Search

Abstract Purpose This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients. Methods Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system. Results A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p = .001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p

Purpose: This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients. Methods: Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system. Results: A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p =.001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p <.001). Six hundred forty-two patients (76.6%) in Group 1 were discharged to their home (normal discharge) and 979 patients (81.7%) were discharged to their home in Group 2, but the discharge-as-death rate was 14.1% in Group 1 and 7.5% in Group 2 (χ2 = 29.80, p <.001). Conclusion: With the application and attainment of the ED LOS management system for severely ill patients, we have concluded the new system produced a lower LOS in the ED, 30 days in-hospital mortality, length of the hospitalization, mortality rate, and a higher rate of normal discharge. [ABSTRACT FROM AUTHOR]

Background: Activating the emergency medical services (EMS) system in case of medical emergencies must be quick and precise. This study was designed to measure public awareness of Riyadh's EMS phone number. Methods: This is a cross-sectional study. It identifies major public hubs in Riyadh, Saudi Arabia, as the target locations. It was conducted from September 1st 2019 to December 31st 2019. A semi-structured survey was developed and distributed in person using convenience sampling to measure public awareness of EMS phone number. Ethical approval was obtained to include both adult and youth populations. Results: A total of 4,806 participants agreed to complete the survey, 2,690 (56%) were male and 2,116 (44%) were female. The majority of participants ,(3,986, 82.9%) were adults above the age of 18, while 820 (17.1%) were minors under the age of 18. In terms of education, 3,320 (69%) participants had completed college-level or higher. Saudi citizens totaled 4,460 (92.8%). Participants who claimed that they knew the EMS phone number was 3,519 (73.2%). However, only 1,854 (38.5%) recalled the EMS phone number correctly. Conclusion: The study results show a lack of public awareness of the local EMS phone number, as only 38.5% of the general public were able to recall the EMS phone number. Therefore, it is highly recommended that a major public campaign geared toward increasing public awareness of the EMS phone number is organized. [SJEMed 2021; 2(2.000): 147-152]

We evaluated the first-medical-contact-to-balloon (FMC2B) time after implementation of a "Call 911" protocol for ST-segment-elevation myocardial infarction (STEMI) interfacility transfers in a regional system. This is a retrospective cohort study of consecutive patients with STEMI requiring interfacility transfer from a STEMI referring hospital, to one of 35 percutaneous coronary intervention-capable STEMI receiving centers (SRCs). The Call 911 protocol allows the referring physician to activate 911 to transport a patient with STEMI to the nearest SRC for primary percutaneous coronary intervention. Patients with interfacility transfers were identified over a 4-year period (2011-2014) from a registry to which SRCs report treatment and outcomes for all patients with STEMI transported via 911. The primary outcomes were median FMC2B time and the proportion of patients achieving the 120-minute goal. FMC2B for primary 911 transports were calculated to serve as a system reference. There were 2471 patients with STEMI transferred to SRCs by 911 transport during the study period, of whom 1942 (79%) had emergent coronary angiography and 1410 (73%) received percutaneous coronary intervention. The median age was 61 years (interquartile range [IQR] 52-71) and 73% were men. The median FMC2B time was 111 minutes (IQR 88-153) with 56% of patients meeting the 120-minute goal. The median STEMI referring hospital door-in-door-out time was 53 minutes (IQR 37-89), emergency medical services transport time was 9 minutes (IQR 7-12), and SRC door-to-balloon time was 44 minutes (IQR 32-60). For primary 911 patients (N=4827), the median FMC2B time was 81 minutes (IQR 67-97). Using a Call 911 protocol in this regional cardiac care system, patients with STEMI requiring interfacility transfers had a median FMC2B time of 111 minutes, with 56% meeting the 120-minute goal.

Sporer KA . 911 patient redirection. Prehosp Disaster Med. 2017;32(6):589-592.

