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Objective: The ambulance service in Victoria, Australia implemented a revised clinical response model (CRM) in 2016 which was designed to increase the diversion of low‐acuity Triple Zero (000) calls to secondary telephone triage and reduce emergency ambulance dispatches. The present study evaluates the influence of the revised CRM on emergency ambulance response times and ED presentations. Methods: A retrospective study of emergency calls for ambulance between 1 January 2015 and 31 December 2018. Ambulance data were linked with ED presentations occurring up to 48 h after contact. Interrupted time series analyses were used to evaluate the impact of the revised CRM. Results: A total of 2 365 529 calls were included. The proportion allocated a Code 1 (time‐critical, lights/sirens) dispatch decreased from 56.6 to 41.0% after implementation of the revised CRM. The proportion of calls not receiving an emergency ambulance increased from 10.4 to 19.6%. Interrupted time series analyses demonstrated an improvement in Code 1 cases attended within 15 min (Key Performance Indicator). However, for patients with out‐of‐hospital cardiac arrest or requiring lights and sirens transport to hospital, there was no improvement in response time performance. By the end of the study period, there was also no difference in the proportion of callers presenting to ED when compared with the estimated proportion assuming the revised CRM had not been implemented. Conclusion: The revised CRM was associated with improved Code 1 response time performance. However, there was no improvement in response times for high acuity patients, and no change in the proportion of callers presenting to ED. [ABSTRACT FROM AUTHOR]

Out‐of‐hospital cardiac arrest (OHCA) is a global public health problem, with survival rates remaining low at around 10% or less despite widespread cardiopulmonary resuscitation (CPR) training and availability of automated external defibrillators (AEDs). This is partly due to the challenges of knowing when and where a sudden OHCA occurs and where the nearest AED is located. In response, countries around the world have begun to use network technology‐based smartphone applications. These applications are activated by emergency medical service dispatchers and alert preregistered volunteer first responders (VFRs) to nearby OHCAs using Global Positioning System localization. Accumulating evidence, although mostly from observational studies, shows their effectiveness in increasing the rate of bystander CPR, defibrillation, and patient survival. Current guidelines recommend the use of these VFR alerting systems, and the results of ongoing randomized trials are awaited for further dissemination. This article also proposed the concept of a life‐saving mobile network (LMN), which uses opportunistic network and wireless sensor network technologies to create a dynamic mesh network of potential victims, rescuers, and defibrillators. The LMN works by detecting a fatal arrhythmia with a wearable sensor device, localizing the victim and the nearest AED with nearby smartphones, and notifying VFRs through peer‐to‐peer communication. While there are challenges and limitations to implementing the LMN in society, this innovative network technology would reduce the tragedy of sudden cardiac death from OHCA. [ABSTRACT FROM AUTHOR]

Background: The maternal mortality and perinatal mortality rate in Cameroon are among the highest worldwide. To improve these outcomes, we conducted a formative qualitative assessment to inform the adaptation of a mobile provider-to-provider intervention in Cameroon. We explored the complex interplay of structural barriers on maternity care in this low-resourced nation. The study aimed to identify structural barriers to maternal care during the early adaptation of the mobile Medical Information Service via Telephone (mMIST) program in Cameroon. Methods: We conducted in-depth interviews and focus groups with 56 key stakeholders including previously and currently pregnant women, primary healthcare providers, administrators, and representatives of the Ministry of Health, recruited by purposive sampling. Thematic coding and analysis via modified grounded theory approach were conducted using NVivo12 software. Results: Three main structural barriers emerged: (1) civil unrest (conflict between Ambazonian militant groups and the Cameroonian government in the Northwest), (2) limitations of the healthcare system, (3) inadequate physical infrastructure. Civil unrest impacted personal security, transportation safety, and disrupted medical transport system. Limitations of healthcare system involved critical shortages of skilled personnel and medical equipment, low commitment to evidence-based care, poor reputation, ineffective health system communication, incentives affecting care, and inadequate data collection. Inadequate physical infrastructure included frequent power outages and geographic distribution of healthcare facilities leading to logistical challenges. Conclusion: Dynamic inter-relations among structural level factors create barriers to maternity care in Cameroon. Implementation of policies and intervention programs addressing structural barriers are necessary to facilitate timely access and utilization of high-quality maternity care. [ABSTRACT FROM AUTHOR]

In Nordic countries, 'welfare technology' is a concept used increasingly by policymakers when discussing the promise of digitalisation in care for older people. In this paper, I draw on data from 14 qualitative ethnographic interviews with employees in municipal eldercare in Sweden, as well as observations carried out at a nursing home, to suggest the importance of studying how good care is enacted through welfare technology, whilst simultaneously attending to the adverse effects sometimes consequent from these practices. In this article, I explore what values are supported when doing care with welfare technology, and what values are neglected in this process. The theoretical starting point for this article takes its inspiration from recent discussions of care within Science and Technology Studies (STS). Employing a double vision of care, the article argues for the importance of understanding how good care is enacted with technology, while also attending to what these care practices exclude and neglect. Focusing on the use of social alarms, the article shows that when doing care with such technology, values such as independence, safety and some forms of togetherness and availability were enhanced; while other values such as other forms togetherness and availability, a stress-free working environment and functionality were neglected. [ABSTRACT FROM AUTHOR]

This article investigates a collection of 64 formulations delivered by physicians in French emergency calls. When a call is transferred from assistant emergency medical dispatcher (EMD) to physician EMD, the latter typically formulates a version of prior talk for the caller to confirm (e.g. alors votre mari euh il tremble c'est ça "so your husband uh he's shaking, is that correct"). Formulations allow physicians to connect the current interaction to the previous one and deflect callers from launching into potentially extended new beginnings. Formulations allow physicians to move to key questions and instructions faster, as a formulation opens a restricted sequential slot for callers to either confirm or disconfirm. However, because of their selective nature, callers may use their responsive turn to alter physicians' formulations—repairing, expanding, or pushing back against the terms of the formulation. Data are in French, with English translation. [ABSTRACT FROM AUTHOR]

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Background: Falls among older individuals contribute significantly to the rise in ambulance transport use. To recognize the importance of future countermeasures, we estimated the projected number and percentage of fall-related emergency medical service (EMS) calls. Methods: We examined the sex, age group, and location of falls among patients aged ≥ 65 years who contacted emergency services in Sapporo City from 2013 to 2021. Annual fall-related calls per population subgroup were calculated, and trends were analyzed. Four models were used to estimate the future number of fall-related calls from the 2025–2060 projected population: (1) based on the 2022 data, estimates from the 2013–2022 data using (2) Poisson progression, (3) neural network, (4) estimates from the 2013–2019 data using neural network. The number of all EMS calls was also determined using the same method to obtain the ratio of all EMS calls. Results: During 2013–2022, 70,262 fall-related calls were made for those aged ≥ 65 years. The rate was higher indoors among females and outdoor among males in most age groups and generally increased with age. After adjusting for age, the rate increased by year. Future estimates of the number of fall calls are approximately double the number in 2022 in 2040 and three times in 2060, with falls accounting for approximately 11% and 13% of all EMS calls in 2040 and 2060, respectively. Conclusion: The number of fall-related EMS calls among older people is expected to increase in the future, and the percentage of EMS calls will also increase; therefore, countermeasures are urgently needed. [ABSTRACT FROM AUTHOR]

