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In this paper, we solved an ambulance location problem with a multi-objective framework considering the case of the study of Emergency Medical Service (EMS) of Antofagasta (Chile). Nowadays, in Antofagasta, the ambulances are located in bases that are not necessarily the optimal location achieving an estimated 67% of coverage under the 8 min not meeting the requirements dictated by the Chilean Ministry of Health. We used a multi-objective model considering mean response time, maximum response time, and the demand not covered. The model is solved using an iterative ε-constraint method to generate a Pareto set of efficient solutions. We considered historical data from the years 2015 and 2016 to generate the demand and emergency nodes with a clustering algorithm. The results show improvements on all criteria of the multi-objective model, where we highlight a potential increment on coverage within 8 min from 67 to 99%. In order to test the new policy in a real setting, a pilot plan is proposed, which reaches 89% of coverage within 8 min.

Background The cardiopulmonary resuscitation (CPR) guidelines recommend identifying and correcting the underlying reversible causes of out-of-hospital cardiac arrest (OHCA). However, it is uncertain how often these causes can be identified and treated. Our aim was to estimate the frequency of point of care ultrasound examinations, blood sample analyses and cause-specific treatments during OHCA. Methods We performed a retrospective study in a physician-staffed helicopter emergency medical service (HEMS) unit. Data on 549 non-traumatic OHCA patients who were undergoing CPR at the arrival of the HEMS unit from 2016 to 2019 were collected from the HEMS database and patient records. We also recorded the frequency of ultrasound examinations, blood sample analyses and specific therapies provided during OHCA, such as procedures or medications other than chest compressions, airway management, ventilation, defibrillation, adrenaline or amiodarone. Results Of the 549 patients, ultrasound was used in 331 (60%) and blood sample analyses in 136 (24%) patients during CPR. A total of 85 (15%) patients received cause-specific treatment, the most common ones being transportation to extracorporeal CPR and percutaneous coronary intervention (PCI) (n = 30), thrombolysis (n = 23), sodium bicarbonate (n = 17), calcium gluconate administration (n = 11) and fluid resuscitation (n = 10). Conclusion In our study, HEMS physicians deployed ultrasound or blood sample analyses in 84% of the encountered OHCA cases. Cause-specific treatment was administered in 15% of the cases. Our study demonstrates the frequent use of differential diagnostic tools and relatively infrequent use of cause-specific treatment during OHCA. Effect on protocol for differential diagnostics should be evaluated for more efficient cause specific treatment during OHCA.

This paper models an operation problem of an unmanned aerial vehicle for the emergency medical service (UEMS) system. The model is set up as a location-allocation problem. The coverage distance and capacity of the UEMS facility are modeled as functions of UAVs assigned. The allocation of the demand point is constrained by the variable coverage distance of each facility. The robust optimization approach is used over the cardinality-constrained uncertain demand, which leads to a nonlinear optimization problem. The UEMS location-allocation problem (ULAP) is reformulated to a solvable problem. An extended formulation and corresponding branch-and-price (B&P) algorithm are also proposed, which strengthen the linear programming relaxation bound. The subproblem of the B&P algorithm is defined as a robust disjunctively constrained integer knapsack problem. Two solution approaches of mixed-integer linear programming reformulation and decomposed dynamic programming are designed for the subproblem. To provide time-efficient solutions for large-scale problems, a restricted master heuristic (RMH) is proposed based on the extended formulation. In computational experiments, the B&P algorithm provided a strong lower bound, and the RMH could find an effective feasible solution within an applicable computation time.

The demographic makeup of fire departments, including firefighters and paramedics, often does not reflect communities. This thesis poses the following research question: What factors support and inhibit the recruitment and retention of African American firefighters and paramedics in the United States? The research relied on documented open-source information and data from fire and emergency medical service (EMS) departments in the United States. In examining issues affecting the recruitment and retention of African Americans in the profession, this study considers the history of the fire service and EMS, along with other internal and external factors that could support or inhibit the recruitment and retention of African Americans. The research offers several recommendations to remedy this issue, including mandating Courageous Conversations workshops, creating a diverse full-time recruiting team, developing pipeline partnerships, and changing hiring and training processes. Civilian, Memphis Fire Department Approved for public release. Distribution is unlimited.

The Emergency Medical Services (EMS) system faced overwhelming challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, further information is required to determine how the pandemic affected the EMS response and the clinical outcomes of out-of-hospital cardiac arrest (OHCA) patients in COVID-19 low-incidence cities. A retrospective study was conducted in Chiayi, Taiwan, a COVID-19 low-incidence urban city. We compared the outcomes and rescue records before (2018–2019) and during (2020–2021) the COVID-19 pandemic. A total of 567 patients before and 497 during the pandemic were enrolled. Multivariate analysis revealed that the COVID-19 pandemic had no significant influence on the achievement of return of spontaneous circulation (ROSC) and sustained ROSC but was associated with lower probabilities of survival to discharge (aOR = 0.43, 95% CI: 0.21–0.89, p = 0.002) and discharge with favorable neurologic outcome among OHCA patients (aOR = 0.35, 95% CI: 0.16–0.77, p = 0.009). Patients’ ages and OHCA locations were also discovered to be independently related to survival results. The overall impact of longer EMS rescue times on survival outcomes during the pandemic was not significant, with an exception of the specific group that experienced prolonged rescue times (total EMS time > 21 min).

The National Health Service (NHS) is under increasing pressure to adopt radical strategies for change, in order to meet UK national targets of net zero emissions by 2050. This thesis aimed to explore and investigate sustainability behaviours of UK ambulance service personnel and how they contribute to a reduce, re-use, recycle (RRR) ethos. Phase one, a systematic literature review (n=114 studies) explored sustainability in Emergency Medical Services (EMS). Phase two phenomenological study explored the role and experiences of NHS ambulance strategic managers (n=6 participants) in England, when implementing their organisational Green Plans. Phase three ethnographical observation explored the sustainability activities, attitudes and behaviours of operational ambulance personnel within two English NHS ASTs (n= 66 participants). Phase one findings identified that rising global temperatures, caused by worldwide carbon emissions, will place an amplified demand on EMS, through an increase in morbidity and mortality rates. It also showed a dearth of empiric sustainability research involving UK ambulance services. Phase two findings revealed an insight into the Sustainability Managers’ challenges of implementing sustainability policy, the factors that incentivise change, staff resistance and tactics to overcome it, short-term and long-term aims, and their opinions with future objectives. Phase three observational findings discovered a diversity of sustainability attitudes and behaviours amongst the staff, where three behavioural groups were identified: firstly, those who were already sustainability pro-active, secondly, those who were willing in attitude, but lacked the facilities, resources, support or means to apply behavioural changes in their practice and finally, those yet to be convinced to adjust towards sustainability behaviours. This thesis provides an original and valuable insight into the sustainability and carbon reduction strategies employed within EMS organisations. Further opportunities may be generated from the findings, which could lead to cost savings across other EMS settings and the wider business communities globally.

Введение (актуальность). Пандемия новой коронавирусной инфекции 2019-2021 гг. стала серьезным испытанием системы здравоохранения страны. В этой ситуации она показала свои реальные возможности в современных условиях. Цель. Целью исследования был анализ динамики показателей оперативной работы больниц скорой помощи в период пандемии новой коронавирусной инфекции. Материалы и методы. Материалом послужили данные федеральной государственной статистики (источники ФСН № 14 и 30, 2019-2021 гг.) 2-х многопрофильных стационаров, работающих в режиме больниц скорой помощи (24/7/365), имеющих принципиальные структурно-функциональные особенности, связанные с наличием коек для пациентов с новой коронавирусной инфекцией. Использованы контент-анализ, нормативный правовой, статистические и аналитические методы. Результаты и обсуждение. Для стационара скорой помощи с развернутыми койками инфекционного профиля для пациентов с новой коронавирусной инфекцией было характерно значительное (в 2 раза) снижение показателей оперативной работы: числа операций (-42,0%) и числа оперированных пациентов (-51,3%), уменьшение числа операций с осложнениями (-95,5%) и умерших оперированных больных (-71,5%). Для стационара скорой помощи, не перепрофилированного для пациентов с новой коронавирусной инфекцией, было характерно увеличение числа операций (на 10,2%), оперированных пациентов (на 18,4%), а также показателей летальности (+40,8%), не связанных непосредственно с осложнениями оперативного лечения. Заключение. Динамика коечного фонда и схем маршрутизации пациентов, перераспределение объемов медицинской помощи между медицинскими организациями, санитарно-эпидемиологическая подготовка – важный опыт, который нам дала пандемия новой коронавирусной инфекции, позволяющий заложить организационный и научно-методический фундамент для дальнейшего развития, повысить готовность к работе в сложных условиях подобных пандемии новой коронавирусной инфекцией., Introduction. Pandemic of the new coronavirus infection 2019-2021 has become a serious test of the country's health care system. In this situation, she showed her real capabilities in modern conditions. Purpose. The purpose of the study: an analysis of the dynamics of the operational performance of emergency hospitals during a pandemic of a new coronavirus infection. Materials and methods. The material was the data of federal state statistics (2019-2021) of 2 multidisciplinary hospitals operating in ambulance hospitals (24/7/365), which have fundamental structural and functional features related to the availability of beds for patients with Covid 19. Content analysis, regulatory, statistical and analytical methods were used. The results of the study: For the NSR hospital with deployed infectious beds for patients with Covid 19, there was a significant (2-fold) decrease in the indicators of operative work: the number of operations (-42.0%) and the number of operated patients (-51.3%), a decrease in the number of operations with complications (-95.5%) and deceased operated patients (-71.5%). The NSR hospital, not repurposed for Covid 19, was characterized by an increase in the number of operations (by 10.2%), operated patients (by 18.4%), as well as mortality rates (+ 40.8%), not directly related to complications of surgical treatment. Conclusion. The dynamics of bed capacity and patient routing schemes, the redistribution of medical care between medical organizations, sanitary and epidemiological training an important experience that the pandemic of a new coronavirus infection gave us, which allows us to lay the organizational and scientific and methodological foundation for further development, to increase readiness for work in difficult conditions such as a pandemic with a new coronavirus infection.

