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Introduction: Placement of percutaneous ventricular support devices such as an intraaortic balloon pump (IABP) or Abiomed Impella device can treat severe cardiogenic shock. Critical care transport medicine (CCTM) providers frequently manage patients supported by these devices during interfacility transfers, often using a helicopter air ambulance (HAA). An understanding of patient needs and management during transport is essential to informing crew configuration and training, and this study adds to the limited existing data on the HAA transport of this complex patient population. Methods: We performed a retrospective chart review of all HAA transports of patients with an IABP (n = 38) or Impella (n = 11) device at a single CCTM program from 2016 to 2020. We evaluated transport times and composite variables for the frequency of adverse events, condition changes requiring critical care evaluation, and critical care interventions. Results: In this observational cohort, patients with an Impella device more frequently had an advanced airway and at least 1 vasopressor or inotrope active prior to transport. While flight times were similar, CCTM teams remained at referring facilities longer for patients with an Impella device (99 vs 68 minutes; p = 0.0097). Compared to patients with an IABP, patients with an Impella device more frequently had a condition change requiring critical care evaluation (100% vs 42%; p = 0.0005) and more frequently received critical care interventions (100% vs 53%; p = 0.0037). Adverse events were uncommon and did not differ for patients with an Impella device compared to an IABP (27% vs 11%; p = 0.178). Conclusion: Patients requiring mechanical circulatory support with IABP and Impella devices frequently require critical care management during transport. Clinicians should ensure the CCTM team has appropriate staffing, training, and resources to meet the critical care needs of these high acuity patients. [ABSTRACT FROM AUTHOR]

This article examines the process of transitioning for newly qualified paramedics (NQPs) entering primary care. Despite the traditional expectation of 3-5 years of experience, there has been an increase in NQPs seeking employment in this field. The article explores the education, experience, and motivations of NQPs, as well as theoretical models of transition. It provides practical recommendations for supporting NQPs, emphasizing the importance of tailored support, clear role expectations, and funding. The article is authored by Joe Copson, Georgette Eaton, and Kamal R Mahtani, and is supported by the National Institute for Health Research (NIHR). [Extracted from the article]

Background: During the summer of 2021, a deadly, unprecedented multiday Heat Dome engulfed western Canada. As a result of this extreme heat event (EHE), emergency dispatchers received an unparalleled increase in incoming 911 calls for ambulance, police, and fire (as first responders) services to attend to hundreds of heat‐vulnerable community members succumbing to the heat. With 103 all‐time heat records broken during this EHE and indoor temperatures of nearly 40°C, the first responders attending these calls faced extensive job demands and highly challenging operating conditions. Initial investigations have explored the health system‐level impacts; however, little has been done to explore the impact on the first responders themselves. Therefore, this study aimed to improve our understanding of EHEs' impacts on the operational capabilities and health of first responders, specifically police, fire, ambulance, and dispatch services. Methods: A systematized review and content analysis of media articles published on the 2021 Heat Dome in Canada was conducted (n = 2909), and four media‐based composite narratives were developed highlighting police, fire, ambulance, and dispatch services. The Job Demands‐Resources (JD‐R) model was applied as a theoretical framework for occupational burnout. Results: The media‐based composite narratives highlighted that first responders faced record‐breaking call volumes, increased mental‐health‐related claims, and exhaustive heat‐related physiological stress. Using the JD‐R model as a theoretical framework for occupational burnout, we identified three measures of stressful job demand: work overload (e.g., the surge in call volume, firefighters responding to medical emergencies), emotional demands (e.g., severe medical emergencies, sudden deaths, unresponsive patients, distraught family members), and physical demands (e.g., resuscitation in personal protective equipment, heat‐related illness). Conclusion: The experiences described underscore the importance of supporting first responders during work in extreme heat conditions. These findings have important implications for addressing rising rates of burnout during and following public health crises, such as EHEs, a problem that is increasingly being recognized as a threat to the Canadian public healthcare system. [ABSTRACT FROM AUTHOR]

Playing with a child is one of the easiest and most effective ways to establish communication. However, illness or injury can lead to negative emotions and stress in a child, making it challenging for them to adapt to treatment during pre-hospital care. The use of therapeutic communication and play in pre-hospital settings facilitates the identification of the patient's current conditions, the assessment of identified situations, and the implementation of pre-hospital care approaches based on these evaluations. The paramedic program included 40 students in the first grade and 40 students in the second grade. The second-grade students received 16 hours of theoretical and 16 hours of practical therapeutic play training from a play therapist. The second-grade students who participated in the training applied therapeutic play techniques in communication with children. Then, The Medical Procedure Fear Scale was administered to all students during their internships in emergency services or ambulance settings with children aged 4-9. The data obtained in the research were analyzed using SPSS 22.0 statistical software. Paramedic students who received therapeutic play training and used therapeutic play in communication with children had lower fear scale scores compared to those who did not receive therapeutic play training and did not use therapeutic play in communication with children. The study concluded that gender and the applied field of the scale did not affect the scale scores, while age was identified as an influential factor. The entire healthcare team, especially paramedics working in emergency health services, should have sufficient knowledge, skills, and experience about children's developmental periods, therapeutic play, and its types. [ABSTRACT FROM AUTHOR]

Copyright of Anatolian Clinic Journal of Medical Sciences is the property of Hayat Saglik ve Sosyal Hizmetler Vakfi 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: There is a notable variation in the percentage of non-conveyed patients within the ambulance service. Discharging patients at the scene includes a risk of adverse events, and both patients and ambulance clinicians experience the complexity of non-conveyance. Therefore, this study aimed to describe factors influencing the care encounter when care in the ambulance service concludes with non-conveyance. Method: A qualitative study design employing the critical incident technique for data collection through individual interviews, and a qualitative analysis based on Fridlund et al. descriptions was utilized. The study conforms to the COREQ checklist for reporting qualitative research. Results: Fourteen Registered Nurses (RN) described 30 incidents and various factors were identified as influencing the care encounter. The factors included communication, sharing information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and an overall understanding of the patient's entire situation. These factors were integrated into the RNs' decision-making process for non-conveyance. Conclusion: The decision-making process for non-conveyance by RNs is a multifaceted approach that incorporates several factors. Communication, sharing of information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and a comprehensive understanding of the patient's entire situation. These findings have the potential to contribute to the development of guidelines supporting the RNs working in the ambulance service in their decisions regarding non-conveyance. Further research is needed on the patient's and relatives' perspective on non-conveyance otherwise, patient participation and partnership in person-centered care are not possible to achieve. [ABSTRACT FROM AUTHOR]

