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Background. The use of lights and siren transport (LST) has been a matter of debate because of the short time savings and well-established increased risks for Emergency Medical Services (EMS) and bystanders. Time-critical hospital intervention (TCHI) denotes urgently needed procedures that cannot be performed properly in an out-of-hospital setting. Since 2013, rapid transportation from the field, fast-track, is currently used for patients with acute ST-elevation myocardial infarction, suspicion of acute stroke and out-of-hospital cardiac arrest. The aim of this study was to determine whether the use of LST was associated with the realization of TCHI for nontrauma cases within 15 minutes of hospital arrival, to quantify overtriage (LST without TCHI) and to identify the predictors of TCHI. Methods. This is a monocentric prospective observational study of nontrauma patients transported by ambulance. Based on Ross et al.’s work in 2016 on trauma patients, TCHI procedures were developed by the study team. Descriptive statistics were used to determine whether the use of LST was associated with the realization of TCHI. Multivariable analyses determined the predictors of TCHI and compared clinical outcomes. Results. On the 324 patients included, 67 (20.7%) benefitted from LST, with 40 (59.7%) receiving TCHI (p<0.001). The overtriage rate was 40.3%. The most common medical TCHI was the fast-track (65.2% of all TCHI). LST was predictive of the need for TCHI (p<0.001), as was the clinical condition of the patient and also when EMS providers expected TCHI. Conclusions. A majority of the LST benefitted from TCHI with an overtriage rate of 40%. To reduce the rate of overtriage (LST without TCHI), LST should mainly be used for fast-track and when TCHI is expected by the EMS providers.

Background. Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. Methods. An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. Results. 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Conclusions. Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.

Acute treatment in emergency medicine revolves around the management and stabilization of sick patients, followed by a transfer to the relevant medical specialist, be it outpatient or inpatient. However, when patients are too sick to be stabilized, i.e., when the care provided in the Emergency Department (ED) may not be sufficient to enable transfer, death may occur. This aspect of emergency medicine is often overlooked, and very few public data exist regarding who dies in the ED. The following retrospective analysis of the mortality figures of a Swiss university hospital from January 1st 2013 to December 31st 2016 attests to the fact that with an incidence of 2.6/1,000, death does occur in the ED. With a broad range of aetiologies, clinical severity at presentation has a high correlation with mortality, a finding that reinforces the necessity of good triage system. Our analysis goes on to show that however (in)frequent death in the ED may be, there exists a lack of advanced directives in a majority of patients (present in only 14.8% of patients during the time of study), a worrying and often challenging situation for Emergency Medicine (EM) teams faced with premorbid patients. Furthermore, a lack of such directives may hinder access to palliative care, as witnessed in part by the fact that palliative measures were only started in 16.6% of patients during the study. The authors hope this study will serve as a stepping stone to promote further research and discussion into early identification methods for patients at risk of death in the ED, as well as motivate a discussion into the integration of palliative care within the ED and EM training curriculum.