Background and aims: On 1 May 2018, Scotland introduced a minimum unit price (MUP) of £0.50 for alcohol, with one UK unit of alcohol being 10 ml of pure ethanol. This study measured the association between MUP and changes in the volume of alcohol‐related ambulance call‐outs in the overall population and in call‐outs subsets (night‐time call‐outs and subpopulations with higher incidence of alcohol‐related harm). Design: An interrupted time−series (ITS) was used to measure variations in the daily volume of alcohol‐related call‐outs. We performed uncontrolled ITS on both the intervention and control group and a controlled ITS built on the difference between the two series. Data were from electronic patient clinical records from the Scottish Ambulance Service. Setting and cases: Alcohol‐related ambulance call‐outs (intervention group) and total ambulance call‐outs for people aged under 13 years (control group) in Scotland, from December 2017 to March 2020. Measurements Call‐outs were deemed alcohol‐related if ambulance clinicians indicated that alcohol was a 'contributing factor' in the call‐out and/or a validated Scottish Ambulance Service algorithm determined that the call‐out was alcohol‐related. Findings No statistically significant association in the volume of call‐outs was found in both the uncontrolled series [step change = 0.062, 95% confidence interval (CI) = −0.012, 0.0135 P = 0.091; slope change = −0.001, 95% CI = −0.001, 0.1 × 10−3P = 0.139] and controlled series (step change = −0.01, 95% CI = −0.317, 0.298 P = 0.951; slope change = −0.003, 95% CI = −0.008, 0.002 P = 0.257). Similarly, no significant changes were found for the night‐time series or for any population subgroups. Conclusions: There appears to be no statistically significant association between the introduction of minimum unit pricing for alcohol in Scotland and the volume of alcohol‐related ambulance call‐outs. This was observed overall, across subpopulations and at night‐time. [ABSTRACT FROM AUTHOR]

This study aims to investigate the strategies and modifications employed by the Complaint Unit Representatives (CURs) in response to complaints recorded in the formal workplace of a medical institution in the Saudi Ministry of Health (MOH). A pragmatic discourse analytic approach was adopted to construct an analytical framework for authentic spoken complaint responses in the Saudi medical institution context. The data were randomly collected from 80 recorded phone conversations between patients and the CURs. It was transcribed verbatim, imported into MAXQDA for qualitative analysis of codes categorizations, and then into SPSS for statistical analysis. The findings showed that the staff employed a balance of transactional and interpersonal approaches in their response strategies, which varied in both quantity and quality depending on the phase or the major sequence of the moves made in the complaint call. Specifically, more transactional strategies were used during the main portion of a complaint and in the medial phase, while more interpersonal strategies were employed during the initial and the final phases of the call. The findings also showed that the CURs tended to downgrade and mitigate their responses to patients' complaints, and they never used upgraders. The influence of the religious culture was also noticeable in their use of downgraders, including optimistic devices and religious expressions. These findings reveal practical implications that can aid the quality team of the Complaint Unit (CU) in assessing the effectiveness and efficiency of the CURs' response strategies when handling complaints, and in providing more effective communication training as needed. [ABSTRACT FROM AUTHOR]

Background and Objectives: Falls are one of the most common adverse events at hospitals that may result in injury and even death. They are also associated with raised length of stay (LOS) and hospitalization costs. This experiment aimed to examine the effectiveness of multiple interventions in reducing inpatient fall rates and the consequent injuries. Methods: The present study was a stepped-wedge cluster-randomized controlled trial. It was done in 18 units in a public university hospital over 36 weeks. Patients included in this research were at risk of falls. Overall, 33 856 patients were admitted, of whom 4766 were considered high-risk patients. During the intervention phases, a series of preventive and control measures were considered, namely staff training; patient education; placement of nursing call bells; adequate lighting; supervision of high-risk patients during transmission and handovers; mobility device allocation; placement of call bell and safe guard in bathrooms; placing "fall alert" signs above patients' beds; nurses informing physicians timely about complications such as delirium and hypoxia; encouraging appropriate use of eyeglasses, hearing aids and footwear; keeping side rails up; and reassessing patients after each fall. The primary outcome was participant falls per 1000 patient-days. Secondary outcomes were fall-related injuries and LOS. Results: The results revealed a decrease in fall rate (n = 4 per 1000 patient-days vs 1.34 per 1000 patient-days, incidence rate ratio (IRR) = 0.19 [95% confidence interval (CI), 0.14-0.26]; P= .001) and injuries (n = 2.4 per 1000 patient-days vs 0.79 per 1000 patient-days, IRR = 0.22 [95% CI, 0.15-0.32]; P= .001) in exposed compared with unexposed phases. There was not a significant difference in LOS (exposed mean 10.63 days [95% CI, 10.26-10.97], unexposed mean 10.84 days [95% CI, 10.59-11.09], mean difference = -0.13 [95% CI, -0.53 to 0.27], P= .52). Conclusions: This multi-interventional trial showed a reduction in falls and fall rates with injury but without an overall effect on LOS. Further research is needed to understand the sustainability of multiple fall prevention strategies in hospitals and their long-term impacts. [ABSTRACT FROM AUTHOR]

The success of each air medical transport mission is dependent on the coordinated efforts of communications specialists, aviation personnel, medical crew members, referring hospitals, local emergency medical services, and fire and law enforcement personnel. Expedited, efficient, and safe patient transport is made possible through the collaboration of all the aforementioned disciplines. In this specialized, unpredictable, and high-pressure environment, each entity plays its own crucial role in rapidly delivering critical care directly to the patient in need. [ABSTRACT FROM AUTHOR]

