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Introduction: The out-of-hospital emergency medical service (EMS) care responses and the transport pathways to hospital play a vital role in patient survival following injury and are the first component of a well-functioning, optimised system of trauma care. Despite longstanding challenges in delivering equitable healthcare services in the health system of Aotearoa-New Zealand (NZ), little is known about inequities in EMS-delivered care and transport pathways to hospital-level care.Methods: This population-level cohort study on out-of-hospital care, based on national EMS data, included trauma patients

Alcohol harms changed significantly during COVID-19, but did not affect the population equally. Vulnerable groups including people with pre-existing mental health or suicidal behaviors may be at greater risk of alcohol-related harms, yet limited public health data are able to assess these. The present study utilised a novel, statewide surveillance system to examine ambulance attendances for alcohol intoxication over a four-year period prior to, and during the strictest lockdowns in Victoria, Australia. While there was an overall reduction in alcohol-related attendances during lockdown (n = 15,064) compared to the 2018–19 period (n = 16,989), alcohol- intoxication attendances involving mental health symptoms increased by 40 % in Melbourne (IRR: 1.40 [1.30–1.51], p < 0.001), and by 25 % in regional Victoria (IRR: 1.25 [1.07–1.44], p = 0.005).There was also a 7 % increase in alcohol-intoxication attendances with co-morbid suicidal behaviors in Melbourne (IRR: 1.07 95%CI [1.02–1.13], p = 0.006), and a 21 % increase in regional Victoria (IRR: 1.21 [1.08–1.35], p = 0.001). These findings suggest that extra services and supports for individuals with co-morbid alcohol-related harms are required to ensure their clinical care needs are being met. • Alcohol consumption and harms increase following exposure to pandemics or disasters, including lockdown restrictions during COVID-19. • People with pre-existing mental health conditions are more vulnerable to alcohol-related harms. • Emergency services including ambulance were placed under increasing strain during lockdown restrictions. • We tracked comorbid alcohol-related harms involving mental health, suicide and self-harm before and during COVID-19. • While overall alcohol attendances decreased, there were significant increases where comorbid conditions were noted. [ABSTRACT FROM AUTHOR]

Background: This scoping review aimed to summarize existing research on point-of-care tests (POCTs) within emergency medical services (EMS). There is a lack of comprehensive reviews covering the breadth and scope of application of POCTs in EMS despite growing interest and potential benefits in this setting. A review of the research will inform how we target future research efforts to support effective implementation and avoid duplication. Methods: We searched three databases to April 2023 using comprehensive terms for POCTs. One author screened titles and abstracts, full-text papers and extracted data with a second author checking the data. A scoping review framework was used to categorise studies according to demographics, study design, medical conditions, biomarkers and test devices. Results: We found 141 papers that included 158 reports of 9 study designs, 155 reports of 40 combinations of biomarker and condition and 161 reports of 41 test-devices. The majority of research was done in the UK (19%), US (17%), and the Netherlands (16%), mostly in land-based EMS (82%). Most frequently assessed were troponin for acute coronary syndromes (26%), lactate for sepsis (14%) or lactate for trauma/critical illness (13%). The majority of research designs investigated the accuracy of the tests (43%). Few studies were of a design to inform guidelines to change patient pathways and the associated outcomes, including, randomised controlled trials (RCTs) (4%), non-randomised studies able to assess causality (6%), economic analyses (1%) or qualitative work on acceptability (3%). In those few cases where RCTs were done there were long delays between initial test-accuracy research and publication of the first RCT, for example 11 years delay for troponin for acute coronary syndromes. Conclusions: We identified a thriving base of research on POCT in the EMS, however most studies established the diagnostic accuracy of the tests with few RCTs, economic analyses or qualitative research on acceptability. The time-lag from diagnostic accuracy to developing an RCT is considerable. Investment in funding and infrastructure is needed to support the research pathway for potential POCTs beyond diagnostic accuracy to designs able to assess clinical effectiveness, acceptability and economic effectiveness. [ABSTRACT FROM AUTHOR]

Background: Research into prehospital risk mitigation using clinical risk scores in conjunction with biomarker analysis is lacking. Aims: This research aimed to identify the extent, range and nature of literature surrounding clinical risk in acute coronary syndrome and adverse cardiac events within the prehospital setting. Methods: This study applied the JBI scoping review methodology to identify peer-reviewed scientific literature published from January 2000 to August 2022. Articles were obtained from searches of two electronic databases, CINAHL Plus and MEDLINE (Ovid). The search results were filtered and selected for analysis through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: The initial search yielded a total of 234 results. Of these, 154 were screened resulting in a final total of 10 articles from which clinical risk scores and prehospital cardiac biomarkers were highlighted for discussion. Conclusion: Clinical risk scores provide practitioners with a foundation for risk analysis when assessing a patient with suspected acute coronary syndrome. The most effective risk-score method to predict major adverse cardiac events was the HEART score. Technological advances in biomarker analysis may assist when used in conjunction with risk scores. [ABSTRACT FROM AUTHOR]

Background: Timely emergency medical services (EMS) are particularly important among trauma patients, as inefficient EMS systems can result in potentially avoidable death before reaching a hospital. The Dhulikhel Hospital Dispatch Center coordinates and monitors a growing network of ambulances, including seven Type B ambulances staffed with a trained prehospital care provider and medical equipment. This study evaluates the prehospital care and outcomes of trauma patients transported by Type B ambulances to Dhulikhel Hospital's Emergency Department, as monitored by the Dispatch Center. Methods: Data were collected via a retrospective chart review of Dispatch Center records, including patient demographics, injury mechanisms, prehospital care, and outcomes. Patients were included if they experienced physical trauma and were transported by a Type B ambulance to Dhulikhel Hospital's Emergency Department between 2019 and 2023. Results: Between 2019 and 2023, 224 trauma patients were transported to the hospital and received prehospital care services from Type B ambulances monitored by the Dispatch Center. Most patients were male (59%), and nearly half were aged 18–44 (49%). The median total transport time for Dhulikhel Hospital-owned Type B ambulances was 40 min. Type B ambulances reached patients across 24 municipalities (88% in Kavrepalanchowk and Sindupalchowk districts). Falls (55%) and road traffic accidents (30%) were the most common injury mechanisms, followed by physical assault (7%). Falls were significantly associated with female, pediatric, and geriatric patients (p < 0.05), while road traffic accidents predominated among males, particularly in adults aged 25–34 years (p < 0.05). Approximately one-third of patients admitted to the hospital after evaluation in the emergency department experienced multiple injuries, and the most prevalent diagnosis of admitted cases were extremity fractures (52%). Conclusion: Trauma cases accounted for 15% (227/1541) of all patients who received transport and prehospital care services from a Type B ambulance monitored by the Dispatch Center between 2019 and 2023. This study demonstrates the critical role of Type B ambulances and an integrated dispatch center in advancing timely and efficient prehospital care for trauma patients in Nepal. [ABSTRACT FROM AUTHOR]

