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The cost effectiveness of medical treatments is not precisely known due to the compounding effect of multiple determining factors. Ambulance response time (RT) to emergency calls is exploited to learn more about the effect of the timing of treatment on health outcomes. This causal relation is identified by exploiting rainfall at the time of the ambulance run as a shock to RT. The analysis focuses on patients who have undergone a cardiac event and shows that a one-minute increase in average RT leads to 105 more deaths each year in one Italian region. Finally, the economic value of the lives that would be saved by reducing RT is quantified to facilitate policymaking., (© 2023 The Authors. Health Economics published by John Wiley & Sons Ltd.)

This study aimed to explore factors associated with ambulance use and emergency department (ED) visits among people with dementia in the month before death. A web-based survey of bereaved family caregivers of people with dementia was conducted in March 2020. Multivariate logistic regression analyses were conducted with ambulance use and ED visits in the month before death as dependent variables. Age and gender of people with dementia and their family caregivers, home care use, decision-makers, comorbidities, degree of independence in daily living, and caregivers' preparedness for death were independent variables. Data were collected from 817 caregivers of people with dementia who had died at hospitals (52.4%), long-term care facilities (25.0%), or own homes (22.4%). Caregivers' lack of preparedness for death was significantly associated with ambulance use in the month before death. Comorbidites and males with dementia were significantly associated with ED visits in the month before death. Better death preparedness of family caregivers may reduce ambulance use for symptoms that can be more effectively addressed by palliative care than acute care for people with dementia., (© 2023 The Authors. Nursing & Health Sciences published by John Wiley & Sons Australia, Ltd.)

Digital technology has an essential role in the development and application of innovations within the health care system. Its application is not limited to the hospital environment but extends to the emergency medical services system. The experimental phase of the shift to electronic emergency medical services documentation was performed within the Azienda Sanitaria Universitaria Friuli Centrale of Udine (Italy), a local health authority covering about 533 000 inhabitants. Considering the results of this study, we believe it is important to continue to update the methods of data collection and analysis in correlation with the management and outcomes of the patients. [ABSTRACT FROM AUTHOR]

The Special Issue on Digital Health commemorates the 40th Anniversary of the Takemi Program in International Health at Harvard University, examining the potential and obstacles of digital health. The articles investigate the influence of digital technologies on health systems worldwide, with a specific focus on low- and middle-income countries. Various topics are explored, such as internet-based health information access, digitally supported health workers, healthcare delivery at home, transportation and logistics management innovations, and utilizing data to enhance health system performance. The papers present detailed case studies, evaluations, and frameworks for comprehending and planning digital health interventions, including studies on chronic disease management in rural South Korea, addressing gender-based violence in rural Nigeria, analyzing the Maharashtra ambulance service in India, and discussing digital transformation in the health product supply chain. Additionally, the text examines the role of digital health within Taiwan's national health insurance system and the utilization of digital health data for Palestine refugees, shedding light on the readiness, obstacles, and possibilities for integrating digital technology into healthcare systems across diverse regions. [Extracted from the article]

Purpose: The aim of this study was to assess the effect of fluid administration by emergency life-saving technicians (ELST) on the prognosis of traffic accident patients by using a propensity score (PS)-matching method., Methods: The study included traffic accident patients registered in the JTDB database from January 2016 to December 2017. The main outcome was hospital mortality, and the secondary outcome was cardiopulmonary arrest on hospital arrival (CPAOA). To reduce potential confounding effects in the comparisons between two groups, we estimated a propensity score (PS) by fitting a logistic regression model that was adjusted for 17 variables before the implementation of fluid administration by ELST at the scene., Results: During the study period, 10,908 traffic accident patients were registered in the JTDB database, and we included 3502 patients in this study. Of these patients, 142 were administered fluid by ELST and 3360 were not administered fluid by ELST. After PS matching, 141 patients were selected from each group. In the PS-matched model, fluid administration by ELST at the scene was not associated with discharge to death (crude OR: 0.859 [95% CI, 0.500-1.475]; p = 0.582). However, the fluid group showed statistically better outcome for CPAOA than the no fluid group in the multiple logistic regression model (adjusted OR: 0.231 [95% CI, 0.055-0.967]; p = 0.045)., Conclusion: In this study, fluid administration to traffic accident patients by ELST was associated not with hospital mortality but with a lower proportion of CPAOA., (© 2021. The Author(s).)