Document the impact of an outbreak of gastroenteritis on local primary health care services, compared to a control period. Controlled observational study with data from the outbreak and a control period. Data obtained from electronic medical records (EMR) of general practitioners (GPs) and the out-of-hours (OOH) service. Telephone data from the OOH service's telephone records. Campylobacteriosis outbreak in Askøy municipality, Norway in 2019. Over 2000 individuals were infected. Patients in contact with GPs and the OOH service during the outbreak and a control period. Patient contacts with GPs and the OOH service during the outbreak and a control period. There was a 36% increase in contacts during the outbreak compared to the control period (4798 vs. 3528), with the OOH service handling 78% of outbreak-related contacts. Telephone advice was the dominant method for managing the increase in contacts to primary care, both in OOH services and daytime general practice (OR 3.73 CI: [3.24–4.28]). Children aged 0–4 years had increased use of primary care during the outbreak (OR 1.51 CI: [1.28–1.78]). GPs referred 25% and OOH services referred 75% of 70 hospitalized cases. The OOH service handled most of the patients during the outbreak, with support from daytime general practice. The outbreak caused a shift towards telephone advice as a means of providing care. Young children significantly increased their use of primary care during the outbreak. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) clinicians demonstrate a high prevalence of chronic medical conditions that place them at risk for early mortality. Workplace health promotion programs improve health outcomes, but the availably of such programs for EMS clinicians has not been described. We investigate the availability, scope, and participation of workplace health promotion programs available to EMS clinicians in North Carolina (NC). We administered an electronic survey based on the Centers for Disease Control and Prevention Worksite Health ScoreCard to key representatives of EMS agencies within NC that provide primarily transport-capable 9-1-1 response with ground ambulances. We collected information on agency size, rurality, elements of health promotion programs offered, incentives for participation, and participation rate. We calculated descriptive statistics using frequency and percentage for worksite and health promotion program characteristics. We compared the participation rate for agencies who did and did not incentivize participation using Fisher's exact test. Complete responses were received from 69 of 92 agencies (response = 75%) that collectively employ 6679 EMS clinicians [median employees per agency 71 (IQR 50–131)]. Most agencies (88.4%, 61/69) offered at least one element of a worksite health program, but only 13.0% (9/69) offered all elements of a worksite health program. In descending order, the availability of program elements were employee assistance programs (73.9%, 51/69), supportive physical and social environment (66.7%, 46/69), health education (62.3%, 43/69), health risk assessments (52.2%, 36/69), and organization culture of health promotion (20.3%, 14/69). Of agencies with programs, few (11.5%, 7/61) required participation, but most (59.0%, 36/61) offered incentives to participate. Participation rates were <25% among nearly all of the agencies that did not offer incentives, but >50% among most agencies that did offer incentives (p < 0.001). While most agencies offer at least one element of a worksite health promotion program, few agencies offer all elements and participation rates are low. [ABSTRACT FROM AUTHOR]

Early identification of stroke symptoms is essential. The rate of stroke identification by call-takers at emergency medical communication centres (EMCCs) varies, and patients who are found in a lying down position are often not identified as having an ongoing stroke. Objectives: this study aimed to explore signs and symptoms of stroke in patients who had fallen or were found in a lying position. Design: a retrospective exploratory qualitative study design was used. Method: a total of 29 emergency calls to EMCCs regarding patients discharged with a stroke diagnosis from a large teaching hospital in Stockholm, Sweden, in January–June 2011, were analysed using qualitative content analysis. Results: during the emergency calls, the callers described a sudden change in the patient's health status including signs such as the patient's loss of bodily control, the patient's perception of a change in sensory perception, and the callers' inability to communicate with the patient. Conclusions: The callers' descriptions of stroke in a person found in a lying position are not always as described in assessment protocols describing the onset of a stroke. Instead, the symptom descriptions are much vaguer. Therefore, to increase identification of stroke during emergency calls, there is a need for an increased understanding of how callers describe stroke symptoms and communicate with the call-takers. [ABSTRACT FROM AUTHOR]

Law enforcement officers are frequent first responders to people experiencing mental health or suicide crises. Yet, as communities consider expanding crisis response options, we know very little about the nature of these calls that could inform decision making about which crisis response is best suited for the situation. This study is an exploratory, descriptive assessment of contextual factors, both individual and situational, of mental health and suicide crisis calls. Our dataset includes 166 calls to 9-1-1 related to a mental health emergency or suicide crisis. The majority were calls related to suicide (125 calls, 75%), which included more contextual factors than mental health crisis calls. Most calls resulted in the subject being transferred to the local emergency department (60%) or were resolved on scene (12%). Police use of force was rare, and no arrests were reported. The implications of these findings for communities developing alternatives to law enforcement crisis response are discussed. [ABSTRACT FROM AUTHOR]

This work aims to describe and analyse the telephone consultation (TC) for palliative care (PC) patients at home and their caregivers provided by a PC team in Portugal in 2020. This study is observational, retrospective, cross-sectional and correlational, conforming to the STROBE checklist. Records of calls between 01/01/20 and 31/12/20 and clinical process consultations were analysed for trend clearance, including cross-tabulations to look for associations between call characteristics. Call data included information on the caller, patient, problem, utility and choice of service. The data were analysed using the statistical program SPSS software (V.26). During 2020, 494 calls were answered. The majority of the contacts were made by relatives and answered by nurses. The main reason for the contact was symptom management. The TC solved 92.91% of the problems, allowing the patient to remain at home, which is associated with a decrease in the number of hospitalisation days and admissions to the emergency department. The identification of the causes that motivated the calls and who solved them allows us to anticipate some needs that may be less controlled at home. Call distribution time may help allocate human resources better. TC is a viable alternative to traditional hospital follow-ups. [ABSTRACT FROM AUTHOR]

Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was "I don't think that my problems are serious enough." At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64-1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12-0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01-0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. [ABSTRACT FROM AUTHOR]

Introduction: The influence of the COVID-19 pandemic on the incidence and effectiveness of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) in the context of out-of-hospital cardiac arrests (OHCA) remains an area of ambiguity and requires further elucidation. The study aims to conduct a systematic review and meta-analysis of the DA-CPR among pre- vs. during COVID-19 periods. Material and methods: This search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A systematic review of the current literature was performed to identify articles that evaluated the impact of the pandemic on DA-CPR. English-language literature was searched up to December 11, 2023, in three databases, including MEDLINE (via PubMed), Embase, and the Cochrane Library. Results: Six studies with 605,354 patients (431,308 patients with OHCA from before the pandemic period and 174,046 OHCA patients from the COVID-19 pandemic period) were included. Pooled analysis showed that DA-CPR before and during the COVID-19 period varied and amounted to 61.4% vs. 62.4%, respectively (OR = 0.94; 95% CI: 0.90 to 0.99; p = 0.02). Moreover, dispatchers recognized cardiac arrest by phone in 61.8% of cases in the pre-pandemic period as well as in the pandemic period (OR = 0.98; 95%CI: 0.95 to 1.01; p = 0.17). Conclusions: This systematic review and meta-analysis suggest the resilience and adaptability of emergency response systems in maintaining DA-CPR effectiveness despite the challenges posed by the pandemic. [ABSTRACT FROM AUTHOR]