Background: In Sweden with about 10 million inhabitants, there are about one million primary ambulance missions every year. Among them, around 10% are assessed by Emergency Medical Service (EMS) clinicians with the primary symptom of dyspnoea. The risk of death among these patients has been reported to be remarkably high, at 11,1% and 13,2%. The aim was to develop a Machine Learning (ML) model to provide support in assessing patients in pre-hospital settings and to compare them with established triage tools. Methods: This was a retrospective observational study including 6,354 patients who called the Swedish emergency telephone number (112) between January and December 2017. Patients presenting with the main symptom of dyspnoea were included which were recruited from two EMS organisations in Göteborg and Södra Älvsborg. Serious Adverse Event (SAE) was used as outcome, defined as any of the following:1) death within 30 days after call for an ambulance, 2) a final diagnosis defined as time-sensitive, 3) admitted to intensive care unit, or 4) readmission within 72 h and admitted to hospital receiving a final time-sensitive diagnosis. Logistic regression, LASSO logistic regression and gradient boosting were compared to the Rapid Emergency Triage and Treatment System for Adults (RETTS-A) and National Early Warning Score2 (NEWS2) with respect to discrimination and calibration of predictions. Eighty percent (80%) of the data was used for model development and 20% for model validation. Results: All ML models showed better performance than RETTS-A and NEWS2 with respect to all evaluated performance metrics. The gradient boosting algorithm had the overall best performance, with excellent calibration of the predictions, and consistently showed higher sensitivity to detect SAE than the other methods. The ROC AUC on test data increased from 0.73 (95% CI 0.70–0.76) with RETTS-A to 0.81 (95% CI 0.78–0.84) using gradient boosting. Conclusions: Among 6,354 ambulance missions caused by patients suffering from dyspnoea, an ML method using gradient boosting demonstrated excellent performance for predicting SAE, with substantial improvement over the more established methods RETTS-A and NEWS2. [ABSTRACT FROM AUTHOR]

Introduction: A disproportionate number of mental health presentations to emergency services are made by frequent presenters. No current consensus definition of a frequent presenter exists. Using a statewide population-based ambulance database, this study (i) applied previous statistical methods to determine thresholds for frequent presenters, (ii) explored characteristics of the identified frequent presenter groups compared to non-frequent presenters and (iii) assessed the reliability of these methods in predicting continued frequent presenter status over time. Methods: Statistical methods utilised in previous studies to identify frequent presenters were applied to all ambulance attendances for mental health symptoms, self-harm and alcohol and other drug issues between 1 January 2017 and 31 December 2020 in Victoria, Australia. Differences in characteristics between identified frequent and non-frequent presenter groups were determined by logistic regression analysis. The consistency of agreement of frequent presenter status over time was assessed using intraclass correlation coefficients. Results: Thresholds for frequent presenters ranged from a mean of 5 to 39 attendances per calendar year, with groups differing in size, service use and characteristics. Compared to non-frequent presenters, frequent presenters had greater odds of being female, presenting with self-harm, experiencing social disadvantage or housing issues, involving police co-attendance and being transported to hospital. All frequent presenter definitions had poor reliability in predicting ongoing frequent presentations over time. Conclusion: A range of methods can define frequent presenters according to thresholds of yearly service use. Reasons for identifying frequent presenters may influence the method chosen. Future studies should explore definitions that capture the dynamic nature of presentations by this group. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality worldwide, particularly in low- and middle-income countries, complicating 1% to 10% of deliveries. Despite improvement in prevention and management, variations in PPH definitions and measurement methods contribute to challenges in accurately assessing its incidence, with up to 90% of PPH-related deaths in high-income countries deemed avoidable through timely intervention. Oxytocin is the primary drug administered during labour or miscarriage, causing an increase in uterine muscle tone, which reduces bleeding and the risk of complications. The aim of the study was to assess the rate of oxytocin use by paramedics for out-of-hospital births in Poland and to verify adherence to WHO-recommended protocols for preventing postpartum haemorrhage in emergency prehospital settings. Methods: We conducted a cross-sectional study using data from the Polish Central System for Emergency Medical Services Missions Monitoring covering all EMS interventions nationwide from 2018 to 2023. The study included cases where oxytocin was administered during EMS interventions for pregnant women, identified through ICD-10 codes (O30–O92), with 62 verified cases meeting the inclusion criteria. Results: Over 6 years, oxytocin was administered in 62 cases when paramedics responded to emergencies involving pregnant women. The mean age of the patients to whom the oxytocin was administered was 29.48 years (SD = 6.25) and ranged from 15 to 43 years. Conclusions: Oxytocin is rarely administered by EMS teams at the prehospital stage. Oxytocin should be considered for incorporation into the set of medications that EMS teams can administer in prehospital settings. There is a need to train EMS teams in the management of pregnancy-related emergencies in accordance with the current medical guidelines. [ABSTRACT FROM AUTHOR]

Introduction: An ambulance used by an emergency medical service team is the workplace of specialised medical personnel, providing daily transportation for patients in life-threatening conditions, from all walks of life, with numerous diseases and injuries. MRSA (methicillin-resistant Staphylococcus aureus) strains are classified as Gram-positive cocci, characterised primarily by their multidrug resistance. Infections caused by S. aureus have a low treatment success rate and are associated with persistent carrier state. This study aimed to isolate MRSA and MSSA (methicillin-sensitive Staphylococcus aureus) in the emergency vehicle and determine drug resistance of these isolates. Materials and Methods: This study involved an ambulance vehicle operated in central Poland. A total of 39 swabs were taken and evaluated from inside the ambulance on permanent duty. The isolates were analysed using catalase and coagulase assays, Gram staining, culturing on Chapman medium, growth evaluation on agar with 5% sheep blood, and assessing the strains' sensitivities to selected antibiotics. Material was collected from 13 designated points located in the medical compartment and driver's cabin. Results: S. aureus bacteria were detected in 51.28% of the samples, 40% of which were MRSA strains. Despite the application of high disinfection standards for the interior of the ambulance, it was not possible to kill all S. aureus strains, which may be because the pathogens in question produce a biofilm that effectively allows them to survive on various surfaces, including those disinfected. Almost 100% of the MRSA isolates were resistant to antibiotics from the β-lactam group (penicillin, ticarcillin, cefotaxime, and cefoxitin), the macrolide group (erythromycin) and the lincosamide group (clindamycin). However, only a few MRSA strains proved resistant to streptomycin (12.5%) and ciprofloxacin (37.5%). β-lactam antibiotics, such as cefotaxime (100% resistant strains) and penicillin (58% resistant strains), were also ineffective against MSSA. Although MSSA isolates showed slight resistance to ticarcillin and erythromycin (33.3%) and clindamycin (25%), the remaining antibiotics proved effective (no resistant strains). Conclusions: Among the isolated strains, the greatest resistance to β-lactam antibiotics and erythromycin was observed. Multidrug-resistant strains of S. aureus were found in the emergency medical system. Even the MSSA strains detected in the studied ambulance showed resistance to some of the antibiotics used. The prevalence of S. aureus strains within ambulances indicates the need for a high hygiene level in daily prehospital work with patients. [ABSTRACT FROM AUTHOR]

