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Day J, Simmonds RL, Shaw L, Price CI, McClelland G, Ford GA, James M, White P, Stein K, Pope C. Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study. Emerg Med J 2024:emermed-2023-213350. [PMID: 38729751 DOI: 10.1136/emermed-2023-213350] [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: 05/09/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Mechanical thrombectomy for stroke is highly effective but time-critical. Delays are common because many patients require transfer between local hospitals and regional centres. A two-stage prehospital redirection pathway consisting of a simple ambulance screen followed by regional centre assessment to select patients for direct admission could optimise access. However, implementation might be challenged by the limited number of thrombectomy providers, a lack of prehospital diagnostic tests for selecting patients and whether finite resources can accommodate longer ambulance journeys plus greater central admissions. We undertook a three-phase, multiregional, qualitative study to obtain health professional views on the acceptability and feasibility of a new pathway. METHODS Online focus groups/semistructured interviews were undertaken designed to capture important contextual influences. We purposively sampled NHS staff in four regions of England. Anonymised interview transcripts underwent deductive thematic analysis guided by the NASSS (Non-adoption, Abandonment and Challenges to Scale-up, Spread and Sustainability, Implementation) Implementation Science framework. RESULTS Twenty-eight staff participated in 4 focus groups, 2 group interviews and 18 individual interviews across 4 Ambulance Trusts, 5 Hospital Trusts and 3 Integrated Stroke Delivery Networks (ISDNs). Five deductive themes were identified: (1) (suspected) stroke as a condition, (2) the pathway change, (3) the value participants placed on the proposed pathway, (4) the possible impact on NHS organisations/adopter systems and (5) the wider healthcare context. Participants perceived suspected stroke as a complex scenario. Most viewed the proposed new thrombectomy pathway as beneficial but potentially challenging to implement. Organisational concerns included staff shortages, increased workflow and bed capacity. Participants also reported wider socioeconomic issues impacting on their services contributing to concerns around the future implementation. CONCLUSIONS Positive views from health professionals were expressed about the concept of a proposed pathway while raising key content and implementation challenges and useful 'real-world' issues for consideration.
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Affiliation(s)
- Jo Day
- NIHR Applied Research Collaboration South West Peninsula, Health and Community Sciences, University of Exeter, Exeter, Devon, UK
| | | | - Lisa Shaw
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher I Price
- Stroke Research Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Graham McClelland
- North East Ambulance Service NHS Foundation Trust, Newcastle Upon Tyne, UK
- Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Gary A Ford
- Oxford University Hospitals NHS Foundation Trust and Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Martin James
- Royal Devon University Healthcare NHS Foundation Trust and University of Exeter, University of Exeter, Exeter, Devon, UK
| | - Phil White
- Stroke Research Group, Clinical and Translational Research Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Ken Stein
- NIHR Applied Research Collaboration South West Peninsula, University of Exeter, Exeter, Devon, UK
| | - Catherine Pope
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Teuben MPJ, Löhr N, Shehu A, Berk T, Jensen KO, Mikova E, Brüesch M, Müller S, Pfeifer R, Mica L, Pape HC, Sprengel K. The value of pre-hospital trauma life support courses for medical personnel-a questionnaire study. Front Med (Lausanne) 2024; 11:1345310. [PMID: 38646559 PMCID: PMC11026852 DOI: 10.3389/fmed.2024.1345310] [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: 11/27/2023] [Accepted: 01/30/2024] [Indexed: 04/23/2024] Open
Abstract
Background The aim of the study was to determine the impact that PHTLS® course participation had on self-confidence of emergency personnel, regarding the pre-hospital treatment of patients who had suffered severe trauma. Furthermore, the goal was to determine the impact of specific medical profession, work experience and prior course participation had on the benefits of PHTLS® training. Methods A structured questionnaire study was performed. Healthcare providers from local emergency services involved in pre-hospital care in the metropolitan area of Zurich (Switzerland, Europe) who completed a PHTLS® course were included. Altered self-confidence, communication, and routines in the treatment of severe trauma patients were examined. The impact of prior course participation, work experience and profession on course benefits were evaluated. Results The response rate was 76%. A total of 6 transport paramedics (TPs), 66 emergency paramedics (EPs) and 15 emergency doctors (EDs) were included. Emergency paramedics had significantly more work experience compared with EDs (respectively 7.1 ± 5.7 yrs. vs. 4.5 ± 2.1 yrs., p = 0.004). 86% of the participants reported increased self-confidence in the pre-hospital management of severe trauma upon PHTLS® training completion. Moreover, according to 84% of respondents, extramural treatment of trauma changed upon course completion. PHTLS® course participants had improved communication in 93% of cases. This was significantly more frequent in EPs than TPs (p = 0.03). Multivariable analysis revealed emergency paramedics benefit the most from PHTLS® course participation. Conclusion The current study shows that PHTLS® training is associated with improved self-confidence and enhanced communication, with regards to treatment of severe trauma patients in a pre-hospital setting, among medical emergency personnel. Additionally, emergency paramedics who took the PHTLS® course improved in overall self-confidence. These findings imply that all medical personal involved in the pre-hospital care of trauma patients, in a metropolitan area in Europe, do benefit from PHTLS® training. This was independent of the profession, previous working experience or prior alternative course participation.
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Affiliation(s)
| | - Nikolaus Löhr
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Alba Shehu
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Till Berk
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kai Oliver Jensen
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Ester Mikova
- University of Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Martin Brüesch
- Institute of Anaesthesiology, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | | | - Roman Pfeifer
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Ladislav Mica
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Hans Christoph Pape
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
| | - Kai Sprengel
- Department of Trauma, University Hospital Zurich, University of Zurich, Zürich, Switzerland
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Leto N, Bjørshol CA, Kurz M, Østerås Ø, Fromm A, Lindner TW. Prehospital identification of acute ischaemic stroke with large vessel occlusion: a retrospective study from western Norway. Emerg Med J 2024; 41:249-254. [PMID: 37968092 PMCID: PMC10982621 DOI: 10.1136/emermed-2023-213236] [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: 03/21/2023] [Accepted: 10/30/2023] [Indexed: 11/17/2023]
Abstract
BACKGROUND In 2019, the emergency medical services (EMS) covering the western Norway Regional Health Authority area implemented its version of the prehospital clinical criteria G-FAST (Gaze deviation, Facial palsy, Arm weakness, Visual loss, Speech disturbance) to detect acute ischaemic stroke (AIS) with large vessel occlusion (LVO). For patients with gaze deviation and at least one other G-FAST symptom, a primary stroke centre (PSC) may be bypassed and the patient taken directly to a comprehensive stroke centre (CSC) for rapid endovascular treatment (EVT) evaluation. The study aim was to investigate the efficacy of the G-FAST criteria for LVO patient selection and direct transfer to a CSC. METHODS This retrospective study included patients with code-red emergency medical communication centre (EMCC) stroke suspicion ambulance dispatch between August to December 2020. Stroke suspicion was defined as having at least one G-FAST symptom at EMS arrival. We obtained patient data from dispatches from EMCCs, EMS records and local EVT registries. Clinical features, CT images, and reperfusion treatment were recorded. The test characteristics for gaze deviation plus one other G-FAST symptom in detecting LVO were determined. RESULTS Among 643 patients, 59 were diagnosed with LVO at hospital arrival. In this group, seven fulfilled the G-FAST criteria for direct transport to a CSC at EMS arrival on scene, resulting in a sensitivity of 12% (95% CI 5% to 23%). The specificity was 99.66% (95% CI 98.77% to 99.96%), the positive predictive value 78%, and the negative predictive value 92%. EVT was performed in 64% (38/59) of LVO cases. Median time from PSC arrival to start of EVT at a CSC was 163 min. CONCLUSION The use of local G-FAST prehospital criteria by EMS personnel to identify patients with AIS with LVO is not suitable for selection of patients with LVO for direct transfer to a CSC.
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Affiliation(s)
- Nedim Leto
- The Regional Centre for Emergency Medical Research Western Norway, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Conrad Arnfinn Bjørshol
- The Regional Centre for Emergency Medical Research Western Norway, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Martin Kurz
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Neurology, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Østerås
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Thomas Werner Lindner
- The Regional Centre for Emergency Medical Research Western Norway, Stavanger University Hospital, Stavanger, Norway
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Jaffe E, Wacht O, Davidovitch N, Strugo R, Blustein O, Rosenblat I, Bin E, Shapira S. Managing a Mega Mass Casualty Event by a Civilian Emergency Medical Services Agency: Lessons From the First Day of the 2023 Hamas-Israel War. Int J Public Health 2024; 69:1606907. [PMID: 38487304 PMCID: PMC10938385 DOI: 10.3389/ijph.2024.1606907] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
On 7 October 2023, Israel faced an unexpected attack by Hamas, causing over 1,200 deaths and injuring more than 9,000 individuals. This report delves into the rapid medical response spearheaded by Israel's civilian Emergency Medical Service, Magen David Adom (MDA), during this crisis. Utilizing data from MDA's electronic database, 4,097 dispatch records from the day were analyzed. Of these, 39.3% were directly related to the attack. EMS teams faced multiple challenges, including handling an overwhelming number of casualties and navigating active combat zones, which impeded safe access to victims, posed significant risks to teams' safety, and constrained patient evacuation strategies. This incident underscores the importance of reinforcing healthcare resilience, particularly emphasizing the need for centralizing various aspects of response efforts. These include streamlined communication, national coordination of pre-hospital resources, and systemic management of patient evacuations. Moreover, providing substantial support for EMS personnel, who operated in highly challenging conditions, is imperative.
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Affiliation(s)
- Eli Jaffe
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Magen David Adom (MDA), Tel Aviv, Israel
| | - Oren Wacht
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Magen David Adom (MDA), Tel Aviv, Israel
| | - Nadav Davidovitch
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Refael Strugo
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Magen David Adom (MDA), Tel Aviv, Israel
| | - Oren Blustein
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Magen David Adom (MDA), Tel Aviv, Israel
| | - Ido Rosenblat
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Magen David Adom (MDA), Tel Aviv, Israel
| | - Eli Bin
- Department of Emergency Medicine, Recanati School for Community Health Professions, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Magen David Adom (MDA), Tel Aviv, Israel
| | - Stav Shapira
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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Staniszewska A, Gaba K, Patterson B, Wilson S, Bell R, Bicknell C, Brooks M, Callaway M, Goode S, Grier S, Hobson A, Mouton R, Neequaye S, Owens G, Rajakaruna C, Redfern E, Tsang G, Hinchliffe R. Consensus statement on the interhospital transfer of patients with acute aortic syndrome: TRAVERSING Delphi study. Emerg Med J 2024; 41:153-161. [PMID: 38050049 PMCID: PMC10894809 DOI: 10.1136/emermed-2023-213362] [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: 06/05/2023] [Accepted: 10/22/2023] [Indexed: 12/06/2023]
Abstract
BACKGROUND Standardisation of referral pathways and the transfer of patients with acute aortic syndromes (AAS) to regional centres are recommended by NHS England in the Acute Aortic Dissection Toolkit. The aim of the Transfer of Thoracic Aortic Vascular Emergencies to Regional Specialist INstitutes Group study was to establish an interdisciplinary consensus on the interhospital transfer of patients with AAS to specialist high-volume aortic centres. METHODS Consensus on the key aspects of interhospital transfer of patients with AAS was established using the Delphi method, in line with Conducting and Reporting of Delphi Studies guidelines. A national patient charity for aortic dissection was involved in the design of the Delphi study. Vascular and cardiothoracic surgeons, emergency physicians, interventional radiologists, cardiologists, intensivists and anaesthetists in the United Kingdom were invited to participate via their respective professional societies. RESULTS Three consecutive rounds of an electronic Delphi survey were completed by 212, 101 and 58 respondents, respectively. Using predefined consensus criteria, 60 out of 117 (51%) statements from the survey were included in the consensus statement. The study concluded that patients can be taken directly to a specialist aortic centre if they have typical symptoms of AAS on the background of known aortic disease or previous aortic intervention. Accepted patients should be transferred in a category 2 ambulance (response time <18 min), ideally accompanied by transfer-trained personnel or Adult Critical Care Transfer Services. A clear plan should be agreed in case of a cardiac arrest occurring during the transfer. Patients should reach the aortic centre within 4 hours of the initial referral from their local hospital. CONCLUSIONS This consensus statement is the first set of national interdisciplinary recommendations on the interhospital transfer of patients with AAS. Its implementation is likely to contribute to safer and more standardised emergency referral pathways to regional high-volume specialist aortic units.