Introduction: Telemedicine is a useful tool for decreasing hospital stress, patient suffering, ambulance needs, hospital anxiety, and costs while improving the standard of care. Nonetheless, the lack of awareness regarding telemedicine poses a barrier to its application, presenting several difficulties in underdeveloped nations like Ethiopia. This review evaluates Ethiopian-specific telemedicine knowledge and associated factors. Methods: This systematic review was conducted using a search of several online databases in addition to the main databases, like Medline, PubMed, Scopus, and Science Direct. The writers have looked for, reviewed, and summarized information about telemedicine knowledge in the healthcare system. This study contained seven studies that examined telemedicine knowledge in the Ethiopian healthcare sector. Studies that followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA) were found using search engines. The investigation was carried out using STATA version 11. The indicator of heterogeneity (I2) was used to assess the level of heterogeneity among the included studies. The funnel plot was visually inspected, and Egger's regression test was run to check for publication bias. The pooled effect size of every study is estimated using a random-effect model meta-analysis. Results: Examination of 2160 studies, seven studies involving 2775 health professionals, and seven out of the 2160 publications assessed satisfied the inclusion criteria and were added to the systematic review and meta-analysis. The pooled prevalence of Telemedicine knowledge was 45.20 (95% CI: 34.87–55.53). Whereas the pooled factor was computer training was 2.24 times (AOR = 2.24 (95%; CI: 1.64–3.08)), computer access was 2.07 times (AOR = 2.07 (95% CI: 1.50–2.87)), internet access was 3.09 times (AOR = 3.09 (95% CI: 1.34–7.13)), social media access were 3.09 times (AOR = 3.09(95%; CI: 1.34–7.13)), educational status degree and above were 2.73 times (AOR = 2.73; 95% CI: 0.85–8.82), Awareness were 3.18 times (AOR = 3.18 (95%; CI: 1.02–9.91)), Management support was 1.85 (AOR = 1.85 (95% CI: 01.25–2.75)), computer literacy were 2.90 times (AOR = 2.90 (95% CI: 1.81–4.64)), computer owner were 1.70 times (AOR = 1.70 (95% CI: 1.05–2.76)), male gender were 1.95 times (AOR = 1.95 (95% CI: 1.32–2.87)). Conclusion: The overall pooled prevalence of telemedicine knowledge was low. Gender, education, management support, computer access, social media access, internet access, telemedicine awareness, and telemedicine training associated with telemedicine knowledge. [ABSTRACT FROM AUTHOR]

The SmartEUS project aims to design, develop, and test a highly innovative model for the provision of Emergency Urgency Services (EUS) based on the concept of clinical pathway (i.e., the entire emergency care chain). The project is innovative both from an organizational and technological point of view. It is based on an e-Health approach, capable of exploiting new digital technologies in a coordinated way to support the evolution of emergency health systems towards dynamic and safer processes. The paper presents the SmartEUS platform which can integrate the information from all the key players in medical emergency response (emergency operation center, emergency medical service, hospital emergency department) improving their coordination. The most relevant innovations of the proposed solution are data integration and interoperability, advanced communication and collaboration, knowledge-based resource allocation, telemedicine integration to support decision making in dispatching and resource assignment. In fact, a Decision Support System is integrated into SmartEUS cloud platform to suggest to the emergency operation center which emergency medical service and hospital emergency department. In fact, information on the patient status can include results from ambulance's on board telediagnosis equipment, alerting the hospital emergency department even before the arrive of the patient, thus guaranteeing the appropriateness of care according to patient needs (e.g., patient pre-triage index, potential pre-hospital diagnosis) and reducing emergency department overcrowding and resources saturation. [ABSTRACT FROM AUTHOR]

Providing pre-hospital emergency services is accessible in Iran but costly for the country's health system. This study calculated the willingness to pay (WTP) for pre-hospital emergency services in Iran. Discrete choice experiment (DCE) was used to measure the population's WTP for ambulance services focusing on time, price, and quality of services. Four hundred and sixty people in Rasht city, Iran, participated in this online survey. Participants preferred lower transfer fees (β = -0.7, P = 0.05), lower time of reaching to the scene (β = -0.061, P = 0.05), lower time to arrive to the hospitals (β = -0.038, P = 0.05), Private ambulance (β = -0.151, P = 0.05), and emergency medical services (EMS) technicians (β = 0.209, P = 0.05). Patients' WTP in selecting EMS services can help policymakers to provide the best services. [ABSTRACT FROM AUTHOR]

An editorial focuses on evaluating the effectiveness of Israel's "First 7 Minutes" training, which aims to enhance lay bystanders' preparedness in responding to terrorism-related mass casualty incidents. It is reported that the training's impact on participants' perceived ability to assist and its benefits for individuals with lower resilience are assessed.

Background: Current data on tranexamic acid (TXA) supports early administration for severe hemorrhagic shock. Administration by EMS has been facilitated by developing protocols and standing orders informed by these data. In this study, patterns of TXA use by EMS agencies serving a large level 1 trauma center were examined. We hypothesized that current widespread TXA use often includes administration outside of data-driven indications. Methods: The trauma registry at a level 1 trauma center was queried for patients who received TXA. To determine the practice patterns and appropriateness of administration of TXA, patients' physiologic state in the prehospital environment based on EMS records, physiologic state on arrival to hospital, and interventions performed in both settings were examined. Over 20 separately managed EMS systems that administer TXA transport patients to this trauma center, allowing for a broad survey of practices. Results: From 2016 to 2021 1089 patients received TXA, 406 (37.3%) having treatment initiated by EMS services. Of these, the average prehospital systolic blood pressure (SBP) was 108.2 mmHg and initial ED SBP was 107.8 mmHg. Only 58.4% of these patients received blood transfusion after arrival to this trauma center. Compliance with standard indications was low with only 14.6% of administrations meeting any data-driven SBP indication. Similar levels of compliance were seen across high volume EMS services. Discussion: Tranexamic acid use has become common in trauma and has been adopted by many EMS systems. These results indicate TXA in the prehospital setting is over-used as administration is not being limited to indications that have shown benefit in prior data. [ABSTRACT FROM AUTHOR]

In vehicular energy networks (VENs) operating in smart health care systems (SHaCarS), reputation of vehicles, i.e., ambulances, plays an important role as all functions depend upon it including message sharing, energy trading, etc. Keeping this in view, this paper presents a reputation management scheme. To ensure that the proposed scheme is secure and transparent, Blockchain (BC) technology is used. In the proposed model, the registration of ambulances is performed through a certificate authority (CA). Later, a pseudo mechanism is designed using Elliptic Curve Digital Signature Algorithm, which ensures conditional anonymity and traceability. The ambulances are provided with the pseudo identities, which are mapped with the real identities to prevent disputes. Besides, the proposed scheme uses a Shamir secret sharing (SSS) algorithm to enable distributed revocation in BC based VENs operating in SHaCarS. In addition, the ambulances' reputation information is stored in interplanetary file system (IPFS) in an efficient manner. The hashes are generated by IPFS upon data storage, which are then stored in BC. The performance evaluation of the proposed system is done via extensive simulations. The results show 18–20% reduction in computational overhead and 35–40% reduction in storage overhead. The proposed system's robustness is tested by inducing the 51% attack and the replay attack. In addition, the security analysis of the smart contract is performed using Oyente. The results show that the system proposed for reputation management in the underlying work is robust and computationally efficient. [ABSTRACT FROM AUTHOR]

Background Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. Objectives To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. Methods We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. Results From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31–6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65–74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. Conclusions Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens. [ABSTRACT FROM AUTHOR]