Background/Objectives: In acute stroke, often-prolonged hospital transport times present an opportunity for early interventions to salvage brain tissue. Remote ischemic conditioning (RIC), where brief cycles of ischemia–reperfusion in a limb are induced to protect the brain, is a promising treatment for this setting. We assessed the usability of a novel RIC system in a simulated emergency response scenario. Methods: Paramedics were asked to use the RIC device in an emergency stroke care and ambulance transport simulation, overseen by a confederate. Feedback on device use was collected through questionnaires, including the System Usability Scale (SUS) and the NASA Task Load Index (NASA-TLX), and a semi-structured interview. Questionnaire responses were summarized using descriptive statistics; interview transcripts were analyzed thematically. Results: Nine paramedics (including the confederate) participated, with a mean of 10.0 ± 10.3 years of professional experience. Questionnaire responses indicated high device usability (mean SUS score: 85.3 ± 12.9 out of 100) and low task-related demands, effort, and frustration (mean NASA-TLX domain scores: ≤3.9 out of 20). Seven paramedics stated they would use the device in daily practice. They expressed concerns related to display screen clarity, interference with standard procedures, cable management, device fragility, and patient discomfort. Suggested improvements included adding indicators of device performance and refining the cuff design. Conclusions: While the device was considered easy to use, paramedics also identified important areas of improvement. With a small, localized study sample, our findings are primarily applicable to the refinement of the RICovery system for use in future clinical trials in the same healthcare setting. However, feedback on the importance of mitigating potential interference of newly introduced procedures with those already established, robustness of equipment, and effective paramedic–patient communication may also help inform the design of other pre-hospital interventions. [ABSTRACT FROM AUTHOR]

Background/Aims: Most birth-related ambulance calls occur without difficulty, but in some cases, complications can arise. Paramedics' involvement in birth is infrequent; therefore, the knowledge and skills required to manage complications can atrophy over time, particularly without educational interventions. This may impact outcomes. The study's aims were to measure the knowledge, attitude, and practice of paramedics in managing obstetric cases. Methods: This cross-sectional questionnaire-based study was carried out with 264 paramedics. Spearman's measure of correlation was used to observe linear correlations between ranks of the observations. Results: The majority of participants were advanced care paramedics (81.1%). Participants reported infrequently attending births in the community, with under half feeling confident in managing these (44%). Antenatal complications and trauma in pregnancy were self-reported areas of weakness; this was consistent with assessed knowledge. Conclusions: Paramedics self-reported infrequently responding to obstetric calls and the majority lacked confidence in managing these. Few indicated an excellent level of obstetric knowledge, reporting a desire to receive more education in this area. Implications for practice: When paramedics lack confidence in managing obstetric emergencies, it can lead to delayed decision making, inadequate assessment, increased error rates and adverse maternal and neonatal outcomes. [ABSTRACT FROM AUTHOR]

Rationale: To date, family satisfaction with emergency medical technicians (EMTs) has only been reported through narrative statements in subjective evaluations. Although a quantitative assessment of healthcare professional satisfaction is desirable, no specific measures have been devised to assess family satisfaction with the healthcare and care provided by EMTs. Aims and Objectives: This study aimed to develop and validate an EMT care family satisfaction scale to measure patient satisfaction with prehospital emergency care. Methods: The study population comprised 216 family members (N = 216) of patients who used ambulances between November 2020 and May 2021 in a single region in Japan. Questionnaires were distributed to the participants who provided informed consent. An exploratory factor analysis of construct validity was performed to validate the Family Satisfaction Scale. The Cronbach's alpha was used to validate the internal consistency reliability of the scale. Results: The exploratory factor analysis results revealed a four‐factor structure: 'explanation and communication,' 'physical treatment,' 'psychological support,' and 'environment in the ambulance.' The Cronbach's range (0.80–0.93) for the total score for each of these four factors and the overall total score confirmed favorable internal reliability of this study. Conclusions: The family satisfaction scale developed in this study was constructed and validated to highlight the role of EMTs and needs of the families in the prehospital care settings. Moreover, this scale can be applied in the evaluation and consideration of interventions to improve family satisfaction with EMTs. [ABSTRACT FROM AUTHOR]

Introduction: Paramedic clinical practice has seen significant evolution from the traditional role of transporting patients to an emergency department (ED). An evolving and flexible scope of practice, modernisation and healthcare reform has necessitated the development of a range of referral pathways for paramedics, with the aim of ensuring that service users receive the most appropriate care at the point of contact. Ambulance conveyance rates to EDs in Northern Ireland (NI) have only occasionally fallen below 75%. A study examining a Northern Ireland Ambulance Service (NIAS) referral pathway showed a much lower referral rate than those of comparable ambulance services. A similar study found that over 70% of people who experience a fall are not referred to falls prevention services. This study aimed to identify what paramedics perceive are the barriers and facilitators to the use of patient care pathways (PCPs) in NI. Methods: In this single-centre qualitative study, participants were recruited using volunteer sampling. Data were collected through 11 semi-structured interviews until data saturation was reached. Online interviews were recorded, transcribed verbatim and thematically analysed. Results: Five main themes were constructed during analysis. The participants discussed their perceptions of the barriers and facilitators to utilising PCPs in relation to risk, cultural issues, person-centred practice, inter-professional communication and operational infrastructure. Conclusion: The study provides insight into perceived barriers and facilitators to the use of PCPs, while indicating the existence of a paramedic workforce dedicated to achieving the best outcomes for people in their care. The themes identified are consistent with existing literature that calls for standardised pathways across regions. Future research should investigate the link between the NHS 111 service and ambulance demand. In order to facilitate the complex decision making involved in referrals, relevant knowledge and skills should be embedded in paramedic education. Efforts should be made to improve inter-professional communication and awareness of the paramedic scope of practice and knowledge base. An intervention designed to reassure staff who have concerns regarding clinical risk may improve referral rates. [ABSTRACT FROM AUTHOR]