There are over 300,000 out-of-hospital cardiac arrests (OHCA) annually in the United States (US) and despite many scientific advances in the field, the survival rate remains low. We seek to determine if return of spontaneous circulation (ROSC) is higher when use of emergency medical dispatch (EMD) protocols is documented for OHCA calls compared to when no EMD protocol use is documented. We also seek identify care-related processes that differ in calls that use EMD protocols. This is a retrospective cohort study of U.S. adults with OHCA prior to emergency medical services (EMS) arrival using 2019 National EMS Information System data. The primary exposure was EMD usage during EMS call. The primary outcome was prehospital ROSC, and secondary outcomes included automated external defibrillator (AED) use before EMS arrival, bystander CPR, and end-of-event EMS survival (survival to the end of the EMS care at transport destination). Multivariable logistic regression adjusted for age, sex, race/ethnicity, primary insurance, rurality, initial rhythm, arrest etiology, and witnessed arrest. Of the 96,269 OHCA cases included, EMD use was documented in 73%. Overall, 26% of subjects achieved ROSC in EMS care. EMD subjects were more likely to achieve ROSC (27.2% vs. 23.5%, uOR 1.22, 95%CI 1.18 − 1.26) even after adjusting for subject and arrest characteristics (aOR 1.13, 95%CI 1.08 − 1.17). EMD subjects also had higher end-of-event survival (19.1% vs. 16.4%, aOR 1.20, 95%CI 1.15 − 1.25). AED use before EMS arrival was more common in the EMD group (28.3% vs. 26.3% %diff 2.0, 95%CI 1.4 to 2.6), as was CPR before EMS arrival (63.8% vs. 55.1%, difference 8.6%, 95%CI 7.9 to 9.3%). In this retrospective analysis, the rate of ROSC was higher in adult OHCA patients when EMD protocol use was reported compared to when it was not reported. The group with documented EMD use also experienced higher rates of bystander AED use, bystander CPR, and end-of-event survival. [ABSTRACT FROM AUTHOR]

Fewer than 10% of individuals who suffer out-of-hospital cardiac arrest (OHCA) survive with good neurologic function. Bystander CPR more than doubles the chance of survival, and telecommunicator-CPR (T-CPR) during a 9-1-1 call substantially improves the frequency of bystander CPR. We examined the barriers to initiation of T-CPR. We analyzed the 9-1-1 call audio from 65 EMS-treated OHCAs from a single US 9-1-1 dispatch center. We initially conducted a thematic analysis aimed at identifying barriers to the initiation of T-CPR. We then conducted a conversation analysis that examined the interactions between telecommunicators and bystanders during the recognition phase (i.e., consciousness and normal breathing). We identified six process themes related to barriers, including incomplete or delayed recognition assessment, delayed repositioning, communication gaps, caller emotional distress, nonessential questions and assessments, and caller refusal, hesitation, or inability to act. We identified three suboptimal outcomes related to arrest recognition and delivery of chest compressions, which are missed OHCA identification, delayed OHCA identification and treatment, and compression instructions not provided following OHCA identification. A primary theme observed during missed OHCA calls was incomplete or delayed recognition assessment and included failure to recognize descriptors indicative of agonal breathing (e.g., "snoring", "slow") or to confirm that breathing was effective in an unconscious victim. We observed that modifiable barriers identified during 9-1-1 calls where OHCA was missed, or treatment was delayed, were often related to incomplete or delayed recognition assessment. Repositioning delays were a common barrier to the initiation of chest compressions. [ABSTRACT FROM AUTHOR]

Background: National guidelines recommend that high-performing systems process 9-1-1 calls within 60 s and deliver the first telecommunicator cardiopulmonary resuscitation compression within 90 s. The inability of systems employing secondary public safety answering points (PSAPs) to capture the call arrival timestamp at the primary PSAP is a challenge in out-of-hospital cardiac arrest response time research. Objective: We sought to measure the interval from call receipt at primary PSAPs to call answer at secondary PSAPs in metropolitan areas. Methods: This was a retrospective observational study evaluating 9-1-1 call transfers between PSAPs serving large urban populations. Call transfer records were extracted from the 9-1-1 telephony systems at the primary and secondary PSAPs covering seven metropolitan EMS systems. For each transferred call, we obtained the call arrival timestamp at both the primary and secondary PSAPs. The primary outcome was the interval between these two times. Results were compared to a national standard of 90% of calls forwarded within 30 s of receipt. Results: Data collected at seven metropolitan EMS agencies from January 1, 2021, through June 30, 2021, yielded 299,679 records for evaluation. The median interval required to transfer a 9-1-1 caller from primary to secondary PSAPs was 41 s (IQR 31, 59), and 86 s at the 90th percentile. The 90th percentile performance level at individual agencies ranged from 63 s to 117 s. Conclusions: The primary to secondary PSAP transfer interval lengths observed in this study preclude these EMS agencies from meeting out-of-hospital cardiac arrest performance recommendations at the 90% percentile performance level. [ABSTRACT FROM AUTHOR]

In many emergency medical services (EMS) systems, a direct medical oversight physician is available to paramedics for mandatory and/or elective consultations. At the time of this study, a clinical support desk (CSD) was being implemented within the medical communications center of a provincial EMS system in addition to the physician resource. The CSD was initially staffed with a registered nurse or an advanced care paramedic. The objective of the current study was to compare CSD "peer to peer" consults versus physician consults with regards to consultation patterns, transport dispositions, and patient safety measures. This retrospective cohort study analyzed 2 months before (September 1 to October 31, 2012) and 2 months after (September 1 to October 31, 2013) implementation of the CSD. In the before period, all clinical consults were fielded by the direct medical oversight physician. In the after period, consults were fielded by the physician, CSD or both. EMS databases were queried, and manual chart review and abstraction of audio recordings were done. Relapses back to EMS within 48 hours of non-transport were measured. 1621 consults were included, with 764 consults in the before period and 857 after (p = 0.02). The number of physician consults decreased from 764 before to 464 after (39.2%, p < 0.001), with the CSD taking 325 (37.9%) consults. The CSD was consulted more for police custody and trip destination. The physician was consulted more for cease resuscitation and clinical consults prior to medication administration. Overall non-transport rates were 595/764 before (77.9%), and 646/857 after (75.4%) (p = 0.2). Non-transports were 233/325 (71.7%) via the CSD, 364/464 (78.4%) via the physician, and 49/68 (72.1%) when both were involved (p = 0.07). Rate of relapse to EMS was similar before (25/524, 4.8%) and after (26/568, 4.6%) (p = 0.76), and between CSD (12/216, 5.5%) and physician consults (13/325, 4.0%) in the after period (p = 0.41). The introduction of a novel "peer-to-peer" consult program was associated with an increased total number of consults made and reduced call volume for direct medical oversight physicians. There was no change in the patient safety measure studied. [ABSTRACT FROM AUTHOR]