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Affiliation(s)
- Aleksandra Staniszewska
- South Mersey Arterial Network, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
| | - Kamran Gaba
- Wessex Vascular Network, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Benjamin Patterson
- Wessex Vascular Network, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Sarah Wilson
- Emergency Department, Wexham Park Hospital, Slough, UK
| | - Rachel Bell
- Department of Vascular Surgery, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle, UK
| | - Colin Bicknell
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Marcus Brooks
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Mark Callaway
- Radiology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Stephen Goode
- Sheffield Vascular Institute, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Scott Grier
- Intensive Care Medicine, North Bristol NHS Trust, Bristol, UK
- Retrieve Adult Critical Care Transfer Service; National Critical Care Transfer Lead, NHS England, Bristol, UK
| | - Alex Hobson
- Department of Cardiology, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Ronelle Mouton
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Simon Neequaye
- Liverpool Vascular and Endovascular Service, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Gareth Owens
- Aortic Dissection Awareness UK & Ireland, London, UK
| | - Cha Rajakaruna
- Cardiac Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Emma Redfern
- Emergency Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Geoffrey Tsang
- Department of Cardiothoracic Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Robert Hinchliffe
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
- Bristol Population Health Science Institute, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Xu Y, Malik N, Chernbumroong S, Vassallo J, Keene D, Foster M, Lord J, Belli A, Hodgetts T, Bowley D, Gkoutos G. Triage in major incidents: development and external validation of novel machine learning-derived primary and secondary triage tools. Emerg Med J 2024; 41:176-183. [PMID: 37751994 PMCID: PMC10894820 DOI: 10.1136/emermed-2022-212440] [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: 03/07/2022] [Accepted: 08/12/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Major incidents (MIs) are an important cause of death and disability. Triage tools are crucial to identifying priority 1 (P1) patients-those needing time-critical, life-saving interventions. Existing expert opinion-derived tools have limited evidence supporting their use. This study employs machine learning (ML) to develop and validate models for novel primary and secondary triage tools. METHODS Adults (16+ years) from the UK Trauma Audit and Research Network (TARN) registry (January 2008-December 2017) served as surrogates for MI victims, with P1 patients identified using predefined criteria. The TARN database was split chronologically into model training and testing (70:30) datasets. Input variables included physiological parameters, age, mechanism and anatomical location of injury. Random forest, extreme gradient boosted tree, logistic regression and decision tree models were trained to predict P1 status, and compared with existing tools (Battlefield Casualty Drills (BCD) Triage Sieve, CareFlight, Modified Physiological Triage Tool, MPTT-24, MSTART, National Ambulance Resilience Unit Triage Sieve and RAMP). Primary and secondary candidate models were selected; the latter was externally validated on patients from the UK military's Joint Theatre Trauma Registry (JTTR). RESULTS Models were internally tested in 57 979 TARN patients. The best existing tool was the BCD Triage Sieve (sensitivity 68.2%, area under the receiver operating curve (AUC) 0.688). Inability to breathe spontaneously, presence of chest injury and mental status were most predictive of P1 status. A decision tree model including these three variables exhibited the best test characteristics (sensitivity 73.0%, AUC 0.782), forming the candidate primary tool. The proposed secondary tool (sensitivity 77.9%, AUC 0.817), applicable via a portable device, includes a fourth variable (injury mechanism). This performed favourably on external validation (sensitivity of 97.6%, AUC 0.778) in 5956 JTTR patients. CONCLUSION Novel triage tools developed using ML outperform existing tools in a nationally representative trauma population. The proposed primary tool requires external validation prior to consideration for practical use. The secondary tool demonstrates good external validity and may be used to support decision-making by healthcare workers responding to MIs.
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Affiliation(s)
- Yuanwei Xu
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Science Centre, University of Birmingham, Birmingham B15 2TT, UK
| | - Nabeela Malik
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Saisakul Chernbumroong
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
| | - James Vassallo
- Emergency Department, Derriford Hospital, Plymouth, UK
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B15 2WB, UK
| | - Damian Keene
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Mark Foster
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - Janet Lord
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Antonio Belli
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Douglas Bowley
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Academic Department of Military Surgery & Trauma, Royal Centre for Defence Medicine, Mindelsohn Way, Edgbaston, Birmingham B152WB, UK
| | - George Gkoutos
- Centre for Computational Biology, Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Health Data Science Centre, University of Birmingham, Birmingham B15 2TT, UK
- NIHR Surgical Reconstruction Microbiology Research Centre, Edgbaston, UK
- Institute of Translational Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- MRC Health Data Research UK (HDR UK), Birmingham, UK
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Affiliation(s)
- Jamie Scott
- Emergency Department, Royal London Hospital, Bartshealth NHS trust, London, UK
- Physician Response Unit, Bartshealth NHS Trust, London, UK
| | - Nicholas Moore
- Emergency Department, Bristol Royal Infirmary, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
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van der Merwe J, Tsakpounidou K, Baskini M, Webb C, Keramydas C, Martins SCO, Klinke ME, Proios H. Continuity and Change in Baseline Stroke Knowledge across the world: Second Wave of FAST Heroes campaign implementation. J Stroke Cerebrovasc Dis 2023; 32:107426. [PMID: 37839302 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107426] [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: 04/20/2023] [Revised: 10/07/2023] [Accepted: 10/10/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES In this work we present the results of the implementation of a globally representative educational school-based stroke awareness programme, FAST (Face, Arm, Speech, Time) Heroes during the second year of education (wave 2). We aimed to observe changes in baseline stroke knowledge between wave 1 and wave 2, distinguish the more fine-grained effect of the campaign on society, and evaluate changes before and after the implementation of wave 2. MATERIALS AND METHODS In wave 2, parents of school-aged children completed an online stroke preparedness questionnaire before (t1) and after (t2) programme implementation. Results between the time points were analyzed with descriptive statistics alongside changes in baseline knowledge between waves 1 and 2. RESULTS 1,611 parents participated in wave 2. Parents increased their knowledge of three stroke symptoms from 69% to 87% (p<.001). Their knowledge of the designated emergency number rose from 75% (t1) to 88% (t2) (p<.001). A 17% increase in baseline knowledge occurred in stroke symptoms identified correctly between wave 1 (11 countries) and 2 (18 countries). CONCLUSIONS Results support the precision and usability of the data collection approach in measuring the change in stroke knowledge between implementation waves. The increased baseline knowledge concerning stroke symptoms in wave 2 needs further examination.
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Affiliation(s)
- Jan van der Merwe
- Boehringer Ingelheim International Gesellschaft mit Beschränkter Haftung (GmbH), Healthcare Affairs and Patient Engagement, Ingelheim am Rhein, Germany; Department of Educational and Social Policy, University of Macedonia, Egnatia Str 156, Thessaloniki, 54636, Greece.
| | - Kalliopi Tsakpounidou
- Department of Educational and Social Policy, University of Macedonia, Egnatia Str 156, Thessaloniki, 54636, Greece.
| | - Maria Baskini
- Department of Educational and Social Policy, University of Macedonia, Egnatia Str 156, Thessaloniki, 54636, Greece.
| | - Chris Webb
- Twelve, 3 Liverpool Gardens, Worthing, West Sussex, England.
| | - Christos Keramydas
- Department of Supply Chain Management, International Hellenic University, Kanellopoulou Str 2, Katerini, 60100, Greece.
| | - Sheila Cristina Ouriques Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento, Neurology, Rua Ramiro Barcelos, 2350, Av. Protásio Alves, 211 - Santa Cecília, Porto Alegre, RS, 90035-903, Brazil.
| | - Marianne Elisabeth Klinke
- Faculty of Nursing, School of Health Sciences, University of Iceland, Eirberg, Eiríksgötu 34, 107, Reykjavik, Iceland.
| | - Hariklia Proios
- Department of Educational and Social Policy, University of Macedonia, Egnatia Str 156, Thessaloniki, 54636, Greece.
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Spina S, Gianquintieri L, Marrazzo F, Migliari M, Sechi GM, Migliori M, Pagliosa A, Bonora R, Langer T, Caiani EG, Fumagalli R. Detection of patients with COVID-19 by the emergency medical services in Lombardy through an operator-based interview and machine learning models. Emerg Med J 2023; 40:810-820. [PMID: 37775256 DOI: 10.1136/emermed-2022-212853] [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: 09/19/2022] [Accepted: 08/24/2023] [Indexed: 10/01/2023]
Abstract
BACKGROUND The regional emergency medical service (EMS) in Lombardy (Italy) developed clinical algorithms based on operator-based interviews to detect patients with COVID-19 and refer them to the most appropriate hospitals. Machine learning (ML)-based models using additional clinical and geospatial epidemiological data may improve the identification of infected patients and guide EMS in detecting COVID-19 cases before confirmation with SARS-CoV-2 reverse transcriptase PCR (rtPCR). METHODS This was an observational, retrospective cohort study using data from October 2020 to July 2021 (training set) and October 2021 to December 2021 (validation set) from patients who underwent a SARS-CoV-2 rtPCR test within 7 days of an EMS call. The performance of an operator-based interview using close contact history and signs/symptoms of COVID-19 was assessed in the training set for its ability to determine which patients had an rtPCR in the 7 days before or after the call. The interview accuracy was compared with four supervised ML models to predict positivity for SARS-CoV-2 within 7 days using readily available prehospital data retrieved from both training and validation sets. RESULTS The training set includes 264 976 patients, median age 74 (IQR 55-84). Test characteristics for the detection of COVID-19-positive patients of the operator-based interview were: sensitivity 85.5%, specificity 58.7%, positive predictive value (PPV) 37.5% and negative predictive value (NPV) 93.3%. Contact history, fever and cough showed the highest association with SARS-CoV-2 infection. In the validation set (103 336 patients, median age 73 (IQR 50-84)), the best-performing ML model had an AUC of 0.85 (95% CI 0.84 to 0.86), sensitivity 91.4% (95 CI% 0.91 to 0.92), specificity 44.2% (95% CI 0.44 to 0.45) and accuracy 85% (95% CI 0.84 to 0.85). PPV and NPV were 13.3% (95% CI 0.13 to 0.14) and 98.2% (95% CI 0.98 to 0.98), respectively. Contact history, fever, call geographical distribution and cough were the most important variables in determining the outcome. CONCLUSION ML-based models might help EMS identify patients with SARS-CoV-2 infection, and in guiding EMS allocation of hospital resources based on prespecified criteria.
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Affiliation(s)
- Stefano Spina
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
- Department of Anesthesia, Critical Care and Pain Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Lorenzo Gianquintieri
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
- Electronics, Information and Biomedical Engineering Department, Politecnico di Milano, Milano, Italy
| | - Francesco Marrazzo
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
- Department of Anesthesia, Critical Care and Pain Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Maurizio Migliari
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
- Department of Anesthesia, Critical Care and Pain Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | | | | | - Andrea Pagliosa
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
| | - Rodolfo Bonora
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
| | - Thomas Langer
- Department of Anesthesia, Critical Care and Pain Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
| | - Enrico Gianluca Caiani
- Electronics, Information and Biomedical Engineering Department, Politecnico di Milano, Milano, Italy
| | - Roberto Fumagalli
- SOREU, Agenzia Regionale Emergenza Urgenza (AREU), Milano, Italy
- Department of Anesthesia, Critical Care and Pain Medicine, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
- Department of Medicine and Surgery, University of Milan-Bicocca, Monza, Italy
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10
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Marzec L, Skotnicka-Klonowicz G, Sikora JP. Pain management in children with burns before admission to the ward: Analysis of selected parts of pre-hospital medical records. ADV CLIN EXP MED 2023; 32:1311-1317. [PMID: 37999637 DOI: 10.17219/acem/174814] [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: 04/05/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND The extent of pre-hospital medical care (PHMC) given to burned patients affects both the patient's condition and the effectiveness of treatment. OBJECTIVES To improve the quality of PHMC of burns in children, based upon an analysis of the selected parts of pre-hospital medical records, with particular emphasis on analgesia. MATERIAL AND METHODS Medical records were used to analyze how PHMC was given to 117 burned children aged 0-18 years, treated at the Pediatric Surgery Ward between January 1, 2014 and December 31, 2017. RESULTS In 41/85 cases, PHMC was delivered by Emergency Medical Teams (EMTs), in 42 in Emergency/Admission Rooms (ARs) and in 2 by Primary Health Care (PHC). Monotherapy was predominant. Medical records from ARs included the following information: the administration of analgesics with the name in 95% (21) of the cases, the route of drug administration in 45% (10), insertion of intravenous access and dressing in 33% (14), and fluid transfusion in 43% (6) cases. The way in which the EMTs provided assistance was described in 34% (14/41) of medical records, the administration of analgesics in 86% (12) cases, cooling and dressing in 43% (6), and the establishment of intravenous access with fluid transfusion in 36% (5) cases. CONCLUSION In burned children, access to analgesic and combined pain therapy is still random, limited and deviates from current recommendations. Prior to the admission to the ward, pain relief with 1 agent administered rectally prevails. There is a need to standardize the procedures for pre-hospital medical assistance provided to burned children, including the method of pain management in line with the Polish recommendations. It is necessary to make the medical staff aware of the obligation to keep medical records in a reliable and legal manner.