Background: Drones are able to deliver automated external defibrillators in cases of out-of-hospital cardiac arrest (OHCA) but can be deployed for other purposes. Our aim was to evaluate the feasibility of sending live photos to dispatch centres before arrival of other units during time-critical incidents., Methods: In this retrospective observational study, the regional dispatch centre implemented a new service using five existing AED-drone systems covering an estimated 200000 inhabitants in Sweden. Drones were deployed automatically over a 4-month study period (December 2022-April 2023) in emergency calls involving suspected OHCAs, traffic accidents and fires in buildings. Upon arrival at the scene, an overhead photo was taken and transmitted to the dispatch centre. Feasibility of providing photos in real time, and time delays intervals were examined., Results: Overall, drones were deployed in 59/440 (13%) of all emergency calls: 26/59 (44%) of suspected OHCAs, 20/59 (34%) of traffic accidents, and 13/59 (22%) of fires in buildings. The main reasons for non-deployment were closed airspace and unfavourable weather conditions (68%). Drones arrived safely at the exact location in 58/59 cases (98%). Their overall median response time was 3:49 min, (IQR 3:18-4:26) vs. emergency medical services (EMS), 05:51 (IQR: 04:29-08:04) p-value for time difference between drone and EMS = 0,05. Drones arrived first on scene in 47/52 cases (90%) and the largest median time difference was found in suspected OHCAs 4:10 min, (IQR: 02:57-05:28). The time difference in the 5/52 (10%) cases when EMS arrived first the time difference was 5:18 min (IQR 2:19-7:38), p = NA. Photos were transmitted correctly in all 59 alerts. No adverse events occurred., Conclusion: In a newly implemented drone dispatch service, drones were dispatched to 13% of relevant EMS calls. When drones were dispatched, they arrived at scene earlier than EMS services in 90% of cases. Drones were able to relay photos to the dispatch centre in all cases. Although severely affected by closed airspace and weather conditions, this novel method may facilitate additional decision-making information during time-critical incidents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: To explore perceptions, concerns and needs of healthcare professionals in an emergency department (ED) from Argentina. Methods: Participatory action research, coordinated and carried out by ED healthcare professionals, which included physicians, nurses and administrative staff who actively engaged in both data collection and analysis. Mixed methodologies were used: documentary analysis of complaints and written claims by patients, 10 individual interviews, and two reflective focus groups of 10 healthcare professionals (who differed in occupation, seniority and experience, including residents in training). Results: The topics that emerged were work factors that lead to errors and threaten patient-centered clinical encounters: work overload and lack of time, the overuse of resources for defensive medicine purposes and technology that replaces physical contact. Healthcare professionals reported episodes of aggression by patients or their families, when long waits and structural insufficiencies (such as lack of beds, saturation of the waiting room, discomfort) threaten patience and tolerance. From these insights, improvements were generated in various areas of the ED. Conclusions: The identification of problems by the ED stakeholders l was a relevant approach that led to a process of collective management change, promoted reflection and raised awareness, allowing the identification of areas for improvement, design strategies and concrete feasible proposals. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to examine the usability, feasibility, acceptability, and appropriateness of the information and communication technology for emergency medical services (ICT-EMS) systems to improve the transportation of emergency patients during the COVID-19 pandemic.Methods: Emergency medical technicians (EMTs) (n = 229) employed at 7 fire stations operated by the North Chungcheong Fire Service Headquarters, South Korea were trained to use ICT-EMS devices prior to a 1-month implementation period. System Usability Scale (SUS), Feasibility of Intervention Measure (FIM), Acceptability of Intervention Measure (AIM), and Intervention Appropriateness Measure (IAM) questionnaires were conducted in the 4th week of the 1-month implementation period to assess the perceived usability, feasibility, acceptability, and appropriateness of the ICT-EMS systems.Results: Among a total of 229 EMTs, 187 EMTs (81.7%) completed the survey. The overall SUS score was significantly low (score of 35.6) indicating an overall negative perception of the ICT-EMS systems. With regard to the feasibility, acceptability, and intervention appropriateness of ICT-EMS, roughly 50 (26.7%) participants agreed that ICT-EMS implementation was possible, appealing, and suitable.Conclusion: Many potential areas of improvement were identified within the ICT-EMS systems. System alterations regarding usability, feasibility, acceptability, and appropriateness may be necessary to successfully implement the ICT-EMS systems. [ABSTRACT FROM AUTHOR]