Diabetes mellitus is a frequently discussed lifestyle disease in today's society. Therefore, I decided to create this bachelor's thesis, which focuses on acute diabetic states in emergency medicine and pre-hospital care by the emergency medical service. The aim of the thesis is to provide an overview of standardized therapy in pre-hospital care and the most common causes of acute diabetic complications that can lead to hospitalization and even life-threatening situations for patients with diabetes. This goal was achieved by collecting data from emergency medical responders from the Emergency Medical Service. The knowledge gained from this work shows that the majority of acute diabetic states were caused by patient errors, whether in inappropriate increases in physical exertion or application of exogenous insulin outside of the prescribed regimen. For successful treatment of acute diabetic states, proper and quick diagnosis is crucial, based on a well-taken medical history and the use of available techniques. Targeted therapeutic procedures help manage these conditions without serious health consequences for patients. The scientific contribution of this work lies in its comprehensive and up-to-date approach to the topic, which enables a better understanding of the issue of acute diabetic states and provides a comprehensive view of current diagnosis and therapy in pre-hospital care. This work may be useful for physicians and nurses working in emergency medicine or emergency medical responders who encounter these conditions in practice. In conclusion, this bachelor's thesis serves primarily to improve the care of patients with acute diabetic states.

Background: The prevalence of children with life-limiting conditions is rising, and since the amendment of the social insurance code in Germany, palliative home care teams have treated an increasing number of children. These teams provide 24/7 readiness, yet some parents still call the general emergency medical service (EMS) for various reasons. EMS is exposed to complex medical problems in rare diseases. Questions arose about the experiences of EMS and whether they felt prepared for emergencies involving children treated by a palliative care team. Methods: This study used a mixed methods approach to focus on the interface between palliative care and EMS. First, open interviews were conducted, and a questionnaire was developed based on the results. The variables included demographic items and individual experiences with patients. Second, a case report of a child with respiratory insufficiency was presented to assess the spontaneous treatment intentions of EMS providers. Finally, the need, relevant topics, and duration of specific training in palliative care for EMS providers were evaluated. Results: In total, 1,005 EMS providers responded to the questionnaire. The average age was 34.5 years (±10.94SD), 74.6% were male. The average work experience was 11.8 years (±9.7), 21.4% were medical doctors. Experience with a call of a life-threatening emergency involving a child was reported by 61.5% and severe psychological distress during such a call was reported by 60.4%. The equivalent distress frequency for adult patient calls was 38.3%. (p < 0.001). After review of the case report, the EMS respondents suggested invasive treatment options and rapid transport to the hospital. Most (93.7%) respondents welcomed the consideration of special training in pediatric palliative care. This training should include basic information about palliative care, an analysis of cases involving palliatively treated children, an ethical perspective, practical recommendations, and available (24/7) local contact for further guidance and support. Conclusion: Emergencies in pediatric palliatively treated patients were more common than expected. EMS providers perceived the situations as stressful, and there is a need for specific training with practical aspects.

The topic of this bachelor thesis is the demanding nature of the job of a medical dispatch center operator, not only during the pandemic. The theoretical part of this thesis describes the work and structure of the emergency medical service, the activities, history, and current state of the medical dispatch center, the job duties and demanding nature of the profession of a medical dispatch center operator, and also describes the Covid-19 pandemic. The practical part of the bachelor thesis contained four objectives and four research questions. The first objective was to map out the demanding nature of the job of a medical dispatch center operator. The second objective aimed to map out the changes in the work of medical dispatch center operators that occurred during the Covid-19 pandemic. The third objective investigated the direct impact of the Covid-19 pandemic on individual medical dispatch center operators. The last objective of this bachelor thesis was to determine how medical dispatch center operators evaluate their preparedness for the job of a medical dispatch center operator. The empirical part of the bachelor thesis was conducted using a semi-structured interview with nine medical dispatch center operators from Pardubice, Jihlava, and České Budějovice. The interview consisted of twenty-four questions, which were divided into nine categories for better clarity. All objectives of this bachelor thesis were fulfilled based on the answers to all research questions. It was found that the job of medical dispatch center operators is undoubtedly demanding, especially from a psychological and communicative standpoint. It was also found that the work of medical dispatch center operators changed during the Covid-19 pandemic, which did not have a significant impact on the operators due to the nature of their profession. We positively evaluate the current preparedness of medical dispatch center operators for their profession. However, the research pointed to insufficient preparedness of medical dispatch center operators before starting this profession.

Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2023; Aachen 1 Online-Ressource : Illustrationen, Diagramme (2023). = Dissertation, Rheinisch-Westfälische Technische Hochschule Aachen, 2023, Background: Although respiratory distress is one of the most common complaints of patients requiring emergency medical services (EMS), there is a lack of evidence on important aspects. Objectives: Our study aims to determine the accuracy of EMS physician diagnostics in the out-of-hospital setting, identify examination findings that correlate with diagnoses, investigate hospital mortality, and identify mortality-associated predictors. Methods: This retrospective observational study examined EMS encounters between December 2015 and May 2016 in the city of Aachen, Germany, in which an EMS physician was present at the scene. Adult patients were included if the EMS physician initially detected dyspnea, low oxygen saturation, or pathological auscultation findings at the scene (n = 719). The analyses were performed by linking out-of-hospital data to hospital records and using binary logistic regressions. Results: The overall diagnostic accuracy was 69.9% (485/694). The highest diagnostic accuracies were observed in asthma (15/15; 100%), hypertensive crisis (28/33; 84.4%), and COPD exacerbation (114/138; 82.6%), lowest accuracies were observed in pneumonia (70/142; 49.3%), pulmonary embolism (8/18; 44.4%), and urinary tract infection (14/35; 40%). The overall hospital mortality rate was 13.8% (99/719). The highest hospital mortality rates were seen in pneumonia (44/142; 31%) and urinary tract infection (7/35; 20%). Identified risk factors for hospital mortality were metabolic acidosis in the initial blood gas analysis (odds ratio [OR] 11.84), the diagnosis of pneumonia (OR 3.22) reduced vigilance (OR 2.58), low oxygen saturation (OR 2.23), and increasing age (OR 1.03 by 1 year increase). Conclusions: Our data highlight the diagnostic uncertainties and high mortality in out-of-hospital emergency patients presenting with respiratory distress. Pneumonia was the most common and most frequently misdiagnosed cause and showed highest hospital mortality. The identified predictors could contribute to an early detection of patients at risk., Published by Aachen

Background Current sepsis screening tools are predominantly based on vital signs. However, patients with serious infections frequently present with normal vital signs and there has been an increased interest to include other variables such as symptoms in screening tools to detect sepsis. The majority of patients with sepsis arrive to the emergency department by emergency medical services. Our hypothesis was that the presentation of sepsis, including symptoms, may differ between patients arriving to the emergency department by emergency medical services and patients arriving by other means. This information is of interest to adapt future sepsis screening tools to the population in which they will be implemented. The aim of the current study was to compare the prevalence of keywords reflecting the clinical presentation of sepsis based on mode of arrival among septic patients presenting to the emergency department. Methods Retrospective cross-sectional study of 479 adult septic patients. Keywords reflecting sepsis presentation upon emergency department arrival were quantified and analyzed based on mode of arrival, i.e., by emergency medical services or by other means. We adjusted for multiple comparisons by applying Bonferroni-adjusted significance levels for all comparisons. Adjustments for age, gender, and sepsis severity were performed by stratification. All patients were admitted to the emergency department of Södersjukhuset, Stockholm, and discharged with an ICD-10 code compatible with sepsis between January 1, and December 31, 2013. Results “Abnormal breathing” (51.8% vs 20.5%, p value p value p value p value p value p value Conclusions The distribution of most keywords related to sepsis presentation was similar irrespective of mode of arrival; however, some differences were present. This information may be useful in clinical decision tools or sepsis screening tools.

Early recanalization of the infarct-related artery to achieve myocardial reperfusion is the primary therapeutic goal in patients with ST-elevation myocardial infarction (STEMI). To decrease the duration of ischaemia, continuous efforts have been made to improve pre-hospital treatment and to target the early period after symptom onset. In this period the platelet content of the fresh coronary thrombus is maximal and the thrombi are dynamic, and thus more susceptible to powerful antiplatelet agents. There have been substantial advances in antiplatelet therapy in the last three decades with several classes of oral and intravenous antiplatelet agents with different therapeutic targets, pharmacokinetics, and pharmacodynamic properties. New parenteral drugs achieve immediate inhibition of platelet aggregation, and fast and easy methods of administration may create the opportunity to bridge the initial gap in platelet inhibition observed with oral P2Y12 inhibitors. Moreover, potential future management of STEMI could directly involve patients in the process of care with self-administered antiplatelet agents designed to achieve rapid reperfusion. However, the potential anti-ischaemic benefits of potent antiplatelet agents will need to be balanced against their risk of increased bleeding. This study presents a comprehensive and updated review of pre-hospital antiplatelet therapy among STEMI patients undergoing primary percutaneous intervention and explores new therapies under development.

