of Columbia (n = 192). We approximate a 95% confidence interval (±0.07). Results An overwhelming number of EMS providers report having limited access to N95 respirators, receiving little or no benefits from COVID-19 related work, and report no institutional policy on social distancing practices despite CDC recommendations. For providers who do have access to N95 respirators, 31% report having to use the same mask for 1 week or longer. Approximately ⅓ of the surveyed participants were unsure of when a COVID-19 patient is infectious. The data suggests regular decontamination of EMS equipment after each patient contact is not a regular practice. Discussion Current practices to educate EMS providers on appropriate response to the novel coronavirus may not be sufficient, and future patients may benefit from a nationally established COVID-19 EMS response protocol. Further investigation on whether current EMS practices are contributing to the spread of infection is warranted. The data reveals concerning deficits in COVID-19 related education and administrative protocols which pose as a serious public health concern that should be urgently addressed.
Collapse
Affiliation(s)
- Christian Ventura
- Council on Research and Continuing Education, Health Advocacy and Medical Exploration Society, Inc. Lawrenceville, NJ 08648 USA.,Department of Natural Sciences, Bard College at Simon's Rock, Great Barrington, MA 01230 USA
| | - Cody Gibson
- Council on Research and Continuing Education, Health Advocacy and Medical Exploration Society, Inc. Lawrenceville, NJ 08648 USA.,Department of Natural Sciences, Calhoun Community College, Tanner, AL 35671 USA
| | | |
Collapse
|
40
|
Foley J, Cronin M, Brent L, Lawrence T, Simms C, Gildea K, Ryan J, Deasy C, Cronin J. Cycling related major trauma in Ireland. Injury 2020; 51:1158-1163. [PMID: 31784058 DOI: 10.1016/j.injury.2019.11.025] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/14/2019] [Accepted: 11/20/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Cycling as a means of transport or recreational activity is increasing in popularity in Ireland. However, increasing numbers of cyclists may lead to an increased number of bicycle collisions and fatalities. The Road Safety Authority is the statutory body for road safety in Ireland but uses police data alone to collate cycling collision statistics. This may lead to an underestimation of cycling injuries in Ireland. Using hospital statistics may provide a greater understanding of cycling trauma in Ireland. OBJECTIVE The present study examines cycling related trauma in Ireland using the Major Trauma Audit (MTA) data collected via the Trauma and Research Network (TARN) from hospitals in Ireland for the period 2014 to 2016. The database was interrogated for demographics, mechanism of injury, injury characteristics and patient outcomes. RESULTS There were 410 cycling collisions recorded in the TARN database which represented 4.4% of trauma captured by TARN for the study period. Of this cohort 79% were male compared with 58% in the overall (TARN) trauma cohort (p < 0.001) and the median (IQR) age was 43.8 years (31.0, 55.7) which is younger than the median (IQR) of 58.9 (36.2, 76.0) years for the overall trauma cohort (p < 0.001). Cycling collisions had a median (IQR) injury severity score (ISS) of 10 (9, 20) which was higher than the overall trauma cohort ISS of 9 (9, 17). Of the mechanisms observed for cycling trauma, 31.7% (n = 130) had a collision with a motor vehicle. Of those who did not wear a helmet, 52.2% (n = 47) sustained a head injury compared with 27.5% (n = 44) in the group who were wearing a helmet (p < 0.001). CONCLUSION The TARN data presented in this paper builds a more complete overview of the burden of cycling collisions in Ireland. Particular points of focus are that serious cycling injuries occur in a predominantly male population, and that only around 30% of cases are recorded as involving a motor vehicle, with the majority having an unknown mechanism of injury. There was an association between helmets and head injuries in this study, but there are likely other contributing factors such as mechanism of injury, velocity or cycling infrastructure. Using hospital data such as the MTA provides valuable information on the injuries sustained by cyclists, but more prospective studies to capture injury mechanism and contributing factors are needed.