Climate change has led to an increase in the frequency and intensity of natural disasters, necessitating the development of efficient crisis management strategies for population sheltering. However, existing research on this topic primarily focuses on the use of public resources such as ambulances and fire trucks, which may sometimes be insufficient due to high demand and impacted locations, worsening the shortage of resources. This research introduces an ontology-based crisis simulation system for population sheltering management that focuses on the integration and distribution of citizen–volunteer drivers/vehicles into the evacuation process. Recognizing the limitations of public resources in current crisis management models, our approach incorporates citizen resources to enhance overall evacuation capacity. We develop an ontology to standardize crisis management knowledge, frame vehicle distribution as a recommendation problem, and design a simulation module incorporating a constraint-based recommender system. The proposed scenario illustrates how the simulation system can recommend citizen resources during crisis situations by considering the constraints to be satisfied. With our system, we aim at helping stakeholders to be prepared for various disaster scenarios: optimizing resource allocation and reducing time to make decisions by decision-makers. [ABSTRACT FROM AUTHOR]

A mobile stroke unit (MSU) is a specialized ambulance, enabling to shorten the time to diagnosis and treatment for stroke patients. In the current paper, we present a simulation-based approach to study the potential impacts of collaborative use of regular ambulances and MSUs in prehospital transportation for stroke patients, denoted as co-dispatching. We integrated a co-dispatch policy in an existing modeling framework for constructing emergency medical services simulation models. In a case study, we applied the extended framework to southern Sweden to evaluate the effectiveness of using the co-dispatch policy for different types of stroke. The results indicate reduced time to diagnosis and treatment for stroke patients when using the co-dispatch policy compared to the situation where either a regular ambulance or an MSU is assigned for a stroke incident. [ABSTRACT FROM AUTHOR]

Ambulance travel time estimations play a pivotal role in ensuring timely and efficient emergency medical care by predicting the duration for an ambulance to reach a specific location. Overlooking factors such as local traffic situations, day of the week, hour of the day, or the weather may create a risk of inaccurately estimating the ambulance travel times, which might lead to delayed emergency response times, potentially impacting patient outcomes. In the current paper, we propose a novel framework for accurately estimating ambulance travel times using machine learning paradigms, employing real-world spatiotemporal ambulance data from the Skane region, Sweden. Our framework includes data preprocessing and feature engineering, with a focus on variables significantly correlated with travel time. First, through a comprehensive exploratory data analysis, we highlight the main characteristics, patterns, and underlying trends of the considered ambulance data set. Then, we present an extensive empirical analysis comparing the performance of different machine learning models across different ambulance travel trip scenarios and feature sets, revealing insights into the importance of each feature in improving the estimation accuracy. Our experiments indicate that the aforementioned factors play a significant role when estimating the travel time. [ABSTRACT FROM AUTHOR]

Vertical flight was sought-after by scientists for centuries, finding early beginnings in children's toys and slowly developing into the modern helicopter. For centuries, true success was elusive, and many machines failed to achieve safe, controlled flight. Despite slow progress, vertical flight enthusiasts were unrelenting and continued trialing new concepts until one finally rose above the rest. As technology advanced, the critical role of helicopters in medical evacuation became apparent. Throughout recent history, continuous progress in vertical flight technology has led to widespread and multifaceted use of helicopters in civilian and military medical operations. [ABSTRACT FROM AUTHOR]

Background and Aim: Though emergency medical services (EMS) respond to all types of emergency calls, they do not always result in the patient being transported to the hospital. This study aimed to explore the determinants influencing emergency call‐response‐based conveyance decisions in a Middle Eastern ambulance service. Methods: This retrospective quantitative analysis of 93,712 emergency calls to the Hamad Medical Corporation Ambulance Service (HMCAS) between January 1 and May 31, 2023, obtained from the HMCAS electronic system, was analyzed to determine pertinent variables. Sociodemographic, emergency dispatch‐related, clinical, and miscellaneous predictors were analyzed. Descriptive, bivariate, ridge logistic regression, and combination analyses were evaluated. Results: 23.95% (N = 21,194) and 76.05% (N = 67,285) resulted in patient nontransport and transportation, respectively. Sociodemographic analysis revealed that males predominantly activated EMS resources, and 60% of males (n = 12,687) were not transported, whilst 65% of females (n = 44,053) were transported. South Asians represented a significant proportion of the transported patients (36%, n = 24,007). "Home" emerged as the primary emergency location (56%, n = 37,725). Bivariate analysis revealed significant associations across several variables, though multicollinearity was identified as a challenge. Ridge regression analysis underscored the role of certain predictors, such as missing provisional diagnoses, in transportation decisions. The upset plot shows that hypertension and diabetes mellitus were the most common combinations in both groups. Conclusions: This study highlights the nuanced complexities governing conveyance decisions. By unveiling patterns such as male predominance, which reflects Qatar's expatriate population, and specific temporal EMS activity peaks, this study accentuates the importance of holistic patient assessment that transcends medical histories. [ABSTRACT FROM AUTHOR]

Introduction: Ambulance service clinical placements are fundamental to paramedicine student education, but the quality and safety of these placements can be highly variable. Inspired by positive results from a nursing facilitator model, this study reports on a collaboration between an Australian university and ambulance service that introduced a paramedic clinical facilitator for undergraduate paramedic students during their ambulance clinical placements. This article describes the experiences of a clinical facilitator model for paramedicine students and their preceptors during the study period. Methods: This study follows an exploratory qualitative research methodology. After implementation of the paramedic clinical facilitator model, two focus groups with paramedicine student participants and two semi-structured interviews with their paramedic preceptors were conducted. Intimate observations were recorded in a reflexive logbook by the facilitator, which was kept for data analysis. Purposive sampling was used to recruit participants, and thematic analysis was used to code data and conceptualise themes. Results: Three broad overarching themes were conceptualised from the data: 1) increased educational opportunities, 2) improved clinical placement management and 3) greater student support and welfare. Both paramedicine students and paramedic preceptors felt that the paramedic clinical facilitator model improved the quality of ambulance clinical placements for undergraduate paramedicine students. Conclusion: This study suggests that a paramedic clinical facilitator model improved the safety and quality of ambulance clinical placement experience for paramedicine students and preceptors. Universities and ambulance services could consider implementing a paramedic facilitator model for ambulance clinical placements in their local contexts. [ABSTRACT FROM AUTHOR]

On October 7, 2023, Israel experienced the worst terror attack in its history – 1,200 people were killed, 239 people were taken hostage, and 1,455 people were wounded. This mass-casualty event (MCE) was more specifically a mega terrorist attack. Due to the overwhelming number of victims who arrived at the two closest hospitals, it became necessary to implement secondary transfers to centers in other areas of the country. Historically, secondary transfer has been implemented in MCEs but usually for the transfer of critical patients from a Level 2 or Level 3 Trauma Center to a Level 1 Center. Magen David Adom (MDA), Israel's National Emergency Pre-Hospital Medical Organization, is designated by the Health Ministry as the incident command at any MCE. On October 7, in addition to the primary transport of victims by ambulance to hospitals throughout Israel, they secondarily transported patients from the two closest hospitals – the Soroka Medical Center (SMC; Level 1 Trauma Center) in Beersheba and the Barzilai Medical Center (BMC; Level 2 Trauma Center) in Ashkelon. Secondary transport began five hours after the event started and continued for approximately 12 hours. During this time, the terrorist infiltration was still on-going. Soroka received 650 victims and secondarily transferred 26, including five in Advanced Life Support (ALS) ambulances. Barzilai received 372 and secondarily transferred 38. These coordinated secondary transfers helped relieve the overwhelmed primary hospitals and are an essential component of any MCE strategy. [ABSTRACT FROM AUTHOR]