Emergency 9-1-1 callers use a wide range of terms to describe abnormal breathing in persons with out-of-hospital cardiac arrest (OHCA). These breathing descriptors can obstruct the telephone cardiopulmonary resuscitation (CPR) process. We conducted an observational study of emergency call audio recordings linked to confirmed OHCAs in a statewide Utstein-style database. Breathing descriptors fell into 1 of 8 groups (eg, gasping, snoring). We divided the study population into groups with and without descriptors for abnormal breathing to investigate the impact of these descriptors on patient outcomes and telephone CPR process. Callers used descriptors in 459 of 2411 cases (19.0%) between October 1, 2010, and December 31, 2014. Survival outcome was better when the caller used a breathing descriptor (19.6% versus 8.8%, P

Objectives: Immediate recognition of out-of-hospital cardiac arrest (OHCA) by Emergency Medical Dispatch (EMD) operators is crucial to facilitate timely initiation of telephone cardiopulmonary resuscitation (T-CPR) and to enable the appropriate level of Emergency Medical Services (EMS) response. The goal of this study was to identify patterns that can increase EMD-level recognition of cardiac arrests prior to EMS arrival.Methods: The Combined Communications Center in Alachua County, Florida provided audio recordings of all emergency calls from January 1, 2018 to November 16, 2018 dispatched as a chief complaint other than OHCA, but later identified as cardiac arrest. A multi-disciplinary medical team transcribed and analyzed the calls to determine common themes and trends.Results: Out of an initial 81 calls meeting inclusion criteria, 69 were immediately recognized as OHCA by EMDs, leaving 12 calls of unrecognized OHCA. In 11 of 12 calls respiratory issues were described to EMD. In 10 of 12 calls the subject was described as unconscious, and in the other 2 calls, the subject lost consciousness during the call.Conclusions: Lack of recognition of OHCA by EMD occurred in most calls due to difficulty communicating the subject's respiratory status. Further emphasis should be placed on identifying non-viable respirations in unconscious patients in EMD training and algorithms to increase recognition of OHCA and initiation of T-CPR. A multi-year review of a comparable dataset from geographically and socioeconomically diverse regions in the United States can validate and expand these preliminary trends. [ABSTRACT FROM AUTHOR]

In the demanding realm of the Emergency Department, addressing every emergency incident efficiently becomes paramount, with time emerging as a critical factor. This paper is dedicated to investigating innovative approaches aimed at diminishing the preparation time required when a patient arrives at the hospital. Our methodology involves the integration of pre-hospital warning data, a valuable resource provided by the National Science and Technology Center for Disaster Reduction (NCDR), with an advanced flashing light alert system. This integration specifically targets a reduction in preparation time for major traumas, Cerebrovascular Accidents (CVAs), Out-Of-Hospital Cardiac Arrests (OHCAs), and Acute Myocardial Infarctions (AMIs) at the South Medical Center in Taiwan. By streamlining these critical processes, our research endeavors to enhance overall efficiency and responsiveness within emergency medical care, achieving an average preparation time of 6.61 minutes.

Promptly calling for assistance in an anaesthetic emergency is important. However, emergency call systems are not present in all locations where anaesthesia is administered, and in those that do have an emergency call system, the call button is often obscured by other equipment or in an unfamiliar location. Placing a red stripe from the ceiling, down the wall, to the emergency call button significantly reduces delays in activating an emergency call, demonstrating a simple but effective system change to the layout of operating theatres., (Copyright © 2024 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.)

Background: Timely dispatch of appropriate emergency medical services (EMS) resources to the scene of medical incidents, and/or provision of treatment at the scene by bystanders and medical emergency lay callers (referred to as 'callers' in this review) can improve patient outcomes. Currently, in dispatch systems worldwide, prioritisation of dispatch relies mostly on verbal telephone information from callers, but advances in mobile phone technology provide means for sharing video footage. This scoping review aimed to map and identify current uses, opportunities, and challenges for using video livestreaming from callers' smartphones to emergency medical dispatch centres., Methods: A scoping review of relevant published literature between 2007 and 2023 in the English language, searched within MEDLINE; CINAHL and PsycINFO, was descriptively synthesised, adhering to the PRISMA extension for scoping reviews., Results: Twenty-four articles remained from the initial search of 1,565 articles. Most studies were simulation-based and focused on emergency medical dispatchers' (referred to as 'dispatcher/s' in this review) assisted video cardiopulmonary resuscitation (CPR), predominantly concerned with measuring how video impacts CPR performance. Nine studies were based on real-life practice. Few studies specifically explored experiences of dispatchers or callers. Only three articles explored the impact that using video had on the dispatch of resources. Opportunities offered by video livestreaming included it being: perceived to be useful; easy to use; reassuring for both dispatchers and callers; and informing dispatcher decision-making. Challenges included the potential emotional impact for dispatchers and callers. There were also concerns about potential misuse of video, although there was no evidence that this was occurring. Evidence suggests a need for appropriate training of dispatchers and video-specific dispatch protocols., Conclusion: Research is sparse in the context of video livestreaming. Few studies have focussed on the use of video livestreaming outside CPR provision, such as for trauma incidents, which are by their nature time-critical where visual information may offer significant benefit. Further investigation into acceptability and experience of the use of video livestreaming is warranted, to understand the potential psychological impact on dispatchers and callers., (© 2024. The Author(s).)