Collapse
Affiliation(s)
- James Foley
- Department of Emergency Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
| | - Marina Cronin
- Major Trauma Audit, National Office of Clinical Audit, Ireland
| | - Louise Brent
- Major Trauma Audit, National Office of Clinical Audit, Ireland
| | - Tom Lawrence
- The Trauma Audit and Research Network, Manchester, United Kingdom
| | - Ciaran Simms
- Centre for Bioengineering & School of Engineering, Trinity College Dublin, Ireland
| | - Kevin Gildea
- Centre for Bioengineering & School of Engineering, Trinity College Dublin, Ireland
| | - John Ryan
- Department of Emergency Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Conor Deasy
- Department of Emergency Medicine, Cork University Hospital, Ireland; Major Trauma Audit, National Office of Clinical Audit, Ireland
| | - John Cronin
- Department of Emergency Medicine, St. Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| |
Collapse
|
41
|
Stadeli KM, Abdullahi D, Ali A, Conrick KM, Paulsen M, Bulger EM, Vavilala MS, Mohamed FB, Ali A, Ibrahim A. Working toward Equity in Emergencies (WE) through Stop the Bleed: A pilot collaborative health program with the Somali community in Seattle. Am J Surg 2020; 219:756-763. [PMID: 32204848 DOI: 10.1016/j.amjsurg.2020.03.004] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/28/2020] [Accepted: 03/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND We developed a culturally-adapted program (WE Stop the Bleed) to increase bleeding control knowledge and self-efficacy among Somali individuals, and to build trust between Somali individuals and first responders. METHODS WE Stop the Bleed was piloted in the Seattle Somali community with first responders as skills coaches. The program included: 1) adapted ACS Stop the Bleed program; 2) cultural exchange. We evaluated knowledge, self-efficacy, and trust between Somali participants and first responders using a pre/post survey. RESULTS Attendance exceeded a priori goals (27 community participants, 13 first responders). 96% of participants would recommend the training. Knowledge and self-efficacy improved pre/post (62%-72%, 65%-93% respectively). First responders indicated increased comfort with Somali individuals, and participants reported positive changes in perceptions of first responders. CONCLUSIONS WE Stop the Bleed is a feasible and acceptable program to increase bleeding control knowledge and self-efficacy among participants and build trust between participants and first responders.
Collapse
Affiliation(s)
- Kathryn M Stadeli
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Dirir Abdullahi
- School of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA; Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA.
| | - Abdifatah Ali
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA.
| | - Kelsey M Conrick
- School of Social Work, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA.
| | - Maria Paulsen
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Eileen M Bulger
- Department of Surgery, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Monica S Vavilala
- Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA, USA; Department of Anesthesiology, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Farah Bille Mohamed
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA; Seattle and King County Public Health, 401 5th Ave, Seattle, WA, 98104, USA; Department of Medicine, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Ahmed Ali
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA; Department of Global Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | - Anisa Ibrahim
- Somali Health Board, 625 Strander Blvd Building B, Tukwila, Washington, 98188, USA; Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| |
Collapse
|
42
|
Skulec R, Callerova J, Vojtisek P, Cerny V. Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study. Intern Emerg Med 2020; 15:303-310. [PMID: 31701317 DOI: 10.1007/s11739-019-02226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
We performed a randomized pre-hospital clinical study to compare two different techniques of ultrasound-guided peripheral venous catheter (PVC) insertion and the conventional cannulation technique in the pre-hospital emergency setting, with a specific focus on the procedural success rate and the time required to introduce PVC. This pre-hospital prospective controlled randomized clinical trial allocated patients treated by emergency medical service to undergo PVC insertion fully controlled by ultrasound (ultrasound guidance of the PVC tip until it penetrates the lumen, group A), PVC insertion partially controlled by ultrasound (target vein identification only, group B) or to receive PVC without any ultrasound guidance (group C). The study outcomes were monitored until the patient was admitted to the hospital. A total of 300 adult patients were enrolled. The success of the first attempt (group A: 88%, group B: 94%, group C: 76%, p < 0.001) and overall success rate (A: 99%, B: 99%, C: 90%, p < 0.001) were significantly higher in the group A, followed by group B when compared to group C. The number of attempts was significantly lower (A: 1.18 ± 0.54, B: 1.05 ± 0.22, C: 1.22 ± 0.57, p < 0.001) and the time required for the procedure shorter (A: 75.3 ± 60.6, B: 43.5 ± 26.0, C: 82.3 ± 100.9 s, p < 0.001) in group B compared to groups A and C. Both techniques of ultrasound-guided PVC placement were associated with higher success rates than the conventional method. However, PVC insertion partially controlled by ultrasound was superior to full ultrasound guidance in terms of time and number of cannulation attempts required.