Objective: Nitrous oxide (Entonox ® ) and methoxyflurane (Penthrox ® ) are inhaled analgesics administered in paramedicine. Occupational exposure to nitrous oxide has been associated with negative health effects, and may inhibit professional capability. The effect of occupational exposure to methoxyflurane has not yet been clearly determined. This study identifies the frequency and duration of ambulance officer (AO) occupational exposure to nitrous oxide and methoxyflurane to provide a foundation for future assessments of occupational toxicity risk., Methods: A retrospective database review of Patient Report Forms (PRFs) in 11 months between February 2016 and February 2018 was conducted. Nitrous oxide was available for the first 5 months studied, followed by 6 months methoxyflurane availability. AO-specific measures of attendance, rate of inhaled analgesic use, and duration of analgesic use were determined. Subgroup analysis by AO qualification and rostered work hours was undertaken., Results: A total of 46,759 PRFs were examined, identifying 1,033 cases of nitrous oxide administration and 1456 cases of methoxyflurane was administration. There was a significant increase in the proportion of cases where inhaled analgesia was administered following the replacement of nitrous oxide with methoxyflurane. Relative risk of exposure to methoxyflurane compared with nitrous oxide was 1.22, while median duration of each exposure remained unchanged (32 vs. 33 min)., Conclusions: Methoxyflurane via the Penthrox ® inhaler was more likely to be administered than nitrous oxide. Most AOs are infrequently exposed to inhaled analgesics and are exposed for durations slightly greater than previously reported. Relative risk of exposure was greatest for lower-qualified AOs. Peak number of exposures and duration values suggest a subset of AOs with higher occupational health risk., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Air pollutants play a crucial role in human health and disease. Emergency ambulance dispatch data have excellent potential for public and environmental health research. This study aimed at investigating the impact of short-term exposure to air pollutants on the emergency ambulance dispatches., Methods: We used data on emergency ambulance dispatches in Shanghai Municipality, China, from April 1, 2016 to December 31, 2017. The association of the daily emergency ambulance dispatches with air pollutants including PM 2.5 (particles ≤ 2.5 μm in aerodynamic diameter), PM 10 , O 3 , NO 2 and SO 2 was analyzed with the use of time-series analyses., Results: A total of 310,825 emergency ambulance dispatches for acute illness occurred in Shanghai during the study period. An increase in PM 2.5 by 10 μg/m 3 at lag1 and lag2 was shown to increase the risk of emergency ambulance dispatches (RR for lag1 = 1.05, 95% CI 1.00-1.11, RR for lag2 = 1.07, 95% CI 1.01-1.12). PM 10 , NO 2 , and SO 2 also showed significant associations with emergency ambulance dispatches in single-pollutant models. Cause-specific analyses showed an elevation in PM 2.5 by 10 μg/m 3 was associated with an increased risk of emergency ambulance dispatches related to respiratory diseases on the current day (lag0, RR 1.17, 95% CI 1.01-1.33), while the impact on emergency ambulance dispatches related to other diseases presented 1-3 days later. The other pollutants have the similar trend., Conclusions: Our findings show a strong relationship between ambient air pollutants and emergency ambulance dispatches. Our study contributes to the growing body of evidence describing the adverse health effects of ambient air pollution and will benefit ambulance services for early warning and effective ambulatory planning., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objectives: To describe the patterns of personal emergency response systems (PERS) use in a statewide cohort of older Australians., Methods: PERS data from clients enrolled in the Personal Alarm Victoria program between January 2014 and June 2017 were analysed. Alarm activation reasons were extracted, and a medical record audit was performed for a sub-cohort of patients admitted to a local hospital following an alarm event. Descriptive statistics were used., Results: There were 42,180 clients enrolled during the study (mean age 80 years, 80% female, 93% living alone). An ambulance attended 44% of the fall-related events and 81% of events coded as unwell. Activation reasons were distributed equally between a fall and feeling unwell, and a repeating pattern of activation reasons was observed. In our sub-cohort (n = 92), the majority of admissions (86%) followed an alarm activation coded as unwell., Conclusion: We demonstrated recurring patterns associated with the reasons for alarm use., (© 2021 AJA Inc.)

Introduction: Ambulance personnel are exposed to traumatic and stressful situations, which can increase the risk of mental health conditions, such as post-traumatic stress disorder (PTSD). High rates of PTSD have been found in ambulance personnel (Petrie et al., 2018), but no review is available to examine post-traumatic growth (PTG - positive psychological change following a trauma) in this population. This literature review provides an overview of the prevalence rates and facilitators that may contribute to PTG in ambulance personnel. Methods: A systematic search was conducted on EBSCOhost in January 2024 across the following six databases: Academic Search Ultimate, PsycINFO, PsycARTICLES, MEDLINE, ERIC and Cumulative Index to Nursing and Allied Health Literature (CINAHL) Ultimate. Results: Eleven papers were identified for this review. Pooled prevalence of PTG was moderate (52%), and facilitators for PTG were grouped into five categories: coping style/strategies, resilience, personality traits, gender and incident characteristics. Conclusions: Numerous facilitators contributed to the development of PTG, although these did not arise in all papers. The quality of research ranged from satisfactory to excellent. Evidence suggested that adaptive coping style, high levels of resilience, the absence of a personality trait (neuroticism) and being female may facilitate PTG. Further research is needed to support the reliability of findings. [ABSTRACT FROM AUTHOR]