Background Mechanical thrombectomy has emerged as standard of care in treatment of patients with acute ischemic stroke attributable to large‐vessel occlusion. Efforts to reduce the time from symptom onset to treatment initiation remain critically important to improve functional outcomes in patients treated with either intravenous thrombolysis, mechanical thrombectomy, or both. The use of ambulance helicopters in prehospital acute stroke care could potentially reduce symptom onset to treatment time to mechanical thrombectomy. This study aims to optimize the use of ambulance helicopters in prehospital transportation of patients with presumed acute stroke attributable to large‐vessel occlusion given economic constraints in health care budget. Methods By means of an economic model within a decision‐analytical framework, this study evaluates the cost‐effectiveness of complementary ambulance helicopters compared with road ambulances only for prehospital acute transportation of patients with presumed stroke and potential eligibility for mechanical thrombectomy, in regard to the number and locations of ambulance helicopters in Sweden. Results A single, optimally located complementary ambulance helicopter was cost‐effective compared with road ambulances only. The most cost‐effective solution in the base‐case scenario with the current 8 thrombectomy centers comprised 13 optimally located helicopters. It reduced mean onset to treatment time with intravenous thrombolysis and onset to treatment time with mechanical thrombectomy by 7.9 and 32.1 minutes, respectively, and produced health gains equal to 91 quality‐adjusted life‐years per year. When the willingness to pay per quality‐adjusted life‐years gained was set at Euro (EUR) 80 000, the incremental net monetary benefit per patient reached EUR 2240. The solution with 13 optimally located helicopters prevailed as the most cost‐effective in the extended scenario analysis with 11 thrombectomy centers, reaching an estimated incremental net monetary benefit per patient at EUR 1754. Furthermore, mean incremental net monetary benefit per patient reached global maximum (EUR 6046) at the geodesic distance of 165.2 km between patient location and the nearest thrombectomy center in the base‐case scenario, and at 238.5 km in the extended scenario with an estimated incremental net monetary benefit per patient at EUR 7994. Conclusion This study demonstrates the cost‐effectiveness of ambulance helicopters as a complementary mode of transportation to road ambulances. The most cost‐effective solution of complementary ambulance helicopters comprises 13 optimally located heliports across Sweden.

Background Education of ‘108' ambulance personnel involved in transporting neonates may improve outcomes. We assessed i) perceptions/practices of ‘108’ ambulance personnel for transporting neonates, ii) clinical parameters of transported neonates at arrival, and iii) outcomes such as survival/mortality and NICU stay (before and after skill-based educational intervention). Methods We conducted a single-arm intervention study (pre-and post) over 18 months. We assessed the perceptions and practices of 77 ambulance personnel on neonatal transport pre- versus post-intervention. Checklists assessed ambulance equipment availability/usage in both phases. We compared clinical parameters and outcomes of transported neonates between the pre-intervention (n=62) and post-intervention (n=53) phases. We analyzed data using SPSS version 25. Results Post-intervention, there was a significant reduction in the levels of hypothermia (p < 0.001), hypoglycemia (p=0.010), and prolonged capillary refill time (p=0.042), along with improvement in the use of intravenous fluids (p