Collapse
Affiliation(s)
- Roman Skulec
- Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, 272 01, Kladno, Czech Republic.
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti Nad Labem, Socialni pece 3316/12A, 400 11, Usti Nad Labem, Czech Republic.
- Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic.
- Faculty of Health Studies, J.E. Purkinje University, Pasteurova 3544/1, 400 96, Usti Nad Labem, Czech Republic.
| | - Jitka Callerova
- Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, 272 01, Kladno, Czech Republic
| | - Petr Vojtisek
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti Nad Labem, Socialni pece 3316/12A, 400 11, Usti Nad Labem, Czech Republic
- Usti and Labem Region Emergency Medical Services, Sociální péče 799/7a, 400 11, Usti and Labem, Czech Republic
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti Nad Labem, Socialni pece 3316/12A, 400 11, Usti Nad Labem, Czech Republic
- Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic
- Faculty of Health Studies, J.E. Purkinje University, Pasteurova 3544/1, 400 96, Usti Nad Labem, Czech Republic
- Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| |
Collapse
|
43
|
Bhandari D, Yadav NK. Developing an integrated emergency medical services in a low-income country like Nepal: a concept paper. Int J Emerg Med 2020; 13:7. [PMID: 32028893 PMCID: PMC7006070 DOI: 10.1186/s12245-020-0268-1] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 01/03/2020] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The main aim of emergency medical services (EMS) should be to provide universal emergency medical care which is EMS system available to all those who need it. Most of the developed countries have an integrated EMS system that is accessible by a single dial number in the whole country. Nepal does not have a proper EMS system. We conducted a literature review regarding methods of developing an integrated EMS system in Nepal. RESULT The fragmented system, high demand-low supply, inequity with the service, and inadequately trained responders are major problems associated with EMS in Nepal. Nepal too should develop an integrated single dial number EMS system to meet the current demand of EMS. Having a paramedic in ambulances as the first responders will prevent chaos and save critical time. Funding models have to be considered while developing an EMS considering the capital as well as operational cost. CONCLUSION Nepal can develop a public private partnership model of EMS where capital cost is provided by the government and operational cost by other methods. Community-based insurance system looks more feasible in a country like Nepal for generating operational cost.