Introduction:Since December 2019, emergency services and Emergency Medical Service (EMS) systems have been at the forefront of the fight against the coronavirus disease 2019 (COVID-19) pandemic world-wide.Objective:The objective of this study was to examine the reasons and the necessity of transportation to the emergency department (ED) by ambulance and the outcomes of these cases with the admissions during the COVID-19 pandemic period and during the same period in 2019.Methods:A retrospective descriptive study was conducted in which patients transported to the ED by ambulance in April 2019 and April 2020 were compared. The primary outcomes were the changes in the number and diagnoses of patients who were transferred to the ED by ambulance during the COVID-19 period. The secondary outcome was the need for patients to be transferred to the hospital by ambulance.Results:A total of 4,466 patients were included in the study. During the COVID-19 period, there was a 41.6% decrease in ED visits and a 31.5% decrease in ambulance calls. The number of critically ill patients transported by ambulance (with diagnoses such as decompensated heart failure [P Conclusions:Understanding how the COVID-19 pandemic is affecting EMS use is important for evaluating the current state of emergency health care and planning to manage possible future outbreaks.

ZusammenfassungPatienten mit Schmerzen können durch den nichtärztlichen Rettungsdienst mitunter nur inadäquat versorgt werden, da aufgrund rechtlicher Einschränkungen die Anwendung stark wirksamer Schmerzmittel (Opioide) bzw. ausbildungsbedingt eine i.v.-Therapie in Deutschland und Österreich oft nicht möglich ist. Häufig müssen Notärzte für schmerzgeplagte Patienten nachgefordert werden, wodurch deren Verfügbarkeit für z. B. vitale Notfälle reduziert sein kann. Inhalativ zu verabreichende Analgetika könnten hierfür eine interessante Alternative darstellen.Derzeit steht dazu in Deutschland und Österreich Lachgas (N2O, als Livopan® im Handel) zur Verfügung, eine Mischung aus jeweils 50 % Lachgas und Sauerstoff. In Österreich ist seit 2018 auch Methoxyfluran (Penthrop®) zur Behandlung mäßiger bis starker Schmerzen nach einem Trauma für die prä- und innerklinische Anwendung bei Erwachsenen zugelassen.In der Zusammenschau der vorhandenen Literatur, jahrzehntelanger Erfahrung in der Anwendung der Sauerstoff-Lachgas-Mischung im angloamerikanischen Bereich und von inhalativem Methoxyfluran v. a. in Australien sowie aktuellen Studien aus Europa kann gefolgert werden, dass diese bei Einhaltung der Anwendungsvorschriften effektiv, sicher und nebenwirkungsarm sind. Dies bestätigt auch eine eigene Untersuchung zu Methoxyfluran im präklinischen Einsatz. Die Anwendung von Lachgas ist aufgrund des Druckgaszylinders von der Handhabung her etwas aufwendig; Methoxyfluran ist einfacher anzuwenden und bei starken Schmerzen auch wirksamer. Die Zulassung von Methoxyfluran ist jedoch auf Erwachsene beschränkt, wo es mit zunehmendem Alter deutlich besser wirkt. Der Einsatz von Lachgas und insbesondere Methoxyfluran könnte aufgrund der Datenlage wie auch eigener Erfahrungen für rettungsdienstliches Fachpersonal nach entsprechender Einweisung empfohlen werden.

Background:Some studies in countries affected by the coronavirus disease of 2019 (COVID-19) pandemic have shown that the missions of Emergency Medical Service (EMS) have changed during the COVID-19 pandemic, and the rate of death and out-of-hospital cardiac arrest (OHCA) has been increased due to the direct and indirect effects of COVID-19.Objective:The aim of this study was to determine the effect of the COVID-19 pandemic on the process of EMS missions, death, and OHCA.Methods:This cross-sectional study was performed in Tehran, Iran. All conducted missions in the first six months of the three consecutive solar years of March 21 until September 22 of 2018-2020, which were registered in the registry bank of the Tehran EMS center, were assessed and compared. Based on the opinion of experts, the technician’s on-scene diagnoses were categorized into 14 groups, and then death and OHCA cases were compared.Results:In this study, the data of 1,050,376 missions performed in three study periods were analyzed. In general, the number of missions in 2020 was 17.83% fewer than that of 2019 (P < .001); however, the number of missions in 2019 was 30.33% more than that of 2018. On the other hand, the missions of respiratory problems, cardiopulmonary arrest, infectious diseases, and poisoning were increased in 2020 compared to that of 2019. The raw number of OHCA and death cases respectively in 2018, 2019, and 2020 were 25.0, 22.7, and 28.6 cases per 1,000 missions. Of all patients who died in 2020, 4.9% were probable/confirmed COVID-19 cases. The history of heart disease, hypertension, diabetes, and respiratory disease in patients in 2020 was more frequent than that of the other two years.Conclusion:This study showed that the number of missions in the Tehran EMS in 2020 were decreased compared to that of 2019, however the number of missions in 2019 was more than that of 2018. Respiratory problems, infectious diseases, poisoning, death, and OHCA were increased compared to the previous two years and cardiovascular complaints, neurological problems, and motor vehicle collisions (MVCs) in 2020 were fewer than that of the other two years

Background The safety of the Emergency Medical Service’s (EMS’s) non-conveyance decision was evaluated by EMS re-contacts, primary health care or emergency department (ED) visits, and hospitalization within 48 h. The secondary outcome was 28-day mortality. Methods This cohort study used prospectively collected data on non-conveyed EMS patients from three different regions in Finland between June 1 and November 30, 2018. The Adjusted International Classification of Primary Care (ICPC2) as the reason for care was compared to hospital discharge diagnoses (ICD10). Multivariable logistic regressions were used to determine factors that were independently associated with adverse outcomes. Results are presented with adjusted odds ratios (aORs) together with 95% confidence intervals (CIs). Data regarding deceased patients were reviewed by the study group. Results Of the non-conveyed EMS patients (n = 11,861), 6.3% re-contacted the EMS, 8.3% attended a primary health care facility, 4.2% went to the ED, 1.6% were hospitalized, and 0.1% died 0–24 h after the EMS mission. The 0–24 h adverse event rate was higher than 24–48 h. After non-conveyance, 32 (0.3%) patients were admitted to an intensive care unit within 24 h. Primary non-urgent EMS mission (aOR 1.49; 95% CI 1.25 to 1.77), EMS arrival at night (aOR 1.82; 95% CI 1.58 to 2.09), ALS unit type vs BLS (aOR 1.43; 95% CI 1.16 to 1.77), rural area (aOR 1.74; 95% CI 1.51 to 1.99), and older patient age (aOR 1.41; 95% CI 1.20 to 1.66) were associated with subsequent primary health care visits (0–24 h). Conclusions Four in five non-conveyed patients did not have any re-contact in follow-up period. EMS non-conveyance seems to be a relatively safe method of focusing ED resources and avoiding ED crowding.

Telemedicine promises to increase the quality of emergency treatments. Besides the transfer of speech and video data, medical device and patient data will add additional value to the tele-guided emergency personnel. In this paper, we develop a concept for transmitting device and patient data via the open communication standards SDC in a telemedical context, including data transmission over mobile radio networks while considering the limitations of public networks, and opening new usage scenarios for telemedicine.

The purpose of this study was to present the characteristics of Emergency Medical Services (EMS) team responses to calls regarding suspected labour in out-of-hospital settings in Poland. We performed a retrospective analysis of EMS team interventions in cases of suspected onset of labour outside a hospital setting. The analysis included 12,816 EMS team responses to calls regarding women in suspected labour in the period between January 2018 and December 2019. The mean age of the patients studied was 28.24 years (SD = 6.47). The majority of patients were at term (76.36%) and in their second pregnancy (29.96%). EMS teams were most often dispatched in the summer (25.95%) and in urban areas (63.26%). Most EMS teams were basic (68.99%) and interventions most often took place between 19:00 and 06:59 (63.14%). Significant differences were observed between preterm and term pregnant women attended by EMS teams in terms of variables such as the age of the patient, number of previous labours, history of miscarriage, presence of vaginal bleeding, time of year, location of call, type and composition of EMS team dispatched, urgency code and time of call, duration of intervention, selected emergency medical procedures performed and test results.

In the course of a firefighting career, firefighters attend line-of-duty funerals for other firefighters, law enforcement officers, emergency medical service (EMS) professionals, and perhaps members of the armed forces from within their community, in addition to funerals of friends and family members. The basic purpose of a funeral in society allows the family and friends to say goodbye to a loved one. The fire service does a lot more. The fire service communal response and normalization of death rituals are something that few, if any, other death-related (DR) occupations do as effectively. This thesis considers the importance of death rituals from a historical perspective. It then examines mental resilience by comparing culture, community, and social identity in the fire service with other DR occupations. Current research on death and trauma in the professional workplace is limited and there is an absence of research connecting consistent participation in death rituals through funeral attendance with mental resilience when encountering death, in particular a line-of-duty death. Policy recommendations include instituting programs that normalize funeral attendance, and additional areas of research include studying those who have had early positive experiences with death and dying and their mental resiliency today. Civilian, FDNY Approved for public release. Distribution is unlimited.

Objectives: During the coronavirus disease 2019 pandemic, emergency medical services (EMSs) were among the most affected; in fact, there were delays in rescue and changes in time-dependent disease networks. The aim of the study is to understand the impact of COVID-19 on the time-dependent trauma network in the Lombardy region. Methods: A retrospective analysis on major trauma was performed by analysing all records saved in the EmMa database from 1 January 2019 to 31 December 2019 and from 1 January 2020 to 31 December 2020. Age, gender, time to first emergency vehicle on scene and mission duration were collected. Results: In 2020, compared to 2019, there was a reduction in major trauma diagnoses in March and April, during the first lockdown, OR 0.59 (95% CI 0.49–0.70; p < 0.0001), and a reduction in road accidents and accidents at work, while injuries related to falls from height and violent events increased. There was no significant increase in the number of deaths in the prehospital setting, OR 1.09 (95% CI 0.73–1.30; p = 0.325). Conclusions: The COVID-19 pandemic has changed the epidemiology of major trauma, but in the Lombardy region there was no significant change in mortality in the out-of-hospital setting.