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INTRODUCTION: A newborn staying in a hospital department constitutes a patient requiring complex care, which sometimes involves the need for transport to another medical facility. The "N" (neonatal) ambulance is a common option for transporting newborns in Poland. The crew members and equipment of the ambulance are strictly defined by legal regulations. The equipment present in the "N" ambulance is tailored to the needs of neonatal patients, with the incubator being its most important component. A list of indications for transporting a pediatric patient to a higher referral hospital has been created. The purpose of this study is to create a pediatric patient profile based on the perspective of the transport team, as well as the characteristics of the medical interventions undertaken. MATERIAL AND METHODS: The retrospective study was conducted based on the data provided by a hospital in central Poland. Medical records in the form of work sheets of the "N" type of emergency medical service team from the period 2018-2022 were analyzed. A total of 1,026 trip sheets were analyzed, wherein 1,025 cases were included in the study. The analysis included data on sex, birth age, body mass, the patient's condition in the department and during transport, the medical activities performed during transport, and the diagnosed condition. The rho-Spearman test was used to calculate the significance of the variables' correlation, at a significance level of p<0.05. RESULTS: During the study period, the "N" ambulance transported patients with 60.8% being boys (n=623) and 39.1% being girls (n=401). Transport most commonly included full-term patients (57.8%; n=592), with normal body mass at birth (64.4%; n=660). There was a statistically significant correlation between the patient's condition in the department and the birth age (Spearman test=- 0.286; p<0.000). The most common diagnoses concerned conditions beginning in the perinatal period (67.6%; n=1048). According to ICD-10, the most common diagnoses given to patients were: P07 (22.8%; n=239), P22 (21.8%; n=229), P23 (9.9%; n=104). The neonatal pathology department (63.3%; n=648) appeared to be the dominant department of destination transport. During transport, the condition of 95.8% of the subjects remained stable (n=982). Patients' condition during transport significantly correlated with department status (Spearman test=0.263; p<0.000). Respiratory support was required in case of 38.1% (n=391) patients in the department and for 37.4% (n=383) subjects during transport. CONCLUSIONS Most of the inter-hospital transports involved boys. More than half of the subjects were born at term between 37 and 42 weeks of gestation, in good overall condition, but required transport to higher referral hospitals due to their condition. The condition of the patients during transport was mostly described as stable, and less than half of the subjects needed respiratory support. [ABSTRACT FROM AUTHOR]

Abstract Background This scoping review aimed to summarize existing research on point-of-care tests (POCTs) within emergency medical services (EMS). There is a lack of comprehensive reviews covering the breadth and scope of application of POCTs in EMS despite growing interest and potential benefits in this setting. A review of the research will inform how we target future research efforts to support effective implementation and avoid duplication. Methods We searched three databases to April 2023 using comprehensive terms for POCTs. One author screened titles and abstracts, full-text papers and extracted data with a second author checking the data. A scoping review framework was used to categorise studies according to demographics, study design, medical conditions, biomarkers and test devices. Results We found 141 papers that included 158 reports of 9 study designs, 155 reports of 40 combinations of biomarker and condition and 161 reports of 41 test-devices. The majority of research was done in the UK (19%), US (17%), and the Netherlands (16%), mostly in land-based EMS (82%). Most frequently assessed were troponin for acute coronary syndromes (26%), lactate for sepsis (14%) or lactate for trauma/critical illness (13%). The majority of research designs investigated the accuracy of the tests (43%). Few studies were of a design to inform guidelines to change patient pathways and the associated outcomes, including, randomised controlled trials (RCTs) (4%), non-randomised studies able to assess causality (6%), economic analyses (1%) or qualitative work on acceptability (3%). In those few cases where RCTs were done there were long delays between initial test-accuracy research and publication of the first RCT, for example 11 years delay for troponin for acute coronary syndromes. Conclusions We identified a thriving base of research on POCT in the EMS, however most studies established the diagnostic accuracy of the tests with few RCTs, economic analyses or qualitative research on acceptability. The time-lag from diagnostic accuracy to developing an RCT is considerable. Investment in funding and infrastructure is needed to support the research pathway for potential POCTs beyond diagnostic accuracy to designs able to assess clinical effectiveness, acceptability and economic effectiveness.

Background: Inadequate handover documentation may result in delay and adverse outcomes during continuity of care. This is much more important in interfacility transfers where improper or missing documentation of prior events from a referring point may result in a break in the continuity of care. Subjects and Methods: This was a cross-sectional observational study done to evaluate the quality of referral documentation available with the patients who were referred to a tertiary care center after consultation in a peripheral center between March 2024 and May 2024. A semi-structured pro forma was used to collect transfer characteristics and quality of transfer documents at the time of admission. Results: A total of 156 children were enrolled in the study. The mean age of children was 6.81 ± 5.79 years. 68 (43.6%) were referred from a private nursing home. Healthcare workers accompanied only 19 (12.2%) children. Referral documentation was available in 121 (77.6%). 96/121 (61.5%) had handwritten referral papers. Pretransport communication was received only in one patient. Patients being referred by private physicians (70.8%) and smaller hospitals (80.9%) have better documentation than medical colleges (40.9%) (P = 0.03), patients being transported in an ambulance (87.23% vs. 73.4%, P = 0.05) have higher chances of having referral documentation. Conclusions: There is a lack of pretransfer referral communication and quality referral documents. Pediatric referral services in the region are fragmented and nonuniform. There is a need to improve pediatric referral documentation and transfer services.

Abstract Background The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers. Methods The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers. Results The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement. Conclusion This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods.

Abstract Rapid economic growth in Indonesia and Malaysia has widened the gap in emergency care supply and demand, intensifying challenges. Our study, from August to November 2022, assesses current diverse challenges in both countries' emergency care systems from frontline staff perspectives. The online survey involved emergency department (ED) personnel from 11 hospitals in Indonesia and Malaysia, drawing from an existing network. The survey collected data on respondents’ characteristics, factors affecting prehospital and ED care quality, missing clinical information, and factors influencing patients’ ED stay duration. With 83 respondents from Indonesia and 109 from Malaysia, the study identified common challenges. In both countries, inadequate clinical information from ambulances posed a primary challenge in prehospital care quality, while crowdedness during night shifts affected ED care quality. Frequent gaps in essential clinical information, such as family and medication history, were observed. Prolonged ED stays were associated with diagnostic studies and their turnaround time. This study offers insights into shared challenges in Indonesia and Malaysia's emergency care systems. Our findings stress recognizing common and country-specific challenges for enhanced emergency care quality in Southeast Asia, supporting tailored interventions.