Collapse
Affiliation(s)
- Deepak Bhandari
- Department of Anesthesia, Critical care and Pain, Nepal Mediciti Hospital, Bhainsepati, Kathmandu, Nepal
| | - Nabin Krishna Yadav
- Department of Anesthesiology And Critical Care, Chitwan Medical College, Bharatpur-10, Chitwan Nepal
| |
Collapse
|
44
|
Shimamoto T, Kiyohara K, Matsuyama T, Kitamura T, Kiguchi T, Nishiyama C, Kobayashi D, Okabayashi S, Kawamura T, Iwami T. Impact of Bystander Cardiopulmonary Resuscitation and Dispatcher Assistance on Survival After Out-of-Hospital Cardiac Arrest Among Adult Patients by Location of Arrest. Int Heart J 2020; 61:46-53. [PMID: 31956145 DOI: 10.1536/ihj.19-301] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We investigated the impact of bystander-initiated cardiopulmonary resuscitation (CPR), dispatcher assistance (DA), and location of arrest on survival and outcomes after out-of-hospital cardiac arrest (OHCA).From a nationwide population-based registry of OHCA patients in Japan, we enrolled adult patients with bystander-witnessed OHCA of medical origin between 2013 and 2015. The primary outcome measure was a neurologically favorable outcome, defined by cerebral performance category 1 or 2. Multivariable logistic regression analysis was used to assess the effects of bystander CPR and DA by location of arrest. A total of 104,621 cases were included (15,984 bystander CPR without DA [15.3%], 40,087 bystander CPR with DA [38.3%], and 48,550 no bystander CPR [46.4%]). In public locations, both the bystander-CPR-with-DA group (22.9% [1,068/4,665]; adjusted odds ratio (AOR), 1.62; 95% confidence interval (CI), 1.43-1.85) and the bystander-CPR-without-DA group (25.8% [918/3,557]; AOR, 1.43; 95% CI, 1.24-1.65) had neurologically favorable outcomes compared with the no-bystander-CPR group (9.9% [610/6,133]). In residential locations, the AORs were 1.44 (95% CI, 1.22-1.70) in the bystander-CPR-without-DA group and 1.60 (95% CI, 1.45-1.77) in the bystander-CPR-with-DA group. However, in nursing homes, bystander CPR was not associated with improved outcomes of OHCA, regardless of the implementation of DA.Bystander CPR with or without DA had better outcomes after OHCA in residential and public locations but not in nursing homes.
Collapse
Affiliation(s)
| | | | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University
| | | | - Chika Nishiyama
- Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science
| | | | | | | | | |
Collapse
|
45
|
Rogerson T, Efstratiades T, Von Oppell U, Davies G, Curtin R. Survival after pre-hospital emergency clamshell thoracotomy for blunt cardiac rupture. Injury 2020; 51:122-3. [PMID: 31551121 DOI: 10.1016/j.injury.2019.09.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 02/02/2023]
Abstract
Blunt trauma causing cardiac rupture is usually fatal. We report a patient with blunt cardiac injury that suffered traumatic cardiac arrest in the pre-hospital phase of their care. A cardiac tamponade was confirmed with portable ultrasound in a brief return of circulation. The patient had a further cardiac arrest and subsequently underwent damage control emergency surgery via a clamshell thoracotomy at the scene. The tamponade was released and a clamp was applied to the identified left atrial appendage rupture, a return of circulation then occurred. He was transferred to a cardiothoracic centre where a left atrial appendage rupture was identified and closed. The patient had a complicated recovery in hospital but went on to survive neurologically intact. This is the first documented case report of a neurologically intact survivor of a pre-hospital clamshell thoracotomy for blunt trauma. Although survivors of blunt trauma who have pre-hospital thoracotomy are extremely rare it should be considered in very specific circumstances.