Izvanbolnička hitna medicinska služba dio je zdravstvenog sustava čiji rad se odvija u nepredvidljivim i specifičnim uvjetima i tako ima svoje osobitosti, po kojima se razlikuje od jedinica za hitni prijem u sklopu bolnica. Jedan od uzroka smrti na terenu je srčani zastoj što podrazumijeva nagli i neočekivani prekid srčane funkcije, a koji se potvrđuje odsutnošću pulsa i disanja. Rana kardiopulmunalna reanimacija (KPR) je bitna kako bi liječenje tih pacijenata bilo što uspješnije. Utstein obrazac u Republici Hrvatskoj nema nacionalnog niti lokalnog izviješća o stopi preživljavanja nakon izvanbolničkog srčanog zastoja. Cilj ovog rada je izvijestiti o uspješnosti KPR nakon IBSZ za Zagrebačku županiju za sve ispostave (Samobor, Zaprešić, Jastrebarsko, Velika Gorica, Vrbovec, Sveti Ivan Zelina, Ivanić Grad i Dugo Selo) te statističkom analizom pokušati identificirati koji su čimbenici povezani sa ishodom KPR. Za ovo istraživanje prikupljeni su retrospektivno podaci za vremenski period od 1.1.2013.g. do 31.12.2021.g., a uvid u medicinsku dokumentaciju i provođenje studije odobrilo je etičko povjerenstvo ZZHMZŽ. U istraživanju su korišteni podaci od ukupno 3631 ispitanika . Rezultati istraživanja ukazuju razlike u uspješnosti reanimacije kod (1) odzivnog vremena, što je odzivno vrijeme kraće to je postotak uspješnosti reanimacije veći, (2) uzroku srčanog zastoja, kod medicinskog uzroka veća je uspješnost KPR, (3) veća stopa preživljenja je ukoliko je početni ritam bio VF i (4) laičko oživljavanje je nekvalitetno i ne čini razliku u preživljavanju., The outpatient emergency medical service is part of the health care system whose work takes place in unpredictable and specific conditions and thus has its own characteristics, which distinguishes it from emergency units within hospitals. One of the causes of death in the field is cardiac arrest, which implies a sudden and unexpected interruption of cardiac function, which is confirmed by the absence of pulse and respiration. Early CPR is essential to make the treatment of these patients as successful as possible. Utstein form in the Republic of Croatia does not have a national or local report on the survival rate after outpatient cardiac arrest. The aim of this paper is to report on the success of KPR after IBSZ for Zagreb County for all branches (Samobor, Zaprešić, Jastrebarsko, Velika Gorica, Vrbovec, Sveti Ivan Zelina, Ivanić Grad and Dugo Selo) and statistical analysis to try to identify which factors are related to the outcome of KPR . Retrospective data for the time period from 1.1.2013 were collected for this research. to 31.12.2021, and the insight into the medical documentation and the implementation of the study was approved by the ethics committee of ZZHMZŽ. The study used data from a total of 3631 respondents, and the data collected were: (1) age (2) gender, (3) whether lay resuscitation has begun (4) response time, (5) cause of cardiac arrest (medical, traumatic) and others), (6) initial rhythm (ventricular tachycardia - VT, ventricular fibrillation - VF, electrical activity without pulse - PEA, asystole, bradycardia), (7) number of patients in whom adrenaline was administered and (8) ROSC (return of spontaneous circulation) during CPR and until arrival at the hospital. The results of the study indicate differences in resuscitation success at (1) response time, the shorter the response time the higher the resuscitation rate, (2) the cause of cardiac arrest, the higher the medical success rate of CPR, (3) the higher the survival rate if the initial rhythm was VF and (4) lay resuscitation is of poor quality and makes no difference in survival. Keywords

The use of the Glidescope® videolaryngoscope might improve tracheal intubation performance in clinicians with limited intubation experience, especially during cardiopulmonary resuscitation (CPR). The objective of this systematic review and meta-analysis is to compare direct laryngoscopy to Glidescope® videolaryngoscopy by these clinicians. PubMed/Medline and Embase were searched from their inception to 7 July 2020 for randomized controlled trials, including simulation studies. Studies on adult patients or adult-sized manikins were included when direct laryngoscopy was compared to Glidescope® videolaryngoscopy by clinicians with limited experience in tracheal intubation (

UVOD: Djelatnici hitne pomoći često moraju djelovati brzo i pružiti medicinsku pomoć u okolnostima života i smrti u nepoznatim i nezgodnim uvjetima, dok ih promatraju slučajni prolaznici i rodbina. Osim vanjskih čimbenika – kao što je sve veći broj hitnih slučajeva i sve veći udio starijih ljudi u populaciji – unutarnji stresori, kao što su strukturne promjene u samom sustavu hitne medicinske pomoći, sa sve većom odgovornošću stavlja medicinske sestre-tehničare zaposlene u hitnoj medicinskoj službi pod stalno rastući pritisak. Svrha ovog istraživanja je provesti statističku analizu zadovoljstva poslom i identificirati čimbenike rizika za nisko zadovoljstvo poslom medicinskih sestara-tehničara na terenu. CILJ ISTRAŽIVANJA: Glavni cilj ovog istraživanja je utvrditi razinu zadovoljstva medicinskih sestara/tehničara poslom na terenu u Zavodima za hitnu medicinu. ISPITANICI I METODE: Za potrebe izrade empirijskog dijela ovog rada proveden je anketni upitnik među 60 medicinskih sestara-tehničara zaposleni pri Hrvatskom zavodu za hitnu medicinu. Anketiranje je provedeno putem online anketnog obrasca tijekom srpnja 2022. godine. U istraživanje su uključeni pripadnici oba spola i svih dobnih skupina iz cijele Hrvatske zaposleni pri Zavodu za hitnu medicinu. REZULTATI: U istraživanju je sudjelovalo 56,67% muškaraca i 41,67% žena, najviše je ispitanika u dobnoj skupini od 30-39 godina života, nešto je više ispitanika sa srednjom stručnom spremom, iako je visok postotak i prvostupnika i magistra sestrinstva. Većina je zaposlena na neodređeno (86,67%), u braku (50%), s prosječnim neto primanjima od 7500-9500 kn (45%) i radnim stažem na trenutnom radnom mjestu do 10 godina (56,67%). Srednja razina zadovoljstva radnim okruženjem je 3,07, rukovoditeljima i upravom 3,18, pogodnostima, nagradama i priznanjima za rad 3,02, te komunikacijom i timskim radom 3,64. Srednja razina pozitivnog utjecaja posla na zdravlje, financije i društveni/obiteljski život je 2,25 dok je srednja razina zadovoljstva poslom je 2,57. ZAKLJUČAK: Medicinske sestre-tehničari općenito su nezadovoljni poslom na terenu u Zavodima za hitnu medicinu. Dužina radnog staža u Zavodu za hitnu medicinu ima utjecaj na zadovoljstvo poslom na terenu i to na način da su ispitanici koji rade duže, manje zadovoljni poslom. Organizacijski čimbenici i međuljudski odnosi nisu pokazali statističku značajnost u utjecaju na zadovoljstvo radom u zavodima za hitnu medicinu., INTRODUCTION: Emergency responders are often required to act quickly and provide medical assistance in life-and-death situations in unfamiliar and inconvenient conditions, with bystanders and relatives watching. In addition to external factors - such as the increasing number of emergency cases and the increasing proportion of elderly people in the population - internal stressors, such as structural changes in the emergency medical care system itself, place nurse-technicians employed in the emergency medical service with increasing responsibility under ever-increasing pressure. The purpose of this research is to conduct a statistical analysis of job satisfaction and identify risk factors for low job satisfaction of nurses-technicians in the field. RESEARCH GOAL: The main objective of this research is to determine the level of satisfaction of nurses/technicians with their work in the field in Emergency Medical Services RESPONDENTS AND METHODS: For the purposes of creating the empirical part of this work, a survey questionnaire was conducted among 60 nurse-technicians employed by the Croatian Institute for Emergency Medicine. The survey was conducted via an online survey form during July 2022. Members of both sexes and all age groups from all over Croatia employed at the Institute of Emergency Medicine were included in the research. RESULTS: 56.67% of men and 41.67% of women participated in the research, the majority of respondents are in the age group of 30-39 years of age, there are slightly more respondents with secondary education, although there is a high percentage of both bachelor's and master's degrees in nursing. Most are employed on an indefinite basis (86.67%), married (50%), with an average net income of HRK 7,500-9,500 (45%) and up to 10 years of experience at their current workplace (56.67%). The average level of satisfaction with the work environment is 3.07, with managers and administration 3.18, with benefits, rewards and recognition for work 3.02, and with communication and teamwork 3.64. The mean level of positive impact of work on health, finances and social/family life is 2.25, while the mean level of job satisfaction is 2.57. CONCLUSION: Nurse-technicians are generally dissatisfied with field work in Emergency Medicine Departments. The length of service in the Department of Emergency Medicine has an impact on job satisfaction in the field in such a way that respondents who work longer are less satisfied with their work. Organizational factors and interpersonal relationships did not show statistical significance in influencing work satisfaction in emergency medicine institutes.