Vehicular ad hoc networks (VANETs) can support safety-critical applications such as the safe and fast movement of emergency vehicles while preventing crashes, delays, and congestion involving emergency vehicles. A simulation approach to evaluate ambulance transit using VANET capabilities is presented in this paper for a real-life road network taken in and around the University of Missouri–Kansas City, USA. Three different VANET functional scenarios are compared with a base scenario (SC-1) which depicts the present-day traffic pattern and vehicle behaviors. In the three scenarios, the second one (SC-2) adds vehicle-to-vehicle (V2V) and vehicle-to-infrastructure (V2I) communications along with the present-day traffic pattern; ambulances use VANETs simply to announce their arrival. The third scenario (SC-3) provides functionalities for ambulances to rerouting when they learn about a current or an anticipated road congestion. And the fourth scenario (SC-4) adds vehicle rerouting capabilities, so ambulance routes can be sent to vehicles, and they can avoid the ambulance path. Performance results are presented and evaluated for metrics such as delay, packet drop ratio, the average speed of the ambulance, average vehicle density, and ambulance message interval time. From the simulation results, it was observed that the ambulance transit time reduces by 12.52%, 14.65%, and 18.75% for SC-2, SC-3, and SC-4, respectively, as compared with SC-1, while the average ambulance speed increases by 14.49%, 15.57%, and 20.90% for SC-2, SC-3, and SC-4, respectively, when compared with SC-1. This paper provides substantial evidence that VANET capabilities for emergency vehicles can enhance crash protection and reduce the commute time for emergency response. [ABSTRACT FROM AUTHOR]

Objective: There are nearly 1000 annual ambulance crashes within the United States involving pediatric patients. In 2012 National Highway Traffic Safety Administration/US Department of Transportation released Best-Practice Recommendations for the Safe Transportation of Children in Emergency Ground Ambulances. The aim of our study was to measure emergency medical services (EMS) providers' knowledge and opinions of how to safely transport pediatric patients. In addition, we aimed to gather information on barriers to safe pediatric transport., Methods: Members of 1 urban and 2 suburban EMS agencies completed an anonymous survey that assessed level of training, years of experience, exposure to pediatric patients, knowledge of best practices, and opinions about barriers to safe transport of pediatric patients., Results: A total of 114 EMS providers answered the survey. Sixty-three percent were basic life support providers who had more than 10 years of experience in EMS. Ninety-six percent reported that they transported 0 to 5 pediatric patients per week. Twenty percent reported being trained on pediatric safe transport practices. Thirty-two percent of providers reported that personnel did not drive faster when transporting a sick pediatric patient. Eighty-six percent reported that it was unsafe to transport a child on a parent's lap, but 27% reported that it was appropriate to transport a newborn on the stretcher with mom. Thirty-eight percent were comfortable identifying proper restraint system/seat for pediatric patients, and only 35% were comfortable installing/using these devices. Provider-reported barriers to safe transport were identified., Discussion: Our survey demonstrates that despite published best practices for the safe transport of children, many providers are unfamiliar with the safest way to transport these patients. In addition, we identified several existing barriers that may contribute to unsafe practices.

Objective: The objective of the present study is to examine variations in paramedic care of the agitated patient, including verbal de-escalation, physical restraint and sedation, provided by ambulance services in Australia and New Zealand., Methods: To examine the care of agitated patients, we first identified and reviewed all clinical practice guidelines for the management of agitated patients in Australian and New Zealand ambulance services between September and November 2018. We then conducted a structured questionnaire to obtain further information on the training, assessment and care of agitated patients by the ambulance services. Two authors extracted the data independently, and all interpretations and results were reviewed and confirmed by relevant ambulance services., Results: There were 10 independent clinical practice guidelines for the care of agitated patients in the 10 ambulance services. All services reported training in the management of agitated patients, and two services used a validated tool to assess the level of agitation. All services used physical restraint, although six services required police presence to restrain the patient. All ambulance services used some form of sedation, typically divided into the management of mild to moderate, and severe agitation. The most common agent for sedation was midazolam, while ketamine was the most common agent for sedating severely agitated patients. The maximum dose was varied, and contraindications for sedating agents varied between services., Conclusions: There were wide variations across the ambulance services in terms of the assessment of agitation, as well as the use of physical restraint and sedation., (© 2019 Australasian College for Emergency Medicine.)

The risk of dying or being injured as a result of traffic collisions is higher for medical emergency responders than for other professional drivers. This systematic review synthesizes the literature regarding the collisions of ambulances, focusing on the prevalence and characteristics surrounding such events. Keywords including paramedics and traffic collisions were searched in papers available in PubMed from January 1990 to July 2021. Two independent reviewers screened the abstracts of 2494 papers and ended up with 93 full-text articles to assess for eligibility, of which 26 papers were finally kept for this review. There was a total of 18 studies conducted in the United States, followed by 3 in Turkey, 2 in Taiwan, 1 in both the United States and Canada, 1 in France, and 1 in Poland. There is a high record of injury and fatal collisions for ambulances compared to other commercial or similarly sized vehicles. Drivers less than 35 years old with low experience and a history of citations are more likely to be involved in such collisions. Ambulance collisions are more likely to happen in urban areas and intersections are the riskiest locations. Most collisions occur when the ambulance is responding to an emergency call (i.e., going to the patient or the hospital) and using lights and sirens. Tailored preventive policies and programs for improving paramedics' safety should be sought to reduce the burden of these occupational collisions. [ABSTRACT FROM AUTHOR]