BackgroundThe Medical Priority Dispatch System (MPDS) is a commonly used computer-based emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. There are five major priority classes used to dispatch 9-1-1 calls in the San Francisco System; Alpha codes are the lowest priority (lowest expected acuity) and Echo are the highest priority.ObjectiveWe sought to determine which MPDS dispatch codes are associated with high prehospital nontransport rates (NTRs).MethodsAll unique MPDS call categories from 2009 in a highly urbanized, two-tier advanced life support (ALS) system were sorted according to highest NTRs. There are many reasons for nontransport, such as "gone on arrival," and "patient denied transport." Those categories with greater than 100 annual calls were further evaluated. MPDS groups that included multiple categories with NTRs exceeding 25% were then identified and each category was analyzed. Results. EMS responded to a total of 81,437 calls in 2009, of which 18,851 were not transported by EMS. The majority of the NTRs were found among "cardiac/ respiratory arrest/death," "assault/sexual assaults," "unknown problem/man down," "traffic/transportation accidents," and "unconscious/fainting." "Cardiac or respiratory arrest/death -obvious death" (9B1) had the highest overall nontransport rate, 99.25% (1/134), most likely due to declaration of death. "Unknown problem -man down -medical alert notification" had the second highest NTR, 67.22% (138/421). However, Echo priority codes had the highest overall nontransport rates (45.45%) and Charlie had the lowest (13.84%).ConclusionsThe nontransport rates of individual MPDS categories vary considerably and should be considered in any system design. We identified 52 unique call categories to have a 25% or greater NTR, 18 of which exceeded 40%. The majority of NTRs occurred among the "cardiac/respiratory arrest/death," "assault/sexual assaults," "unknown problem/man down," "traffic/transportation accidents," and "unconscious/fainting" categories. The higher the priority code within each subset (AB vs. CDE), the less likely the patient was to be transported. Charlie priority codes had a lower NTR than Delta, and Delta was lower than Echo. Charlie codes were therefore the strongest predictors of hospital transport, while Echo codes (highest priority) were those with the highest nontransport rates and were the worst predictors of hospital transport in the emergent subset.

BackgroundThe Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. MPDS is a computer-based EMD system that uses callers' responses to scripted questions to categorize cases into groups and subgroups, based on complaint and perceived acuity.ObjectiveThis study evaluates the ability of MPDS codes to predict prehospital use of medications.MethodsAll transported prehospital patients assigned a subgroup by MPDS from January 1, 2009 to December 31, 2009 in a diverse urban community were matched with their prehospital electronic patient care records. The records of transported patients dispatched through EMD were queried for prehospital interventions and matched to their MPDS classifications. Only MPDS subgroups with 10 or more calls were included in the analysis.ResultsA total of 38,005 patients met inclusion criteria. Patients with chest pain, breathing problems, heart problems, and diabetic problems received the most medications. Medications were administered in 19% of all calls. The individual MPDS subgroup with the highest rate of medication administration was 6E1A (breathing problems, 76%). Higher rates of Advanced Life Support (ALS) interventions in higher-acuity categories (e.g., Alpha, Bravo, Charlie) were seen in several EMD categories, including unconscious/fainting, breathing problems, and abdominal pain; but this was not observed in many other categories, including seizure, sick person, traumatic injury, and hemorrhage/lacerations.ConclusionsMedications were administered in 19% of all calls. There were higher rates of ALS interventions in higher-acuity categories that were not observed in many other categories.