The COVID-19 pandemic has profoundly affected the lives of almost every individual in every nation, with numbers of infections continuing to grow. Across these nations, first responders are essential in their roles addressing emergencies, despite their risk of exposure to COVID-19 in the course of their work. We sought to understand the impacts of the COVID-19 pandemic on the lives of volunteer firefighters in the United States, an understudied group of these first responders. Interviews were conducted with volunteer firefighters between September and November 2021. Interviews were analyzed using deductive dominant thematic analysis. Thirty-three firefighters were interviewed who had an average of 22 years of service and a mean age of 52 years. Interviewees described pandemic-related challenges including the fear of COVID exposure and frustrations with work and personal relationships. They also identified unexpected work-related benefits including a deepened commitment to serve and improvements to training and safety. Further, some volunteers noted personal benefits such as developing stronger connections with others, having a new outlook on life, and observing goodwill. Our findings provide insight into the multifaceted and complex impact of the COVID-19 pandemic on volunteer firefighters.

Thidathit Prachanukool, Chaiyaporn Yuksen, Sirada Jintanavasan, Chetsadakon Jenpanitpong, Sorawich Watcharakitpaisan, Parama Kaninworapan, Konwachira Maijan Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Chaiyaporn YuksenDepartment of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandTel +668-9472-691Fax +66-2201-2404Email chaiyapool0634@hotmail.comObjective: Palliative care is an approach to improve quality of life in patients with life-limiting diseases. The sudden nature of such conditions involves emergency providers as the first responders, who have roles in delivering appropriate care to meet patients’ needs. In this study, we evaluated whether previous experience in palliative care among paramedic students could affect their decision-making skills in prehospital work.Methods: This questionnaire-based prospective cross-sectional study was conducted from October 2019 to November 2020. We compared two groups of paramedic students in a tertiary hospital in Bangkok, Thailand. The class of 2019 did not attend palliative care courses and the class of 2020 completed a 2-week course regarding in-hospital palliative care services. Questionnaires including rating scales and checklists and involving cases with and without malignancy were completed via a web-based data collection form. The reliability of the questionnaire was tested. Decision-making skills were categorized into seven domains comprising life-sustaining treatment, withholding or withdrawing life-sustaining treatment, advance care planning, self-autonomy, decision-making capacity and surrogate decision-makers, prehospital dyspnea management, and communication skills.Results: Among 57 paramedics, 52 (91%) completed the questionnaire. There was no significant difference in decision-making between the two groups in all seven domains (p> 0.050). Overall, participants more often recognized patients who were eligible for palliative care and made more decisions to withhold or withdraw life-sustaining treatment when patients had advanced malignancy than in cases of non-malignancy (100% and 84.6% respectively, p=0.006).Conclusion: Our findings showed that the decision-making process for patients regarding prehospital palliative care was not significantly different between two groups of emergency personnel with and without in-hospital palliative care experience.Keywords: emergency medical service, emergency personnel, palliative care, paramedics, prehospital care

Thidathit Prachanukool, Chaiyaporn Yuksen, Sirada Jintanavasan, Chetsadakon Jenpanitpong, Sorawich Watcharakitpaisan, Parama Kaninworapan, Konwachira Maijan Department of Emergency Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Chaiyaporn YuksenDepartment of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, ThailandTel +668-9472-691Fax +66-2201-2404Email chaiyapool0634@hotmail.comObjective: Palliative care is an approach to improve quality of life in patients with life-limiting diseases. The sudden nature of such conditions involves emergency providers as the first responders, who have roles in delivering appropriate care to meet patients’ needs. In this study, we evaluated whether previous experience in palliative care among paramedic students could affect their decision-making skills in prehospital work.Methods: This questionnaire-based prospective cross-sectional study was conducted from October 2019 to November 2020. We compared two groups of paramedic students in a tertiary hospital in Bangkok, Thailand. The class of 2019 did not attend palliative care courses and the class of 2020 completed a 2-week course regarding in-hospital palliative care services. Questionnaires including rating scales and checklists and involving cases with and without malignancy were completed via a web-based data collection form. The reliability of the questionnaire was tested. Decision-making skills were categorized into seven domains comprising life-sustaining treatment, withholding or withdrawing life-sustaining treatment, advance care planning, self-autonomy, decision-making capacity and surrogate decision-makers, prehospital dyspnea management, and communication skills.Results: Among 57 paramedics, 52 (91%) completed the questionnaire. There was no significant difference in decision-making between the two groups in all seven domains (p> 0.050). Overall, participants more often recognized patients who were eligible for palliative care and made more decisions to withhold or withdraw life-sustaining treatment when patients had advanced malignancy than in cases of non-malignancy (100% and 84.6% respectively, p=0.006).Conclusion: Our findings showed that the decision-making process for patients regarding prehospital palliative care was not significantly different between two groups of emergency personnel with and without in-hospital palliative care experience.Keywords: emergency medical service, emergency personnel, palliative care, paramedics, prehospital care

Background:. Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China. Methods:. A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented. Results:. The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3% (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07–3.35), unaware-only (OR: 2.38, 95% CI: 2.31–2.46), and low-income-only (OR: 1.67, 95% CI: 1.63–1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions. Conclusion:. The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.

Zusammenfassung Hintergrund Im Rettungsdienst können, im Gegensatz zum stationären Setting, adäquate Dolmetscher häufig nicht ohne Weiteres hinzugezogen werden. Gleichzeitig erfordern Notfallsituationen aber eine rasche Anamnese und ein Assessment als Basis für jedes therapeutische Handeln. Material und Methoden Eine Smartphone-App, die auf 18 Sprachen eine basale Kommunikation mittels 600 fest eingesprochener unterschiedlicher Phrasen auf 20 Sprachen ermöglicht, wurde über 6 Monate in vier Rettungswachen pilotiert. Abschließend wurde die Nutzbarkeit der App durch das gesamte Rettungsdienstpersonal in einer Fragebogenstudie unter Verwendung des System Usability Scores und des AttrakDiff-Fragebogens bewertet. Ergebnisse Die Rücklaufquote betrug 48,5 % und n = 48 Fragebögen wurden ausgewertet. Das Durchschnittsalter der Befragten betrug 36 Jahre und fast zwei Drittel waren männlichen Geschlechts. Der System Usability Score zeigte im Median 67,5 Punkte, was eine grenzwertig gute Nutzbarkeit zeigte. Im AttrakDiff-Fragebogen zeigte sich die pragmatische Qualität mit durchschnittlich 0,69 (SD 0,86), die hedonische Qualität mit 0,59 (SD 0,58) und die Attraktivität (ATT) mit 0,64 Punkten (SD 0,83). Die Durchschnittswerte zeigen zufriedenstellende Werte jeweils oberhalb der neutral markierenden Grenze von 0. Auffällig zeigte sich, dass in wesentlichen Bewertungskriterien diejenigen Rettungsdienstkräfte, die angaben, die App bereits aktiv im Einsatz mit Patienten genutzt zu haben, die App signifikant besser einschätzten. Diskussion Vor dem Hintergrund, dass es sich bei der untersuchten App um ein komplexes Arbeitswerkzeug handelt, werden die Nutzbarkeit und Attraktivität als insgesamt gut eingeschätzt, wobei in der Nutzung erfahrene Rettungskräfte diese noch positiver einschätzten. Dies könnte auf eine Art Schwellenangst hindeuten, einer bereits durch Sprach- und kulturelle Barrieren geprägten Rettungssituation mit einer ebenfalls recht komplexen Intervention zu begegnen.

The reorganization of an emergency medical system means that we look for new locations of ambulance stations with the aim of improving the accessibility of the service. We applied two tools that are well known in the operations research community, namely mathematical programming, and computer simulation. Using the hierarchical pq-median model, we proposed optimal locations of the stations throughout the country and within large towns. Several solutions have been calculated that differ in the number of stations that are supposed to be relocated to new positions. The locations proposed by the mathematical programming model were evaluated via computer simulation. The approach was demonstrated under the conditions of the Slovak Republic using real historical data on ambulance dispatches. We have concluded that (i) the distribution of the stations proposed by the hierarchical pq-median model overcomes the current distribution; the performance of the system has significantly improved even if only 10% of the stations are relocated to new municipalities; (ii) the variant that relocates 40% of the stations is a reasonable compromise between the benefits and induced costs; (iii) optimizing station locations in big towns can significantly improve the local as well as the nationwide performance indicators; the response times in two regional capitals has reduced by more than 4 min.

Background: Comorbid mental illness may delay recognition of stroke symptoms and reduce the chance of reperfusion therapy. The aim of this study was to compare the use of reperfusion therapy and treatment delays in patients with or without a history of mental illness. Methods: A nationwide registry-based cohort study of patients with ischemic stroke. We combined data from the Danish Stroke Registry and the Danish Quality Database for Prehospital Emergency Medical Services from 2016 to 2017 containing information on reperfusion therapy (thrombolysis or thrombectomy) and relevant time stamps. Patients were categorized according to the severity of their mental health history (how recent and severity, for example, hospital- versus primary-based care). Results: A total of 19 592 admissions were included (18% had a minor, 3% had a moderate, and 3% had a history of major mental illness). Significant differences were found regarding age, comorbidity, and socioeconomic factors. Reperfusion therapy was used in 17% of patients. Patients with a history of mental illness were less likely to receive reperfusion therapy: risk ratios with 95% CI were 0.79 (0.72–0.86) for minor, 0.85 (0.72–0.99) for moderate, and 0.63 (0.51–0.77) for patients with a history major mental illness, respectively. Total prehospital delay was longer for patients with a history of major mental illness compared to patients with no history of mental illness, especially when no call had been made to the emergency medical service. The median times from symptom onset to hospital arrival was 811 minutes (197–2845) and 115 minutes (41–188), respectively. We found no differences regarding door-to-needle time, response time, on-scene time, transport time, nor in time-to-imaging among patients arriving within 4 hours from symptoms onset between patients with and without a history of mental illness. Conclusions: Almost one-quarter of patients with ischemic stroke had a history of mental illness. Regardless of severity of mental illness, these patients were less likely to receive reperfusion therapy. Longer delays from symptom onset to hospital arrival contributed to the patients’ risk of not being eligible for reperfusion therapy.