The role of the emergency medical service (EMS) is changing globally as ambulance crews respond to a shifting burden of disease, as well as societal stressors such as violence and inequality. New ways of thinking about how to provide emergency care are required to shift EMS from a role primarily focused on clinical care and transporting patients to hospital. In this paper, we present the experience of the Philippi Project (PP), an innovative community-based model of care developed by front line ambulance crews in a low-income neighbourhood in Cape Town, South Africa. Our insights were developed through observational, interview and document review work, within an overall embedded research approach. Our analysis draws on the everyday health systems resilience (EHSR) framework, which sees resilience as an emergent process that may be stimulated through response to stress and shock. Responses take the form of absorptive, adaptive or transformative strategies and are underpinned by system capacities (cognitive, behavioural and contextual). We consider the PP as a potentially transformative resilience strategy, defined as a new way of working that offered the promise of long-term health system gains. We found that the PP's initial development was supported by a range of system capacity attributes (such as the intentional development of relationships, a sense of collective purpose and creating spaces for constructive sense-making). However, the PP was hard to sustain over time because emergent ways of working were undermined both by other capacity attributes rooted in pre-existing organizational routines and two contextual shocks (Coronavirus and a violent incident). The paper adds a new empirical contribution to the still-small EHSR literature. In addition, the PP experience offers globally relevant lessons for developing community-based models of EMS care. It demonstrates that front line staff can develop creative solutions to their stressful daily realities, but only if space is created and protected. [ABSTRACT FROM AUTHOR]

The term 'zero responder' was initially devised in 2010 to describe those passing by or unharmed in a mass casualty incident, who provide life-saving care for injured persons before qualified professionals arrive. This review aims to determine how the literature defines the role of the zero responder and to explore how they can be better integrated into the emergency response. Current definitions of the zero responder in a medical setting were found through a literature search of several databases and online libraries using defined search terms. Additionally, a manual search of citations in included articles was performed to yield more results. In total, 16 papers defining the zero responder were included. These definitions were evaluated, and a revised definition was suggested to clarify the role in a medical setting relating to mass casualty incidents. The role of the zero responder can be facilitated through authority recognition and adequate equipment provision. Familiarisation with the term and role of zero responders among ambulance services is essential for effective collaboration. Further research and clarity on the integration of these two groups is necessary to facilitate effective and safe working between them. [ABSTRACT FROM AUTHOR]

Background: Ambulance personnel are frequently exposed to traumatic accidents, which makes them a high risk for poor mental health. High rates of Post-Traumatic Stress Symptoms (PTSS) have been found within ambulance personnel samples but no review has been completed to examine the factors that may be implicated in the development of these symptoms. This literature review provides an overview of the factors that predict PTSS in ambulance personnel. Methods: A systematic search strategy was conducted in April 2020 across the following four databases: PsycINFO, PsycARTICLES, MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results: Eighteen papers were included in this review, and the predictive factors examined were grouped into four categories: coping style, personal factors, environmental factors and organisational factors. Conclusions: An array of factors across the four categories were implicated in the development of PTSS, but these tended to be indicated in only one or two papers. Evidence was found to suggest that dysfunctional coping styles, reduced levels of some personality traits, proximity and nature of the critical incident and high levels of organisation stress can all lead to PTSS. Further research is needed to support the reliability of findings. [ABSTRACT FROM AUTHOR]