Background Community First Responders are trained volunteers dispatched by ambulance services to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until highly skilled ambulance staff arrive. Community First Responder schemes were first introduced to support ambulance services in rural communities, where access to prehospital emergency care is more likely to be delayed. Evidence is lacking on their contribution to rural healthcare provision, how care is provided and how this might be improved. Objectives We aimed to describe Community First Responder activities, organisation, costs of provision and outcomes of care together with perceptions and views of patients, public, Community First Responders, ambulance service staff and commissioners of their current and future role including innovations in the rural health and care workforce. Design We used a mixed-methods design, using a lens of pragmatism and the ‘actor’, ‘behaviour change’ and ‘causal pathway’ framework to integrate quantitative routine and qualitative (policy, guideline and protocol documents with stakeholder interview) data from 6 of 10 English ambulance services. We identified potential innovations in Community First Responder provision and prioritised these using a modified nominal group technique. Patients and public were involved throughout the study. Results In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, Community First Responders attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5%). They were significantly more likely to be called out to rural (vs. urban) areas and to attend older (vs. younger), white (vs. minority ethnic) people in more affluent (vs. deprived) areas with cardiorespiratory and neurological (vs. other emergency) conditions for higher-priority emergency or urgent (category 1 and 2 compared with category 3, 4 or 5) calls but did also attend lower-category calls for conditions such as falls. We examined 10 documents from seven ambulance services. Ambulance policies and protocols integrated Community First Responders into ambulance service structures to achieve the safe and effective operation of volunteers. Costs, mainly for training, equipment and support, varied widely but were not always clearly delineated. Community First Responders enabled a faster prehospital response time. There was no clear benefit in out-of-hospital cardiac arrest outcomes. A specific Community First Responder falls response reduced ambulance attendances and was potentially cost saving. We conducted semistructured interviews with 47 different stakeholders engaged in Community First Responder functions. This showed the trajectory of becoming a Community First Responder, the Community First Responder role, governance and practice, and the positive views of Community First Responders from stakeholders despite public lack of understanding of their role. Community First Responders’ scope of practice varied between ambulance services and had developed into new areas. Innovations prioritised at the consensus workshop were changes in processes and structures and an expanded scope of practice supported by training, which included counselling, peer support, better communication with the control room, navigation and communication technology, and specific mandatory and standardised training for Community First Responders. Limitations Missing data and small numbers of interviews in some stakeholder groups (patients, commissioners) are sources of bias. Future research Future research should include a robust evaluation of innovations involving Community First Responders. Trial registration This trial is registered as ClinicalTrials.gov, NCT04279262. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR127920) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 18. See the NIHR Funding and Awards website for further award information. Plain language summary Background Community First Responders are volunteers who attend emergencies, particularly in rural areas, and provide help until the ambulance arrives. Research aims We aimed to describe Community First Responder activities, costs and effects and get the views of the public, Community First Responders, ambulance staff and commissioners on the current and future role of Community First Responders. Research design Our study design combined different approaches. We examined routine ambulance patient information, reviewed ambulance policies and guidelines, and gathered information from interviews to make sense of our findings. Through interviews we learned about ways that the work of Community First Responders had been enhanced or could be improved. In a 1-day workshop, a group of lay and professional experts ranked in order of importance ideas about future developments involving Community First Responders. Research findings Community First Responders arrived before ambulance staff for a higher proportion of calls in rural than in urban areas. They attended people with various conditions, including breathing problems, chest pain, stroke, drowsiness, diabetes and falls, and usually the highest-priority emergencies but also lower-priority calls. Policies aimed to ensure that Community First Responders provided safe, effective care. Costs, mainly used for management, training and equipment, were sometimes incomplete or inaccurate and varied widely between services. Community First Responders attending meant faster responses and positive experiences for those patients and relatives interviewed. A Community First Responder scheme responding to people who had fallen at home led to fewer ambulances attending and possible financial savings. Survival among people attended because their heart had stopped was no better when Community First Responders arrived early. Interviews revealed why and how Community First Responders volunteered and were trained, what they did and how they felt. Interviewees were largely positive about Community First Responders. Improvements suggested included support from colleagues or counsellors, better communication with ambulance services, technology for communication and locating patients, and better training. Conclusions Community First Responders have benefits in terms of response times and patient care. Future improvements should be evaluated. Scientific summary Text in this section is reproduced from Botan V, Asghar Z, Rowan E, et al. What Is the Contribution of Community First Responders to Rural Emergency Medical Service Provision in the UK? Paper presented at: Society for Academic Primary Care Annual Scientific Meeting: Recovery and Innovation; 4–6 July 2022; University of Central Lancashire, Preston, England, which is an open access article distributed under the terms of the Creative Commons CC BY-NC licence, which permits unrestricted use, distribution, and reproduction in any medium, for non-commercial use, provided the original work is properly cited. See http://creativecommons.org/licenses/by-nc/4.0/. Background Community First Responders (CFRs) are trained lay (and sometimes health professional) volunteers dispatched by Emergency Medical Services (EMS) to potentially life-threatening emergencies such as cardiac arrest in the first vital minutes to provide care until ambulance staff arrive. CFR schemes were first introduced to support ambulance services to rural communities where access to prehospital emergency care is more likely to be delayed. Apart from a few small-scale evaluations, surveys and qualitative studies of CFRs, evidence is lacking for their contribution to rural EMS provision, how care is provided and how this might be improved. We sought to provide evidence for the contribution and costs of CFR schemes to rural healthcare delivery and outcomes and to identify ways that these services can be improved, innovated or developed further to benefit rural communities. Objectives We aimed to investigate current activities, costs of provision and outcomes of CFR schemes, and explore views of patients, public, CFRs, CFR leads and primary care commissioners on CFRs, working with our stakeholders to develop recommendations for future innovations in rural CFR provision. Our objectives were to: 1. Describe the contribution of CFRs to rural healthcare provision in terms of the numbers and timing of calls attended, together with the types of conditions and characteristics of people attended. 2. Evaluate the costs, funding sources and consequences [response time, out-of-hospital cardiac arrest (OHCA) outcomes, response to falls] of CFR schemes. 3a. Explore ambulance policies, guidelines and protocols for CFRs. 3b. Explore stakeholder (patients, relatives, ambulance staff, primary care, commissioners, CFRs and CFR scheme organisers) experiences and perceptions of CFRs’ current role and the potential for future developments and innovations. We also aimed to ask CFRs and CFR scheme organisers about challenges in and solutions to recruiting, training and retaining CFRs in rural areas and how to ensure governance and accountability for safe, high-quality care. 4. Assimilate and integrate data derived from objectives 1–3, synthesising these to develop a list of recommendations for future innovations. 5. Prioritise recommendations for future developments/innovations in rural CFR provision through a consensus stakeholder workshop. Methods We used a mixed-methods design, using a lens of pragmatism and the ‘actor’, ‘behaviour change’ and ‘causal pathway’ (ABC) framework to integrate quantitative (cross-sectional) and qualitative (policy, guideline and protocol document together with stakeholder interview) data using the ‘following the thread’ approach to triangulation. For the cross-sectional study of calls attended by CFRs, we used a retrospective observational study design, analysing routine electronic clinical records data from 6 of 10 regional ambulance services in England between 1 January 2019 and 31 December 2019. For the survey of CFR costs and resource use, we used a bespoke self-administered questionnaire e-mailed to ambulance trust directors of research and heads of research requesting information on the workforce of volunteer CFRs, the budget allocated to CFRs and the actual expenditure for the financial years 2017–8, 2018–9 and 2019–20. For the counterfactual analysis of the impact of CFR attendance on response times, we compared incidents that CFRs attended with those where ambulance staff attended in close geographical locations to derive response time distributions for each, adjusting by severity category and urban–rural classification, to estimate difference in attendance times and meeting of response target thresholds. For the analysis of OHCA outcomes related to CFR attendance, we derived Utstein-style templates for cardiac arrest incidents presenting to East Midlands Ambulance Service attended by both CFRs and ambulance staff. We compared outcomes for return of spontaneous circulation (ROSC) and 30-day survival using multivariable regressions models comparing CFR arrival before EMS with EMS alone for both. For the evaluation of the CFR response to falls provided by LIVES (Lincolnshire Integrated Voluntary Emergency Service), the falls response programme (FRP), introduced in Lincolnshire in 2019 and recommissioned after an initial pilot, we examined its operation, effects and cost-effectiveness during the period April 2020 to December 2021 using a cross-sectional design that linked falls episode data involving the programme from the ambulance service and the CFR scheme involved. We identified potential innovations in CFR provision that were prioritised using a modified nominal group technique in a consensus meeting. Patients and public were involved throughout the study. Results In 4.5 million incidents from six English regional ambulance services during 2019, pre COVID-19 pandemic, CFRs attended first a higher proportion of calls in rural areas (almost 4% of calls) than in urban areas (around 1.5% of calls). Community First Responders attended first in more than 9% of category 1 calls and almost 5% of category 2 calls. They first attended 6.5% of the total number of neurological (e.g. loss of consciousness, convulsions, collapse) or endocrine (e.g. hypo- or hyperglycaemia) conditions and 5.9% of the total number of cardiorespiratory conditions (including breathing problems, chest pain and stroke). In a multivariable model, the main predictors of CFR attendance were rurality [odds ratio (OR) 2.05, 95% confidence interval (CI) 1.99 to 2.11; p

IntroductionCluster surveillance, identification, and containment are primary outbreak management techniques; however, adapting these for low- and middle-income countries is an ongoing challenge. We aimed to evaluate the utility of prehospital call center ambulance dispatch (CCAD) data for surveillance by examining the correlation between influenza-like illness (ILI)-related dispatch calls and COVID-19 cases.MethodsWe performed a retrospective analysis of state-level CCAD and COVID-19 data recorded between January 1 and April 30, 2020, in Telangana, India. The primary outcome was a time series correlation between ILI calls in CCAD and COVID-19 case counts. Secondarily, we looked for a year-to-year correlation of ILI calls in the same period over 2018, 2019, and 2020.ResultsOn average, ILI calls comprised 12.9% (95% CI 11.7%-14.1%) of total daily calls in 2020, compared to 7.8% (95% CI 7.6%-8.0%) in 2018, and 7.7% (95% CI 7.5%-7.7%) in 2019. ILI call counts from 2018, 2019, and 2020 aligned closely until March 19, when 2020 ILI calls increased, representing 16% of all calls by March 23 and 27.5% by April 7. In contrast to the significant correlation observed between 2020 and previous years' January-February calls (2020 and 2019-Durbin-Watson test statistic [DW] = 0.749, p  0.251, the 95% upper confidence limit).ConclusionsThe statistically significant time series correlation between ILI calls and COVID-19 cases suggests prehospital CCAD can be part of early warning systems aiding outbreak cluster surveillance, identification, and containment.