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Affiliation(s)
- Leszek Marzec
- Faculty of Medical and Health Sciences, State Vocational University of prof. Stanisław Tarnowski, Tarnobrzeg, Poland
| | | | - Janusz P Sikora
- Department of Pediatric Emergency Medicine, 2nd Chair of Pediatrics, Central Clinical Hospital, Medical University of Lodz, Poland
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11
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Goodacre S, Sutton L, Thomas B, Hawksworth O, Iftikhar K, Croft S, Fuller G, Waterhouse S, Hind D, Bradburn M, Smyth MA, Perkins GD, Millins M, Rosser A, Dickson JM, Wilson MJ. Prehospital early warning scores for adults with suspected sepsis: retrospective diagnostic cohort study. Emerg Med J 2023; 40:768-776. [PMID: 37673643 PMCID: PMC10646863 DOI: 10.1136/emermed-2023-213315] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/18/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND Ambulance services need to identify and prioritise patients with sepsis for early hospital assessment. We aimed to determine the accuracy of early warning scores alongside paramedic diagnostic impression to identify sepsis that required urgent treatment. METHODS We undertook a retrospective diagnostic cohort study involving adult emergency medical cases transported to Sheffield Teaching Hospitals ED by Yorkshire Ambulance Service in 2019. We used routine ambulance service data to calculate 21 early warning scores and categorise paramedic diagnostic impressions as sepsis, infection, non-specific presentation or other presentation. We linked cases to hospital records and identified those meeting the sepsis-3 definition who received urgent hospital treatment for sepsis (reference standard). Analysis determined the accuracy of strategies that combined early warning scores at varying thresholds for positivity with paramedic diagnostic impression. RESULTS We linked 12 870/24 955 (51.6%) cases and identified 348/12 870 (2.7%) with a positive reference standard. None of the strategies provided sensitivity greater than 0.80 with positive predictive value greater than 0.15. The area under the receiver operating characteristic curve for the National Early Warning Score, version 2 (NEWS2) applied to patients with a diagnostic impression of sepsis or infection was 0.756 (95% CI 0.729, 0.783). No other early warning score provided clearly superior accuracy to NEWS2. Paramedic impression of sepsis or infection had sensitivity of 0.572 (0.519, 0.623) and positive predictive value of 0.156 (0.137, 0.176). NEWS2 thresholds of >4, >6 and >8 applied to patients with a diagnostic impression of sepsis or infection, respectively, provided sensitivities and positive predictive values of 0.522 (0.469, 0.574) and 0.216 (0.189, 0.245), 0.447 (0.395, 0.499) and 0.274 (0.239, 0.313), and 0.314 (0.268, 0.365) and 0.333 (0.284, 0.386). CONCLUSION No strategy is ideal but using NEWS2 alongside paramedic diagnostic impression of infection or sepsis could identify one-third to half of sepsis cases without prioritising unmanageable numbers. No other score provided clearly superior accuracy to NEWS2. TRIAL REGISTRATION NUMBER researchregistry5268, https://www.researchregistry.com/browse-the-registry%23home/registrationdetails/5de7bbd97ca5b50015041c33/.
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Affiliation(s)
- Steve Goodacre
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Laura Sutton
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Ben Thomas
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Olivia Hawksworth
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | | | - Susan Croft
- Emergency Department, Northern General Hospital, Sheffield, UK
| | - Gordon Fuller
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Simon Waterhouse
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Daniel Hind
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Mike Bradburn
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | | | | | - Mark Millins
- Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Andy Rosser
- West Midlands Ambulance Service, West Midlands, UK
| | - Jon M Dickson
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
| | - Matthew Joseph Wilson
- Sheffield Centre for Health and Related Research (SCHARR), The University of Sheffield, Sheffield, UK
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12
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Hong Tuan Ha V, Jost D, Bougouin W, Joly G, Jouffroy R, Jabre P, Beganton F, Derkenne C, Lemoine S, Frédéric L, Lamhaut L, Loeb T, Revaux F, Dumas F, Trichereau J, Stibbe O, Deye N, Marijon E, Cariou A, Jouven X, Travers S. Trends in survival from out-of-hospital cardiac arrest with a shockable rhythm and its association with bystander resuscitation: a retrospective study. Emerg Med J 2023; 40:761-767. [PMID: 37640438 DOI: 10.1136/emermed-2023-213220] [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: 03/08/2023] [Accepted: 08/18/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVE Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Despite decades of investment and research, survival remains disappointingly low. We report the trends in survival after a ventricular fibrillation/pulseless ventricular tachycardia OHCA, over a 13-year period, in a French urban region, and describe the simultaneous evolution of the rescue system. METHODS We investigated four 18-month periods between 2005 and 2018. The first period was considered baseline and included patients from the randomised controlled trial 'DEFI 2005'. The three following periods were based on the Paris Sudden Death Expertise Center Registry (France). Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team. Primary outcome was survival at hospital discharge with a good neurological outcome. RESULTS Of 21 781 patients under consideration, 3476 (16%) met the inclusion criteria. Over all study periods, survival at hospital discharge increased from 12% in 2005 to 25% in 2018 (p<0.001), and return of spontaneous circulation at hospital admission increased from 43% to 58% (p=0.004).Lay-rescuer cardiopulmonary resuscitation (CPR) and telephone CPR (T-CPR) rates increased significantly, but public defibrillator use remained limited. CONCLUSION In a two-tiered rescue system, survival from OHCA at hospital discharge doubled over a 13-year study period. Concomitantly, the system implemented an OHCA patient registry and increased T-CPR frequency, despite a consistently low rate of public defibrillator use.
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Affiliation(s)
- Vivien Hong Tuan Ha
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Daniel Jost
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Wulfran Bougouin
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Guillaume Joly
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Romain Jouffroy
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
- Service de médecine intensive et réanimation, Hôpital Universitaire Ambroise Paré, Assistance Publique-Hopitaux de Paris, Paris, France
| | - Patricia Jabre
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- SAMU de Paris, Necker Hospital, Paris, France
| | - Frankie Beganton
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
| | - Clément Derkenne
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Sabine Lemoine
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Lemoine Frédéric
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Lionel Lamhaut
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- SAMU de Paris, Necker Hospital, Paris, France
| | - Thomas Loeb
- SAMU 92 - Prehospital Emergency Department, Hôpital Raymond-Poincare, Garches, France
| | - François Revaux
- SAMU 94, Assistance Publique-Hopitaux de Paris, Créteil, France
| | - Florence Dumas
- Sudden Death Expertise Center, INSERM U970, Paris Cardiovascular Research Center (PARCC), Paris, France
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Julie Trichereau
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Olivier Stibbe
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
| | - Nicolas Deye
- Intensive Care Unit, Lariboisière Hospital, Paris, France
- Inserm U942, Sorbonne Paris Nord University, Paris, France
| | - Eloi Marijon
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Alain Cariou
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Xavier Jouven
- Paris Descartes-Sorbonne Cité University, Paris, France
| | - Stephane Travers
- Prehospital Emergency Medicine Department, Paris Fire Brigade, Paris, France
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13
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Cohen N, Cohen DM, Barbi E, Shavit I. Analgesia and Sedation of Pediatric Patients with Major Trauma in Pre-Hospital and Emergency Department Settings-A Narrative Review. J Clin Med 2023; 12:5260. [PMID: 37629302 PMCID: PMC10455791 DOI: 10.3390/jcm12165260] [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: 06/20/2023] [Revised: 07/18/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Children who sustain major injuries are at risk of receiving insufficient pain relief and sedation, which can have physical and psychological repercussions. Heightened emotional distress can increase the likelihood of developing symptoms of post-traumatic stress. Providing sufficient analgesia and sedation for children with major trauma presents specific challenges, given the potential for drug-related adverse events, particularly in non-intubated patients. The current literature suggests that a relatively low percentage of pediatric patients receive adequate analgesia in pre-hospital and emergency department settings following major trauma. There are only sparse data on the safety of the provision of analgesia and sedation in children with major trauma in the pre-hospital and ED settings. The few studies that examined sedation protocols in this context highlight the importance of physician training and competency in managing pediatric airways. There is a pressing need for prospective studies that focus upon pediatric major trauma in the pre-hospital and emergency department setting to evaluate the benefits and risks of administering analgesia and sedation to these patients. The aim of this narrative review was to offer an updated overview of analgesia and sedation management in children with major trauma in pre-hospital and ED settings.
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Affiliation(s)
- Neta Cohen
- Pediatric Emergency Medicine Department, Dana Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman St, Tel Aviv 6423906, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Daniel M. Cohen
- Nationwide Children’s Hospital, The Ohio State University, Columbus, OH 43210, USA;
| | - Egidio Barbi
- Department of Pediatrics, Institute for Maternal and Child Health—IRCCS Burlo Garofolo, 34137 Trieste, Italy;
- Clinical Department of Medical Surgical and Health Science, University of Trieste, 34127 Trieste, Italy
| | - Itai Shavit
- Division of Pediatrics, Hadassah Medical Center, Jerusalem 9112001, Israel;
- Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem 9112102, Israel
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14
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Ramage L, McLachlan S. Top research priorities in prehospital critical care. Emerg Med J 2023; 40:536-537. [PMID: 36898825 DOI: 10.1136/emermed-2023-213120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Lisa Ramage
- Emergency Department, Addenbrooke's Hospital, Cambridge, Cambridgeshire, UK
- MAGPAS Air Ambulance, Huntingdon, Cambridgeshire, UK
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, UK
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Earls Colne, Colchester, Essex, UK
- Anglia Ruskin University, Chelmsford, Essex, UK
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15
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Hodkinson ME. Top research priorities in prehospital critical care. Emerg Med J 2023; 40:536. [PMID: 36898824 DOI: 10.1136/emermed-2023-213116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
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16
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Ramage L, McLachlan S, Williams K. Determining the top research priorities in UK prehospital critical care: a modified Delphi study. Emerg Med J 2023; 40:271-276. [PMID: 36650041 PMCID: PMC10086275 DOI: 10.1136/emermed-2022-212622] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 05/30/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prehospital critical care is a rapidly evolving field. There is a paucity of evidence relating to its practice, with limited progress in answering those research questions identified over a decade ago. It is vital that evidence gaps are identified and addressed. This study aimed to define the current research priorities in UK prehospital critical care. METHODS This modified national Delphi study was coordinated by the Pre-HOspital Trainee Operated research Network and conducted in four rounds between October 2021 and April 2022. Rounds 1 and 2 were conducted online with clinicians involved in prehospital critical care delivery and non-clinical prehospital researchers. Rounds 3 and 4 were completed online by a subject matter expert (SME) panel. RESULTS In round 1, 78 participants submitted 394 research questions relating to prehospital critical care delivery in the UK. These were refined and categorised into 192 questions, which were scored for importance in round 2. Fifty questions were discussed and scored by the SME panel in round 3. Round 4 created a ranked top 20 list. The top research priority was 'Which cardiac arrest patients should critical care teams be dispatched to; how do we identify these patients during the emergency call?'. Other priorities included dispatch optimisation, out-of-hospital medical cardiac arrest management, optimising resuscitation in haemorrhagic shock, improving traumatic brain injury outcomes and optimising management of traumatic cardiac arrest. CONCLUSIONS This modified Delphi study identified 20 research priorities where efforts should be concentrated to develop collaborative prehospital critical care research within the UK over the next 5 years.