Background: In 2014, the Hazelwood coalmine fire in regional Victoria, Australia shrouded nearby communities in smoke for six weeks. Prior investigations identified substantial adverse effects, including increases in the use of health services. In this study, we examined the effects on hospital and ambulance use in the eight years following the fire., Methods: Using Victorian hospital (Jan 2009-Jun 2022) and ambulance (Jan 2013-Dec 2021) data, we conducted an interrupted time series of changes to the rate of hospital admissions, emergency presentations, and ambulance attendances. A categorical exposure model compared two locations, most-exposed Morwell and less-exposed Latrobe Valley, to the rest of regional Victoria. A continuous exposure model used spatial estimates of fire-related PM 2.5 . Analyses were stratified by sex, age group (<65/65+ years), and condition (cardiovascular, respiratory, mental health, injury)., Results: There were small but significant increases in overall hospital admissions and emergency presentations across all analyses, but little evidence of change in overall ambulance attendances. Effects varied considerably by condition, with the biggest relative increases observed among hospital admissions for mental health conditions and injuries. While cardiovascular-related hospital admissions and emergency presentations increased post-fire, ambulance attendances decreased., Conclusions: Our findings suggest the Hazelwood coalmine fire likely increased hospital usage. However, it is unclear whether this was due to the direct effects of smoke exposure on health, or the disruptive socioeconomic and behavioural impacts of an environmental disaster that affected how communities engaged with various health services., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:Michael J Abramson reports financial support was provided by Pfizer Inc. Michael J Abramson reports financial support was provided by Boehringer Ingelheim Corp USA. Michael J Abramson reports financial support was provided by Sanofi. Michael J Abramson reports financial support was provided by GlaxoSmithKline Inc. Rongbin Xu reports financial support was provided by VicHealth. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Early diagnosis and antibiotic therapy in patients with sepsis reduce morbidity and mortality, thus pre-hospital management is likely to affect patient outcomes. Pre-hospital administration may increase the risk of unnecessary use of broad-spectrum antibiotics, but identification of an infectious focus enables more targeted antibiotic therapy. The aim of this study was to investigate how paramedics, with or without the assistance of general practitioners, can administer empiric intravenous antibiotic treatment against sepsis in a timely manner., Methods: Cohort study of patients with suspected sepsis that received pre-hospital intravenous antibiotics and were transported to hospital. The setting was mainly rural with long average distance to hospital. Patients received targeted antibiotic treatment after an assessment based on clinical work-up supported by scoring systems. Patients were prospectively included from May 2018 to August 2022. Results are presented as median or absolute values, and chi-square tests were used to compare categorical data., Results: We included 328 patients. Median age was 76 years (IQR 64, 83) and 48.5% of patients were female. 30-days all-cause mortality was 10.4%. In cases where a suspected infectious focus was determined, the hospital discharge papers confirmed the pre-hospital diagnosis focus in 195 cases (79.3%). The presence of a general practitioner during the pre-hospital assessment increased the rate of correctly identified infectious focus from 72.6% to 86.1% (p = 0.009). Concordance between pre-hospital identification of a tentative focus and discharge diagnosis was highest for lower respiratory tract (p = 0.02) and urinary tract infections (p = 0.03). Antibiotic treatment was initiated 44 min (median) after arrival of ambulance, and median transportation time to hospital was 69 min. Antibiotic therapy was started 76 min (median) before arrival at hospital., Conclusions: Pre-hospital identification of infectious focus in suspected sepsis was feasible, and collaboration with primary care physicians increased level of diagnostic accuracy. This allowed initiation of intravenous focus-directed antibiotics more than one hour before arrival in hospital in a rural setting. The effect of pre-hospital therapy on timing was much stronger than in previous studies from more urban areas., (© 2024. The Author(s).)

The benefits of community-based, grassroots food practices, such as community gardens or kitchens, are widely acknowledged. However, they have also been shown to support neoliberal and exclusionary dynamics. This paper examines this contradiction on the ground by unpacking the processes and mechanisms through which these initiatives reproduce, reinforce or challenge social inequities and injustices in the city. It suggests the concept of community food space to look at the articulation of practices and intentions within these groups, and highlight emancipatory practices situated around food rather than simply about food. The paper draws upon an ongoing militant ethnography into community food spaces in Berlin, Germany. Exploring the complex and diverse landscape of Berlin food activism, it illuminates the ways in which food may be used to perpetuate unjust social configurations or, on the contrary, to advance social justice at both local and structural levels. [ABSTRACT FROM AUTHOR]