Study objectiveOne in 4 deaths from COVID-19 has been attributed to hospital crowding. We simulated how many ambulances would be required to rebalance hospital load through systematic interhospital transfers. We assessed the potential feasibility of such a strategy and explored whether transfer requirement was a helpful measure and visualization of regional hospital crowding during COVID-19 surges.MethodsUsing data from the United States hospitals reporting occupancy to the Department of Health and Human Services from July 2020 to March 2022 and road network driving times, we estimated the number of ambulances required weekly to relieve overcapacity hospitals.ResultsDuring the peak week, which ended on January 8, 2021, approximately 1,563 ambulances would be needed for 15,389 simulated patient transports, of which 6,530 (42%) transports involved a 1-way driving time of more than 3 hours. Transfer demands were dramatically lower during most other weeks, with the median week requiring only 134 ambulances (interquartile range, 84 to 295) and involving only 116 transports with 1-way driving times above 3 hours (interquartile range, 4 to 548). On average, receiving hospitals were larger and located in more rural areas than sending hospitals.ConclusionThis simulation demonstrated that for most weeks during the pandemic, ambulance availability and bed capacity were unlikely to have been the main impediments to rebalancing hospital loads. Our metric provided an immediately available and much more complete measure of hospital system strain than counts of hospital admissions alone.

Abstract Background Mobility assessment enhances the ability of vital sign-based early warning scores to predict risk. Currently mobility is not routinely assessed in a standardized manner in Denmark during the ambulance transfer of unselected emergency patients. The aim of this study was to develop and test the inter-rater reliability of a simple prehospital mobility score for pre-hospital use in ambulances and to test its inter-rater reliability. Method Following a pilot study, we developed a 4-level prehospital mobility score based of the question”How much help did the patient need to be mobilized to the ambulance trolley”. Possible scores were no-, a little-, moderate-, and a lot of help. A cross-sectional study of inter-rater agreement among ambulance personnel was then carried out. Paramedics on ambulance runs in the North- and Central Denmark Region, as well as The Fareoe Islands, were included as a convenience sample between July 2020—May 2021. The simple prehospital mobility score was tested, both by the paramedics in the ambulance and by an additional observer. The study outcomes were inter-rater agreements by weighted kappa between the paramedics and between observers and paramedics. Results We included 251 mobility assessments where the patient mobility was scored. Paramedics agreed on the mobility score for 202 patients (80,5%). For 47 (18.7%), there was a deviation of one between scores, in two (

The article focuses on the use of supplemental oxygen in paediatric intensive care units (PICUs) and compares the effects of higher and lower target oxygen saturation levels on critically ill children. It discusses the findings of a pragmatic, multicentre, open-label, randomised controlled trial conducted in 15 UK PICUs, which showed a slight benefit for the lower target saturation strategy over the higher target saturation strategy.

Background: Appropriate maternal referral system plays an essential role in curbing maternal mortality. Although the occurrence of obstetric complications is often unpredictable, addressing bottlenecks of the referral system is crucial to facilitate the women to have access to timely lifesaving interventions. Nonetheless, little is known about the barriers to maternal referral system in the eastern Ethiopia. Therefore, this study aimed to explore the barriers to maternal referral system at selected referral hospitals in eastern Ethiopia. Methods: Key informant interviews and in-depth interviews were conducted among purposively selected respondents who had a role in maternal referral processes. A total of 12 key informants that comprised of liaison officers, healthcare providers and three in-depth interviews with referred women were conducted. Semi-structured interview guide was developed and used to facilitate the interviews. All the interviews were tape recorded, complemented by note taking. Then audio recorded interviews were transcribed as per verbatim and imported to NVivo for coding and merging. The data were thematically synthesized. Results: The study identified a range of barriers that affect the maternal referral system in Eastern Ethiopia. The main barriers are grouped into three domains, such as: communication, transportation, and healthcare system. The most commonly reported barriers were lack of pre-referral communication and feedback, using informal communication, incomplete referral forms, poor ambulance service including misuse of ambulances, lack of skilled healthcare escort and lack of medical equipment at emergency, unnecessary self-referrals, poor referral skills and limited number of health professions. Conclusions: The maternal referral system is overwhelmingly affected by lack of skill, logistics (referral form), misuse of available ambulance, poor communication, and limited seeking of feedback. Regular consultative meeting with relevant stakeholders and uptake of feedback are crucial to improve referral communication, proper use of ambulance and building capacity of health workforce about referral are essential to improve maternal referral system. [ABSTRACT FROM AUTHOR]

Objectives: In this study we aimed to explore EMCC triage of suspected and confirmed stroke patients to gain more knowledge about the initial phase of the acute stroke response chain. Accurate dispatch at the Emergency Medical Communication Center (EMCC) is crucial for optimal resource utilization in the prehospital service, and early identification of acute stroke is known to improve patient outcome. Materials and methods: We conducted a descriptive retrospective study based on data from the Emergency Department and EMCC records at a comprehensive stroke center in Oslo, Norway, during a six-month period (2019–2020). Patients dispatched with EMCC stroke criteria and/or discharged with a stroke diagnosis were included. We identified EMCC true positive, false positive and false negative stroke patients and estimated EMCC stroke sensitivity and positive predictive value (PPV). Furthermore, we analyzed prehospital time intervals and identified patient destinations to gain knowledge on ambulance services assessments. Results: We included 1298 patients. EMCC stroke sensitivity was 77% (95% CI: 72 − 82%), and PPV was 16% (95% CI: 14 − 18%). EMCC false negative stroke patients experienced an increased median prehospital delay of 11 min (p < 0.001). Upon arrival at the scene, 68% of the EMCC false negative patients were identified as suspected stroke cases by the ambulance services. Similarly, 68% of the false positive stroke patients were either referred to a GP, out-of-hours GP acute clinic, local hospitals or left at the scene by the ambulance services, indicating that no obvious stroke symptoms were identified by ambulance personnel upon arrival at the scene. Conclusions: This study reveals a high EMCC stroke sensitivity and an extensive number of false positive stroke dispatches. By comparing the assessments made by both the EMCC and the ambulance service, we have identified specific patient groups that should be the focus for future research efforts aimed at improving the sensitivity and specificity of stroke recognition in the EMCC. [ABSTRACT FROM AUTHOR]

Ambulance vehicles face a challenging issue in minimizing the response time for an emergency call due to the high volume of traffic and traffic signal delays. Several research works have proposed ambulance vehicle detection approaches and techniques to prioritize ambulance vehicles by turning the traffic light to green for saving patients' lives. However, the detection of ambulance vehicles is a challenging issue due to the similarities between ambulance vehicles and other commercial trucks. In this paper, we chose a machine learning (ML) technique, namely, YOLOv8 (You Only Look Once), for ambulance vehicle detection by synchronizing it with the traffic camera and sending an open signal to the traffic system for clearing the way on the road. This will reduce the amount of time it takes the ambulance to arrive at the traffic light. In particular, we managed to gather our own dataset from 10 different countries. Each country has 300 images of its own ambulance vehicles (i.e., 3000 images in total). Then, we trained our YOLOv8 model on these datasets with various techniques, including pre-trained vs. non-pre-trained, and compared them. Moreover, we introduced a layered system consisting of a data acquisition layer, an ambulance detection layer, a monitoring layer, and a cloud layer to support our cloud-based ambulance detection system. Last but not least, we conducted several experiments to validate our proposed system. Furthermore, we compared the performance of our YOLOv8 model with other models presented in the literature including YOLOv5 and YOLOv7. The results of the experiments are quite promising where the universal model of YOLOv8 scored an average of 0.982, 0.976, 0.958, and 0.967 for the accuracy, precision, recall, and F1-score, respectively. [ABSTRACT FROM AUTHOR]