Abstract Background In modern emergency medical services (EMS), ambulances increasingly focus on examining and treating the patient at the scene. This has led to increased levels of non-conveyance. In Finland, for instance, approximately 40% of EMS dispatches end up in non-conveyance. As EMS systems evolve, the proportion of non-conveyance could serve as a cost-effective measure to assess the quality of the dispatch criteria, if a link to the performance of urgency assessment would be established. The purpose of this study was to investigate whether the proportion of non-conveyance is associated with the test performance levels of the urgency assessment. This investigation was done separately within each dispatch category. Methods A retrospective evaluation of the data was conducted on all EMS dispatches in the Pirkanmaa Hospital District from 1 August 2021 through 31 August 2021. There were a total of 7,245 EMS dispatches during the study period of which 829 were excluded. This study was conducted by comparing the existing test performance levels (sensitivity, specificity and under- or overestimation) of the emergency response centre’s urgency assessment with the non-conveyance rate (%) of each dispatch category. The relationships between the variables were measured using Spearman’s rank correlation coefficient. Results The proportion of over-triage was the only urgency assessment’s test performance variable that had a statistically significant correlation with the proportion of non-conveyance (r = 0.568; p = 0.003). Other test performance variables of the urgency assessment had no or little correlation to the proportion of non-conveyance. Of the 6,416 EMS dispatches in the study period, 42% (2,672) resulted in non-conveyance of the patient. In nine dispatch categories, at least half (51–69%) of the dispatches ended in non-conveyance. Conclusions Based on this study, it seems that the percentage of non-conveyance in the dispatch category could be used, with certain limitations, to assess the proportion of over-triage in the dispatch category. The method is particularly applicable in scenarios where the dispatch criteria have undergone modifications and there is a need to monitor the effect of the changes on the level of over-triage.

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

Abstract Background Although unplanned deliveries in ambulances are uncommon, Emergency Medical Services (EMS) providers may encounter this situation before reaching the hospital. This research aims to gather insights from Emergency Medical Technicians (EMTs), midwives, and expectant mothers to examine the causes of giving birth in ambulances and the challenges EMTs, pregnant women, and midwives face during delivery. Methods A qualitative study was conducted, and 28 EMTs, midwives, and pregnant women who had experience with pre-hospital births in the ambulance were interviewed. Data were analyzed using thematic content analysis. The MAXQDA/10 software was employed for data analysis and code extraction. Results The analysis of the interviews revealed two main categories: factors that cause delivery in the ambulance and its challenges. The factors include cultural problems, weak management, and inaccessibility to facilities. The challenges consist of fear and anxiety, native culture, and lack of resources. Conclusions Several approaches should be implemented to reduce the number of births in ambulances and Pre-hospital Emergency Medical Services (PEMS). These include long-term community cultural activities, public education, awareness campaigns, education and follow-up for pregnant women, and improved accessibility to health facilities. Additionally, EMTS need to receive proper education and training for ambulance deliveries. Enhancing ambulance services and supporting EMTs in dealing with litigation claims are also critical.

Abstract The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospital emergency care, affecting both the safety and well-being of the clinicians involved. This study aimed to explore the experiences of Swedish ambulance clinicians when encountering threats and violence during their work. A qualitative approach was used, involving semi-structured interviews with 11 ambulance clinicians from various regions of Sweden. The participants were selected to ensure diversity in gender, age, and educational background. The data were collected over three weeks in 2021 and analyzed using qualitative content analysis. The analysis revealed three key categories related to the challenges faced by ambulance clinicians: Police cooperation challenges, Strategies for a safe care environment, and Impact during and relief after stressful events. These categories highlight the complexities of managing threats and violence in the field. This study sheds light on the multifaceted challenges that ambulance clinicians face due to threats and violence. It underscores the urgent need for comprehensive training, effective communication, and clear role allocation in complex situations. Furthermore, it emphasizes the importance of organized support systems to help clinicians cope with the aftermath of stressful events.

Background/Objectives: the timely and effective management of acute myocardial infarction (AMI) is crucial to improve patient outcomes. 'Self-Referral' is defined as instances either where patients arrive at the hospital by their own means or are transported by someone else, rather than through professional emergency medical services. This approach can lead to treatment delays and potentially worsen outcomes. This study aims to identify the factors associated with the choice of self-referral among patients with AMI in Saxony-Anhalt, Germany. Methods: We used the data from the Regional Myocardial Infarction Registry of Saxony-Anhalt (RHESA), which included 4044 patients with confirmed acute myocardial infarction (AMI), including 48.7% from urban areas (city of Halle) and 51.3% from rural areas (Altmark). The gender distribution was 65% male and 35% female, covering an age range from 25 to over 80 years. Multivariable logistic regression identified factors associated with self-referral and its impact on reaching a hospital with percutaneous coronary intervention (PCI) capability. Results: Rural residents were more likely to self-refer compared to those in urban settings (adjusted odds ratio 2.43 [95% CI: 2.00–2.94]). Odds of self-referral decreased with age, while metabolic factors, including hypertension, high body mass index (BMI), and diabetes, as well as sex were not associated with self-referral. Self-referral did not increase the odds of arriving in a hospital without PCI capability. (Adjusted odds ratio 1.12 [95% CI: 0.85–1.47]). Furthermore, in cases of self-referral, women did not have a disadvantage in reaching a hospital with PCI (0.91; 0.59–1.41) compared to men. However, in medically attended transports, women were at a disadvantage (odds ratio: 1.33; 95% CI: 1.06–1.67). Conclusions: These findings highlight the need for public education on self-referral and for medical personnel training to prevent gender bias in AMI transport to PCI-capable hospitals. [ABSTRACT FROM AUTHOR]

Background: The emergency medical service (EMS) addresses all chief complaints across all ages in various contexts. Children in EMS present a particular challenge due to their unique anatomical and physical properties, which require specific training that EMS clinicians often report lacking. This combination exposes children to incidents threatening patient safety. The most common method to highlight incidents is the incident reporting system. Studies have shown underreporting of such incidents, highlighting the need for multiple methods to measure and enhance patient safety in EMS for children. Thus, the aim of this study was to modify and adapt the current Ambulance TT for road-based EMS (ATT) to a pediatric version (pATT) with a guide containing definitions of triggers. Methods: The adaption of the ambulance trigger tool to a version suitable for children followed a stepwise manner, including (1) a review of previous literature to pinpoint areas of risk regarding patient safety among children in EMS. (2) Three sessions of expert panel discussions via video meetings were held to evaluate each trigger of the ATT in terms of clinical relevance, comprehensibility, language and areas of risk regarding patient safety among children in EMS. (3) Clinical use of the pATT along with Retrospective Record Review (RRR). (4) Calculation of Item-level validity index and positive predictive value (PPV) for each trigger. (5) calculate inter-rater reliability between two independent record reviewers. Results: The literature search revealed 422 respective 561 articles in Cinahl and Medline where headlines and abstracts were read to identify areas posing risks to patient safety in EMS for children. During the structured discussions, one trigger was added to the existing 19 derived from the ATT, and the trigger definitions were modified to suit children. The three most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (63.9%), incomplete documentation (48.3%), and the patient is non conveyed after EMS assessment (41.1%). The positive triggers were categorized into near miss (54.6%), no harm incident (5.8%), and harmful incident (0.4%). Inter-rater reliability testing showed excellent agreement. Conclusion: This study demonstrates the adaptation of an existing trigger tool (ATT) to one suitable for children. It also shows that the trigger tool, along with retrospective record review, is a feasible method to evaluate patient safety in EMS, thus complementing existing methods. [ABSTRACT FROM AUTHOR]