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Affiliation(s)
- Lisa Ramage
- Pre-Hospital Trainee Operated Research Network (PHOTON), London, UK
- Essex and Herts Air Ambulance, Earls Colne, Colchester, UK
| | - Sarah McLachlan
- Essex and Herts Air Ambulance, Earls Colne, Colchester, UK
- Anglia Ruskin University, Chelmsford, UK
| | - Kristian Williams
- Welsh Ambulance Services NHS Trust, Saint Asaph, UK
- Bangor University, Bangor, UK
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17
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Butterfield M, Bodnar D, Williamson F, Parker L, Ryan G. Prevalence of secondary insults and outcomes of patients with traumatic brain injury intubated in the prehospital setting: a retrospective cohort study. Emerg Med J 2023; 40:167-174. [PMID: 36604161 PMCID: PMC9985756 DOI: 10.1136/emermed-2022-212513] [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: 04/10/2022] [Accepted: 12/21/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Prehospital neuroprotective strategies aim to prevent secondary insults (SIs) in traumatic brain injury (TBI). This includes haemodynamic optimisation in addition to oxygenation and ventilation targets achieved through rapid sequence intubation (RSI).The primary aim was to report the incidence and prevalence of SIs (prolonged hypotension, prolonged hypoxia and hyperventilation) and outcomes of patients with TBI who were intubated in the prehospital setting. METHODS A retrospective cohort study of adult patients with TBI who underwent RSI by a metropolitan road-based service in South-East Queensland, Australia between 1 January 2017 and 31 December 2020. Patients were divided into two cohorts based on the presence or absence of any SI sustained. Prolonged SIs were defined as occurring for ≥5 min. The association between SIs and mortality was examined in multivariable logistic regression and reported with adjusted ORs (aORs) and 95% CIs. RESULTS 277 patients were included for analysis. Median 'Head' Abbreviated Injury Scale and Injury Severity Score were 4 (IQR: 3-5) and 26 (IQR: 17-34), respectively. Most episodes of prolonged hypotension and prolonged hypoxia were detected with the first patient contact on scene. Overall, 28-day mortality was 26%. Patients who sustained any SI had a higher mortality than those sustaining no SI (34.9% vs 14.7%, p<0.001). Prolonged hypoxia was an independent predictor of mortality (aOR 4.86 (95% CI 1.65 to 15.61)) but not prolonged hypotension (aOR 1.45 (95% CI 0.5 to 4.25)) or an end-tidal carbon dioxide <30 mm Hg on hospital arrival (aOR 1.28 (95% CI 0.5 to 3.21)). CONCLUSION SIs were common in the early phase of prehospital care. The association of prolonged hypoxia and mortality in TBI is potentially more significant than previously recognised, and if corrected early, may improve outcomes. There may be a greater role for bystander intervention in prevention of early hypoxic insult in TBI.
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Affiliation(s)
- Michael Butterfield
- Emergency Department, Logan Hospital, Meadowbrook, Queensland, Australia .,LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia
| | - Daniel Bodnar
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Frances Williamson
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia.,The University of Queensland, Brisbane, Queensland, Australia
| | - Lachlan Parker
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Glenn Ryan
- Queensland Ambulance Service, Brisbane, Queensland, Australia.,Emergency Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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18
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Krammel M, Drahohs V, Hamp T, Lemoyne S, Grassmann D, Schreiber W, Sulzgruber P, Schnaubelt S. The Epidemiology of Pre-Hospital EMS Treatment of Geriatric Patients in the City of Vienna-An Overview. J Clin Med 2023; 12:jcm12020643. [PMID: 36675572 PMCID: PMC9865411 DOI: 10.3390/jcm12020643] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
Background: The city of Vienna, Austria, has a gradually aging population. Elderly people, over 65 years old and living at home or in nursing homes, frequently use Emergency Medical Services (EMS). However, there is no previous data comparing the EMS utilization of elderly- and non-elderly patients in Vienna. Methods: We retrospectively analyzed all EMS incidents in Vienna from 2012 to 2019. Transport- and emergency physician treatment rates, annual fluctuations, and the number of non-transports were compared between elderly (≥65 years) and non-elderly (18−64 years) patients. Results: Elderly people accounted for 42.6% of the total EMS responses in adult patients, representing an annual response rate of 223 per 1000 inhabitants ≥ 65 years. Compared to 76 per 1000 inhabitants in patients 18−64 years old, this results in an incidence rate ratio (IRR) of 2.93 [2.92−2.94]. Elderly people were more likely (OR 1.68 [1.65−1.70]) to need emergency physicians, compared to 18−64 year-olds. Nursing home residents were twice (OR 2.11 [2.06−2.17]) as likely to need emergency physicians than the rest of the study group. Non-transports were more likely to occur in patients over 65 years than in non-elderlies (14% vs. 12%, p < 0.001). Conclusions: The elderly population ≥ 65 years in Vienna shows higher EMS response rates than younger adults. They need emergency physicians more often, especially when residing in nursing homes. The economical and organizational strain this puts on the emergency response system should trigger further research and the development of solutions, such as specific response units dedicated to elderly people.
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Affiliation(s)
- Mario Krammel
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Valentin Drahohs
- Department of Anaesthesiology and Critical Care Medicine, Hospital St. Poelten, 3100 St. Poelten, Austria
| | - Thomas Hamp
- Emergency Medical Service, 1030 Vienna, Austria
- Department of Anaesthesiology, General Intensive Care Medicine, and Pain Therapy, Medical University of Vienna, 1090 Vienna, Austria
| | - Sabine Lemoyne
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
| | - Daniel Grassmann
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Emergency Medical Service, 1030 Vienna, Austria
| | - Wolfgang Schreiber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Patrick Sulzgruber
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
| | - Sebastian Schnaubelt
- Austrian Cardiac Arrest Awareness Association (PULS), 1090 Vienna, Austria
- Department of Emergency Medicine, Antwerp University Hospital, 2650 Edegem, Belgium
- Department of Emergency Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence:
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19
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Martín-Conty JL, Polonio-López B, Sanz-García A, del Pozo Vegas C, Mordillo-Mateos L, Bernal-Jiménez JJ, Conty-Serrano R, Castro Villamor MA, López-Izquierdo R, Martín-Rodríguez F. COVID-19 as a risk factor for long-term mortality in patients managed by the emergency medical system: A prospective, multicenter, ambulance-based cohort study. Front Public Health 2023; 10:1076627. [PMID: 36703850 PMCID: PMC9871910 DOI: 10.3389/fpubh.2022.1076627] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/15/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction COVID-19 has initially been studied in terms of an acute-phase disease, although recently more attention has been given to the long-term consequences. In this study, we examined COVID-19 as an independent risk factor for long-term mortality in patients with acute illness treated by EMS (emergency medical services) who have previously had the disease against those who have not had the disease. Methods A prospective, multicenter, ambulance-based, ongoing study was performed with adult patients with acute disease managed by EMS and transferred with high priority to the emergency department (ED) as study subjects. The study involved six advanced life support units, 38 basic life support units, and five emergency departments from Spain. Sociodemographic inputs, baseline vital signs, pre-hospital blood tests, and comorbidities, including COVID-19, were collected. The main outcome was long-term mortality, which was classified into 1-year all-cause mortality and 1-year in- and out-of-hospital mortality. To compare both the patients with COVID-19 vs. patients without COVID-19 and to compare survival vs non-survival, two main statistical analyses were performed, namely, a longitudinal analysis (Cox regression) and a logistic regression analysis. Results Between 12 March 2020 and 30 September 2021, a total of 3,107 patients were included in the study, with 2,594 patients without COVID-19 and 513 patients previously suffering from COVID-19. The mortality rate was higher in patients with COVID-19 than in patients without COVID-19 (31.8 vs. 17.9%). A logistic regression showed that patients previously diagnosed with COVID-19 presented higher rates of nursing home residency, a higher number of breaths per minute, and suffering from connective disease, dementia, and congestive heart failure. The longitudinal analysis showed that COVID-19 was a risk factor for mortality [hazard ratio 1.33 (1.10-1.61); p < 0.001]. Conclusion The COVID-19 group presented an almost double mortality rate compared with the non-COVID-19 group. The final model adjusted for confusion factors suggested that COVID-19 was a risk factor for long-term mortality.
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Affiliation(s)
- José L. Martín-Conty
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Begoña Polonio-López
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Technological Innovation Applied to Health Research Group (ITAS), Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
| | - Ancor Sanz-García
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain,Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,*Correspondence: Ancor Sanz-García ✉
| | - Carlos del Pozo Vegas
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Emergency Department, Hospital Clínico Universitario, Valladolid, Spain
| | - Laura Mordillo-Mateos
- Faculty of Health Sciences, Universidad de Castilla-la Mancha, Talavera de la Reina, Spain
| | | | | | - Miguel A. Castro Villamor
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain
| | - Raúl López-Izquierdo
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Emergency Department, Hospital Universitario Rio Hortega, Valladolid, Spain
| | - Francisco Martín-Rodríguez
- Prehospital Early Warning Scoring-System Investigation Group, Valladolid, Spain,Faculty of Medicine, Universidad de Valladolid, Valladolid, Spain,Advanced Life Support, Emergency Medical Services (SACYL), Valladolid, Spain
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20
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Nehme E, Nehme Z, Cox S, Smith K. Outcomes of paediatric patients who are not transported to hospital by Emergency Medical Services: a data linkage study. J Accid Emerg Med 2023; 40:12-19. [PMID: 36202623 DOI: 10.1136/emermed-2022-212350] [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: 01/24/2022] [Accepted: 09/24/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Data on the safety of non-transport decisions for paediatric patients attended by Emergency Medical Services (EMS) are lacking. We describe the characteristics and outcomes of paediatric non-transported patients in Victoria, Australia. METHODS A retrospective data linkage study of consecutive paediatric (aged <18 years) non-transported patients between January 2015 and June 2019. Patients were linked to ED, hospital admission and death records. Multivariable logistic regression analyses were used to determine factors associated with EMS recontact, ED presentation, hospital admission and an adverse event (death/cardiac arrest, intensive care unit admission or highest ED triage category) within 48 hours of the initial emergency call. RESULTS In total, 62 975 non-transported patients were included. The mean age was 7.1 (SD 6.0) years and 48.9% were male. Overall, 2.2% recontacted the EMS within 48 hours, 13.7% self-presented to a public ED, 2.4% were admitted to hospital and 0.1% had an adverse event, including two deaths. Among patients with paramedic-initiated non-transport (excluding transport refusals and transport via other means), 5.6% presented to a public ED, 1.1% were admitted to hospital and 0.05% had an adverse event. In the overall population, an abnormal vital sign on initial assessment increased the odds of hospital admission and an adverse event. Among paramedic-initiated non-transports, cases occurring in the early hours of the morning (04:00-08:00 hours) were associated with increased odds of subsequent hospital admission, while the odds of ED presentation and hospital admission also increased with increasing prior exposure to non-transported cases. CONCLUSION Adverse events were rare among paramedic-initiated non-transport cases. Vital sign derangements and attendance by paramedics with higher prior exposure to non-transports were associated with poorer outcomes and may be used to improve safety.
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Affiliation(s)
- Emily Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia .,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Ziad Nehme
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Paramedicine, Monash University, Clayton, Victoria, Australia
| | - Shelley Cox
- Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Karen Smith
- Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.,Department of Paramedicine, Monash University, Clayton, Victoria, Australia
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21
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Scott J, Khanom A, Straw J, Strickland A, Porter A, Snooks H. Paediatric frequent use of emergency medical services: a systematic review. Emerg Med J 2022; 40:emermed-2021-211701. [PMID: 36600465 DOI: 10.1136/emermed-2021-211701] [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: 05/25/2021] [Accepted: 10/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Frequent use of emergency medical services (EMS) is recognised to be a global phenomenon, although paediatric frequent use is poorly understood. This systematic review aimed to understand how paediatric frequent use of EMS is currently defined, identify factors associated with paediatric frequent use of EMS and determine effectiveness of interventions for paediatric patients who frequently use EMS. METHODS Four electronic databases (Medline, CINAHL, Web of Science and PsycINFO) were searched to September 2022 for primary, peer-reviewed research studies published in English from January 2000. Studies were included that examined frequent use (>1 contact during study period) of EMS or other services with arrival via EMS. Paediatric patients were defined as <18 years of age or otherwise defined by study authors as paediatric/adolescent/children. Data were extracted using a structured proforma, and quality was assessed using the Standard Quality Assessment Criteria for Quantitative Studies but did not influence inclusion decisions. Data were presented using narrative synthesis. RESULTS The search resulted in 4172 unique references, with 12 papers included in the review from 7 countries. Four were EMS studies, and eight Emergency Department with arrival via EMS. All studies used retrospective designs, with no interventional studies identified. Paediatric frequent EMS users were more likely to use services for medical reasons rather than trauma, including respiratory complaints, mental health and seizures, but data on gender and ethnicity were inconclusive and silent on socioeconomic status. There was no consistency in definitions of either a paediatric patient or of frequent use. CONCLUSION The broad range of reasons for frequent use suggests that a single intervention is unlikely to be effective at addressing the causes of frequent use. There is a need for further research to better identify the underlying reasons for frequent EMS use among paediatric patients and to develop interventions in this population.