Introduction: Free-text fields in medical protocols often contain important information expressed in many variations. Thus, the content analysis of these free-text fields is highly important [ref:1]. But the analysis is often associated with a high level of manual effort because they are [for full text, please go to the a.m. URL]

In 2019, an urban ambulance system was deployed in the city of Beira, Mozambique to refer patients from peripheral health centres (HCs) to the only hospital of the city (Beira Central Hospital—HCB). Initially, the system worked following a first-in–first-out approach, thus leading to referrals not based on severity condition. With the aim of improving the process, the South African Triage Scale (SATS) has been subsequently introduced in three HCs. In this study, we assessed the impact of SATS implementation on the selection process and the accuracy of triage performed by nurses. We assessed 552 and 1608 referral charts from before and after SATS implementation, respectively, and we retrospectively calculated codes. We compared the expected referred patients’ codes from the two phases, and nurse-assigned codes to the expected ones. The proportion of referred orange and red codes significantly increased (+12.2% and +12.9%) while the proportion of green and yellow codes decreased (−18.7% and −5.8%). The overall rates of accuracy, and under- and overtriage were 34.2%, 36.3%, and 29.5%, respectively. The implementation of SATS modified the pattern of referred patients and increased the number of severe cases receiving advanced medical care at HCB. While nurses’ accuracy improved with the routine use of the protocol, the observed rates of incorrect triage suggest that further research is needed to identify factors affecting SATS application in this setting.

Bolest Covid-19 je respiratorna bolest koju uzrokuje SARS-CoV-2 virus. Bolest se prvi puta pojavila krajem 2019. godine u Kini, a nedugo zatim se proširila i na cijeli svijet. Iako je utjecala na cijelo čovječanstvo, u ovom radu govorit će se o njenom utjecaju na rad izvanbolničke hitne medicinske službe (IHMS), točnije na utjecaj pandemije na vrijeme izlaska tima na intervencije s obzirom na to da je primarni cilj hitne medicinske službe maksimalno skraćenje vremena od nastanka hitnog stanja do konačnog medicinskog zbrinjavanja. Cilj ovoga rada je prikazati prosječno vrijeme izlaska tima izvanbolničke hitne medicinske službe Primorsko-goranske županije na intervenciju za vrijeme pandemije Covida 19. Za istraživanje se koristio prigodni uzorak ispitanika te metoda rada na dokumentaciji, točnije prikupljanje podataka iz medicinske dokumentacije Zavoda za hitnu medicinu Primorsko-goranske županije, iz baze podataka e-Hitna. Istraživanje obuhvaća razdoblje od 01.01.2020. do 31.12.2021. godine, a samo istraživanje provedeno je u mjesecu travnju 2022. godine. Statistička analiza podataka provedena je pomoću Student-t testa i Fisher egzaktnog testa. Rezultati statističke analize pokazuju da prosječno vrijeme od početka poziva do izlaska tima na intervenciju A kriterija nevezanu za Covid dijagnozu u 2020. godini, iznosi 0:00:16 s više od standardnog vremena dok za one vezane za Covid dijagnozu u prosjeku iznosi 0:12:19 s više. U 2021. godini prosječno vrijeme od početka poziva do izlaska tima na intervencije A kriterija nevezane za Covid dijagnozu iznosi 0:00:14 s više od standardnog vremena dok na one vezane za Covid dijagnozu u prosjeku iznosi 0:05:25 s više. U 2020. godini, prosječno vrijeme dolaska tima na intervenciju A kriterija od primitka poziva, ne vezanih za Covid dijagnozu iznosi 0:06:15 s više uspoređujući sa standardnim vremenom za urbane sredine ili 0:05:07 s više u odnosu na standardno vrijeme za ruralne sredine. Prosječno vrijeme dolaska tima na intervenciju A kriterija od primitka poziva, za intervencije vezane za Covid dijagnozu iznosi 0:23:57 s više za urbane te 0:13:55 s više za ruralne sredine. U 2021. godini, prosječno vrijeme dolaska tima na intervenciju A kriterija od primitka poziva, nevezano za Covid dijagnozu iznosi 0:06:15 s više u odnosu na standardno vrijeme za urbane sredine ili 0:03:00 min manje u odnosu na standardno vrijeme za ruralne sredine. Prosječno vrijeme dolaska tima na intervenciju A kriterija od primitka poziva, za intervencije vezane za Covid dijagnozu iznosi 0:15:22 s više za urbane te 0:05:22 s više za ruralne sredine. Ovim istraživanjem zaključuje se da je pandemija Covid-19 značajno utjecala na produljenje vremena potrebnog za izlazak i dolazak tima IHMS na intervenciju što u konačnici negativno utječe na uspješnost i stupanj izlječenja pacijenta koji zahtijeva hitnu medicinsku pomoć., Covid-19 disease is a respiratory disease caused by the SARS-CoV-2 virus. The disease first appeared in late 2019. in China, and soon after spread to the whole world. Although it has affected all of humanity, this paper will discuss its impact on the work of emergency medical service (EMS), more precisely, on the time of the egress of EMS, given that the primary goal of emergency medical services is to shorten the time from the occurance of emergency conditions until final medical care. The aim of this paper work is to show the average time of the egress of the EMS of the Primorsko-goranska County to interventions during the Covid 19 pandemic. In this research a suitable sample of respondents had been used with the method of working on documentation, more precisely collecting data from the medical documentation of the Institute of Emergency Medicine of the Primorsko-goranska County, from the e-Hitna database. The research covers the period from 01.01.2020. to 31.12.2021. and the survey itself was conducted in April 2022. Statistical analysis of data was performed using Student-t test and Fisher exact test. The results shows that the average time from the call reception to the team's egress on intervention in A criteria that isn't related to the diagnosis of Covid in 2020 is 0:00:16 s longer than the standard time, while for those related to the diagnosis of Covid the time is 0:12:19 s longer than the standard time. In 2021, the average time from the call reception to the team's egress on interventions A criteria not related to Covid diagnosis is 0:00:14 s longer than the standard time, while for Covid related diagnosis is 0:05:25 s longer than standard time. In 2020, the average time for EMS team arrival to intervention in A criteria from the receipt of calls, not related to Covid diagnosis is 0:06:15 s longer compared to the standard time for the urban environment or 0:05:07 s longer than the standard time for rural areas. In other hand average time of arrival of the team to intervention in A criteria from the receipt of call, for Covid diagnosis interventions is 0:23:57 s longer for urban and 0:13:55 s longer for rural areas. In 2021, the average time of arrival of the team to the intervention in A criteria, from the call reception, not related to the Covid diagnosis is 0:06:15 s longer than the standard time for urban areas or 0:03:00 min shorter for rural areas. Furthermore average time of responding and EMS team arrival to intervention in A criteria from the receipt of calls, for interventions related to Covid diagnosis is 0:15:22 s longer for urban and 0:05:22 s longer for rural areas. This study concludes that the Covid-19 pandemic significantly influenced the prolongation of the responding time needed for the emergency medical service team to egress and arrive on interventions, which unfortunately negatively affects the success and quality of patient treatment in need for emergency medical care.

International audience; In this paper, we consider the problem of allocation of Emergency Vehicles (EVs) to Rescue Centers (RCs). The objective is to improve the operational response of the Fire and Rescue Services (SDIS) in France. More precisely, we focus on the mid-term management, and on the process of redeployment of EVs in RCs according to the evolution of requirements. At this level of decision, we do not have information on accidents. We only used the available information on the simultaneity of requirements. Based on the Hurwicz criterion, we develop a mathematical model and an iterative algorithm to solve it. The proposed approach takes into account both the uncertainty on the occurrence sequence of accidents, and the attitude towards optimization of the decision maker (DM). An illustration from the DM’s point of view is presented. It shows that this uncertainty significantly impacts the deployment of EVs. Results show that the proposed approach has an efficient resolution time for real size problems.