Background: Tele-assisted home-based palliative care (THPC) usually fulfills the desire of terminal patients to pass away at home. The overall costs of such a service deserve evaluation. Objectives: This study aims to determine health care utilization and costs for cancer patients at the end of life, stratified by THPC service. Design: Patients who received THPC were matched 1:1 based on age, gender, year of death, and propensity score with those who did not receive THPC. Setting/Subjects: A total of 773 cancer patients passed away in a regional hospital in Taiwan during the period of 2012–2020, of which 293 received THPC. Measurements: We measured the rates and costs of outpatient clinic visits, emergency department (ED) visits, hospitalizations, and intensive care unit (ICU) admissions during the last week, the last two weeks and the last month before death. In addition, we estimated the driving times and expenses required for transportation from each cancer patient's home to the hospital using Google Maps. National Health Insurance (NHI) reimbursements and out-of-pocket expenses were also calculated. Results: In comparison with patients without THPC, those who received THPC had a 50% lower likelihood of visiting the ED or being hospitalized, a more than 90% reduced chance of ICU admission, but were four times more likely to obtain their medicines from outpatient clinics. THPC patients had similar out-of-pocket expenditures, approximately half of the NHI costs, and lower rates and costs for ambulance transportation to the ED. Conclusions: THPC reduced health care costs for terminal cancer patients in the last week, the last two weeks, and the last month before death, while also increasing the likelihood of patients being able to rest and pass away at home. [ABSTRACT FROM AUTHOR]

Background: Inadequate handover documentation may result in delay and adverse outcomes during continuity of care. This is much more important in interfacility transfers where improper or missing documentation of prior events from a referring point may result in a break in the continuity of care. Subjects and Methods: This was a cross-sectional observational study done to evaluate the quality of referral documentation available with the patients who were referred to a tertiary care center after consultation in a peripheral center between March 2024 and May 2024. A semi-structured pro forma was used to collect transfer characteristics and quality of transfer documents at the time of admission. Results: A total of 156 children were enrolled in the study. The mean age of children was 6.81 ± 5.79 years. 68 (43.6%) were referred from a private nursing home. Healthcare workers accompanied only 19 (12.2%) children. Referral documentation was available in 121 (77.6%). 96/121 (61.5%) had handwritten referral papers. Pretransport communication was received only in one patient. Patients being referred by private physicians (70.8%) and smaller hospitals (80.9%) have better documentation than medical colleges (40.9%) (P = 0.03), patients being transported in an ambulance (87.23% vs. 73.4%, P = 0.05) have higher chances of having referral documentation. Conclusions: There is a lack of pretransfer referral communication and quality referral documents. Pediatric referral services in the region are fragmented and nonuniform. There is a need to improve pediatric referral documentation and transfer services. [ABSTRACT FROM AUTHOR]

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

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

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado 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: In modern emergency medical services (EMS), ambulances increasingly focus on examining and treating the patient at the scene. This has led to increased levels of non-conveyance. In Finland, for instance, approximately 40% of EMS dispatches end up in non-conveyance. As EMS systems evolve, the proportion of non-conveyance could serve as a cost-effective measure to assess the quality of the dispatch criteria, if a link to the performance of urgency assessment would be established. The purpose of this study was to investigate whether the proportion of non-conveyance is associated with the test performance levels of the urgency assessment. This investigation was done separately within each dispatch category. Methods: A retrospective evaluation of the data was conducted on all EMS dispatches in the Pirkanmaa Hospital District from 1 August 2021 through 31 August 2021. There were a total of 7,245 EMS dispatches during the study period of which 829 were excluded. This study was conducted by comparing the existing test performance levels (sensitivity, specificity and under- or overestimation) of the emergency response centre's urgency assessment with the non-conveyance rate (%) of each dispatch category. The relationships between the variables were measured using Spearman's rank correlation coefficient. Results: The proportion of over-triage was the only urgency assessment's test performance variable that had a statistically significant correlation with the proportion of non-conveyance (r = 0.568; p = 0.003). Other test performance variables of the urgency assessment had no or little correlation to the proportion of non-conveyance. Of the 6,416 EMS dispatches in the study period, 42% (2,672) resulted in non-conveyance of the patient. In nine dispatch categories, at least half (51–69%) of the dispatches ended in non-conveyance. Conclusions: Based on this study, it seems that the percentage of non-conveyance in the dispatch category could be used, with certain limitations, to assess the proportion of over-triage in the dispatch category. The method is particularly applicable in scenarios where the dispatch criteria have undergone modifications and there is a need to monitor the effect of the changes on the level of over-triage. [ABSTRACT FROM AUTHOR]

Rapid economic growth in Indonesia and Malaysia has widened the gap in emergency care supply and demand, intensifying challenges. Our study, from August to November 2022, assesses current diverse challenges in both countries' emergency care systems from frontline staff perspectives. The online survey involved emergency department (ED) personnel from 11 hospitals in Indonesia and Malaysia, drawing from an existing network. The survey collected data on respondents' characteristics, factors affecting prehospital and ED care quality, missing clinical information, and factors influencing patients' ED stay duration. With 83 respondents from Indonesia and 109 from Malaysia, the study identified common challenges. In both countries, inadequate clinical information from ambulances posed a primary challenge in prehospital care quality, while crowdedness during night shifts affected ED care quality. Frequent gaps in essential clinical information, such as family and medication history, were observed. Prolonged ED stays were associated with diagnostic studies and their turnaround time. This study offers insights into shared challenges in Indonesia and Malaysia's emergency care systems. Our findings stress recognizing common and country-specific challenges for enhanced emergency care quality in Southeast Asia, supporting tailored interventions. [ABSTRACT FROM AUTHOR]