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Affiliation(s)
- Jason Scott
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | | | - Joanne Straw
- Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Annette Strickland
- Emergency Operations Centre, Yorkshire Ambulance Service NHS Trust, Wakefield, UK
| | - Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
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22
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Sampson FC, Bell F, Coster JE, Miller E, Easom N. Stakeholder perspectives of piloting pre-hospital COVID-19 lateral flow testing and direct admissions pathway: exploring why well-received ideas have low uptake. Br Paramed J 2022; 7:15-25. [PMID: 36531798 PMCID: PMC9730192 DOI: 10.29045/14784726.2022.12.7.3.15] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023] Open
Abstract
Introduction In January 2021, Yorkshire Ambulance Service and Hull University Teaching Hospitals implemented a pilot COVID-19 lateral flow testing (LFT) and direct admissions pathway to assess the feasibility of using pre-hospital LFTs to bypass the emergency department. Due to lower than anticipated uptake of the pilot among paramedics, we undertook a process evaluation to assess reasons for low uptake and perceived potential benefits and risks associated with the pilot. Methods We undertook semi-structured telephone interviews with 12 paramedics and hospital staff. We aimed to interview paramedics who had taken part in the pilot, those who had received the project information but not taken part and ward staff receiving patients from the pilot. We transcribed interviews verbatim and analysed data using thematic analysis. Results Participation in the pilot appeared to be positively influenced by high personal capacity for undertaking research (being 'research-keen') and negatively influenced by 'COVID-19 exhaustion', electronic information overload and lack of time for training. Barriers to use of the pathway related to 'poor timing' of the pilot, restrictive patient eligibility and inclusion criteria. The rapid rollout meant that paramedics had limited knowledge or awareness of the pilot, and pilot participants reported poor understanding of the pilot criteria or the rationale for the criteria. Participants who were involved in the pilot were overwhelmingly positive about the intervention, which they perceived as having limited risks and high potential benefits to the health service, patients and themselves, and supported future roll-out. Conclusions Ambulance clinician involvement in rapid research pilots may be improved by using multiple recruitment methods (electronic and other), providing protected time for training and increased direct support for paramedics with lower personal capacity for research. Improved communication (including face-to-face approaches) may help understanding of eligibility criteria and increase appropriate recruitment.
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Affiliation(s)
- Fiona C Sampson
- University of Sheffield ORCID iD: https://orcid.org/0000-0003-2321-0302
| | - Fiona Bell
- Yorkshire Ambulance Service NHS Trust ORCID iD: https://orcid.org/0000-0003-4503-1903
| | - Joanne E Coster
- University of Sheffield ORCID iD: https://orcid.org/0000-0002-0599-4222
| | | | - Nicholas Easom
- Hull University Teaching Hospital NHS Trust ORCID iD: https://orcid.org/0000-0001-6413-919X
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23
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Aengst J, Walker-Stevenson G, Harrod T, Ivankovic J, Neilson J, Guise JM. Uncomfortable yet necessary: The impact of PPE on communication in emergency medicine. Int J Qual Health Care 2022; 34:6854825. [PMID: 36448555 PMCID: PMC9782918 DOI: 10.1093/intqhc/mzac095] [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: 06/21/2022] [Revised: 11/09/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The efficacy of pre-hospital emergency services is heavily dependent on the effective communication of care providers. This effective communication occurs between providers as part of a team and also among providers interacting with family members and patients. The COVID-19 pandemic introduced a number of communication challenges to emergency care, which are primarily linked to the increased use of personal protective equipment (PPE). OBJECTIVE We sought to analyze the impacts of the COVID-19 pandemic on emergency medical service (EMS) workers and pre-hospital care delivery. METHODS We conducted focus groups and one-on-one interviews with fire-based EMS first responders between September 2021 and 2022. Interviews included questions about job-related stress, EMS skills, work experiences and changes during COVID-19. Interviews were recorded, independently dual coded and analyzed for themes. RESULTS Two hundred twenty-three first responders participated in 40 focus groups and 40 lead paramedics participated in individual interviews. We found that additional use of PPE was reported to have significantly impaired efficiency and perceptions of quality of care-among EMS team members and also between EMS workers and patients. EMS personnels also experienced on-scene hostility on arrival (from both families and other agencies). Extensive use of PPE muffles voices, obscures facial expressions and can cause team members to have difficulty recognizing and communicating with one another and can be a barrier to showing empathy and connecting with patients. Creative solutions such as putting a hand on someone's shoulder, wearing name tags on suits and explaining rationale for perceived delays were mentioned as methods to transcend these barriers. The appearance of providers in heavy PPE can be unsettling and create barriers to human connection, particularly for pediatric patients. CONCLUSION Human connection is an important element of health-care delivery and healing. These findings shed light on new skills that are needed to initiate and maintain human connection in these times of PPE use, especially full-body PPE. Awareness of the communication and empathy barriers posed by PPE is the first step to improving provider-patient interactions in pre-hospital EMS. Additionally, 'communication-friendly' adaptations of PPE equipment may be an important area for future research and development in manufacturing and the health-care industry.
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Affiliation(s)
- Jennifer Aengst
- Department of Anthropology, Portland State University, P.O. Box 751, Portland, OR 97207, USA
| | - Grace Walker-Stevenson
- Address reprint requests to: Grace Walker-Stevenson, Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA. Tel: +503-494-3666; Fax: +503-494-2391; E-mail:
| | - Tabria Harrod
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jonathan Ivankovic
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jacob Neilson
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239, USA
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24
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Shibahashi K, Kawabata H, Sugiyama K, Hamabe Y. Association of the COVID-19 pandemic with bystander cardiopulmonary resuscitation for out-of-hospital cardiac arrest: a population-based analysis in Tokyo, Japan. Emerg Med J 2022; 39:emermed-2021-212212. [PMID: 35705365 PMCID: PMC9240453 DOI: 10.1136/emermed-2021-212212] [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: 12/01/2021] [Accepted: 05/22/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND The impact of the COVID-19 pandemic on bystander cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) is unclear. This study aimed to investigate whether rates of bystander CPR and patient outcomes changed during the initial state of emergency declared in Tokyo for the COVID-19 pandemic. METHODS This retrospective study used data from a population-based database of OHCA maintained by the Tokyo Fire Department. By comparing data from the periods before (18 February to 6 April 2020) and during the declaration of a state of emergency (7 April 2020 to 25 May 2020), we estimated the change in bystander CPR rate, prehospital return of spontaneous circulation, and survival and neurological outcomes 1 month after OHCA, accounting for outcome trends in 2019. We performed a multivariate regression analysis to evaluate the potential mechanisms for associations between the state of emergency and these outcomes. RESULTS The witnessed arrest rates before and after the declaration periods in 2020 were 42.5% and 45.1%, respectively, compared with 44.1% and 44.7% in the respective corresponding periods in 2019. The difference between the two periods in 2020 was not statistically significant when the trend in 2019 was considered. The bystander CPR rates before and after the declaration periods significantly increased from 34.4% to 43.9% in 2020, an 8.3% increase after adjusting for the trend in 2019. This finding was significant even after adjusting for patient and bystander characteristics and the emergency medical service response. There were no significant differences between the two periods in the other study outcomes. CONCLUSION The COVID-19 pandemic was associated with an improvement in the bystander CPR rate in Tokyo, while patient outcomes were maintained. Pandemic-related changes in patient and bystander characteristics do not fully explain the underlying mechanism; there may be other mechanisms through which the community response to public emergency increased during the pandemic.
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Affiliation(s)
- Keita Shibahashi
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | | | - Kazuhiro Sugiyama
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
| | - Yuichi Hamabe
- Tertiary Emergency Medical Center, Metropolitan Bokutoh Hospital, Sumida-ku, Tokyo, Japan
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25
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Peel M. Acute behavioural disturbance: recognition, assessment and management. Emerg Nurse 2022; 30:e2126. [PMID: 35357781 DOI: 10.7748/en.2022.e2126] [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] [Accepted: 02/08/2022] [Indexed: 11/09/2022]
Abstract
Acute behavioural disturbance (ABD) is a clinical emergency which typically affects overweight men in their mid-thirties who chronically misuse illicit stimulants. People with ABD are most likely to be seen in police custody or emergency departments, therefore nurses working in these areas must be able to recognise the signs and symptoms and know how to respond appropriately. Presentation varies, but the signs and symptoms commonly include extreme agitation, hyperthermia, hostility and exceptional strength without fatigue. Further, it is important to recognise that people with ABD are at risk of developing metabolic acidosis, hyperkalaemia, rhabdomyolysis or disseminated intravascular coagulation. This article gives an overview of ABD and describes the main elements of management and treatment.
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Affiliation(s)
- Matthew Peel
- Leeds Community Healthcare NHS Trust, Leeds, England
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26
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O'Cathain A, Simpson R, Phillips M, Knowles E. Tendency to call an ambulance or attend an emergency department for minor or non-urgent problems: a vignette-based population survey in Britain. Emerg Med J 2022; 39:436-442. [PMID: 35273021 PMCID: PMC9132851 DOI: 10.1136/emermed-2020-210271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 02/15/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND There are concerns about high levels of demand for emergency health services. The aim was to identify the characteristics of the British population with a tendency to contact emergency medical services and EDs for minor or non-urgent problems. METHODS A survey of the British adult population in 2018. Six vignettes were constructed about illness in adults (cough/sore throat or diarrhoea/vomiting), injury in adults (sore rib or back pain) and fever in children (occurring weekday or weekend). RESULTS The response rate was 42%, with 2906 respondents. 11% (319/2716) of respondents selected to contact an ambulance and 43% ED, mainly for the vignettes about fever in children and sore rib. Males, people from ethnic minority communities and older people had a tendency to contact emergency services for minor problems. Tendency to call an ambulance was also characterised by 'low resources' (manual or unskilled occupations, no car, low health literacy), worry that a symptom might be serious, distress (feeling overwhelmed by health problems) and frequent use of EDs. For EDs, there was an attraction to EDs because of availability of tests. CONCLUSION Whereas use of emergency ambulances for minor or non-urgent problems appeared to be driven by people's lack of resources, including lack of transport, use of EDs appeared to be driven by their attractive characteristic of offering tests quickly.
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Affiliation(s)
- Alicia O'Cathain
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Rebecca Simpson
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | - Emma Knowles
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
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27
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Bohoněk M. Use of unmanned aerial systems in the health care. Cas Lek Cesk 2022; 161:147-152. [PMID: 36100455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The use of unmanned aerial systems (drones) in the medical care, especially for the distribution of blood, laboratory samples, drugs and medical supplies is the subject of several research and practical pilot projects around the world with a wide perspective of use in civilian and military settings. For the purposes of medical service of troops, this is a suitable and promising solution for strengthening of pre-hospital care in advanced lines and in small combat task forces, which often operate in the rear of the enemy, in conditions of irregular warfare and difficult to access medevac. Deploying drones can effectively enhance the capabilities of mobile medical teams and at the same time life-saving prehospital healthcare concepts such as "remote damage control resuscitation" and "blood far forward". The paper presents a brief overview of the development and use of drones in medical applications for civil and military use.
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28
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Blusztein D, Dinh D, Stub D, Dawson L, Brennan A, Reid C, Smith K, Nehme Z, Andrew E, Bernard S, Lefkovits J. Predictors of hospital prenotification for STEMI and association of prenotification with outcomes. Emerg Med J 2021; 39:666-671. [PMID: 34907005 DOI: 10.1136/emermed-2020-210522] [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: 08/12/2020] [Accepted: 11/26/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Delay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification. METHODS This was a retrospective study of prospective Victorian Cardiac Outcomes Registry data for patients undergoing primary percutaneous coronary intervention for STEMI from 2013-2018. Postcardiac arrest were excluded. Patients were grouped by whether they arrived by ambulance with prenotification (group 1), arrived by ambulance without prenotification (group 2) or self-presented (group 3). We compared groups by FMC-BT, incidence of major adverse cardiac and cerebrovascular events (MACCE), mortality and factors associated with the use of prenotification. RESULTS 2891 patients were in group 1 (79.3% male), 1620 in group 2 (75.7% male) and 1220 in group 3 (82.9% male). Patients who had prenotification were more likely to present in-hours (p=0.004) and self-presenters had lowest rates of cardiogenic shock (p<0.001). Prenotification had shorter FMC-BT than without prenotification (104 min vs 132 min, p<0.001) Self-presenters had superior clinical outcomes, with no difference between ambulance groups. Groups 1 and 2 had similar 30-day MACCE outcomes (7.4% group 1 vs 9.1% group 2, p=0.05) and similar mortality (4.6% group 1 vs 5.9% group 2, p=0.07). In multivariable analysis, male gender, right coronary artery culprit and in-hours presentation independently predicted use of prenotification (all p<0.05). CONCLUSION Differences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment.