Collapse
|
46
|
McCreary D, Cheng C, Lin ZC, Nehme Z, Fitzgerald M, Mitra B. Haemodynamics as a determinant of need for pre-hospital application of a pelvic circumferential compression device in adult trauma patients. Injury 2020; 51:4-9. [PMID: 31431329 DOI: 10.1016/j.injury.2019.08.001] [Citation(s) in RCA: 3] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 07/23/2019] [Accepted: 08/03/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Pelvic ring fractures are common following high-energy blunt trauma and can lead to substantial haemorrhage, morbidity and mortality. Pelvic circumferential compression devices (PCCDs) improve position and stability of open-book type pelvic fracture, and can improve haemodynamics in patients with hypovolaemic shock. However, PCCDs may cause adverse outcomes including worsening of lateral compression fracture patterns and routine use is associated with high costs. Controversy regarding indication of PCCDs exists with some centres recommending PCCD in the setting of hypovolaemic shock compared to placement for any suspected pelvic injury. OBJECTIVE To assess the need for PCCD application based on pre-hospital vital signs and mechanism of injury. METHODS A retrospective cohort study was conducted in a single adult major trauma centre examining a 2-year period. Patients were sub-grouped based on initial pre-hospital and emergency department observations as haemodynamically normal (heart rate <100 bpm, systolic blood pressure ≥100 mmHg and Glasgow Coma Scale ≥13) or abnormal. Diagnostic accuracy of pre-hospital haemodynamics as a predictor of pelvic fracture requiring intervention within 24 h was assessed. RESULTS There were 376 patients with PCCD in-situ on hospital arrival. Pelvic fractures were diagnosed in 137 patients (36.4%). Of these, 39 (28.5%) were haemodynamically normal and 98 (71.5%) were haemodynamically abnormal. The most common mechanisms of injury were motor vehicle collision (57.7%) and motorcycle collision (13.8%). Of those with fractures, 40 patients (29.2%) required pelvic intervention within 24 h of admission; of these, 8 (20%) were haemodynamically normal and 32 (80%) were haemodynamically abnormal. As a test for pelvic fracture requiring intervention within 24 h, abnormal pre-hospital haemodynamics had a sensitivity of 0.80 (95% CI 0.64-0.91), specificity of 0.32 (95% CI 0.27-0.38) and negative predictive value (NPV) of 0.93 (95% CI 0.88-0.96). Combined with absence of a major mechanism of injury, normal haemodynamics had a sensitivity 1.00, specificity 0.51 (95% CI 0.36-0.66) and NPV of 1.00 for pelvic intervention within 24 h. CONCLUSION Normal haemodynamic status, combined with absence of major mechanism of injury can rule out requirement for urgent pelvic intervention. Ongoing surveillance is recommended to monitor for any adverse effects of this change in practice.
Collapse
Affiliation(s)
- D McCreary
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia.
| | - C Cheng
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Z C Lin
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Z Nehme
- Department of Research & Evaluation, Ambulance Victoria, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; Department of Community Emergency Health & Paramedic Practice, Monash University, Australia
| | - M Fitzgerald
- Trauma Services, Alfred Health, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - B Mitra
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia; Department of Epidemiology & Preventive Medicine, Monash University, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| |
Collapse
|
47
|
Beattie G, Cohan C, Brooke M, Kaplanes S, Victorino GP. Automatic acoustic gunshot sensor technology's impact on trauma care. Am J Emerg Med 2020; 38:1340-5. [PMID: 31836336 DOI: 10.1016/j.ajem.2019.10.042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 10/25/2019] [Accepted: 10/29/2019] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION As cities nation-wide combat gun violence, with less than 20% of shots fired reported to police, use of acoustic gunshot sensor (AGS) technology is increasingly common. However, there are no studies to date investigating whether these technologies affect outcomes for victims of gunshot wounds (GSW). We hypothesized that the AGS technology would be associated with decreased prehospital transport time. METHODS All GSW patients from 2014 to 2016 were collected from our institutional registry and cross-referenced with local police department data regarding times and locations of AGS alerts. Each GSW incident was categorized as related or unrelated to an AGS alert. Admission data, trauma outcomes, and prehospital time were then compared. RESULTS We analyzed 731 patients. Of these, 192 were AGS-related (26%) and 539 were not (74%). AGS-related patients were more likely to be female (p < 0.01), have a higher injury severity score (ISS) (p < 0.01), and require an operation (p = 0.03). Ventilator days (p < 0.05) and hospital length of stay (p < 0.01) was greater in the AGS cohort. Mortality, however, did not differ between groups (p = 0.5). On multivariable analysis, both total prehospital time and on-scene time were lower in the AGS group (p < 0.01). CONCLUSION Our study suggests reduced transport times, decreased prehospital and emergency medical service on-scene times with AGS technology. Additionally, despite higher ISS and use of more hospital resources, mortality was similar to non-AGS counterparts. The potential of AGS technology to further decrease prehospital times in the urban setting may provide an opportunity to improve outcomes in trauma patients with penetrating injuries.