Background: Video streaming in emergency medical communication centers (EMCC) from caller to medical dispatcher has recently been introduced in some countries. Death by trauma is a leading cause of death and injuries are a frequent reason to contact EMCC. We aimed to investigate if video streaming is associated with recognition of a need for first aid during calls regarding injured patients and improve quality of bystander first aid., Methods: A prospective observational study including patients from three health regions in Norway, from November 2021 to February 2023 (registered in clinical trials 10/25/2021, NCT05121649). Cases where video streaming had been used as a supplement during the medical emergency call were compared to cases where video streaming was not used during the call. Patients were included by ambulance personnel on the scene of accident if they met the following criteria: 1. Ambulance personnel arrived at a patient who had an injury, 2. One or more bystanders had been present before their arrival, 3. One or more of the following first aid measures had been performed by bystander or should have been performed: airway management, control of external bleeding, recovery position, and hypothermia prevention. Ambulance personnel assessed quality of first aid performed by bystander, and information concerning use of video streaming and patient need for first aid measures recognized by dispatcher was collected through EMCC audio logs and patient charts. We present descriptive data and results from a logistic regression analysis., Results: Data was collected on 113 cases, and dispatchers used video streaming in addition to standard telephone communication in 12/113 (10%) of the cases. The odds for the dispatcher to recognize a need for first aid during a medical emergency call were more than five times higher when video streaming was used compared to no use of video streaming (OR 5.30, 95% CI 1.11-25.44). Overall quality of bystander first aid was rated as "high". The odds ratio for the patient receiving first aid of higher quality were 1.82 (p-value 0.46) when video streaming was used by dispatcher during the call., Conclusion: Our findings show that video streaming is not frequently used by dispatchers in calls regarding patients with injuries, but that video streaming is associated with improved recognition of patients' first aid needs. We found no statistically significant difference in first aid quality comparing the calls where video streaming as a supplement were used with the calls with audio only., (© 2024. The Author(s).)

Objectives: The ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an emergency situation to prevent unnecessary delays in treatment. This study aimed to explore emergency medical dispatchers' (EMDs) perceptions of the structured protocol they use., Design: Voluntary participation in semistructured phenomenological focus groups. The participants were asked to discuss their experiences of using Medical Priority Dispatch System Protocol 24 (pregnancy, childbirth and miscarriage). Thematic analysis was applied to code and group topics. Discussion between the EMDs is presented for each theme and their experiences, including quotes, are presented to offer an overview of the maternity protocol and its use., Setting: A large urban UK ambulance service., Participants: 23 control room staff., Results: Perceptions of maternity emergencies, challenges with key questions, the need for sensitivity surrounding miscarriage, using prearrival instructions and postdispatch instructions to help patients and ideas for additional ProQA functionality emerged as the five overarching themes. Protocol 24 was considered to reflect many of the clinical factors EMDs associate with maternity emergencies although further factors, including some non-clinical, were suggested for inclusion. Miscarriage and termination-related calls were thought to be challenging as the language of the protocol is designed for pregnancy. However, instructions were generally considered well written and user-friendly, although some were thought to be unnecessary. EMDs were largely positive regarding the ProQA software, but felt backward navigation was difficult if a situation changed., Conclusions: Maternity calls were considered rewarding but complex by EMDs. We suggest changes including the use of more sensitive language in response to miscarriage and termination and make recommendations for the omission and inclusion of specific instructions, as well as enhancements to key questions and functionality. Further research is needed to ensure focus group findings are generalisable to other services, particularly in other countries., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