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Affiliation(s)
- David Blusztein
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Diem Dinh
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Dion Stub
- Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Luke Dawson
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Angela Brennan
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher Reid
- NHMRC Centre for Research Excellence in Cardiovascular Outcomes Improvement, Curtin University, Perth, Western Australia, Australia
| | - Karen Smith
- Department of Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Ziad Nehme
- Department of Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Emily Andrew
- Department of Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Ambulance Victoria, Melbourne, Victoria, Australia
| | - Jeffrey Lefkovits
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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29
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Alenazi A, Alotaibi B, Saleh N, Alshibani A, Alharbi M, Aljerian N, Alharthy N, Alsomali S. Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia. Br Paramed J 2021; 6:24-30. [PMID: 34970079 DOI: 10.29045/14784726.2021.12.6.3.24] [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] [Indexed: 11/11/2022] Open
Abstract
Objective The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management. Method The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs' success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics' perception of advanced airway management. Result In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1-5 TIs or SADs a year. Conclusion Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.
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Affiliation(s)
- Amani Alenazi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
| | | | | | | | - Meshal Alharbi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
| | | | - Nesrin Alharthy
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
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30
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Urquhart C, Martin J, Ross M. Outcomes following out-of-hospital cardiac arrest in the aeromedical retrieval population of the remote Top End of the Northern Territory, Australia. Aust J Rural Health 2021; 30:87-94. [PMID: 34797613 DOI: 10.1111/ajr.12812] [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: 04/23/2021] [Revised: 09/09/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Out-of-hospital cardiac arrest is an event with an extremely poor prognosis. There is limited literature on the outcomes for regional Australia, with none specifically addressing remote populations. We aimed to assess out-of-hospital cardiac arrest outcomes in the aeromedical retrieval population of the Top End Medical Retrieval Service. DESIGN We retrospectively identified all cardiac arrests, deaths and patients who had cardiopulmonary resuscitation within the aeromedical retrieval database for a 5-year period from January 2012 to December 2016. SETTING Retrieval patients across the Top End of the Northern Territory, Australia. PARTICIPANTS All patients within the cohort with a non-traumatic out-of-hospital cardiac arrest. MAIN OUTCOME MEASURES Data were collected on outcomes as per Utstein definitions, along with patient demographics, retrieval timings and interventions. RESULTS Seventy-five patients suffering cardiac arrest were identified, with 58 having a non-traumatic arrest in an out-of-hospital setting. The median age of the cohort was 40 years, and 53% had an initial shockable rhythm. Return of spontaneous circulation was achieved in 55% and 43% survived to hospital. The survival to hospital discharge and 28 days were 31% and 29%, respectively. CONCLUSIONS Although the study has a small sample size and limitations on generalisability due to the restricted nature of the cohort selection, the results suggest a 28-day survival rate is potentially comparable to other regions of Australia and the rest of the world. Further research needs to be undertaken in out-of-hospital cardiac arrest in remote regions to establish a true population-based cohort and ascertain where improvements can be made.
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Affiliation(s)
- Colin Urquhart
- Cairns Hospital & LifeFlight Retrieval Medicine, Cairns, Qld, Australia.,CareFlight, Darwin, NT, Australia
| | | | - Mark Ross
- CareFlight & Royal Darwin Hospital, Darwin, NT, Australia
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31
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Lyons J, Gabbe BJ, Rawlinson D, Lockey D, Fry RJ, Akbari A, Lyons RA. Impact of a physician - critical care practitioner pre-hospital service in Wales on trauma survival: a retrospective analysis of linked registry data. Anaesthesia 2021; 76:1475-1481. [PMID: 33780550 DOI: 10.1111/anae.15457] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 01/02/2023]
Abstract
The Emergency Medical Retrieval and Transfer Service for Wales launched in 2015. This service delivers senior pre-hospital doctors and advanced critical care practitioners to the scene of time-critical life- and limb-threatening incidents to provide advanced decision-making and pre-hospital clinical care. The impact of the service on 30-day mortality was evaluated retrospectively using a data linkage system. The study included patients who sustained moderate-to-severe blunt traumatic injuries (injury severity score ≥ 9) between 27 April 2015 and 30 November 2018. The association between pre-hospital management by the Emergency Medical Retrieval and Transfer Service and 30-day mortality was assessed using multivariable logistic regression. In total, data from 4035 patients were analysed, of which 412 (10%) were treated by the Emergency Medical Retrieval and Transfer Service. A greater proportion of patients treated by the Emergency Medical Retrieval and Transfer Service had an injury severity score ≥ 16 and Glasgow coma scale ≤ 12 (288 (70%) vs. 1435 (40%) and 126 (31%) vs. 325 (9%), respectively). The unadjusted 30-day mortality rate was 11.7% for patients managed by the Emergency Medical Retrieval and Transfer Service compared with 9.6% for patients managed by standard pre-hospital care services. However, after adjustment for differences in case-mix, the 30-day mortality rate for patients treated by the Emergency Medical Retrieval and Transfer Service was 37% lower (adjusted odds ratio 0.63 (95%CI 0.41-0.97); p = 0.037). The introduction of an emergency medical retrieval service was associated with a reduction in 30-day mortality for patients with blunt traumatic injury.
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Affiliation(s)
- J Lyons
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - B J Gabbe
- Emergency and Trauma Research Unit, School of Public Health and Preventive Medicine at Monash University, Melbourne, Australia.,Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - D Rawlinson
- Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK.,Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - D Lockey
- Emergency Medical Retrieval and Transfer Service (EMRTS) Cymru, Wales, UK
| | - R J Fry
- GIS and Health Geographies, Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - A Akbari
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
| | - R A Lyons
- Public Health Medicine (Health Data Research UK), Swansea University, Swansea, UK
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32
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Bodnar D, Stevens Z, Williams S, Handy M, Rashford S, Brown NJ. Hypofibrinogenaemia and hypocalcaemia in adult trauma patients receiving pre-hospital packed red blood cell transfusions: Potential for supplementary pre-hospital therapeutic interventions. Emerg Med Australas 2021; 34:333-340. [PMID: 34706397 DOI: 10.1111/1742-6723.13887] [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: 04/05/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report the arrival ionised calcium (iCa) and fibrinogen concentrations in trauma patients treated with packed red blood cells by the road-based high-acuity response units of a metropolitan ambulance service. METHODS A retrospective review of trauma patients treated with packed red blood cells by high-acuity response units between January 2012 and December 2016. Patients were identified from databases at southeast Queensland adult trauma centres, Pathology Queensland Central Transfusion Laboratory, Gold Coast University Hospital blood bank and the Queensland Ambulance Service. Patient characteristics, results of laboratory tests within 30 min of ED arrival were analysed. RESULTS A total of 164 cases were analysed. The median injury severity score was 33.5 (interquartile range 22-41), with blunt trauma the commonest mechanism of injury (n = 128, 78.0%). Fifty-eight of the 117 patients (24.4%) with fibrinogen measured had a fibrinogen concentration ≤1.5 g/L; 79 of the 123 patients (64.2%) with an international normalised ratio (INR) measurement had an INR >1.2; 97 of 148 patients (63.8%) with an iCa measured, had an iCa below the Pathology Queensland reference range of 1.15-1.32 mmol/L. Arrival fibrinogen concentration ≤1.5 g/L and arrival iCa ≤1.00 were associated with in-hospital mortality with odds ratio 11.90 (95% confidence interval 4.50-31.65) and odds ratio 4.97 (95% confidence interval 1.42-17.47), respectively. CONCLUSIONS Hypocalcaemia and hypofibrinogenaemia on ED arrival were common in this cohort. Future work should evaluate whether outcomes improve by correction of these deficits during the pre-hospital phase of trauma care.
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Affiliation(s)
- Daniel Bodnar
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Emergency Department, Queensland Children's Hospital, Brisbane, Queensland, Australia.,Queensland Ambulance Service, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Zoe Stevens
- John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Sue Williams
- Pathology Queensland Central Transfusion Laboratory, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Michael Handy
- Trauma Service, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Steven Rashford
- Queensland Ambulance Service, Brisbane, Queensland, Australia
| | - Nathan J Brown
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Ivec N, Beauchamp A, Sutton K, Mitchell E, O'Meara P, Bowles KA, Williams B. Investigating first-year graduate paramedics' reason for current work location: A cross-sectional, data linkage study. Aust J Rural Health 2021; 29:678-687. [PMID: 34490966 DOI: 10.1111/ajr.12786] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/27/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aims to describe the demographic and employment characteristics of first-year graduates from a Victorian-based paramedicine course and investigate factors that influenced their choice in place of practice. DESIGN Cross-sectional study using data from the Nursing and Allied Health Graduate Outcomes Tracking study. SETTING Victoria, Australia. PARTICIPANTS First-year graduates (2019) from the Monash University range of paramedicine programs. MAIN OUTCOME MEASURES Variables of interest included principal place of practice and the reasons for working in the current location. RESULTS Over half of the 2018 paramedicine course graduates responded to the 2019 Graduate Outcomes Survey. Nearly all were registered as paramedics (including double registrants as nurses), and over a fifth were from a rural background; however, less than that were working in a rural area. Of those with complete data, the most cited reasons for current work location were 'spouse/partner's employment or career', 'opportunity for career advancement' and 'scope of practice within the role'. CONCLUSION This study provides important insight into the factors associated with rural practice location amongst paramedicine graduates, specifically rural origin or personal, lifestyle and professional influences. The study adds to the sparse literature about paramedic practice location decision-making and highlights the need for further systematic longitudinal research examining the 'where' and 'why'.
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Affiliation(s)
- Nicola Ivec
- Faculty of Medicine, Nursing, and Health Sciences, Monash University, Clayton, Victoria, Australia
| | | | - Keith Sutton
- Monash Rural Health, Warragul, Victoria, Australia
| | | | - Peter O'Meara
- Faculty of Medicine, Nursing and Health Sciences, School of Primary Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Kelly-Ann Bowles
- Faculty of Medicine, Nursing and Health Sciences, School of Primary Allied Health Care, Monash University, Melbourne, Victoria, Australia
| | - Brett Williams
- Faculty of Medicine, Nursing and Health Sciences, School of Primary Allied Health Care, Monash University, Melbourne, Victoria, Australia
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Koohsari E, Darban F, Safarzai E, Kordi M. Understanding the effect of post-traumatic stress on the professional quality of life of pre-hospital emergency staff. Emerg Nurse 2021; 29:33-40. [PMID: 33783169 DOI: 10.7748/en.2021.e2073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Affiliation(s)
- Edsris Koohsari
- Medical Emergency Center, Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Fatemeh Darban
- Iranshahr University of Medical Sciences, Iranshahr, Iran
| | - Enayatollah Safarzai
- Ali Ibn Abi Taleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Mehri Kordi
- nursing office, Iranshahr University of Medical Sciences, Iranshahr, Iran
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Hurst T, Lendrum R. Advanced pre-hospital critical care and outcome after major injury: present and future. Anaesthesia 2021; 76:1450-1453. [PMID: 34106471 DOI: 10.1111/anae.15522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2021] [Indexed: 12/13/2022]
Affiliation(s)
- T Hurst
- Barts Health NHS Trust and London's Air Ambulance, Royal London Hospital, Whitechapel, London, UK.,Department of Critical Care, King's College Hospital, London, UK
| | - R Lendrum
- Barts Health NHS Trust and London's Air Ambulance, Royal London Hospital, Whitechapel, London, UK.,Department of Anaesthesia, Critical Care and Pain Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
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36
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Pochaisan O, Pattanarattanamolee R, Pongphuttha W, Chadbunchachai W, Nakahara S. Development of an emergency medical services system in Thailand: Roles of the universal health coverage and the national lead agency. Emerg Med Australas 2021; 33:756-758. [PMID: 33977648 DOI: 10.1111/1742-6723.13794] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 03/23/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022]
Abstract
This paper describes how the Thai health sector developed nationwide emergency medical services (EMS), despite limited resources and we try to extract lessons applicable to other resource-constrained settings. The government of Thailand has strengthened EMS by integrating it into the general healthcare system and formulating a national development plan and lead agency for EMS. The government emphasized the deployment of low-cost basic-level EMS units stationed near the communities, named as 'first-responder units'. In Khon Kaen Province, which has led the nationwide EMS development of Thailand, the availability of EMS (number of EMS units) and utilisation of EMS (proportion of severe trauma patients transported to hospital by EMS) greatly increased from 2000 to 2017. This success is due to the emphasis on the first-responder units through consistent national policies.