Background: 9-1-1 telecommunicators are frequently exposed to indirect traumatic events that impact their mental and physical health and are often required to work overtime with rotating shifts. Previous studies reported various harmful effects of overtime on the health and well-being of workers, such as musculoskeletal injuries, burnout, low job satisfaction, fatigue, and intent to leave. However, there is limited research on the impact of overtime hours on 9-1-1 telecommunicators' stress symptoms, especially mandatory overtime hours. This study aimed to examine the relationship between overtime hours—mandatory and voluntary—and the level of stress symptoms among 9-1-1 telecommunicators. Methods: We used secondary data from the surveys of the "Multi-tasking to hyper-tasking: Investigating the impact of Next Generation 9-1-1" study for analysis. Linear mixed-effects regression was applied to examine the association of overtime hours with the stress level. Results: Of the 403 participants, 47.6% reported that they were required to work mandatory overtime, and the mean mandatory overtime was 7.51 (SD = 12.78) hours in the past month. 58.3% reported working voluntary overtime, and the mean voluntary overtime was 11.63 (SD = 17.48) hours. This study found that mandatory overtime hours were associated with an increase in self-reported stress symptoms (β = 0.30, p =.002), whereas no significant association was found between voluntary overtime and the level of stress symptoms (β = −0.01, p =.885). Conclusion/Application to Practice: Study results highlight the importance of reducing mandatory overtime in call centers as one possible strategy for reducing stress levels among this critical workforce. [ABSTRACT FROM AUTHOR]

Personal Emergency Response Systems (PERS) are electronic medical alert devices that help people with intellectual and developmental disabilities (IDD) receive assistance in emergencies. According to research on older adults, PERS improve health outcomes, provide people with a sense of security and peace of mind, promote independence, and prevent institutionalization. The aim of this study was to examine if, and how, states provided PERS to people with IDD in their Medicaid Home and Community Based Services (HCBS) waiver programs in fiscal year (FY) 2021. To do so, we qualitatively and quantitatively analyzed HCBS data on participant services and cost‐neutrality demonstrations to examine thematic trends in how and why states offered PERS, as well as total unduplicated participants, total projected spending, projected spending per participant, reimbursement rates, and annual service provision per participant. In FY 2021, 42 waivers (39.25%) from 25 states and the District of Columbia (57.78%) projected spending $9.87 million on PERS services for 9538 people with IDD. PERS services included the installation of devices (77.78%), monthly service fees (73.61%), equipment maintenance (44.44%), and training of people with IDD or their caregivers about the equipment (41.67%). States said they provided PERS in order to prevent institutionalization (23.61%), promote independence (16.67%), and maximize mobility (11.11%). Given the potential benefits for independent living, independence, and reducing costs, as well as the disparities unearthed in this study, we believe states should expand how they provide PERS to people with IDD in HCBS and do so in a more consistent manner. This may be especially beneficial as PERS can be cost‐prohibitive for many people with IDD, who frequently live in poverty, and HCBS reimbursement for technology is the top barrier to implementing technology according to IDD providers. [ABSTRACT FROM AUTHOR]

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Anaesthesiologie & Intensivmedizin is the property of DGAI e.V. - Deutsche Gesellschaft fur Anasthesiologie und Intensivmedizin e.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background. The main influencing factor in the success of the crisis management process is the group's readiness to deal with the crisis. Training models are a tool to maintain the preparation of personnel, increase their ability to achieve certain goals, and help them acquire information, skills, and ways of thinking. This research aimed to design and validate a training model for the staff of the hospital incident command system. Methods. The research method was a qualitative-quantitative (mixed method) approach. The statistical population in the qualitative part included experts in the field of incident command system, and in the quantitative part included managers and staff of this system in the hospitals of Guilan province in Iran. The sampling method in the qualitative part was the judgmental forecasting method. Also, the sampling method was cluster random in the quantitative part. According to the data saturation principle, the sample size in the qualitative section was 15 people, and in the quantitative section, 226 people were selected based on Cochran's formula. The data collection tool in the qualitative part was a semi-structured interview and in the quantitative part was a questionnaire extracted from the interview. Results. After analyzing the categories resulting from interviews with 15 experts, 43 open codes and 12 central codes were determined. Also, five selection codes were obtained as follows: design, analysis, evaluation and feedback, policymaking and determination of strategies, and implementation and support dimension. The findings showed that the design dimension had a more significant effect on designing the training model (path coefficient = 0.987 and t = 176.713). Also, all components had a significant relationship in pattern design. For data analysis, we used the MAXQDA2020 and SmartPls3 software in Conclusion. The results of this research showed that effective command in possible incidents depends on the effective training of employees with a new and up-to-date model. [ABSTRACT FROM AUTHOR]

Background: In pre-hospital emergency care, decisions regarding patient non-conveyance emerged as significant determinants of healthcare outcomes and resource utilization. These complex decisions became integral to the progress of emergency medical services, thus warranting an evolving exploration within the medical discourse. Objectives and methods: This narrative review aimed to synthesize and critically evaluate various theoretical stances on patient non-conveyance in the pre-hospital emergency. The focus on studies published between January 2012 and August 2022 was intentional to capture contemporary practices and insights. PubMed and Google Scholar served as the primary databases for the investigation, while the AL-Rayyan® software facilitated a thorough screening process. Results and discussion: Twenty-nine studies—encompassing articles, books, and theses—were discovered through our search, each presenting unique perspectives on patient non-transport, thus highlighting its criticality as a healthcare concern. Predominant factors influencing non-transport decisions were classified into patient-initiated refusals (PIR), clinician-initiated decisions (CID), and dispatcher-initiated decisions (DID). Conclusions: The issue of patient non-conveyance to hospitals continues to pose a crucial challenge to the seamless operation of emergency healthcare systems, warranting increased attention from various healthcare entities. To comprehend and pinpoint potential areas of improvement, a comprehensive analysis of pre-hospital non-transport events is imperative. A well-informed, strategic approach could prevent resource waste while ensuring patients receive the required and definitive care. Key messages: Why is this topic important? Some studies have suggested that non-transport to hospitals following emergency calls is safe. However, it is a concerning issue for health systems. It is also considered a key performance metric for health systems. What does this review attempt to show? This review aimed to map the various factors discussed in the literature regarding the decisions not to transport patients following emergency calls in a pre-hospital setting. What are the key findings? The existing theories regarding non-transport to hospitals after the provision of emergency care in the pre-hospital setting were identified. Non-transport due to non-clinical decisions jeopardizes emergency care outcomes for paediatric and elderly patients in particular. Hence, further research is required to identify and control the factors governing these decisions. How is patient care impacted? The decisions regarding patient transport following emergency calls in a pre-hospital setting are crucial for patient outcomes. They could impact the pre-hospital emergency care outcomes as well as patient safety. They can also affect the emergency services resources' ability to respond to other critical emergencies. [ABSTRACT FROM AUTHOR]