Background/purpose: The study aim was to develop a model for predicting patients with emergency medical service (EMS) witnessed out-of-hospital cardiac arrest (OHCA). Methods: We used fire-based EMS data from Taipei city to develop the prediction model. Patients included in this study were those who were initially alive, non-traumatic, and age ≧20 years. Data were extracted from electronic records of ambulance run sheets and an Utstein-style OHCA registry. The primary outcome (EMS-witnessed OHCA) was defined as cardiac arrest occurring during the service of emergency medical technicians before arrival at a receiving hospital. Area under the receiver operating characteristic curve (AUROC) and the Hosmer–Lemeshow (HL) test were used to examine discrimination and calibration. The point value system with Youden's J Index was used to find the optimal cut-off value. Results: From 2011 to 2015, a total of 252,771 patients were included. Of them, 660 (0.26%) were EMS-witnessed OHCA. The model, including the predictors of male gender, respiratory rate≦10 cycles/min, heart rate

Introduction: Acute kidney injury (AKI) is common in hospitalized patients (1.92%). The effect of serum corrected and ionized calcium levels in predicting emergency hemodialysis in patients with AKI is unknown. In this study, we aimed to compare serum corrected and ionized calcium levels in patients who were diagnosed with AKI in the emergency service.Methods: Our study was planned retrospectively. Group 1: Patients with AKI who underwent at least one session of emergency hemodialysis. Group 2: The patients with AKIN stage 1-3 who did not undergo hemodialysis. Serum corrected and ionized calcium, creatinine and albumin values of the patients at the time of admission were analyzed. All data of the study were recorded by SPSS 19.0. For statistical significance, p

Background Despite the proven value of multicriteria decision analysis in the health field, there is a lack of studies focused on prioritising victims in the Emergency Medical Service, EMS. With this, and knowing that the decision maker needs a direction on which choice may be the most appropriate, based on different and often conflicting criteria. The current work developed a new model for prioritizing victims of SAMU/192, based on the multicriteria decision methodology, taking into account the scarcity of resources. Methods An expert panel and a discussion group were formed, which defined the limits of the problem, and identified the evaluation criteria for choosing a victim, amongst four alternatives illustrated from hypothetical scenarios of emergency situations—clinical and traumatic diseases of absolute priority. For prioritization, an additive mathematical method was used that aggregates criteria in a flexible and interactive version, FITradeoff. Results The structuring of the problem led the researchers to identify twenty-five evaluation criteria, amongst which ten were essential to guide decisions. As a result, in the simulation of prioritization of four requesting victims in view of the availability of only one ambulance, the proposed model supported the decision by suggesting the prioritization of one of the victims. Conclusions This work contributed to the prioritization of victims using multicriteria decision support methodology. Selecting and weighing the criteria in this study indicated that the protocols that guide regulatory physicians do not consider all the criteria for prioritizing victims in an environment of scarcity of resources. Finally, the proposed model can support crucial decision based on a rational and transparent decision-making process that can be applied in other EMS.

Background: First responder programs were developed to speed up access to cardiopulmonary resuscitation and defibrillation for out-of-hospital cardiac arrest (OHCA) victims. Little is known about the factors influencing the efficiency of the first responders arriving before the EMS and, therefore, effectively contributing to the chain of survival. Objectives: The primary objective of this retrospective observational study was to identify the factors associated with first responders' arrival before EMS in the context of a regional first responder program arranged to deliver automated external defibrillators on suspected OHCA scenes. Methods: Eight hundred ninety-six dispatches where FRs intervened were collected from 2018 to 2022. A robust Poisson regression was performed to estimate the role of the time of day, the immediate availability of a defibrillator, the type of first responder, distances between the responder, the event and the dispatched vehicle, and the nearest available defibrillator on the probability of responder arriving before EMS. Moreover, a geospatial logistic regression model was built. Results: Responders arrived before EMS in 13.4% of dispatches and delivered a shock in 0.9%. The immediate availability of a defibrillator for the responder (OR=3.24) and special categories such as taxi drivers and police (OR=1.74) were factors significantly associated with the responder arriving before EMS. Moreover, a geospatial effect suggested that first responder programs may have a greater impact in rural areas. Conclusions: When dispatched to OHCA scenes, responders already carrying defibrillators could more probably reach the scene before EMS. Special first responder categories are more competitive and should be further investigated.

Aim Offshore wind energy is a fast growing market. Accordingly, a correspondingly large number of employees are working at the wind farms. Owing to the harsh operating conditions, accidents and medical emergencies occur there. The care of these patients poses special challenges. The aim of the investigation was to determine whether telemedical emergency care is technically possible on the North Sea, far away from any medical care. Subject and methods We were able to establish a raw data supported telemedical integration with a rescue service monitor for transmission of ECG, blood pressure, saturation and other vital parameters to a telemedicine centre. As a first step, a satellite connection was set up on a supply ship for the transmission, which was then made available for data transfer via WLAN. Results In this project, we were able to show in tests as well as in actual patient care that telemedical support of rescue service personnel on site using raw data transmission is also possible offshore on a supply ship. In this project, defined areas with WLAN coverage were necessary in which the transmission worked in 100% of cases. Conclusion The care of emergencies in the area of offshore wind farms is an increasing problem, which can be sensibly treated with telemedical support. Technical possibilities can also be created on site in the North Sea. The further expansion of a communication network, for example, with LTE or 5G, is necessary to enable telemedical care independent of supply ships.

Background Patient with dizziness are challenging in prehospital care. The aim was to describe final diagnosis among patients assessed by EMS as suffering from dizziness with focus on time-critical conditions. Methods Consecutive patients assessed by an EMS clinician during 12 months in a single large EMS system in Gothenburg, Sweden (660,000 inhabitants), were assessed. The study comprised patients given ESS code 11 dizziness. The main end-point was the final diagnosis (ICD code). Results There were 58,575 primary missions, of which 2,048 (3.5%) were assessed as ESS code 11 (dizziness). Of these, 161 (8%) were excluded. Among the remaining 1887 cases, there were 230 different ICD codes and 96 (5%) had a time-critical condition. The majority (88%) had a cerebrovascular disease. The most typical symptoms among time-critical conditions were an acute onset (63%) and nausea, vomiting (61%). When compared with non-time-critical conditions, those with time-critical conditions were older and had a higher median systolic blood pressure at EMS arrival. Conclusion Among primary missions by the EMS, 3.5% had dizziness. Of these, 5% had a time-critical condition and the majority had a cerebrovascular disease. Instruments to identify time-critical conditions among patients seen by EMS due to dizziness are required.

Emergency medical service (EMS) plays an essential role in increasing survival rates as it provides first aid to victims of life-threatening emergencies. However, unbalanced EMS supply-demand distribution in the metropolis may cause a shortage of accessible EMS resources and delay the first aid treatment. There is an urgent need to discover the hidden EMS supply-demand relation, predict the incoming EMS demand, and take precautions against unexpected emergencies. This study assumes that EMS demand correlates with population demographic data, regional socioeconomic factors, and hospital conditions. To model these correlated factors, we represent Tokyo’s ambulance record data as a hospital-region bipartite graph and propose a bipartite graph convolutional neural network model to predict the EMS demand between hospital-region pairs. Our approach achieves 77.3% – 87.7% accuracy in binary demand label prediction task. It significantly outperforms traditional machine learning algorithms, statistical models, and the latest graph-based methods. Finally, we use a case study to show the significance of EMS demand forecasting, proving that our approach can contribute to public health emergency management by making EMS predictions.

Background Unknown and unpredictable situations cause emergency medical service (EMS) providers to experience various stressful factors. These factors are affected by sociocultural conditions and expectations of the casualty and affect EMS providers' performance and health at the incident scene. The present study was conducted to explore EMS providers' perception of stressful and health-threatening factors in emergency missions. Method This qualitative conventional content analysis was conducted in 2020. The participants included 16 EMS providers working at the Emergency Medical Services Department in Hamadan Province, Iran. The participants were selected using purposive sampling and underwent semi-structured interviews until data saturation. Data were analyzed using the Graneheim and Lundman method. Results Analysis of the interview data yielded six subcategories (i.e., incident scene hazards, violence-related injuries, physical injuries caused by patient care/handling, ambulance crash-related injuries, emotional impact of patients' suffering and ailments, and highly stressful missions), two main categories (i.e., physical injuries and psychological tensions), and a theme of occupational injuries. Conclusions According to the results, in addition to having concerns about caring for patients and saving the injured, EMS providers also worry about potential threats to their own health. The present study identified and described some major stressors in emergency missions. Thus, for a better and more effective efficiency, the present study results can be used to reduce or modify stressors in EMS providers.

Introduction Despite the growing number of studies on the epidemiology of out-of-hospital cardiac arrest (OHCA) in Poland, this issue has not been sufficiently studied. Notably, there has been a lack of uniform Utstein-style data reporting. Aim To evaluate the epidemiology of OHCA, patient characteristics, the laypeople and emergency medical service (EMS) response to cardiac arrest, and outcomes of OHCA patients, based on a prospective registry encompassing a population of 2.7 million Poles. Material and methods Consecutive, adult, EMS-treated OHCA cases in 2018 were analyzed. Prehospital data were collected using case report forms by EMS. Information on in-hospital procedures and outcomes was based on data from the public payer of health care services. Multivariable logistic regression analysis was performed to find independent predictors of survival to discharge. Results A total of 1392 patients were included. Most OHCA occurred at home (74.7%). In 66.8% of OHCA cases, the cardiac arrest was witnessed by bystanders and in another 20.4% by EMS. Laypeople performed cardiopulmonary resuscitation (CPR) in 54.4% of non-EMS-witnessed events, and an automated external defibrillator (AED) was used in 4.6% of patients who received bystander CPR. Finally, 30.7% of all patients were transported to the hospital, and 9.2% survived to hospital discharge. Epinephrine administration, unwitnessed OHCA, longer response time, older age, and initial non-shockable rhythm were independently associated with lower survival to discharge. Conclusions The prognosis of OHCA patients in Poland is poor. There is still room for improvement in increasing the prevalence of bystander CPR and AED use before EMS arrival.