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Affiliation(s)
| | | | | | | | - Shinji Nakahara
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan
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37
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Turner J, Brown A, Boldy R, Lumley-Holmes J, Rosser A, James A. Out-of-hospital cardiac arrest due to hanging: a retrospective analysis. Emerg Med J 2021; 39:106-110. [PMID: 33931431 DOI: 10.1136/emermed-2020-210839] [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: 10/22/2020] [Revised: 04/15/2021] [Accepted: 04/21/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND There has been little research into the prehospital management of cardiac arrest following hanging despite it being among the most prevalent methods of suicide worldwide. The aim of this study was to report the characteristics, resuscitative treatment and outcomes of patients managed in the prehospital environment for cardiac arrest secondary to hanging and compare these with all-cause out-of-hospital cardiac arrest (OHCA). METHODS Data from a UK ambulance service cardiac arrest registry were extracted for all cases in which treatment was provided for OHCA due to hanging between 1 January 2013 and 30 June 2018. Cases were linked to outcome data obtained from the Trauma Audit and Research Network. Comparison of the cohort was made to previously published data from a UK study of all-cause OHCA with 95% CIs calculated for the proportional difference between the studies in selected presentation and outcome variables. RESULTS 189 cases were identified. 95 patients were conveyed to hospital and four of these survived to discharge. 40 patients were conveyed despite absence of a spontaneous circulation and none of these patients survived. While only three patients were initially in a shockable rhythm, DC shocks were administered in 20 cases. There was one case of failed ventilation prompting front-of-neck access for oxygenation. By comparison with all-cause OHCA the proportion of patients with a spontaneous circulation at hospital handover was similar (27.0% vs 27.5%; 0.5% difference, 95% CI -5.9% to 6.8%, p=0.882) but survival to hospital discharge was significantly lower (2.2% vs 8.4%; 6.2% difference, 95% CI 4.1% to 8.3%, p=0.002). CONCLUSION Clinical outcomes following OHCA due to hanging are poor, particularly when patients are transported while in cardiac arrest. Failure to ventilate was uncommon, and clinicians should be alert to the possibility of shockable rhythms developing during resuscitation.
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Affiliation(s)
- Jake Turner
- Anaesthetic Department, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Aidan Brown
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Rhiannon Boldy
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | | | - Andy Rosser
- West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK
| | - Alex James
- Midlands Air Ambulance, Midlands Air Ambulance Charity, Stourbridge, UK.,West Midlands Ambulance Service NHS Foundation Trust, Brierley Hill, UK.,Anaesthetic Department, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK.,School Medicine, University of Keele, Newcastle-under-Lyme, Staffordshire, UK
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38
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Abstract
Retrieval medicine and pre-hospital care in remote Australia are challenging, requiring competencies in major trauma, high-risk obstetrics, critical care in adults and children, severe mental health-related agitation and envenomation. They keep a city-based retrieval and pre-hospital care doctor on their toes. Cultural fluencies to enhance care for Aboriginal and remote communities are critical during the long hours taken for the patient journey from the accident scene or clinic to definitive care.
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Affiliation(s)
- Joseph Ting
- Department of Emergency Medicine, Mater Hospital Brisbane, Brisbane, Queensland, Australia.,Department of Emergency Medicine, Ipswich Hospital, Ipswich, Queensland, Australia.,Retrieval Service, Central Australian Retrieval Service, Alice Springs, Northern Territory, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
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39
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Lamb D, Withnall RD. A qualitative study to investigate the psychosocial effects of operational deployments on Medical Emergency Response Team personnel. Stress Health 2021; 37:364-377. [PMID: 33112039 DOI: 10.1002/smi.3001] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 09/07/2020] [Accepted: 09/22/2020] [Indexed: 11/11/2022]
Abstract
The stressors associated with emergency medical teams responding to critical incidents are well documented; however, the impact of such duties on the UK military personnel had never been investigated. This study explored the psychosocial effects of Medical Emergency Response Teams (MERT) operating in Afghanistan to inform the development of a Resilience Model. A structured and contextually relevant process could then be applied for a team's preparation for, delivery of and recovery from, their duties. A qualitative cross-sectional design used semi-structured interviews and 15 multidisciplinary team members participated. Interviews were transcribed verbatim and data were systematically analysed using grounded theory. Emergent theory poses that developing resilience against the demands of this role is dependent upon personnel having a realistic understanding of the deployed environment by phased immersion within it. This preparatory training generates situational awareness, trust and strong team cohesion, which together with peer and organizational support are necessary factors to effectively cope with the role. To limit the costs of caring, there is a need for MERT personnel to segregate the physiological and emotional aspects of delivering care to the injured; those unable to do so may be at greater risk of poor mental health outcomes. The preparatory training of MERT personnel must be further developed to provide an immersive environment that more closely matches the reality of the role. A period of stability is required post deployment with the support of peers to enable personnel to more efficiently transition back to their home life.
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Affiliation(s)
- Di Lamb
- Academic Department of Military Nursing, Royal Centre for Defence Medicine, Birmingham, UK
| | - Rich Dj Withnall
- Royal Centre for Defence Medicine, Research & Clinical Innovation, Birmingham, UK
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40
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Nakahara S, Nagao T, Nishi R, Sakamoto T. Task-shift Model in Pre-hospital Care and Standardized Nationwide Data Collection in Japan: Improved Outcomes for Out-of-hospital Cardiac Arrest Patients. JMA J 2021; 4:8-16. [PMID: 33575498 PMCID: PMC7872786 DOI: 10.31662/jmaj.2020-0074] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/09/2020] [Indexed: 11/11/2022] Open
Abstract
Out-of-hospital cardiac arrest (OHCA) is a growing worldwide public health concern. Previously, Japan experienced poorer outcomes among OHCA patients than in other high-income countries. In the early 1990s, through policy changes, the Japanese government introduced a task-shift model in pre-hospital care. Some medical practices previously provided by physicians exclusively were delegated to non-physicians, including laypeople. Additionally, we initiated a nationwide data collection system for evaluation. We started a nationwide registry of OHCA patients, a paramedic system to provide advanced life-support care, and basic life-support training for laypeople. In the 2000s, the procedures paramedics could provide were expanded, laypeople were allowed to use automated external defibrillators, and the Utstein style was introduced to the national registry. Consequently, pre-hospital advanced care and bystander first-aid increased, registry-based research contributed to evidence-based practices, and―most importantly―outcomes of OHCA patients considerably improved. These Japanese experiences demonstrate that streamlining pre-hospital care, including bystander interventions and standardized data collection, can improve OHCA patient outcomes. Despite this progress, however, there still exist many issues to be addressed in response to the changing and increasing care demands within Japan’s aging population.
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Affiliation(s)
- Shinji Nakahara
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kawasaki, Japan.,Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tsuyoshi Nagao
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Ryuichi Nishi
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tetsuya Sakamoto
- Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan
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Schiefer J, Perbix W, Grigutsch D, Ribitsch B, Fuchs P, Schulz A. Pre-Hospital Care Of Patients With Severe Burns In Germany: A Review Of 29 Years Of Experience. Ann Burns Fire Disasters 2020; 33:267-275. [PMID: 33708015 PMCID: PMC7894850] [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] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/05/2020] [Indexed: 06/12/2023]
Abstract
Despite the high number of burn injuries worldwide, pre-hospital care differs across regions. Data documenting pre-hospital care of severe burn injuries in Germany are scarce. Nevertheless, efficient prehospital care of burn patients is crucial for later outcomes. Therefore, we retrospectively analyzed pre-hospital care in patients admitted to the burn intensive care unit of a specialized burn center in Germany from 1989 to 2018. Approximately one-third of all admitted patients arrived intubated to the burn intensive care unit. Mean total burned surface area was higher in intubated patients than in non-intubated patients. Hypothermia prevention measures were undertaken in most patients. Although cooling was performed in only 36 primarily admitted patients, it did not have an effect on temperature at admission. Instead, in the regression analysis a positive influence on mortality could be found (p=0.03). Inhalation injury was a reason for intubation and corticosteroid therapy. Corticosteroid use declined over the years and had no significant influence on mortality (p=0.38). Inhalation injury could be diagnosed in only 50.68% of patients receiving corticosteroids. Furthermore, especially in recent years, most patients with inhalation injuries did not receive corticosteroids. Although efficient prehospital care is crucial for later outcomes, standard pre-hospital care through first aiders and emergency personnel has not been applied. Therefore, strategies for information exchange, leading to standardized pre-hospital treatment guidelines, should be given high priority with special attention on pre-hospital cooling. In the future, data from registries and surveys can help expand information regarding pre-hospital burn treatment.
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Affiliation(s)
- J.L. Schiefer
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - W. Perbix
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - D. Grigutsch
- Clinic of Anesthesiology, University Hospital Bonn, Germany
| | - B. Ribitsch
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - P.C. Fuchs
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
| | - A. Schulz
- Clinic for Plastic and Hand Surgery, Burn Care Center, University of Witten/Herdecke, Cologne Merheim Medical Center (CMMC), Cologne, Germany
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Abstract
Background: The weight of children provides the cornerstone of their clinical management, as many drug dosages, equipment sizes, fluid boluses, as well as DC shock energy, are administered on a per kilogram basis. Children who attend hospital are weighed using scales prior to receiving these interventions. This is not possible in the pre-hospital environment. A paucity of evidence exists to support the page for age weight guidance indicated by JRCALC, and it remains unknown if this approach meets the reference standard of 70% of estimations within 10% of actual weight and 95% within 20% of actual weight. Methods: We used a cross-sectional study design and collected data from a convenience sample of children who attended the outpatients department of a major hospital in England between July and September 2019. All children aged between 1 and 11 years who were weighed were eligible for inclusion. Outcomes were to determine if the page for age approach meets the reference standard and to determine any implications for care. Results: 341 children were included in this study. Each age group consisted of varying numbers of children. 50.5% (172/341) of the sample were female. Observed weights ranged from 8.28 to 82.70 kg (median 20.60 kg). The mean weight of girls versus boys was 24.69 kg and 23.39 kg respectively (95% CI -4.12–1.32, p = 0.3123). Observed weights were greater than the page for age guidance weight in all age groups, and the accuracy of page for age weight guidance diminished with age. Adrenaline 1:10,000 doses and defibrillation energy levels guided by page for age differ from those guided by weight, but are not deleterious to care. Conclusion: Page for age weight guidance does not meet the reference standard. Most paediatric pre-hospital care is administered by age and not weight. In the absence of an accurate weight, ambulance clinicians should continue to use the page for age system, although the gold standard remains to use an accurate weight measurement. While there are no facilities to weigh children in ambulances, if an accurate weight is available then consideration should be given to using this rather than age.
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Abstract
Introduction: Recognising acute traumatic coagulopathy (ATC) poses a significant challenge to improving survival in emergency care. Paramedics are in a prime position to identify ATC in pre-hospital major trauma and initiate appropriate coagulopathy management. Method: A database literature review was conducted using Scopus, CINAHL and MEDLINE. Results: Two themes were identified from four studies: prediction tools, and point-of-care testing. Prediction tools identified key common ATC markers in the pre-hospital setting, including: systolic blood pressure, reduced Glasgow Coma Score and trauma to the chest, abdomen and pelvis. Point-of-care testing was found to have limited value. Conclusion: Future research needs to explore paramedics using prediction tools in identifying ATC, which could alert hospitals to prepare for blood products for damage control resuscitation.
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Genziani M, Gillard S, Samuels L, Chambers M. Emergency workers' experiences of the use of section 136 of the Mental Health Act 1983: interpretative phenomenological investigation. BJPsych Bull 2020; 44:250-254. [PMID: 32180542 PMCID: PMC7684767 DOI: 10.1192/bjb.2020.21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS AND METHOD To explore the experiences of emergency workers dealing with incidents in which section 136 of the Mental Health Act 1983 is invoked by the police. Data from interviews with police officers and ambulance workers in a London locality were subject to interpretative phenomenological analysis. RESULTS Participants felt they were the first port of call and that training should be improved to help them deal with those experiencing mental health crises in the community. Police participants noted time pressures trying to gain individuals' trust and described section 136 detention as sometimes feeling like a betrayal of the individual. Most participants had negative experiences of admissions to the 136 suite; several suggested ways of improving the admissions system. Several went beyond their expected duties to ensure that distressed individuals were supported before accessing mental healthcare services. CLINICAL IMPLICATIONS Improving training of emergency workers in dealing with mental health crises would also help with aftercare decision-making. Learning identified from the participants' experiences lends support to collaboration between emergency and mental health services, an important step towards improving the section 136 process so that detainees can access help without unnecessary delay.