Ketamine is an opioid-alternative used for analgesia in the prehospital setting. There are knowledge gaps regarding its use during emergency medical services (EMS) encounters for pediatric patients. Our objective was to compare pain reduction, adverse events, and prehospital deaths between ketamine and opioids when used for analgesia administered by any route among pediatric patients. This was a retrospective review of 9-1-1 EMS records of injured pediatric patients (≤17 years of age) who received ketamine or opioids for analgesia using the ESO Data Collaborative (calendar years 2019-2020). We excluded interfacility transfers, patients receiving both medications, those with EMS clinician impressions indicating behavioral disorders, and those who received medication to facilitate advanced airway placement. EMS narrative review was performed to confirm ketamine use was for analgesia and to identify any unplanned airway placements. We assessed pain score reduction (0–10 ordinal scale) and clinician-documented patient response (improved, unchanged, worsened, unknown). Adverse events were defined as change in vital signs (GCS, SBP, RR, SpO2), bag valve mask ventilation alone, or death. Descriptive statistics were calculated to compare outcomes between groups. Overall, 9,223 patients were included, 190 (2.1%) received ketamine and 9,033 (97.9%) received opioids. Mean age in years was 12.8 [SD 4.0] for ketamine and 12.7 [SD 4.0] for opioids. Patients in both groups experienced pain reduction, and more patients receiving ketamine had EMS clinician reported improvement (93.2% vs. 87.9%, p = 0.03). Ketamine was associated with a greater average reduction in pain score than opioids (mean difference: −4.4 [SD 3.5], and −3.1 [SD 2.8], p < 0.001). Adverse events were rare with few patients receiving ventilatory support following the use of ketamine or opioids, (0, [SD 0.0%] vs. 6 [SD 0.1%], p = 1). There were no unplanned airway placements or prehospital deaths identified. We identified similar high rates of pain reduction and rare adverse events among pediatric patients who received ketamine or opioids. A greater pain reduction was noted among patients administered ketamine. Intubation as a result of medication administration did not occur and need for ventilatory assistance was rare. [ABSTRACT FROM AUTHOR]

We investigated the relation between leader airtime management and team effectiveness in Emergency Management Command and Control (EMCC) teams. Leader airtime management concerns leaders' interventions to structure who shares information when using opening and closing statements to respectively stimulate or reduce information sharing. We coded leaders' airtime management statements across different meeting phases (structuring, information sharing, decision making) using video-recordings of 12 EMCC exercises involving two consecutive meetings each. Experts rated two components of team effectiveness: Team Situation Awareness (TSA) and Team Decision Making (TDM). We found that closing statements were more frequently used in the decision-making phase than in any other meeting phase. Also, leaders of teams with lower TSA used more opening statements in the decision-making phase of the first team meeting than leaders of teams with higher TSA. These results confirm the importance of the timing of leader airtime management for EMCC team effectiveness. Practitioner summary: We investigated leader airtime management and team effectiveness in EMCC teams. We video-coded 12 exercises; experts rated team effectiveness. In the decision-making phase, leaders use more closing statements, and leaders of less effective teams use more opening statements. Leaders are advised to adjust their airtime management to meeting phases. [ABSTRACT FROM AUTHOR]

Objectives: To help to tackle gender-based violence against women in the aftermath of COVID-19 or other potential crisis situations, as recommended by the European Institute for Gender Equality, the present study aims to investigate the relationship between calls to the National Anti-violence Number (NAN) and the socio-sanitary pandemic factors during 2021, a period in which the scenario changed due to containment measures that gradually allowed women to emerge from the condition of isolation. In addition, the present work aims to identify significant changes in the number of calls to NAN during the progression of the pandemic in 2021. Methods: Using Italian Civil Protection Department data on the socio-sanitary pandemic factors (defined by daily number of cases, swabs, deaths, hospitalizations, dismissions, intensive care unit hospitalizations, people isolated at home, and quarantine after 15 and 30 days) and NAN data. Correlation analyses, a joinpoint regression analysis, and Granger causality tests were performed. Results: The number of calls correlated with the daily number of cases, swabs, deaths, hospitalizations, dismissions, intensive care unit hospitalizations, and quarantine after 15 and 30 days. The identified joinpoints showed significant changes in the number of daily anti-violence calls during the year. Furthermore, we found evidence of a significant causality between daily hospitalizations, daily home quarantined, daily dismissed patients, and calls to NAN. Conclusions: The results underline the influence of containment measures on the increased access to NAN, suggesting the need for a greater implementation of social and psychological support services in other potential crisis situations. [ABSTRACT FROM AUTHOR]

Copyright of Karya Journal of Health Science is the property of Karya Journal of Health Science and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Emergency medical services (EMS) systems are designed to provide care in the field and while transporting patients to a hospital; however, patients enrolled in hospice may not want invasive therapies nor benefit from hospitalization. For many reasons, encounters with hospice patients can be challenging for EMS systems, EMS clinicians, hospice clinicians, hospice patients, and their families. EMS clinicians should receive hospice-focused education that fosters a basic understanding of hospice, palliative therapies, and advance care planning documents (e.g., Physician Orders for Life Sustaining Treatment). This education should emphasize the ongoing development of end-of-life communication skills. EMS medical directors and local hospice organizations should collaborate to develop hospice patient-centered EMS protocols that address symptom management and delineate appropriate and goal concordant clinical interventions, and that are within the agency-level scope of practice for local EMS clinicians. Partnerships between EMS and hospice organizations can facilitate access to hospice teams who can provide clear guidance on whether to treat-in-place with follow-up care or to transport hospice patients to the hospital. EMS medical directors and local hospice organizations should collaborate to perform needs assessments of hospice patient EMS utilization. EMS medical directors should consider including a focus on EMS care of hospice patients as part of their overall quality management program(s). Ideally these efforts should be collaborative with local hospice agencies in order to facilitate meaningful process improvement strategies that include both EMS and hospice stakeholders. Reimbursement programs should reasonably compensate EMS agencies for scene treatment in place, as well as transport to alternative destinations such as in-patient hospice facilities. [ABSTRACT FROM AUTHOR]

Many community paramedic interventions aim to reduce unnecessary emergency department visits among high utilizers of acute care, but fewer focus specifically on reducing summons for emergency medical services (EMS). We implemented an EMS-based pilot program that identified high utilizers of 9-1-1 and facilitated community paramedic outreach encounters to understand and address potentially unnecessary 9-1-1 calls. This study compares the pre- and post-intervention incidence rate of 9-1-1 calls among program participants. This retrospective evaluation was conducted using pilot data from a single U.S. EMS agency that responds to approximately 100,000 9-1-1 calls annually. High utilizers, defined as individuals with ≥3 9-1-1 calls in 90 days, were identified for recruitment between February 1, 2019 and December 31, 2019. Community paramedics recruited participants via phone and then conducted home visits to assist them with navigation away from unnecessary 9-1-1 use. Dispatch data from September 1, 2018 to December 31, 2019 were used to compute the incidence rate of 9-1-1 calls per 30 person-days of observation before and after the initial home visits. Data from 108 program participants were analyzed. The majority were over the age of 50 (79%), and 33% completed more than one visit. Median person-days of observation before and after the initial home visit were 354 days and 132 days, respectively. Participants called 9-1-1 an average of 0.68 times per 30 person-days prior to the community paramedic intervention, and 0.51 times per 30 person-days after the intervention, which represents an overall mean decrease in 9-1-1 utilization of 25% (p < 0.001). Although a decrease in 9-1-1 utilization was observed in the majority of participants, the 9-1-1 call rate increased in 29% of participants. No statistically significant changes in 9-1-1 use were observed in participants who received more than one home visit or who were in the highest quartile of 9-1-1 use prior to the intervention. This pilot work demonstrates the feasibility of an EMS-based, community paramedic-only intervention to reduce unnecessary 9-1-1 calls and suggests that some modest reductions in EMS use may be achievable by dispatching community paramedics to conduct home visits with frequent users of 9-1-1. [ABSTRACT FROM AUTHOR]