Background: Sepsis is defined as a dysfunctional host response to infection. The diverse clinical presentations of sepsis pose diagnostic challenges and there is a demand for enhanced diagnostic markers for sepsis as well as an understanding of the underlying pathological mechanisms involved in sepsis. From this perspective, metabolomics has emerged as a potentially valuable tool for aiding in the early identification of sepsis that could highlight key metabolic pathways and underlying pathological mechanisms. Objective: The aim of this investigation is to explore the early metabolomic and lipidomic profiles in a prospective cohort where plasma samples (n = 138) were obtained during ambulance transport among patients with infection according to clinical judgement who subsequently developed sepsis, patients who developed non-septic infection, and symptomatic controls without an infection. Methods: Multiplatform metabolomics and lipidomics were performed using UHPLC–MS/MS and UHPLC–QTOFMS. Uni- and multivariable analysis were used to identify metabolite profiles in sepsis vs symptomatic control and sepsis vs non-septic infection. Results: Univariable analysis disclosed that out of the 457 annotated metabolites measured across three different platforms, 23 polar, 27 semipolar metabolites and 133 molecular lipids exhibited significant differences between patients who developed sepsis and symptomatic controls following correction for multiple testing. Furthermore, 84 metabolites remained significantly different between sepsis and symptomatic controls following adjustment for age, sex, and Charlson comorbidity score. Notably, no significant differences were identified in metabolites levels when comparing patients with sepsis and non-septic infection in univariable and multivariable analyses. Conclusion: Overall, we found that the metabolome, including the lipidome, was decreased in patients experiencing infection and sepsis, with no significant differences between the two conditions. This finding indicates that the observed metabolic profiles are shared between both infection and sepsis, rather than being exclusive to sepsis alone. [ABSTRACT FROM AUTHOR]

Background: Ambulance callouts and conveyances continue to increase disproportionately to population growth. This is largely driven by low- and medium-acuity patients who do not require ambulance management. We aimed to estimate the proportion of patients paramedics have conveyed to an emergency department (ED) via ambulance whom they considered suitable for primary care, and understand the barriers that contributed to these decisions. Methods: A cross-sectional survey of registered paramedics in Victoria, Australia, was undertaken using an online questionnaire during 2022. Responses are presented using descriptive statistics, and logistic regression was used to identify associations between paramedic characteristics and barriers influencing primary care pathway referral. Results: A total of 367 responses were received. Of these, 70% of paramedics reported that at least half of the patients they conveyed to an ED were suitable for a primary care pathway. Paramedics reported high levels of confidence and support for primary care pathways in lieu of transport, however this had no correlation with their self-reported practice. The most common barrier to primary care pathway referral was limited access to a suitable primary care pathway (68%) followed by fear of an internal complaint, litigation or organisational pressure to convey patients to an ED (66%). Paramedics regarded themselves as more supportive of primary care pathway referral than those around them, including their peers, mentors, employers and university. They also reported that the COVID-19 pandemic had increased their personal support for primary care pathways, as well as organisational support from their employer, without corresponding increase in the broader medical and public communities. In fact, paramedics reported the COVID-19 pandemic had decreased support from the public and patients to refer patients to primary care pathways, and 57% of paramedics reported conveying a patient that had declined their primary care referral in the past week. Conclusions: Paramedics frequently convey to an ED patients who they believe are appropriate for a primary care pathway. Paramedics face practical barriers such as a lack of available primary care providers and perceived lack of cultural support that contribute to this practice. Paramedics are increasingly attending low- and medium-acuity patients, and paramedics in our survey self-reported that at least half of the patients they conveyed to an ED were appropriate for a primary care pathway. Notable barriers to primary care referrals included limited access to suitable primary care and fear of organisational repercussions or litigation following non-conveyance. This research has important implications for the educational, practical and organisational support given to paramedics regarding primary care diversion for suitable patients. [ABSTRACT FROM AUTHOR]

Background: First responders (i.e. police and ambulance staff) have increasingly become part of the mental health care system, often being the first port of call for those experiencing a crisis. Despite their frequent involvement in supporting those with mental health problems, there is evidence that mental health stigma is high amongst first responders. Aims: The aim of the present study was to evaluate a brief training video aimed at reducing mental health stigma amongst first responders. Methods: First responders watched a training video based on the cognitive behavioural model of mental health stigma, and involved contributions from people with lived experience, and first responders. Measures of mental health stigma were collected before and after viewing the training. Results: The training video produced small but significant improvements in mental health stigma, and these effects did not differ between police and ambulance staff. We were unable to determine what psychological constructs mediated this change in stigma. The feedback on the training video was generally positive, but also indicated some key areas for future development. Conclusions: The present study provides encouraging evidence that levels of mental health stigma can be improved using a resource-light training intervention. [ABSTRACT FROM AUTHOR]

Background: Assistive devices (ADs) for ambulation are commonly provided to improve safety and independence in older adults. Despite the common use of these devices, there are no standard prescribing guidelines, and non-health care providers, including caregivers and family members, often make decisions about the need for ADs. Identifying factors or a single screening test associated with AD use would benefit clinicians and non-health care caregivers in making decisions to adopt an AD for patients, clients, and family members. Purpose/Objectives: The purpose of this cross-sectional study was to identify the test that best predicts ADs for ambulation and non-AD use among community-dwelling individuals. Methods: Eighty-five older adults (81.6 ± 8.2 years old) who underwent outpatient physical therapy participated in this study. They participated in a series of tests, including the Timed Up and Go, handgrip and quadriceps strength, the 30-second chair-rise test, the 5-m fast gait speed, the Functional Independence Measure, the locomotive syndrome tests (stand-up test, 2-step test [2ST], and the Locomo-5 Checklist), and numeric pain scales. Mann-Whitney U tests were used to identify differences between those who did and did not use an AD for ambulation. Logistic regression analyses were used to examine which test best predicted AD use. Results: 80% of participants (n = 68) used an AD for ambulation. There were significant differences in all test variables between users and nonusers (P = .033 to P < .001), except for quadriceps strength, age, and pain (all P > .05). Only the 2ST was a significant predictor of AD use, with a cutoff distance of the toe-to-toe stride shorter than 93% of body height (sensitivity: 72%, and specificity: 82%, P = .048). Discussion: Simple functional measures differed between those who did and did not use ADs for ambulation; however, only the 2ST predicted AD status. Individuals who cannot step 93% of their body height may be appropriate for an AD. Conclusions: If comprehensive clinical evaluations are not available to make decisions about AD use, the 2ST can be used to make clinical recommendations for an AD for ambulation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to summarize the literature on the applications of machine learning (ML) and their performance in Emergency Medical Services (EMS). Methods: Four relevant electronic databases were searched (from inception through January 2024) for all original studies that employed EMS-guided ML algorithms to enhance the clinical and operational performance of EMS. Two reviewers screened the retrieved studies and extracted relevant data from the included studies. The characteristics of included studies, employed ML algorithms, and their performance were quantitively described across primary domains and subdomains. Results: This review included a total of 164 studies published from 2005 through 2024. Of those, 125 were clinical domain focused and 39 were operational. The characteristics of ML algorithms such as sample size, number and type of input features, and performance varied between and within domains and subdomains of applications. Clinical applications of ML algorithms involved triage or diagnosis classification (n = 62), treatment prediction (n = 12), or clinical outcome prediction (n = 50), mainly for out-of-hospital cardiac arrest/OHCA (n = 62), cardiovascular diseases/CVDs (n = 19), and trauma (n = 24). The performance of these ML algorithms varied, with a median area under the receiver operating characteristic curve (AUC) of 85.6%, accuracy of 88.1%, sensitivity of 86.05%, and specificity of 86.5%. Within the operational studies, the operational task of most ML algorithms was ambulance allocation (n = 21), followed by ambulance detection (n = 5), ambulance deployment (n = 5), route optimization (n = 5), and quality assurance (n = 3). The performance of all operational ML algorithms varied and had a median AUC of 96.1%, accuracy of 90.0%, sensitivity of 94.4%, and specificity of 87.7%. Generally, neural network and ensemble algorithms, to some degree, out-performed other ML algorithms. Conclusion: Triaging and managing different prehospital medical conditions and augmenting ambulance performance can be improved by ML algorithms. Future reports should focus on a specific clinical condition or operational task to improve the precision of the performance metrics of ML models. [ABSTRACT FROM AUTHOR]