BackgroundThe Medical Priority Dispatch System (MPDS) is an emergency medical dispatch (EMD) system that is widely used to prioritize 9-1-1 calls and optimize resource allocation. Calls are assigned an MPDS determinant, which includes a number (1-32) representing chief complaint and priority (Alpha through Echo) representing acuity.ObjectiveThis study evaluates the number of emergency dispatches per cardiac arrest (NOD-CA) in cardiac arrest and non-cardiac arrest MPDS determinants.MethodsAll patients assigned a determinant by MPDS from January 1, 2008 to June 30, 2009 in a large metropolitan area were included. Prehospital electronic patient care records were linked with dispatch data. For each MPDS determinant, the number of calls for which the paramedic impression was listed as "Cardiac Arrest - Non-Traumatic" was tabulated. The NOD-CA was calculated for each cardiac arrest and non-cardiac arrest MPDS determinant. Non-MPDS calls with cardiac arrests were analyzed separately.ResultsA total of 101,642 patients were included. Among them, 555 had "Cardiac Arrest - Non-Traumatic" listed as the paramedic impression. The Cardiac/Respiratory Arrest/Death protocol had the highest number of cardiac arrests (285), followed by Breathing Problems (99) and Unconscious/Fainting (76). Overall, 183 dispatched occurred for each cardiac arrest, 131 of which resulted in a lights and sirens response. The NOD-CA was 7 in the Cardiac Arrest/Death protocol, 122 in Breathing Problems, and 104 in Unconscious/Fainting. 31 Cardiac arrests occurred in non-MPDS dispatch categories (N=62,989), most of which were calls for medical assistance from police or fire units.ConclusionsMPDS was designed to detect cardiac arrest with high sensitivity, leading to a significant degree of mistriage. The number of dispatches for each cardiac arrest may be a useful way to quantify the degree of mistriage and optimize EMS dispatch. This large descriptive study revealed a low NOD-CA in most cardiac arrest MPDS determinants. We demonstrated significant variability in the NOD-CA among non-cardiac arrest MPDS determinants, and few cardiac arrests in non-MPDS dispatch categories.

Copyright of Revista de Pesquisa: Cuidado é Fundamental is the property of Revista de Pesquisa: Cuidado e Fundamental Online 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.)

To describe the barriers to cardiopulmonary resuscitation (CPR) initiation and continuation in emergency calls for out-of-hospital cardiac arrest (OHCA). We analysed 295 consecutive emergency calls relating to OHCA over a four-month period (1 January – 30 April 2021). Calls included were paramedic-confirmed, non-traumatic, non-EMS-witnessed OHCA, where the caller was with the patient. Calls were listened to in full and coded in terms of barriers to CPR initiation and continuation, and patient and caller characteristics. Overall, CPR was performed in 69% of calls and, in 85% of these, callers continued performing CPR until EMS arrival. Nearly all callers (99%) experienced barriers to CPR initiation and/or continuation during the call. The barriers identified were classified into eight categories: reluctance, appropriateness, emotion, bystander physical ability, patient access, leaving the scene, communication failure, caller actions and call-taker instructions. Of these, bystander physical ability was the most prevalent barrier to both CPR initiation and continuation, occurring in 191 (65%) calls, followed by communication failure which occurred in 160 (54%) calls. Callers stopping or interrupting CPR performance due to being fatigued was lower than expected (n = 54, 26% of callers who performed CPR). Barriers to CPR initiation that related to bystander physical ability, caller actions, communication failure, emotion, leaving the scene, patient access, procedural barriers, and reluctance were mostly overcome by the caller (i.e., CPR was performed). Barriers to CPR initiation and continuation were commonly experienced by callers, however they were frequently overcome. Future research should investigate the strategies that were successful. [ABSTRACT FROM AUTHOR]

Introduction: 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., Objective: We examined the barriers to initiation of T-CPR., Methods: 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)., Results: 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., Conclusions: 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.

Objective: Analysis of interventions by fire protection units in road traffic incidents alerted by the eCall system between 2016 and 2022., Materials and Methods: Data from the State Fire Service Decision Support System (SFS DSS), provided by the Operational Planning Office, were used. Events from January 1, 2016, 00:00 to December 31, 2022, 23:59 were analyzed. Quantitative data were described using mean (Mean) and standard deviation (SD). Correlations and differences at a significance level of p  < 0.05 were considered statistically significant. The analysis is anonymous for both victims and officers involved in the interventions., Results: Between 2016 and 2022, firefighters were alerted by the e-call system 896 times. The shortest average intervention time was 47 ± 37 min and was recorded in 2021. In the comparative analysis of intervention time and factors conditioning the use of the eCall system, it was shown that this time was significantly statistically dependent on the number of cars involved in the incident ( p  < 0.001), the number of injured persons ( p  < 0.001), the type of intervention ( p  < 0.001),), and the occurrence of fuel leakage ( p  < 0.001)., Conclusions: ECall is a relevant system for reporting accidents and collisions on the road. While it proves reliable in road incidents, a significantly high number of false alarms initiated from eCall requires system refinement to avoid accidental alarms and user education about the possibility of unintentionally sending an alarm signal. The authors predict that as the number of vehicles with the eCall system introduced to the roads increases, so will the number of notifications from this system. Data from the analysis of false reports suggest that mechanics and electricians in facilities performing repairs and maintenance of vehicles with the eCall system may lack the necessary knowledge of the need to deactivate the system before starting work. The number of injured people had no impact on the intervention time, which may prove that the rescue services were properly prepared.