Introduction: The aim of the study was to investigate the relationship between alexithymia, two types of ruminations (intrusive and deliberate) and post-traumatic stress disorder (PTSD) symptoms for two groups of emergency workers working in Poland: paramedics and emergency call centre operators. Material and methods: The research project was conducted the Wielkopolskie voivodship in Poland. The participants were paramedics (n = 72; 54 men, 18 women) and dispatchers (n = 66; 35 men, 31 women). The following Polish versions of standardized tools were used: the Impact of Event Scale-Revised (IES-R), Toronto Alexithymia Scale-20 (TAS-20), and the Event Related Rumination Inventory (ERRI). Results: Analysis of the correlation with Spearman's test demonstrated a statistically significant relationship in both groups between the symptoms of PTSD and ruminations and alexithymia and intrusive ruminations. The correlation between intrusive ruminations and PTSD was stronger for the paramedic group. Also, in the paramedic group, ruminations acted as a mediator for the relation of alexithymia and the intensity of post-traumatic stress. Conclusions: The results of the study provide some evidence that paramedics present more PTSD symptoms than emergency call centre operators. The important individual features which increase PTSD are emotional-cognitive aspects of mental processing: ruminations and alexithymia. The paramedics' direct participation in traumatic events is more overloading for them than the indirect participation in traumatic events for dispatchers. [ABSTRACT FROM AUTHOR]

Background: Social alarms are considered an appropriate technology to ensure the safety and independence of older adults, but limited research has been conducted on their actual use. We, therefore, explored the access, experiences, and use of social alarms among home-bound people with dementia and their informal caregivers (dyads). Methods: From May 2019 to October 2021, the LIVE@Home.Path mixed-method intervention trial collected data from semi-quantitative questionnaires and qualitative interviews conducted among home-dwelling people with dementia and their informal caregivers in Norway. The study focused on data from the final assessment at 24 months. Results: A total of 278 dyads were included, and 82 participants reached the final assessment. The mean age of the patients was 83 years; 74.6% were female; 50% lived alone; and 58% had their child as a caregiver. A total of 62.2% of subjects had access to a social alarm. Caregivers were more likely to answer that the device was not in use (23.6%) compared to patients (14%). Qualitative data revealed that approximately 50% of the patients were not aware of having such an alarm. Regression analyses assessed that access to a social alarm was associated with increasing age (86-97 years, p = 0.005) and living alone (p < 0.001). Compared to their caregivers, people with dementia were more likely to answer that the device gave them a false sense of security (28% vs. 9.9%), while caregivers were more likely to answer that the social alarm was of no value (31.4% vs.14.0%). The number of social alarms installed increased from 39.5% at baseline to 68% at 24 months. The frequency of unused social alarms increased from 12 months (17.7%) to 24 months (23.5%), and patients were less likely to feel safe during this period (60.8% vs. 70%). Conclusion: Depending on their living situation, patients and family members experienced the installed social alarm differently. There is a gap between access to and the use of social alarms. The results indicate an urgent need for better routines in municipalities with regard to the provision and follow-up of existing social alarms. To meet the users' changing needs and abilities, passive monitoring may help them adapt to declining cognitive abilities and increase their safety. [ABSTRACT FROM AUTHOR]

Background: Nurses, regardless of experience, sometimes wait for the Modified Early Warning Score to indicate physiological decline before initiating the hospital's Rapid Response Team (RRT). The goal of this quality improvement initiative was to reduce nurse hesitancy to call the RRT, as indicated by the monthly number of proactive calls before the Modified Early Warning Score increased and triggered an automated page. Method: Education, planned handoff communication, debriefing, and good catch emails were the educational strategies used in the implementation of the quality improvement initiatives, encouraging RRT calls sooner. Increasing RRT knowledge and communication is an evidence-based practice strategy to reduce nurse reluctance to call the RRT. Results: After implementation, monthly proactive RRT calls increased (χ2 [1, n = 1,964] = 14.6085, p =.000159). Bedside interventions, unscheduled transfers, and Acute Physiologic and Chronic Health Evaluation scores did not differ. Conclusion: Education, structured handoff communication, and acknowledging good catches reduced nurses' reluctance to call the RRT proactively. [J Contin Educ Nurs. 2023;54(6):281–288.] [ABSTRACT FROM AUTHOR]

Objective: In the context of increasing demand for ambulance services, emergency mental health cases are among the most difficult for ambulance clinicians to attend, partly because the cases often involve referring patients to other services. We describe the characteristics of mental health emergencies in the East Midlands region of the United Kingdom. We explore the association between 999 (i.e. emergency) call records, the clinical impressions of ambulance clinicians attending emergencies and the outcomes of ambulance attendance. We consider the implications of our results for optimizing patient care and ambulance service delivery. Methods: We conducted a retrospective observational study of records of all patients experiencing mental health emergencies attended by ambulances between 1 January 2018 and 31 July 2020. The records comprised details of 103,801 '999' calls (Dispatch), the preliminary diagnoses by ambulance clinicians on-scene (Primary Clinical Impression) and the outcomes of ambulance attendance for patients (Outcome). Results: A multinomial regression analysis found that model fit with Outcome data was improved with the addition of Dispatch and Primary Clinical Impression categories compared to the fit for the model containing only the intercept and Outcome categories (Chi-square = 18,357.56, df = 180, p < 0.01). Dispatch was a poor predictor of Primary Clinical impression. The most common predictors of Outcome care pathways other than 'Treated and transported' were records of respiratory conditions at Dispatch and anxiety reported by clinicians on-scene. Conclusions: Drawing on the expertise of mental health specialists may help '999' dispatchers distinguish between physical and mental health emergencies and refer patients to appropriate services earlier in the response cycle. Further investigation is needed to determine if training Dispatch operatives for early triage and referral can be appropriately managed without compromising patient safety. [ABSTRACT FROM AUTHOR]