Collapse
|
48
|
Abstract
Vascular access devices are common and necessary in healthcare provision but their use poses a significant risk of acquiring an infection. Ambulance/emergency inserted peripheral intravenous catheters (PIVCs) potentially have higher risks of catheter-related bloodstream infection (CRBSI) because of the inability to maintain asepsis during the insertion procedure. Local guidelines (Queensland, Australia) recommend the removal or replacement of PIVCs inserted in these situations within 24 hours. Routine clinical audits performed within the authors' health service demonstrated a delay in removing ambulance/emergency inserted PIVCs beyond acceptable dwell times. Ambulance/emergency inserted PIVCs were not being recognised as requiring removal by ward staff. A quality improvement project involving key stakeholder engagement, the roll out of a sticker to readily identify ambulance/emergency inserted PIVCs and education of ward staff was introduced to enable identification of this high-risk group. Post-implementation audits demonstrated a significant reduction in numbers of ambulance/emergency PIVCs remaining in situ for longer than 24 hours.
Collapse
Affiliation(s)
- Leanne Ruegg
- Clinical Nurse Consultant, Vascular Access Surveillance and Education, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Mark Faucett
- Clinical Nurse, Vascular Access Surveillance and Education, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Keat Choong
- Infectious Diseases Physician, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| |
Collapse
|
49
|
Teuben M, Löhr N, Jensen KO, Brüesch M, Müller S, Pfeifer R, Mica L, Pape HC, Sprengel K. Improved pre-hospital care efficiency due to the implementation of pre-hospital trauma life support (PHTLS ®) algorithms. Eur J Trauma Emerg Surg 2019; 46:1321-1325. [PMID: 31079191 DOI: 10.1007/s00068-019-01141-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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: 01/25/2019] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE Pre-hospital trauma life support (PHTLS®) includes a standardized algorithm for pre-hospital care. Implementation of PHTLS® led to improved outcome in less developed medical trauma systems. We aimed to determine the impact of PHTLS® on quality of pre-hospital care in a European metropolitan area. We hypothesized that the introduction of PHTLS® was associated with improved efficiency of pre-hospital care for severely injured patients and less emergency physician deployment. METHODS We included adult polytrauma (ISS > 15) patients that were admitted to our level one trauma center during a 7-year time period. Patients were grouped based on the presence or absence of a PHTLS®-trained paramedic in the pre-hospital trauma team. Group I (no-PHTLS group) included all casualties treated by no-PHTLS®-trained personnel. Group II (PHTLS group) was composed of casualties managed by a PHTLS® qualified team. We compared outcome between groups. RESULTS During the study period, 187,839 rescue operations were executed and 280 patients were included. No differences were seen in patient characteristics, trauma severity or geographical distances between groups. Transfer times were significantly reduced in PHTLS® teams than non-qualified teams (9.3 vs. 10.5 min, P = 0.006). Furthermore, the in-field operation times were significantly reduced in PHTLS® qualified teams (36.2 vs. 42.6 min, P = 0.003). Emergency physician involvement did not differ between groups. CONCLUSION This is the first study to show that the implementation of PHTLS® algorithms in a European metropolitan area is associated with improved efficiency of pre-hospital care for the severely injured. We therefore recommend considering the introduction of PHTLS® in metropolitan areas in the first world.