Background/Aim: Cardiac arrest (CA) is a leading cause of mortality in the last forty years worldwide. Immediately initiated cardiopulmonary resuscitation (CPR) improves chances for survival. Aim of this study was to determine the efficiency of the Emergency medical service (EMS) dispatch centre in the absence of the uniform emergency medical dispatch assessment protocols in the management of cardiac arrest. Methods: The retrospective and observational study was conducted in Institute for Emergency Medical Service Novi Sad (IEMS Novi Sad) Serbia during a one-year follow-up. The study included patients with out-of-hospital cardiac arrests who underwent CPR. Results: EMS teams of the IEMS Novi Sad had 198 CPRs in the follow-up period. In 142 (71.72 %) calls, the EMS dispatcher got information that the patient was unconscious. The reported reaction time I by the dispatchers for the unconscious patients was 1.37 ± 1.27 minutes, actual duration of the conversation between the dispatcher and a caller - was longer: 138.21 ± 103.02 seconds (p < 0.001). The average conversation time with a caller was 61.37 ± 31.13 seconds. In 6 (4.22 %) cases, the EMS team was dispatched to a patient before the phone call was terminated. At the moment of arrival, all patients were unconscious, 194 (94.37 %) were pulseless, while the remaining 8 (5.63 %) experienced cardiac arrest during the examination. The cardiac arrest was witnessed by a layman in 120 (84.51 %) cases and CPR was initiated by bystanders, before the arrival of the EMS team, only in 13 (10.83 %) patients. Twenty-seven (19.01 %) patients arrived in a hospital with vital signs. Conclusion: The absence of the uniform EMS dispatch assessment protocols for the triage of incoming calls and phone assisted CPR for lay rescuers decreases the survival rate of patients with cardiac arrest.

Choosing the optimal positioning of Emergency Medical Services (EMS) base stations is needed to provide timely assistance in emergency conditions. In rural countries, this is obtained through a tiered system, where ambulances take charge of patients from specific gathering centres, and then take them to the hospitals. Here, a dynamic programming technique based on Dijkstra's algorithm has been devised to optimally allocate EMS to different base stations, based on location and travelling times for the paths leading to gathering centres and hospitals. The system, implemented in Java, has been tested on in-silico data simulating different scenarios of network connectivity, and validated against experimental data of EMS calls managed from the national EMS in Sierra Leone in 2021. The system allows to predict the average travel times to reach hospital facilities as a function of the number of ambulances and Base stations used.

Uvod: Rad u hitnoj medicini uključuje svakodnevni susret sa životno ugroženim pojedincima, izloženost visokoj razini stresa i emocionalnoj patnji, neadekvatne radne uvjete, izloženost infekcijama, kontaminiranom biološkom materijalu i kemikalijama, teško dostupnim mjestima intervencija i čestim susretima s nasiljem. Navedeni čimbenici mogu biti odgovorni za pojavu psihičkog, fizičkog i emocionalnog stresa kod djelatnika u hitnoj službi. Visoke razine stresa i uvjeti rada negativno utječu na kvalitetu života zdravstvenih djelatnika jer poteškoće s kojima se suočavaju mogu imati negativne učinke na njihovo fizičko i psihičko zdravlje te socijalno funkcioniranje Cilj: Glavni cilj ovog istraživanja je analizirati kvalitetu života zdravstvenih djelatnika Zavoda za hitnu medicinu Karlovačke županije u odnosu na sociodemografska i radna obilježja ispitanika Metode: Istraživanje je provedeno na uzorku od 70 ispitanika koji su zaposleni u Zavodu za hitnu medicinu Karlovačke županije. Za ispitivanje razine kvalitete života korišten je WHOQOL‐BREF upitnik kvalitete života Rezultati: Kvaliteta života među zdravstvenim djelatnicima u Zavodu za hitnu medicinu Karlovačke županije je zadovoljavajuća. Ispitanici ženskog spola su statistički značajno nezadovoljniji psihološkim zdravljem od muških ispitanika. Pronađena je statistički značajna razlika u domeni okoliša u kojoj su ispitanici u dobnoj skupini od 36 do 45 godina postigli statistički značajno niži rezultat od ispitanika u ostalim dobnim skupinama. Liječnici niti po jednom dijelu upitnika ne iskazuju statistički značajno više rezultate od medicinskih sestara/tehničara dok u domeni psihičkog zdravlja medicinske sestre iskazuju višu razinu kvalitete života u odnosu na liječnike. Zaključak: Djelatnost hitne medicinske službe spada među najstresnije radno okruženje zbog velikog radnog opterećenja, stanja pacijenata, vremenskog ograničenja za djelovanje, brzog donošenja odluka u kritičnim situacijama i nedostatka ljudskih i tehničkih resursa. Rad u službi hitne pomoći može stoga dovesti do loše kvalitete života, što može uzrokovati lošu kvalitetu usluga za pacijente., Introduction: Emergency medicine includes daily encounters with life-threatening individuals, exposure to high levels of stress and emotional suffering, inadequate working conditions, exposure to infections, contaminated biological material and chemicals, hard-to-reach intervention sites and frequent encounters with violence. These factors may be responsible for the occurrence of psychological, physical and emotional stress in emergency workers. High levels of stress and working conditions negatively affect the quality of life of health professionals because the difficulties they face can have negative effects on their physical and mental health and social functioning. Objective: The main objective of this research is to analyze the quality of life of health professionals of the Institute of Emergency Medicine of Karlovac County in relation to socio-demographic and work characteristics of respondents Methods: The research was conducted on a sample of 70 respondents who are employed in the Institute of Emergency Medicine of Karlovac County. The WHOQOL ‐ BREF Quality of Life Questionnaire was used to examine the level of quality of life Results: The quality of life among health professionals in the Institute of Emergency Medicine of Karlovac County is satisfactory. Female respondents were statistically significantly more dissatisfied with psychological health than male respondents. A statistically significant difference was found in the field of environment in which respondents in the age group of 36 to 45 years achieved a statistically significantly lower result than respondents in other age groups. Doctors do not show statistically significantly higher results in any part of the questionnaire than nurses / technicians, while in the field of mental health nurses show a higher level of quality of life compared to doctors. Conclusion: The emergency medical service is one of the most stressful work environments due to heavy workloads, patient conditions, time constraints, rapid decision-making in critical situations and lack of human and technical resources. Working in an ambulance service can therefore lead to a poor quality of life, which in turn can lead to a poor quality of service for patients.

The COVID-19 pandemic and its resulting social restrictions have significant implications for mental health. The objective of this study was to determine the monthly trends and types of patients experiencing a mental health crisis (MHC) who used emergency medical services (EMSs) before and during the COVID-19 pandemic. A retrospective observational study was conducted using EMS data. During the study period, 8577 patients used EMSs for MHCs. EMS dispatches for MHCs and suicide completion after the COVID-19 pandemic were decreased by 12.4% and 12.7%, respectively, compared to those before the COVID-19 pandemic. Segmented regression analysis found that the number of patients per month was 6.79 before the COVID-19 pandemic. The number decreased to 4.52 patients per month during the COVID-19 pandemic, although the decrease was not statistically significant. The monthly number of patients experiencing an MHC decreased during strict social distancing measures but increased during relaxed social distancing measures. The percentage of hanging increased from 14.20% before the COVID-19 pandemic to 14.30% (p = 0.03) during the COVID-19 pandemic, whereas the percentages of jumping (from 15.55% to 15.28%, p = 0.01) and self-harm by smoke (from 4.59% to 3.84%, p < 0.001) during the COVID-19 pandemic were decreased compared to those before COVID-19. However, the effect size for the above findings was small (below 0.20). More than 25% of the patients experiencing an MHC who used EMSs refused to transfer to the ED over both study periods (26.49% in the pre-COVID-19 period and 28.53% in the COVID-19 period). The COVID-19 pandemic and social restrictions seemed to have some effects on the use of EMSs by MHC patients. Hanging is mainly performed indoors and is not found easily if social distancing persists, and a patient experiencing an MHC who refuses to be transferred could potentially attempt suicide. Subsequent studies should be performed to determine whether these findings are temporary during the COVID-19 pandemic or whether they will show different aspects after the COVID-19 pandemic.

INTRODUCTION: Road accidents lead to injuries which are one of the most common causes of hospitalisation in trauma centres. Proper placement and number of EMS units determine quick arrival in the scene of accident and need for transport to the adequate healthcare entity. MATERIAL AND METHODS: An analysis was carried out of the profile of the patient, the distance to the scene of accident as well as the allocation of accident casualties to healthcare entities. A statistical analysis was conducted by means of the Chi-Square Test of Independence and the Kruskal–Wallis test by ranks. RESULTS: Distances between the scenes of accidents and places where EMS units were stationed was from 0.5 to 37 kilometres (mean: 9.8 km). 170 patients participated in the accidents. Most frequently, these were males at the age from 21 to 40 (mean: 35.77 ± 15.45). The most common diagnoses according to ICD-10 were injuries to the head (42.7%) and injuries of lower limbs (12%). In most cases, the accident casualties were transported to the Emergency Department in Łuków. 21 patients in total were placed in hospital facilities outside the catchment area. The Polish Medical Air Rescue transported the 10 patients in the most severe condition. CONCLUSIONS:Road accidents are most frequently experienced by middle-aged men. Injuries to the head and of lower limbs are the most common injuries. The placement of EMS units in the area under analysis is optimal, but the mean distance covered by the ambulance to reach to scene of accident is nearly 10 kilometres. Despite the presence of the Emergency Department in Łuków, one in ten injured patient warrants transport outside the catchment area and almost 6% of patients qualify for transport by air.

INTRODUCTION: Pharmacotherapy is essential during emergency medical services (EMS). Medication administered in pre-hospital conditions enables i.a.: sedation, analgesia, treatment of arrhythmias, and resuscitation. The equipment of the paramedic’s box (Drug Kit) in an ambulance depends on the Rescue System in a given country. In Poland, since several years, there has been a standardized list of medications available in the emergency medical services. The authors attempt to assess the indication of pharmaceuticals that are most commonly used and those that may turn out to be unnecessary in pre-hospital care. MATERIAL AND METHODS: The interventions of two emergency medical teams (specialized "SEMS" and basic "BEMS") from 2019 were analyzed. The Kolmogorov-Smirnov variable distribution normality test was used for statistical analysis; Pearson correlation and Chi squared independence tests. All results were considered significant at p