Background: Linked datasets for trauma system monitoring should ideally follow patients from the prehospital scene to hospital admission and post-discharge. Having a well-defined cohort when using administrative datasets is essential because they must capture the representative population. Unlike hospital electronic health records (EHR), ambulance patient-care records lack access to sources beyond immediate clinical notes. Relying on a limited set of variables to define a study population might result in missed patient inclusion. We aimed to compare two methods of identifying prehospital trauma patients: one using only those documented under a trauma protocol and another incorporating additional data elements from ambulance patient care records., Methods: We analyzed data from six routinely collected administrative datasets from 2015 to 2018, including ambulance patient-care records, aeromedical data, emergency department visits, hospitalizations, rehabilitation outcomes, and death records. Three prehospital trauma cohorts were created: an Extended-T-protocol cohort (patients transported under a trauma protocol and/or patients with prespecified criteria from structured data fields), T-protocol cohort (only patients documented as transported under a trauma protocol) and non-T-protocol (extended-T-protocol population not in the T-protocol cohort). Patient-encounter characteristics, mortality, clinical and post-hospital discharge outcomes were compared. A conservative p-value of 0.01 was considered significant RESULTS: Of 1 038 263 patient-encounters included in the extended-T-population 814 729 (78.5 %) were transported, with 438 893 (53.9 %) documented as a T-protocol patient. Half (49.6 %) of the non-T-protocol sub-cohort had an International Classification of Disease 10th edition injury or external cause code, indicating 79644 missed patients when a T-protocol-only definition was used. The non-T-protocol sub-cohort also identified additional patients with intubation, prehospital blood transfusion and positive eFAST. A higher proportion of non-T protocol patients than T-protocol patients were admitted to the ICU (4.6% vs 3.6 %), ventilated (1.8% vs 1.3 %), received in-hospital transfusion (7.9 vs 6.8 %) or died (1.8% vs 1.3 %). Urgent trauma surgery was similar between groups (1.3% vs 1.4 %)., Conclusion: The extended-T-population definition identified 50 % more admitted patients with an ICD-10-AM code consistent with an injury, including patients with severe trauma. Developing an EHR phenotype incorporating multiple data fields of ambulance-transported trauma patients for use with linked data may avoid missing these patients., Competing Interests: Declaration of competing interest Matthew Miller reports financial support was provided by New South Wales Institute for Trauma and Injury Management (ITIM). If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Matthew Miller is supported in his PhD by an Australian Commonwealth Government Research Training Program (RTP) scholarship., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Integrating the Internet of Medical Things (IoMT) in the Hospital system has modified the traditional medical service from a reactive system based on hospitalization and diseases to a preventive and interoperable system based mainly on the interactive data flow between patients and health professionals. Medical data is collected and processed using medically connected objects (MCOs). According to gathered data, the new medical system should be able to sort patient states based on urgent and critical vital signs, and consequently, priorities are defined. In this paper, we focus on managing priority in hospital emergencies to adapt dynamic operations and interactions with different stakeholders according to the changes in their execution context. Indeed, based on data sensed from MCOs implemented in ambulances, emergency rooms might be prepared to receive injured persons like victims of road accidents or other incidents. Therefore, we design a context-aware monitoring framework for injured people based on gathered medical data to manage priorities. [ABSTRACT FROM AUTHOR]

The main purpose of this paper is to demonstrate how important it is for the Ministry of Internal Affairs to have a sufficient budget to carry out the missions entrusted by law. The Ministry of Internal Affairs has very important responsibilities in terms of maintaining public order and intervention in emergency situations. The Romanian Police, the Romanian Gendarmerie, the Romanian Border Police, which are in charge of maintaining public order, as well as the General Inspectorate for Emergency Situations, which is in charge of extinguishing fires and providing first aid through SMURD ambulances, are active within the Ministry of Internal Affairs. In this paper, the possible negative impacts of the application of the Government's Emergency Ordinances regarding some fiscal-budgetary measures, adopted in 2023, will be presented. [ABSTRACT FROM AUTHOR]

The paper concerns numerical study of the ultra-light seat frame serving transported patients in ambulance. The structure of seat was designed to be built of the carbon fibers, aluminium and steel. The present prototype distinguishes itself with low mass and high strength. During modelling, the stress state and displacement state were verified based on requirements according to regulation ECE14. In simulation, solid, beam and connection elements were employed to consider all the parts of structures. The analysis of the stress state verification based on the assumptions of boundary conditions close to regulation ECE14. The isotropic materials were considered to be in elastic range. In case of composite materials, TSAI-WU (TSW) criterion for assessment of strength was taken into account. Five different variants of seat were taken into consideration to indicate the differences between them. The paper includes the results of analysis of composite structure under static loads which were shown and discussed. [ABSTRACT FROM AUTHOR]

Trauma Care's International Conference, held in Telford, UK in May 2011, once again featured a successful ‘Free Paper' competition, which attracted abstracts and presentations from a variety of disciplines related to trauma. The overall standard was high but the winning presentation came from Adam Low (see p. 371). Presenting authors are marked by *. [ABSTRACT FROM PUBLISHER]

The objective of this study is to determine the impacts of low-intensity heat on human health in regions with hot, humid summers. Current literature has highlighted an increase in mortality and morbidity rates during significant heat events. While the impacts on high-intensity events are established, the impacts on low-intensity events, particularly in regions with hot, humid summers, are less clear. A scoping review was conducted searching three databases (PubMed, EMBASE, Web of Science) using key terms based on the inclusion criteria. We included papers that investigated the direct human health impacts of low-intensity heat events (single day or heatwaves) in regions with hot, humid summers in middle- and high-income countries. We excluded papers written in languages other than English. Of the 600 publications identified, 33 met the inclusion criteria. Findings suggest that low-intensity heatwaves can increase all-cause non-accidental, cardiovascular-, respiratory- and diabetes-related mortality, in regions experiencing hot, humid summers. Impacts of low-intensity heatwaves on morbidity are less clear, with research predominantly focusing on hospitalisation rates with a range of outcomes. Few studies investigating the impact of low-intensity heat events on emergency department presentations and ambulance dispatches were found. However, the data from a limited number of studies suggest that both of these outcome measures increase during low-intensity heat events. Low-intensity heat events may increase mortality. There is insufficient evidence of a causal effect of low-intensity heat events on increasing morbidity for a firm conclusion. Further research on the impact of low-intensity heat on morbidity and mortality using consistent parameters is warranted. [ABSTRACT FROM AUTHOR]