Introduction: Emergency medical services (EMS) providers encounter a variety of challenges due to the unpredictable, uncontrollable, and dynamic conditions in the pre-hospital field. This study explored the perceived professional challenges among EMS providers. Materials and methods: This study was conducted using a qualitative research approach and the method of content analysis. Eighteen EMS providers were purposively selected from EMS stations in Hamadan, Iran. The collected data were then analyzed based on the Granheim and Lundman's method. Results: Based on data analysis, five categories and one theme were identified. The extracted theme was professional challenges. The five categories were as follows: Ineffective policies; multicultural and multidisciplinary factors; ambulance dispatch route problems; legal issues; and abuse against the emergency medical services Conclusion: In general, it has been found that EMS providers encounter numerous and complex professional challenges during their work. EMS managers can utilize the findings of the present study to develop strategies for reducing the professional challenges faced by EMS providers. By doing so, they can improve the quality of care in the prehospital field. [ABSTRACT FROM AUTHOR]

Background: Quad bikes are popular recreational, four-wheeled bikes in the Middle East. Injury prevention programs targeting quad bike crashes in the United Arab Emirates (UAE) need evidence about the risk factors and behaviours associated with these crashes in the target population. This is a protocol for a study aiming to investigate quad bike rider behaviours and to assess the risk factors associated with related injuries in the UAE. Methods: This is a cross-sectional observational study aiming to describe a seasonal sport in a desert environment. With an estimated sample size of 451, the survey will follow a three-stage, location-based sampling strategy using the line-transect method. A sampling frame of desert locations with high injury incidences was developed, using Dubai ambulance injury records. Further expansion of the sampling frame was participatory, involving police, enthusiasts, emergency responders and gas station employees. The data collection will be limited to the winter months in fifteen high-injury desert locations across three major Emirates in the UAE. Trained researchers will observe the riders directly in the desert to note their riding habits, followed by a researcher-administered interview on riding and injury history. The interviews will be administered in Arabic and English using Qualtrics software on handheld tablets with offline and online entry mode. In addition, paper-based entry with the same format will be used as a contingency in busy quad bike locations. Conclusion: The objective of this study protocol is to develop a comprehensive survey that will furnish substantial evidence for the formulation of effective injury prevention strategies. To enhance the credibility of the recorded riding behaviors, field observations will be employed. The uniqueness of this study lies in its innovative sampling strategy, custom-tailored to accommodate the highly mobile and transient population of desert bikers in the UAE. [ABSTRACT FROM AUTHOR]

This article presents the findings of a study on the impact of the COVID-19 lockdown on healthcare access, food affordability, and family income in a resource-limited setting in Kano, Nigeria. The study found that the lockdown had a negative effect on these factors, with many respondents reporting difficulties accessing healthcare services, affording food, and experiencing reduced family income. The study suggests the need for investments in telemedicine services and social assistance programs to address these challenges. However, the study acknowledges limitations and calls for further research to improve future planning and distribution of government assistance. [Extracted from the article]

Introduction: Pediatric patients account for 6-10% of emergency medical services (EMS) activations in the United States. Approximately 30% of these children are not transported to an emergency department (ED). Adult data in the literature reports higher hospitalization and complications following non-transport. Few studies discuss epidemiology and characteristics of pediatric non-transport; however, data on outcome is limited. Our primary aim was to determine outcomes of non-transported children within our urban EMS system before and during the COVID-19 pandemic. Our secondary objective was to explore reasons for non-transport. Methods: This was a prospective, descriptive pilot study. We compared EMS data for September 2019 (pre-COVID-19) to September 2020 (pandemic). Included were children aged 0-17 years who activated EMS and did not receive transport to the primary hospital for the EMS capture area. We defined outcomes as repeat EMS activation, ED visits, and hospital admissions, all within 72 hours. Data was obtained via electronic capture. We used descriptive statistics to analyze our data, chi square for categorical data, stepwise logistic regression, and univariate logistic regression to test for association of covariates with non-transport. Results: There were 1,089 pediatric EMS activations in September 2019 and 780 in September 2020. Non-transport occurred in 633 (58%) in September 2019 and 412 (53%) in September 2020. Emergency medical services was reactivated within 72 hours in the following: 9/633 (1.4%) in 2019; and 5/412 (1.2%) in 2020 (P = 0.77). Visits to the ED occurred in 57/633 (9%) in 2019 and 42/412 (10%) in 2020 (P = 0.53). Hospital admissions occurred in 10/633 (1.5%) in 2019 and 4/412 (0.97%) in 2020 (P = 0.19). One non-transported patient was admitted to the intensive care unit in September 2020 (<1%) and survived. Hispanic ethnicity, age >12 years, and fever were associated with repeat EMS activation. The most common reason for non-transport in both study periods was that the parent felt an ambulance was not necessary (47%). Conclusion: In our system, non-transport of pediatric patients occurred in >50% of EMS activations with no significant adverse outcome. Age >12 years, fever, and Hispanic ethnicity were more common in repeated EMS activations. The most common reason for non-transport was parents feeling it was not necessary. Future studies are needed to develop reliable EMS guidelines for pediatric non-transport. [ABSTRACT FROM AUTHOR]

Medical sociologists argue that diagnosis is a critical component of medicine and that diagnosis is most obviously exercised by doctors. This scholarship, however, largely ignores other medical workers. I extend the concept of working diagnosis to help solve this problem. These are partial and preliminary medical classifications of suffering that are imposed between informal experiences of illness and formal classifications of disease. In a complex division of medical labour where doctoring is a minority practice, working diagnoses are critical forces that shape, and are shaped by, the relational conditions of medical production. To illustrate the analytical promise of this concept, I sharpen it through an ethnography of ambulance work in California. Working diagnoses in this case are officially referred to as 'primary impressions'. I show how these impressions are deeply embedded in the relations of paramedical production. Three are specifically highlighted: the relations between ambulance crews and their patients, the relations between ambulance crews and their nurse and police counterparts and the relations between ambulance crews and their managers. I work towards a simple but rarely stated conclusion: medical sociologists should focus more heavily on how diagnostic processes influence labour processes and vice versa. [ABSTRACT FROM AUTHOR]

This document provides summaries of various studies and programs related to telehealth and its impact on healthcare delivery. The studies cover a range of topics, including cost comparisons between telemedicine and in-person visits, measures of access to care in telehealth research, and the use of telehealth for specific populations and conditions. The programs discussed include virtual comprehensive care for children with medical complexity, school-based telehealth programs, and the use of telehealth in rural emergency departments. The studies highlight the potential benefits and challenges of telehealth in improving access to care and patient outcomes. [Extracted from the article]