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Affiliation(s)
- Mirella Genziani
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, UK
| | - Steve Gillard
- Population Health Research Institute, St George's, University of London, UK
| | | | - Mary Chambers
- Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, UK
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Hansda U, Sahoo S, Biswas S, Mohanty CR, Barik S, Giri PP. How much ambulance personnel know about basic life support (BLS)? A hospital-based study from Eastern India. J Family Med Prim Care 2020; 9:5601-5605. [PMID: 33532402 PMCID: PMC7842495 DOI: 10.4103/jfmpc.jfmpc_680_20] [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: 04/22/2020] [Revised: 06/10/2020] [Accepted: 07/04/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Basic life support (BLS) is an important component of emergency medical management. Ambulance personnel play a key role in resuscitation to save a life before reaching the hospital. We do not have any published data about the level of knowledge on BLS among the ambulance personnel. Objective: This study was done with the objective to assess the level of knowledge on BLS among the ambulance personnel. Materials and Methods: A cross-sectional study was done in the emergency department (ED) of a tertiary care hospital. Universal sampling was done taking all the personnel of ambulances over the period of one month. Data were collected about the type of vehicle used for ambulance, the number of personnel in an ambulance, educational qualifications, and equipment present in their ambulances. The questionnaire to capture the level of knowledge were based on American Heart Association 2015 guidelines. Result: The total number of ambulance arrivals was 729 times. But data analysis was done from 104 ambulances excluding the repeat arrivals and those who did not give consent. There were 62 type-C and D ambulances, and 42 were type-B ambulances. Total of 210 personnel were there in 104 ambulances. Seventy-nine team leaders did not have any paramedical degrees. Fifty-eight team leaders were trained in BLS before working in an ambulance. In spite of this, 66 (63%) team leaders had poor performance (score of 0 to 4). Conclusion: The level of knowledge on BLS was poor in more than half of the ambulance personnel. They should be trained regularly on providing BLS.
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Affiliation(s)
- Upendra Hansda
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sangeeta Sahoo
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sankalan Biswas
- Seventh Semester MBBS Student, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chitta Ranjan Mohanty
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sadananda Barik
- Department of Trauma and Emergency, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Prajna Paramita Giri
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Le Borgne P, Oberlin M, Bassand A, Abensur Vuillaume L, Gottwalles Y, Noizet M, Gennai S, Baicry F, Jaeger D, Girerd N, Lefebvre F, Bilbault P, Chouihed T. Pre-Hospital Management of Critically Ill Patients with SARS-CoV-2 Infection: A Retrospective Multicenter Study. J Clin Med 2020; 9:E3744. [PMID: 33233324 PMCID: PMC7700636 DOI: 10.3390/jcm9113744] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 10/12/2020] [Revised: 11/10/2020] [Accepted: 11/15/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION The COVID-19 outbreak had a major impact on healthcare systems worldwide. Our study aims to describe the characteristics and therapeutic emergency mobile service (EMS) management of patients with vital distress due to COVID-19, their in-hospital care pathway and their in-hospital outcome. METHODS This retrospective and multicentric study was conducted in the six main centers of the French Greater East region, an area heavily impacted by the pandemic. All patients requiring EMS dispatch and who were admitted straight to the intensive care unit (ICU) were included. Clinical data from their pre-hospital and hospital management were retrieved. RESULTS We included a total of 103 patients (78.6% male, median age 68). In the initial stage, patients were in a critical condition (median oxygen saturation was 72% (60-80%)). In the field, 77.7% (CI 95%: 71.8-88.3%) were intubated. Almost half of our population (45.6%, CI 95%: 37.1-56.9%) had clinical Phenotype 1 (silent hypoxemia), while the remaining half presented Phenotype 2 (acute respiratory failure). In the ICU, a great number had ARDS (77.7%, CI 95% 71.8-88.3% with a PaO2/FiO2 < 200). In-hospital mortality was 33% (CI 95%: 24.6-43.3%). The two phenotypes showed clinical and radiological differences (respiratory rate, OR = 0.98, p = 0.02; CT scan lesion extension >50%, OR = 0.76, p < 0.03). However, no difference was found in terms of overall in-hospital mortality (OR = 1.07, p = 0.74). CONCLUSION The clinical phenotypes appear to be very distinguishable in the pre-hospital field, yet no difference was found in terms of mortality. This leads us to recommend an identical management in the initial phase, despite the two distinct presentations.
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Affiliation(s)
- Pierrick Le Borgne
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Mathieu Oberlin
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
| | - Adrien Bassand
- Emergency Department, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; (A.B.); (D.J.); (T.C.)
| | - Laure Abensur Vuillaume
- Emergency Department, Regional Hospital of Metz-Thionville, 1, Allée du Château, 57530 Ars-Laquenexy, France;
| | - Yannick Gottwalles
- Emergency Department, General Hospital of Colmar, 39 Avenue de la Liberté, 68024 Colmar, France;
| | - Marc Noizet
- Emergency Department, Mulhouse hospital, 20 Avenue du Dr René Laennec, 68100 Mulhouse, France;
| | - Stéphane Gennai
- Emergency Department, Reims University Hospital, 45 Rue Cognac-Jay, 51100 Reims, France;
| | - Florent Baicry
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
| | - Deborah Jaeger
- Emergency Department, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; (A.B.); (D.J.); (T.C.)
| | - Nicolas Girerd
- Centre d’Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France;
| | - François Lefebvre
- Department of Public Health, University Hospital of Strasbourg, 1 Place de l’Hôpital, 67000 Strasbourg, France;
| | - Pascal Bilbault
- Emergency Department, University Hospital of Strasbourg, 1 Avenue Molière, 67000 Strasbourg, France; (M.O.); (F.B.); (P.B.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative NanoMedicine (RNM), Fédération de Médecine Translationnelle (FMTS), University of Strasbourg, 67000 Strasbourg, France
| | - Tahar Chouihed
- Emergency Department, University Hospital of Nancy, 29 Avenue du Maréchal de Lattre de Tassigny, 54035 Nancy, France; (A.B.); (D.J.); (T.C.)
- Centre d’Investigations Cliniques-1433, and INSERM U1116, F-CRIN INI-CRCT, Université de Lorraine, 54000 Nancy, France;
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Pereira B, Dorigatti A, Calderon L, Negrão M, Meirelles G, Duchesne J. Pre-hospital environment bleeding: from history to future prospects. Anaesthesiol Intensive Ther 2019; 51:240-8. [PMID: 31418256 DOI: 10.5114/ait.2019.86059] [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] [Indexed: 11/17/2022] Open
Abstract
While the blood was related to life since antiquity, scientific investigations on anatomy and physio-logy of the circulation system had to wait until the arrival of the 16th century. In trauma patients, hemorrhagic shock is the main risk factor for multiple organ dysfunction and consequent increased mortality. On the pre-hospital setting intravenous administration of crystalloid solution became the more common intervention during resuscitation of trauma patient due to many reasons although currently new discussions have blossomed on regards type of fluids and resuscitation. The object of this manuscript is to review the history of pre-hospital care bleeding management and to gather new perspectives for the future. Herein authors discuss several issues on bleeding control: 1. Current status and future possibilities on stop the bleeding in the the pre-hospital setting - movements after the Hartford Consensus, use of topic homeostatic agents, tourniquets, REBOA and other radical interventions; 2. Damage control resuscitation in the pre-hospital environment - is massive transfusion protocol feasible at this setting? Tranexemic acid should be done? Possibilities that may improve survival and coagulopathy understanding; 3. Critical decision and decision making on stop the bleed; 4. Proposed flowchart on bleeding control. The implementation of measures to stop acute bleeding in the pre-hospital setting is a well-known and well-founded measure. However, the provision of current evidence demonstrates that these measures go far beyond compression and elevation of the limb as was known in the past. The deep understanding of the mechanism of coagulopathy and the new adjuvant arsenal to control bleeding are essential for a better quality of pre-hospital medical care as well as lower mortality rates.
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Janagama SR, Strehlow M, Gimkala A, Rao GVR, Matheson L, Mahadevan S, Newberry JA. Critical Communication: A Cross-sectional Study of Signout at the Prehospital and Hospital Interface. Cureus 2020; 12:e7114. [PMID: 32140371 PMCID: PMC7047340 DOI: 10.7759/cureus.7114] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Miscommunication during patient handoff contributes to an estimated 80% of serious medical errors and, consequently, plays a key role in the estimated five million excess deaths annually from poor quality of care in low- and middle-income countries (LMICs). Objective The objective of this study was to assess signout communication during patient handoffs between prehospital personnel and hospital staff. Methods This is a cross-sectional study, with a convenience sample of 931 interfacility transfers for pregnant women across four states from November 7 to December 13, 2016. A complete signout, as defined for this study, contains all necessary signout elements for patient care exchanged verbally or in written form between an emergency medical technician (EMT) and a physician or nurse. Results Enrollment of 786 cases from 931 interfacility transfers resulted in 1572 opportunities for signout. EMTs and a physician or nurse signed out in 1549 cases (98.5%). Signout contained all elements in 135 cases (8.6%). The mean percentage of signout elements included was 45.2% (95% CI, 43.9-46.6). Physician involvement was correlated with a higher mean percent (63.4% [95% CI, 62-64.8]) compared to nurse involvement (23.6% [95% CI, 22.5-24.8]). With respect to the frequency of signout communication, 63.1% of EMTs reported often or always giving signout, and 60.5% reported often or always giving signout; they reported feeling moderately to very comfortable with signout (73.7%) and 34.1% requested further training. Conclusions Physicians, nurses, and the EMTs conducted signout 99% of the time but often fell short of including all elements required for optimal patient care. Interventions aimed at improving the quality of patient care must include strengthening signout communication.
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Affiliation(s)
| | - Matthew Strehlow
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
| | - Aruna Gimkala
- Research, Gunupati Venkata Krishnareddy Emergency Management and Research Institute, Hyderabad, IND
| | - G V Ramana Rao
- Emergency Medicine Learning Centre & Research, Gunupati Venkata Krishnareddy Emergency Management and Research Institute, Hyderabad, IND
| | - Loretta Matheson
- Emergency Medicine, Stanford University School of Medicine, Palo Alto, USA
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Abstract
Recent incidents in the UK and the alleged chemical attacks in Syria by the Bashar al-Assad regime have brought the subject of chemical weapons back into the public domain. To date these types of event have been relatively rare because terrorist plans to harm large numbers of people have mostly been thwarted. This is the first part of a two-part article on nerve agents. Part one gives an overview of these agents, their historical background and manufacture, and how the agents affect physiology. Part two, which will appear in the next issue, considers the pre-hospital response to the use of nerve agents, including effective triage and decontamination, and in-hospital treatment.
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Affiliation(s)
- Stephen McGhee
- College of Nursing, University of South Florida, Tampa, Florida, United States
| | - Alan Finnegan
- Mental health nursing, University of Chester, Chester, England
| | - Neil Angus
- University of the Highlands and Islands, Inverness, Scotland
| | - John Clochesy
- School of Nursing, University of Miami, Coral Gables, Florida, United States
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O'Neill A, Harrhy L. Reducing attendance at trauma clinics by providing first-point-of-contact treatment. Emerg Nurse 2020; 27:25-29. [PMID: 31468848 DOI: 10.7748/en.2019.e1946] [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] [Accepted: 04/02/2019] [Indexed: 11/09/2022]
Abstract
In 2016, the urgent and ambulatory care service in Oxfordshire formed part of a cross-organisational partnership working group. The group consisted of Oxford Health NHS Foundation Trust community minor injury units (MIUs) at Abingdon and Witney, and Oxford University Hospitals NHS Foundation Trust (OUH) trauma and orthopaedic specialties and emergency department (ED). The aim was to redesign fracture management pathways and delivery of definitive care at patients' first point of contact with the NHS. This article discusses the implementation of the trauma pathways in two of Oxfordshire's community MIUs. In total, a range of seven common fracture pathways seen in the ED and community MIUs were redesigned so that patients were treated definitively at the first point of contact and discharged with a safety net supported by leaflets; a direct contact facility to OUH trauma specialties was part of the safety net allowing patients to self-refer to the trauma clinic if they had any concerns. In total, 513 patients were treated and discharged on see, treat and discharge fracture pathways in the first year of pathway operation, which represented a 21% decrease in patient referral rates to the trauma clinic at OUH compared with the previous year.
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Affiliation(s)
| | - Leigh Harrhy
- Oxford Health NHS Foundation Trust, Oxford, England
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