Background: Since the COVID-19 pandemic and the introduction of the National Partnership Agreement: Right Care, Right Person in the UK, paramedics spend about 1.8 million hours per year managing people with mental health issues. The UK health service needs to address the urgent training requirements for paramedics to provide mental healthcare in emergency care provision. Aims: To identify and examine current research on how paramedics manage people with mental health issues. Methods: A scoping review was carried out using the five stages of Arksey and O'Malley's framework. A research question—'How do paramedics manage patients with mental health issues?'—was developed, databases searched, studies identified and data charted, summarised and reported. Findings: Fifteen papers were included, and five themes identified: perceptions and expectations; call triage and inter-service collaboration; communication skills; lack of education and training; and assessment and evidence-based interventions. Conclusions: There is global evidence of the deficiencies in paramedic education around mental health presentation and a need for evidence-based education and interventions to improve patient outcomes. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office 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.)

The increasing prevalence of threats and violence against ambulance clinicians is a critical issue that has not been adequately studied. These incidents pose significant challenges to the provision of prehospital emergency care, affecting both the safety and well-being of the clinicians involved. This study aimed to explore the experiences of Swedish ambulance clinicians when encountering threats and violence during their work. A qualitative approach was used, involving semi-structured interviews with 11 ambulance clinicians from various regions of Sweden. The participants were selected to ensure diversity in gender, age, and educational background. The data were collected over three weeks in 2021 and analyzed using qualitative content analysis. The analysis revealed three key categories related to the challenges faced by ambulance clinicians: Police cooperation challenges, Strategies for a safe care environment, and Impact during and relief after stressful events. These categories highlight the complexities of managing threats and violence in the field. This study sheds light on the multifaceted challenges that ambulance clinicians face due to threats and violence. It underscores the urgent need for comprehensive training, effective communication, and clear role allocation in complex situations. Furthermore, it emphasizes the importance of organized support systems to help clinicians cope with the aftermath of stressful events. [ABSTRACT FROM AUTHOR]

Introduction: Postpartum hemorrhage (PPH) is a critical birth complication, and is stated by the World Health Organization (WHO) as among the five most frequent causes of death during pregnancy. External aortic compression (EAC) is recommended by the WHO as an intervention to achieve temporary bleeding control. An increasing number of births outside hospital underlines the importance of competence in handling potential birth complications, such as PPH. The aim of this study was to assess prehospital personnel's education, training, knowledge, and experiences regarding PPH and EAC across Norway. Methods: Prehospital personnel were invited to respond to a questionnaire through social media. Questions included those on education, training, knowledge, and experience regarding PPH and EAC. The Statistical Package for the Social Sciences (SPSS) version 28 was used to analyze the data, using descriptive statistics. Results: Over a two-month period, 211 prehospital personnel responded to the questionnaire, of whom 55.5% were male. The respondents had an average of 10.3 years of prehospital experience. About half of the respondents had received education (48.6%) and training (62.4%) in PPH management. Still, 95.7 percent reported a need for more education and training. On knowledge questions, only half of the responses were correct (43.7% to 60.5%). Only 21 percent of the respondents had experienced patients with PPH, and of these only 3.8 percent had used EAC. Bimanual uterine compression was the most frequent intervention used (62.5%) across hospital trusts. Conclusions: Even if prehospital personnel receive education and training in the management of PPH and EAC, almost all report needing more. The results indicate a national variation, which may be discussed as to whether it is appropriate. [ABSTRACT FROM AUTHOR]

Aims: In tackling rising diabetes‐related emergencies, the need to understand and address emergency service usage by people with type 1 diabetes is vital. This review aimed to quantify current trends in presentations for type 1 diabetes‐related emergencies and identify public health strategies that reduce the frequency of diabetes‐related emergencies and improve glycaemic management. Methods: Medline (OVID), Cochrane and CINAHL were searched for studies published between 2000 and 2023, focusing on people with type 1 diabetes, severe hypoglycaemia and/or diabetic ketoacidosis, and ambulance and/or emergency department usage. There were 1313 papers identified, with 37 publications meeting review criteria. Results: The incidence of type 1 diabetes‐related emergencies varied from 2.4 to 14.6% over one year for hypoglycaemic episodes, and between 0.07 and 11.8 events per 100 person‐years for hyperglycaemic episodes. Notably, our findings revealed that ongoing diabetes education and the integration of diabetes technology, such as continuous glucose monitoring and insulin pump therapy, significantly reduced the incidence of these emergencies. However, socio‐economic disparities posed barriers to accessing these technologies, subsequently shifting the cost to emergency healthcare and highlighting the need for governments to consider subsidising these technologies as part of preventative measures. Conclusions: Improving access to continuous glucose monitoring and insulin pump therapy, in combination with ongoing diabetes education focusing on symptom recognition and early management, will reduce the incidence of diabetes‐related emergencies. Concurrent research assessing emergency healthcare usage patterns during the implementation of such measures is essential to ensure these are cost‐effective. [ABSTRACT FROM AUTHOR]

'Ramping' is a commonly used term in contemporary Australian healthcare. It is also a part of the public and political zeitgeist. However, its precise definition varies among sources. In the published literature, there are distinctions between related terms, such as 'entry overload' and 'Patient Off Stretcher Time Delay'. How ramping is defined and how it came to be defined have significance for policies and procedures relating to the described phenomenon. Through examination of the history of the term, insights are obtained into the underlying issues contributing to ramping and, accordingly, associated possible solutions. [ABSTRACT FROM AUTHOR]