Background: Emergency medical services (EMS) are intended to provide people with immediate, effective, and safe access to the healthcare system. The effects of pandemics on emergency medical services (EMS) have not been studied sufficiently. The aim of this paper is to assess the frequency and structure of calls at an ambulance station in Kazakhstan during the period of 2019–2023. Methods: A retrospective analysis was conducted to estimate the incidence of emergency assistance cases from 2019 to 2023. Results: An analysis of the structure and number of ambulance calls before the pandemic, during the pandemic, and post-pandemic period did not reveal significant changes, except for calls in urgency category IV. Patients of urgency category IV handled by an ambulance decreased by 2 and 1.7 times in 2020 and 2021, respectively, which appears to be related to quarantine measures. In 2022 and 2023, category IV calls were 4.7 and 4.5 times higher than in 2019. Conclusions: This study's findings suggest no changes in the dynamics of ambulance calls, except urgency category IV calls. The number of category IV urgent calls decreased significantly during the COVID-19 pandemic and increased in the post-pandemic period. [ABSTRACT FROM AUTHOR]

Paediatric supraventricular tachycardia (SVT) is a common arrhythmia of great clinical significance. If not treated promptly, it can cause heart failure and cardiogenic shock. Depending on the patient's condition, SVT treatment involves vagal manoeuvres, pharmacological, or direct current cardioversion. The goal of acute SVT management is to immediately convert SVT to a normal sinus rhythm (NSR) and prevent its recurrence. Adenosine is recommended as the first-line treatment for stable SVT by the European Resuscitation Council (ERC) and American Heart Association (AHA) guidelines, when vagal manoeuvres have proven ineffective. The ERC and AHA guidelines recommend the intravenous route of administration. The intraosseous (IO) administration technique is also possible, but still relatively unknown. The aim of this paper is to describe a 3.5-year-old child with SVT that was converted to NSR following IO administration of adenosine. Successful conversion was achieved after the second attempt with the adenosine dose. In the described case, there was no recurrence of SVT. [ABSTRACT FROM AUTHOR]

Background: With millions of unscheduled patient contacts every year and increasing call outs clustered around the most deprived communities, it is clear the ambulance sector could have a role to play in improving population health. However, the application and value of a public health approach within the ambulance sector has not been comprehensively explored. A scoping review was undertaken to explore the role of the ambulance sector in the delivery of public health interventions and what impact this has on population health and ambulance sector outcomes. Methods: A search strategy was developed on MEDLINE and translated to other major medical and health related bibliographic databases (Embase; CINAHL; HMIC; Science and Social Sciences Citation Index; Cochrane Library) to identify literature published since 2000 in OECD countries. Targeted grey literature, reference list, and citation searching was also carried out. Search results were downloaded to Microsoft Excel and screened by three reviewers according to pre-determined inclusion / exclusion criteria. Data from included studies, such as the type of activity noted within the paper, the population involved and the public health approach that was utilised, was extracted from within the paper using a data extraction form and narratively synthesised. Results: Fifty-two references were included in the final review (37 database searching; 9 reference list searching; 6 grey literature). Included articles were categorised according to the relevant public health domains and subdomains as articulated by the UK Faculty of Public Health: Health improvement domain: Public health education and advice (Health promotion sub-domain) (n=13) Emergency Services personnel providing vaccines (Disease prevention sub-domain) (n=1) Health care public health domain Paramedicine (Service delivery sub-domain) (n=30) Screening tools and referral pathways used by the ambulance sector (Service delivery sub-domain) (n=28) Health intelligence using ambulance sector data (population health management sub-domain) (n=26) Of note, some domains (e.g. health protection) returned nil results. Discussion: The scoping review demonstrates the breadth of public health related activities in which the ambulance sector is involved. However, an overemphasis on demand management outcomes precludes definitive conclusions on the impact of ambulance sector-led public health initiatives on public health outcomes. Future evaluations of public health initiatives should incorporate wider health system perspectives beyond the immediately apparent remit of the ambulance sector. [ABSTRACT FROM AUTHOR]

Purpose: This paper aims to identify human rights violations of patients during the early periods of the COVID-19 pandemic in Ghana by investigating the experiences of people on how health-care professionals discharged their responsibilities during the time in question. Design/methodology/approach: Explanatory design of the mixed methods approach was adopted, with the intention of collecting both quantitative and qualitative data sequentially, and then integrating the results at the interpretation stage. The approach enriched the quality of data collected as it offered the advantage of shedding light on the primary motivations and reasons for attitudes and behaviours and helped to provide an in-depth understanding of how individuals interpret the happenings around them and their experiences. Thus, although some amount of quantitative method was used in the data collection, the core of this paper is based on the qualitative interpretations. Findings: The study reveals that health-care professionals, especially those in the Tema Metropolis, undermined certain fundamental human rights of patients during the early period of the COVID-19 pandemic. This includes failure to provide information to patients about treatment options and potential risks of medications; failure to seek the informed consent of patients before performing medical procedures; denial of access to medical files of patients for transfer; and inability or failure to provide medical ambulances services to patients on time. Originality/value: Although many publications on human rights dimensions and health protective issues on COVID-19 pandemic are available on a global scale, still little information pertaining to experiences of individuals with health-care professionals during the early days of the COVID-19 pandemic, especially in Ghana through the lens of patient's rights exists. This paper, therefore, fills an important gap in health-care management information, critical for policy decision-making processes regarding patient's rights in times of pandemic control. [ABSTRACT FROM AUTHOR]