Background: The Emergency Medical Communications Center (EMCC) is essential in emergencies and often represents the public's first encounter with the healthcare system. Previous research has mainly focused on the dispatcher's perspective. Therefore, there is a lack of insight into the callers' perspectives, the attainment of which may contribute significantly to improving the quality of this vital public service. Most calls are now made from mobile phones, opening up novel approaches for obtaining caller feedback using tools such as short-message services (SMS). Thus, this study aims to obtain a better understanding of callers' actual experiences and how they perceived their interaction with the EMCC., Methods: A combination of quantitative and qualitative study methods was used. An SMS survey was sent to the mobile phone numbers of everyone who had contacted 113 during the last months. This was followed by 31 semi-structured interviews with people either satisfied or dissatisfied. Thematic analysis was used to investigate the interviews., Results: We received 1680 (35%) responses to the SMS survey, sent to 4807 unique numbers. Most respondents (88%) were satisfied, evaluating their experience as 5 or 6 on a six-point scale, whereas 5% answered with 1 or 2. The interviews revealed that callers were in distress before calling 113. By actively listening and taking the caller seriously, and affirming that it was the right choice to call the emergency number, the EMCC make callers experience a feeling of help and satisfaction, regardless of whether an ambulance was dispatched to their location. If callers did not feel taken seriously or listened to, they were less satisfied. A negative experience may lead to a higher distress threshold and an adjusted strategy before the caller makes contact 113 next time. Callers with positive experiences expressed more trust in the healthcare systems., Conclusions: For the callers, the most important was being taken seriously and listened to. Additionally, they welcomed that dispatchers express empathy and affirm that callers made the right choice to call EMCC, as this positively affects communication with callers. The 113 calls aimed to cooperate in finding a solution to the caller's problem., (© 2023. The Author(s).)

Copyright of Notfall & Rettungsmedizin is the property of Springer Nature 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.)

Objective: To determine whether dispatcher assistance via smart glasses improves bystander basic life support (BLS) performance compared with standard telephone assistance in a simulated out-of-hospital cardiac arrest (OHCA) scenario., Methods: Pilot study in which 28 lay people randomly assigned to a smart glasses-video assistance (SG-VA) intervention group or a smartphone-audio assistance (SP-AA) control group received dispatcher guidance from a dispatcher to provide BLS in an OHCA simulation. SG-VA rescuers received assistance via a video call with smart glasses (Vuzix, Blade) connected to a wireless network, while SP-AA rescuers received instructions over a smartphone with the speaker function activated. BLS protocol steps, quality of chest compressions, and performance times were compared., Results: Nine of the 14 SG-VA rescuers correctly completed the BLS protocol compared with none of the SP-AA rescuers (p = 0.01). A significantly higher number of SG-VA rescuers successfully opened the airway (13 vs. 5, p = 0.002), checked breathing (13 vs. 8, p = 0.03), correctly positioned the automatic external defibrillator pads (14 vs.6, p = 0.001), and warned bystanders to stay clear before delivering the shock (12 vs. 0, p < 0.001). No significant differences were observed for performance times or chest compression quality. The mean compression rate was 104 compressions per minute in the SG-VA group and 98 compressions per minute in the SP-AA group (p = 0.46); mean depth of compression was 4.5 cm and 4.4 cm (p = 0.49), respectively., Conclusions: Smart glasses could significantly improve dispatcher-assisted bystander performance in an OHCA event. Their potential in real-life situations should be evaluated., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Inc.)