This article describes the development and evaluation of an online workplace stress reduction toolkit for use by managers of 9-1-1 emergency communication centers (ECCs). A three-step process for development and testing of digital learning resources was used: (1) establishing need and focus through ECC manager stakeholder engagement, (2) pretesting of the toolkit with the target ECC manager audience, and (3) toolkit utilization and evaluation. The toolkit was developed in close partnership with stakeholders throughout the entire process. Toolkit usage was documented via registration data. The evaluation utilized an online survey that included closed and open-ended questions, which were analyzed using descriptive statistics and qualitative thematic analysis. Over a 20-month period, 274 people registered for the toolkit and, of those, 184 (67%) accessed the content. Respondents to the evaluation survey (N = 156) scored the toolkit highly on satisfaction, self-efficacy, and perceived utility measures. Survey respondents reported intent to apply toolkit content through the following: providing organizational resources to help workers take better care of themselves (41%); creating a lower stress worksite environment (35%) and sharing resources with staff to (1) reduce stress (19%), (2) support conflict resolution (21%), and (3) prevent and/or stop bullying (17%). In delivering actionable content to ECC managers, the toolkit shows promise in addressing and mitigating occupational stress in ECCs. Further research needs to determine the relationship of this strategy for reducing ECC stress. [ABSTRACT FROM AUTHOR]

Whether ambulance transport patterns are optimized to match children to high-readiness emergency departments (EDs) and the resulting effect on survival are unknown. We quantified the number of children transported by 9-1-1 emergency medical services (EMS) to high-readiness EDs, additional children within 30 minutes of a high-readiness ED, and the estimated effect on survival. This was a cross-sectional study using data from the National EMS Information System for 5,461 EMS agencies in 28 states from 1/1/2012 through 12/31/2019, matched to the 2013 National Pediatric Readiness Project assessment of ED pediatric readiness. We performed a geospatial analysis of children 0 to 17 years requiring 9-1-1 EMS transport to acute care hospitals, including day-, time-, and traffic-adjusted estimates for driving times to all EDs within 30 minutes of the scene. We categorized receiving hospitals by quartile of ED pediatric readiness using the weighted Pediatric Readiness Score (wPRS, range 0-100) and defined a high-risk subgroup of children as a proxy for admission. We used published estimates for the survival benefit of high readiness EDs to estimate the number of lives saved. There were 808,536 children transported by EMS, of whom 253,541 (31.4%) were high-risk. Among the 2,261 receiving hospitals, the median wPRS was 70 (IQR 57-85, range 26-100) and the median number of receiving hospitals within 30 minutes was 4 per child (IQR 2-11, range 1 to 53). Among all children, 411,685 (50.9%) were taken to EDs in the highest quartile of pediatric readiness, and 180,547 (22.3%) children transported to lower readiness EDs were within 30 minutes of a high readiness ED. Findings were similar among high-risk children. Based on high-risk children, we estimated that 3,050 pediatric lives were saved by transport to high-readiness EDs and an additional 1,719 lives could have been saved by shifting transports to high readiness EDs within 30 minutes. Approximately half of children transported by EMS were taken to high-readiness EDs and an additional one quarter could have been transported to such an ED, with measurable effect on survival. [ABSTRACT FROM AUTHOR]

Introduction: Hypothermia is an uncommon cause of cardiac arrest in the United Kingdom, and more commonly occurs in countries experiencing avalanches and significant winter climates; however, this case demonstrates that the presentation can occur in the United Kingdom. This case adds to a body of evidence that prolonged resuscitation can be successful in patients suffering a cardiac arrest secondary to hypothermia, leading to a good neurological outcome. Case presentation: The patient suffered a witnessed out-of-hospital cardiac arrest following rescue from a free-flowing river, and underwent prolonged resuscitation. The patient presented in persistent ventricular fibrillation, unresponsive to defibrillation attempts. An oesophageal probe recorded the patient's temperature as 24°C. Rescuers were guided by the Resuscitation Council UK advanced life support algorithm to withhold drug therapy and limit defibrillation attempts to three, until the patient had been rewarmed to above 30°C. Appropriate triage of the patient to an extracorporeal life support (ECLS) capable centre allowed specialised treatment to be initiated, and culminated in successful resuscitation once normothermia was restored. After a short stay in intensive care, the patient was discharged for rehabilitation due to a hypoxic spinal cord injury before discharge home. Conclusion: This case highlights that hypothermia is a reversible cause of cardiac arrest, which needs to be recognised and acted upon appropriately to provide the best possible chance for a positive outcome. Low-reading thermometers capable of identifying the temperature thresholds stated in the Resuscitation Council UK guidelines are required, to allow clinicians to adapt their practice according to the presenting situation. Tympanic thermometers are often limited to their lowest recordable temperature, and invasive monitoring such as oesophageal or rectal probes are not common in UK ambulance service practice. With the necessary equipment, patients can be triaged to an ECLS-capable centre, allowing them to receive the specialist rewarming that they require. [ABSTRACT FROM AUTHOR]

Objective: There is no empirical definition of adult frequent use of ambulance services. This study aimed to define a threshold, and utilise this to explore characteristics of people frequently using services. Methods: This was a retrospective cross-sectional study in a single ambulance service in England. Routinely collected, pseudo-anonymised call- and patient-level data were collected for two months (January and June 2019). Incidents, defined as independent episodes of care, were analysed using a zero-truncated Poisson regression model to determine a suitable frequent-use threshold, with comparisons subsequently made between frequent and non-frequent users. Results: A total of 101,356 incidents involving 83,994 patients were included in the analysis. Two potentially appropriate thresholds were identified: five incidents per month (A); and six incidents per month (B). Threshold A produced 3137 incidents from 205 patients, with five patients likely false-positive identifications. Threshold B produced 2217 incidents from 95 patients, with no false-positive identifications but 100 false-negatives compared to threshold A. Regardless of threshold, frequent users compared to non-frequent users had relatively reduced service use between 08:00 and 15:00, were younger and were more likely to receive lower-priority responses (all p < 0.001). We identified several chief complaints indicative of increased frequent use, including chest pain, psychiatric/suicide attempt and abdominal pains/problems. Conclusions: We suggest a threshold of five incidents per month, with recognition that a small number of patients may be incorrectly identified as using ambulance services frequently. The rationale for this choice is discussed. This threshold may be applicable in wider UK settings and could be used for the routine automated identification of people using ambulance services frequently. The identified characteristics can help inform interventions. Future research should examine applicability of this threshold in other UK ambulance services and countries where patterns and determinants of frequent ambulance use may differ. [ABSTRACT FROM AUTHOR]

Hospital incident command systems (HICS) were implemented to expand mental and behavioral healthcare (MBHC) services during the COVID-19 pandemic. Data on patient census, nurse vacancies, staff injuries, and staff perceptions were analyzed to quantify issues and track progress toward HICS goals. Data, environment of care, staffing, staff support, staff education, and communication resources were developed. After HICS implementation, 84% of nurses reported confidence in providing care to youth with acute MBHC needs. Nurse leaders should consider HICS for addressing other crises. [ABSTRACT FROM AUTHOR]