Background: Reconfiguration of the Irish acute hospital sector resulted in the establishment of a Medical Assessment Unit (MAU) in Mallow General Hospital (MGH). We developed a protocol whereby certain patients deemed to be low risk for clinical deterioration could be brought by the National Ambulance Service (NAS) to the MAU following a 999 or 112 call., Aims: The aim of this paper is to report on the initial experience of this quality improvement initiative., Methods: The Plan-Do-Study-Act (PDSA) Cycle for quality improvement was implemented when undertaking this project. A pathway was established whereby, following discussion between paramedic and physician, patients for whom a 999 or 112 call had been made could be brought directly to the MAU in MGH. Strict inclusion and exclusion criteria were agreed. The protocol was implemented from the 1st of September 2022 for a 3-month pilot period., Results: Of 39 patients discussed, 29 were accepted for review in the MAU. One of the 29 accepted patients declined transfer to MAU. Of 28 patients reviewed in the MAU, 7 were discharged home. One patient required same day transfer to a model 4 centre. Twenty patients were admitted to MGH with an average length of stay of 8 days. Frailty and falls accounted for 7 of the admissions and the mean length of stay for these patients was 12 days., Conclusions: Our results have demonstrated the safety, feasibility and effectiveness of this pathway. With increased resourcing, upscaling of this initiative is possible and should be considered., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Objective: The objective of this study was to quantify the impact of heatwaves on likelihood of ambulance callouts for Australia., Methods: A systematic review and meta-analysis was conducted to retrieve and synthesise evidence published from 1 January 2011 to 31 May 2023 about the association between heatwaves and the likelihood of ambulance callouts in Australia. Different heatwave definitions were used ranging from excess heat factor to heatwave defined as a continuous period with temperatures above certain defined thresholds (which varied based on study locations)., Results: We included nine papers which met the inclusion criteria for the review. Eight were eligible for the meta-analyses. The multilevel meta-analyses revealed that the likelihood of ambulance callouts for all causes and for cardiovascular diseases increased by 10% (95% confidence interval: 8%, 13%) and 5% (95% confidence interval: 1%, 3%), respectively, during heatwave days., Conclusions: Exposure to heatwaves is associated with an increased likelihood of ambulance callouts, and there is a dose-response association between heatwave severity and the likelihood of ambulance callouts., Implications for Public Health: The number of heatwave days are going to increase, and this will mean an increase in the likelihood of ambulance callouts, thereby, spotlighting the real burden that heatwaves place on our already stressed healthcare system. The findings of this study underscore the critical need for proactive measures, including the establishment of research initiatives and holistic heat health awareness campaigns, spanning from the individual and community levels to the healthcare system, in order to create a more resilient Australia in the face of heatwave-related challenges., Competing Interests: Conflicts of interest Authors declare no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: People who call emergency ambulances frequently are often vulnerable because of health and social circumstances, have unresolved problems or cannot access appropriate care. They have higher mortality rates. Case management by interdisciplinary teams can help reduce demand for emergency services and is available in some UK regions. We report results of interviews with people who use emergency ambulance services frequently to understand their experiences of calling and receiving treatment., Methods: We used a two-stage recruitment process. A UK ambulance service identified six people who were known to them as frequently calling emergency services. Through third-sector organisations, we also recruited nine individuals with healthcare experiences reflecting the characteristics of people who call frequently. We gained informed consent to record and transcribe all telephone interviews. We used thematic analysis to explore the results., Results: People said they make frequent calls to emergency ambulance services as a last resort when they perceive their care needs are urgent and other routes to help have failed. Those with the most complex health needs generally felt their immediate requirements were not resolved and underlying mental and physical problems led them to call again. A third of respondents were also attended to by police and were arrested for behaviour associated with their health needs. Those callers receiving case management did not know they were selected for this. Some respondents were concerned that case management could label frequent callers as troublemakers., Conclusion: People who make frequent calls to emergency ambulance services feel their health and care needs are urgent and ongoing. They cannot see alternative ways to receive help and resolve problems. Communication between health professionals and service users appears inadequate. More research is needed to understand service users' motivations and requirements to inform design and delivery of accessible and effective services., Patient or Public Contribution: People with relevant experience were involved in developing, undertaking and disseminating this research. Two public contributors helped design and deliver the study, including developing and analysing service user interviews and drafting this paper. Eight public members of a Lived Experience Advisory Panel contributed at key stages of study design, interpretation and dissemination. Two more public contributors were members of an independent Study Steering Committee., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)