Background: Ambulance care is characterised by disaster medicine, traumatology and care for acute illnesses and accidents. The focus of ambulance care is clearly on medical care, whereas interpersonal interaction between patients and ambulance clinicians appears less prioritised. A patient within ambulance care needs to be listened to, be taken seriously, be treated with empathy and be seen as a unique person. These are fundamental to delivering Person‐centred care. Aim: The purpose is to describe how the care relationship and interaction between patients and ambulance clinicians in prehospital emergency care are described in the literature and how they can be interpreted from a person‐centred perspective. Data Sources and Review Methods: A qualitative meta‐synthesis was used. Data collection was carried out with PubMed, CINAHL Plus and Web of Science in September–October 2022 and in August–September 2023. The first article searching applied a timeline 1990–2022 and the second applied a timeline 2022–2023. A total of 13 studies employing a qualitative approach were evaluated and included in the interpretive analysis. Results: Three themes were identified: A good care relationship, Decision‐making and Hindrances to practising person‐centred care in ambulance care. Trust, good communication and respect for patients' dignity were the most important parts of the good care relationship between patients and ambulance clinicians. Decision‐making regarding the examination of patients, medical treatment and transport to the receiving care unit was one of the tasks that ambulance clinicians do independently but in cooperation with patients and family members. Person‐centred care within ambulance care may be hindered due to environmental factors, attitudes and behaviour of ambulance clinicians and patient‐related factors. Conclusion: Many ambulance clinicians have already adopted Person‐centred care, but several factors can hinder Person‐centred care in interactions with patients. Although the results build on a limited number of studies, they indicate that person‐centred care needs to be further developed and studied for high‐quality ambulance care. [ABSTRACT FROM AUTHOR]

Background: Transfers to the emergency department can be burdensome for the residents of long‐term residential care facilities (LTRCFs) and often lead to adverse effects. Since March 2019, a nurse‐led acute outreach service unit "Mobile hospital" (in Finnish, Liikkuva sairaala, LiiSa) has been providing on‐site care to LTRCF residents to reduce transfers to the emergency department. Methods: This study compares the numbers and acuities of emergency medical service (EMS) missions carried out in the LTRCFs of Espoo and Kauniainen during two six‐month periods: before the implementation of LiiSa and with LiiSa in use. In Finland, EMS missions are divided into four categories (A–D), with category A missions being the most urgent. These categories were used to investigate the impact on mission acuities. Results: Due to the implementation of LiiSa, the number of EMS missions decreased by 16.8% (95% confidence interval 10.6%–22.6%, p < 0.001), the number of category D missions by 19.8% (7.1%–30.8%, p = 0.003) and the number of category C missions by 30.3% (17.3%–41.3%, p < 0.001). Changes in the numbers of category A and B missions were not statistically significant. Conclusions: LiiSa helped to avoid many transfers of frail LTRCF patients to the emergency department, and it did not hinder the care of patients with true emergencies by EMSs. [ABSTRACT FROM AUTHOR]

Background: Older patients are often vulnerable and highly dependent on healthcare professionals' assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy. Aim: To describe ambulance clinicians' understanding of older patients' self-determination when the patient's decision-making ability is impaired. Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology. Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews. Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority. Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will ; and (2) Contradictions about the patient's best interests. The clinicians' interpretations are based on an understanding of the patient's situation using substitute decision-making in emergency situations and conversations that reveal the patient's explicit wishes. Sometimes the clinicians collaborate to validate the patient's implicit will, while they at other times subordinate themselves to others' opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient's self-determination. Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient's unique needs based on a holistic perspective and their ability to be autonomous. [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]

Medical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls. Descriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed. In total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required. Hospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs. [ABSTRACT FROM AUTHOR]

Maintaining mental health is essential for professions with higher stress levels and challenging environments, including emergency specializations. In this study, the occurrence of distress, anxiety, and depression among a group of ambulance and hospital emergency care professionals was assessed (n = 202). A cross-sectional, quantitative, descriptive online survey was conducted, including the internationally validated Beck depression inventory (BDI), the perceived stress scale (PSS-14), and the State–Trait Anxiety Inventory (STAI). Statistical analyses involved descriptive statistics, the χ2-test, Mann–Whitney U test, Kruskal–Wallis test, Dunn–Bonferroni test, logistic regression (LR), Cramer coefficient (Cramer's V), Kolmogorov–Smirnov test, and Spearman's rank correlation coefficient (rs). Based on the results, female professionals are more likely to have depressive symptoms (OR = 2.6, 95% CI = 1.3–5.1), perceived stress (OR = 1.2, 95% CI = 1.2–4.1), and anxiety (OR = 2.1, 95% CI = 1.0–4.1) than male professionals. Perceived stress levels decreased proportionally with increasing years spent working in healthcare (OR = 7.4, 95% CI = 7.1–8.3). Extended work shifts of 12 or 24 h increase the risk of perceived stress and anxiety in emergency care workers (p = 0.02). Customized stress management interventions are needed to mitigate the amplified mental strain associated with gender, working years, and longer shifts in the emergency care sector to sustain their mental health and well-being. [ABSTRACT FROM AUTHOR]

Injuries to humans caused by wild animals, particularly bears, are rarely mentioned in the literature. Such injuries are frequent in Siberia, which is a territory surrounded by dense forests inhabited by brown bears. In the last 4 months alone (September–December 2023), four bear attacks on humans were registered in Khakassia, Russia. This article presents a clinical case of rehabilitating a patient after a bear attack, who suffered multiple fragmentary fractures of the facial skeleton with displaced bone fragments, subcutaneous emphysema of the soft tissues of the face, damage to the parietal and right occipital regions and paranasal sinus hemorrhage on the left side. The nature of the injuries was enhanced by trauma to the upper extremity caused by the patient defending himself against the animal. In addition to the damage to his face, the bear tried to open his cranium, as evidenced by four furrows caused by its canines, including two each on the frontal and occipital bones of the skull. The patient's complex treatment included both maxillofacial and reconstructive surgeries, and outpatient treatment involved the formation of normotrophic scars using a neodymium laser and injections of a heterogeneous composition consisting of microparticles of "crosslinked" collagen of animal origin placed in a gel identical to the natural extracellular matrix. [ABSTRACT FROM AUTHOR]

Background & aim: Women have been present in pre-hospital emergency in most countries; but recently such a decision has been made in Iran. Therefore, it is necessary to examine the opinion of the employees regarding the feasibility of the presence of women in order to meet the needs of the service recipients. The present study was conducted with the aim of assessing the feasibility of women's presence in pre-hospital emergency missions from the staff's point of view. Methods: This research was a cross sectional study. The research community was the employees working in the emergency departments of the medical system in the East Azerbaijan province, Iran. Sampling was done by stratified random method and random sampling was done from all cities in proportion to the volume of each stratify on the entire population. Finally, 326 employees were included in the study. A researcher-made tool with three subscales was used to collect data. Results: According to the findings, the acceptance rate of women's presence in the pre-hospital emergency was high from the staff's point of view. However, the current conditions and facilities are considered to be not enough. In addition, according to the findings, having a strong spirit, crisis management in difficult and heartbreaking conditions, covering gender differences and being in harmony with cultural, religious and social principles were declared as the most important expectations of the employees from the role of women in the pre-hospital emergency system. Conclusion: Based on the findings, the staff consider the presence of women in the pre-hospital emergency as necessary, but first special facilities should be provided for their presence and reasonable expectations should be considered for them. Based on these findings, it is recommended that policymakers focus on the level of the society's culture, the conditions for hiring female personnel, adding specialized equipment, modifying and changing work rules, so that the presence of female personnel in the pre-hospital emergency system is possible. [ABSTRACT FROM AUTHOR]