Background: Accessing the emergency medical services system via 9-1-1 operators is an effective way for patients to seek urgent health care; however, technological advances and telecommunication practices inundate the 9-1-1 and emergency services infrastructure with unintentional calls that delay response efforts to legitimate medical emergencies. Objective: To determine whether the change in university-wide dial-out prefix from “9” to “7” reduced unnecessary calls to a 9-1-1 call center. Methods: This is a retrospective study conducted utilizing information obtained from the University of North Carolina at Chapel Hill (UNC) Department of Public Safety (DPS) call center. Call center calls received during pre-change, intervening, and post-change periods were included in the study. The cost savings, defined in time and money, resulting from the prefix change were also examined. Results: A total of 33,646 calls were made during the study period (January 11, 2010 through December 31, 2012) and included in the analysis. The prefix change was found to reduce the rate of invalid calls to the call center by 319 calls per month, resulting in a 43% reduction in total calls to the call center while preserving the rate of valid calls. The largest decrease occurred in hang-up calls (a decrease of 232 calls per month), especially those originating from the university. The prefix change was found to save the UNC DPS telecommunications division approximately $798.82 per month and the police officer division approximately $3,874.95 per month. Conclusion: A prefix change was not only beneficial to the UNC community but it also has potentially wide-reaching effects. A reduction of invalid 9-1-1 calls translates to telecommunicators having more time available to handle true emergencies, phone lines remaining available for true emergencies, and police officers dedicating more time and effort to matters that necessitate officer assistance. Based on the call decrease seen with the prefix change, this study may be used as evidence to advocate for a change of dial-out codes beginning with “9.” [ABSTRACT FROM AUTHOR]

Introduction Our aim is to expedite prehospital assessment of remote and rural patients using remotely-supported ultrasound and satellite/cellular communications. In this paradigm, paramedics are remotely-supported ultrasound operators, guided by hospital-based specialists, to record images before receiving diagnostic advice. Technology can support users in areas with little access to medical imaging and suboptimal communications coverage by connecting to multiple cellular networks and/or satellites to stream live ultrasound and audio-video. Methods An ambulance-based demonstrator system captured standard trauma and novel transcranial ultrasound scans from 10 healthy volunteers at 16 locations across the Scottish Highlands. Volunteers underwent brief scanning training before receiving expert guidance via the communications link. Ultrasound images were streamed with an audio/video feed to reviewers for interpretation. Two sessions were transmitted via satellite and 21 used cellular networks. Reviewers rated image and communication quality, and their utility for diagnosis. Transmission latency and bandwidth were recorded, and effects of scanner and reviewer experience were assessed. Results Appropriate views were provided in 94% of the simulated trauma scans. The mean upload rate was 835/150 kbps and mean latency was 114/2072 ms for cellular and satellite networks, respectively. Scanning experience had a significant impact on time to achieve a diagnostic image, and review of offline scans required significantly less time than live-streamed scans. Discussion This prehospital ultrasound system could facilitate early diagnosis and streamlining of treatment pathways for remote emergency patients, being particularly applicable in rural areas worldwide with poor communications infrastructure and extensive transport times. [ABSTRACT FROM AUTHOR]

Background: Predicting case types that are unlikely to be treated by paramedics can aid in managing demand for emergency ambulances by identifying cases suitable for alternative management pathways. The aim of this study was to identify the patient characteristics and triage outcomes associated with 'no paramedic treatment' for cases referred for emergency ambulance dispatch following secondary telephone triage. Methods: A retrospective cohort analysis was conducted of cases referred for emergency ambulance dispatch following secondary telephone triage between September 2009 and June 2012. Multivariable logistic regression modelling was used to identify explanatory variables associated with 'no paramedic treatment'. Results: There were 19,041 cases eligible for inclusion in this study over almost three years, of which 8510 (44.7%) were not treated after being sent an emergency ambulance following secondary triage. Age, time of day, pain, triage guideline group, and comorbidities were associated with 'no paramedic treatment'. In particular, cases 0-4 years of age or those with psychiatric conditions were significantly less likely to be treated by paramedics, and increasing pain resulted in higher rates of paramedic treatment. Conclusions: This study highlights that case characteristics can be used to identify particular case types that may benefit from care pathways other than emergency ambulance dispatch. This process is also useful to identify gaps in the alternative care pathways currently available. These findings offer the opportunity to optimise secondary telephone triage services to support their strategic purpose of minimising unnecessary emergency ambulance demand and to match the right case with the right care pathway. [ABSTRACT FROM AUTHOR]