Collapse
Affiliation(s)
- Michel Teuben
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
| | - Nikolaus Löhr
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Kai Oliver Jensen
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Martin Brüesch
- Institute of Anesthesiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Stephan Müller
- City of Zurich, Schutz and Rettung, Neumuehlequai 40, 8021, Zurich, Switzerland
| | - Roman Pfeifer
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Ladislav Mica
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Hans-Christoph Pape
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - Kai Sprengel
- Department of Traumatology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| |
Collapse
|
50
|
Beck B, Smith K, Mercier E, Bernard S, Jones C, Meadley B, Clair TS, Jennings PA, Nehme Z, Burke M, Bassed R, Fitzgerald M, Judson R, Teague W, Mitra B, Mathew J, Buck A, Varma D, Gabbe B, Bray J, McLellan S, Ford J, Siedenburg J, Cameron P. Potentially preventable trauma deaths: A retrospective review. Injury 2019; 50:1009-1016. [PMID: 30898389 DOI: 10.1016/j.injury.2019.03.003] [Citation(s) in RCA: 19] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/24/2019] [Accepted: 03/04/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Reviewing prehospital trauma deaths provides an opportunity to identify system improvements that may reduce trauma mortality. The objective of this study was to identify the number and rate of potentially preventable trauma deaths through expert panel reviews of prehospital and early in-hospital trauma deaths. METHODS We conducted a retrospective review of prehospital and early in-hospital (<24 h) trauma deaths following a traumatic out-of-hospital cardiac arrest that were attended by Ambulance Victoria (AV) in the state of Victoria, Australia, between 2008 and 2014. Expert panels were used to review cases that had resuscitation attempted by paramedics and underwent a full autopsy. Patients with a mechanism of hanging, drowning or those with anatomical injuries deemed to be unsurvivable were excluded. RESULTS Of the 1183 cases that underwent full autopsies, resuscitation was attempted by paramedics in 336 (28%) cases. Of these, 113 cases (34%) were deemed to have potentially survivable injuries and underwent expert panel review. There were 90 (80%) deaths that were not preventable, 19 (17%) potentially preventable deaths and 4 (3%) preventable deaths. Potentially preventable or preventable deaths represented 20% of those cases that underwent review and 7% of cases that had attempted resuscitation. CONCLUSIONS The number of potentially preventable or preventable trauma deaths in the pre-hospital and early in-hospital resuscitation phase was low. Specific circumstances were identified in which the trauma system could be further improved.
Collapse
Affiliation(s)
- Ben Beck
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada.
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia
| | - Eric Mercier
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; The Intensive Care Unit, The Alfred Hospital
| | | | - Ben Meadley
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | - Toby St Clair
- Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | - Paul A Jennings
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Ziad Nehme
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia; Ambulance Victoria, Victoria, Australia
| | - Michael Burke
- Victorian Institute of Forensic Medicine, Victoria, Australia
| | - Richard Bassed
- Victorian Institute of Forensic Medicine, Victoria, Australia; Department of Forensic Medicine, Monash University, Victoria, Australia
| | - Mark Fitzgerald
- Trauma Service, The Alfred, Victoria, Australia; National Trauma Research Institute, Victoria, Australia
| | - Rodney Judson
- General Surgery, The Royal Melbourne Hospital, Victoria, Australia; Department of Surgery, The University of Melbourne, Victoria, Australia
| | - Warwick Teague
- Trauma Service, The Royal Children's Hospital, Victoria, Australia; Department of Paediatrics, University of Melbourne, Victoria, Australia; Surgical Research Group, Murdoch Children's Research Institute, Victoria, Australia
| | - Biswadev Mitra
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; National Trauma Research Institute, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Joseph Mathew
- Trauma Service, The Alfred, Victoria, Australia; National Trauma Research Institute, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| | - Andrew Buck
- Emergency Department, Royal Darwin Hospital, Northern Territory, Australia
| | - Dinesh Varma
- Department of Surgery, The University of Melbourne, Victoria, Australia; Radiology, The Alfred, Victoria, Australia
| | - Belinda Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
| | - Susan McLellan
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Jane Ford
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Josine Siedenburg
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia; National Trauma Research Institute, Victoria, Australia; Emergency and Trauma Centre, The Alfred, Victoria, Australia
| |
Collapse
|