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Background: The quality of care given by EMS staff is in part monitored by routine review of deployment reports that the providers must complete after each deployment. The assessment consists of determining whether a deployment was performed in a medically correct manner and thus whether the clinical reasoning process was appropriate. The time used during the deployment is also measured, as there are often time limits for performing different parts of the deployment and these must be adhered to. One might question whether measuring the time spent really gives insight into the quality of care, and if it might not be more useful to see how that time was spent. We therefore conceived a study to map the EMS care process and evaluate this process in relation to the time used., Methods: We used a focused ethnographic study design. Video recordings of EMS deployments in combination with semi-structured interviews of the EMS providers involved, were thematically analysed. This led to insights into the EMS care process and the embedded clinical reasoning. By categorising the professional activities we identified we were able to define a model that describes in general the EMS care process. We reported the first part of this study in which we developed this so called SPART model in a separate paper. In this second part of the study we determined the execution time within a deployment and measured the frequency of occurrence and the duration of the identified activities. We interpreted the operational content and the time variables both qualitatively and quantitatively. We also determined the distribution of activities over the three deployment operational periods (response, on-scene and transport period)., Results: Using the SPART model, we gained insight into the different activities' nature, order, and duration. We could qualitatively judge the effectiveness of the clinical reasoning process, i.e., the quality of care delivered. Generally, the studied cases were followable, and the clinical reasoning process was medically logical. The diagnostic process sometimes continued after the clinical decision, which was not medically logical. Remarkably, this never changed the clinical decision. Although this could negatively affect the quality of care, we found no clinical evidence that this was the case., Conclusion: Our findings demonstrated that the quality of care in EMS can be measured by using the SPART model to evaluate EMS deployments. We concluded that qualitative judgment was more important than quantitative evaluation. Interpreting the order of different activities led to the clearest understanding of the clinical reasoning process. It was concluded that knowledge of the exact time used per activity and, in total, had the least impact on understanding the clinical reasoning process., Competing Interests: All authors declare that they have no competing interests related to this work., (Copyright: © 2024 Dercksen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Purpose: To evaluate the pre-hospital administration of tranexamic acid in ambulance-treated trauma patients with a severe hemorrhage after the implementation of tranexamic acid administration in the Dutch pre-hospital protocol., Methods: All patients with a severe hemorrhage who were treated and conveyed by EMS professionals between January 2015, and December 2017, to any trauma-receiving emergency department in the eight participating trauma regions in the Netherlands, were included. A severe hemorrhage was defined as extracranial injury with > 20% body volume blood loss, an extremity amputation above the wrist or ankle, or a grade ≥ 4 visceral organ injury. The main outcome was to determine the proportion of patients with a severe hemorrhage who received pre-hospital treatment with tranexamic acid. A Generalized Linear Model (GLM) was performed to investigate the relationship between pre-hospital tranexamic acid treatment and 24 h mortality., Results: A total of 477 patients had a severe hemorrhage, of whom 124 patients (26.0%) received tranexamic acid before arriving at the hospital. More than half (58.4%) of the untreated patients were suspected of a severe hemorrhage by EMS professionals. Patients treated with tranexamic acid had a significantly lower risk on 24 h mortality than untreated patients (OR 0.43 [95% CI 0.19-0.97])., Conclusion: Approximately a quarter of the patients with a severe hemorrhage received tranexamic acid before arriving at the hospital, while a severe hemorrhage was suspected in more than half of the non-treated patients. Severely hemorrhaging patients treated with tranexamic acid before arrival at the hospital had a lower risk to die within 24 h after injury., (© 2023. The Author(s).)

Background: Clinical reasoning is a crucial task within the Emergency Medical Services (EMS) care process. Both contextual and cognitive factors make the task susceptible to errors. Understanding the EMS care process' structure could help identify and address issues that interfere with clinical reasoning. The EMS care process is complex and only basically described. In this research, we aimed to define the different phases of the process and develop an overarching model that can help detect and correct potential error sources, improve clinical reasoning and optimize patient care., Methods: We conducted a focused ethnography study utilizing non-participant video observations of real-life EMS deployments combined with thematic analysis of peer interviews. After an initial qualitative analysis of 7 video observations, we formulated a tentative conceptual model of the EMS care process. To test and refine this model, we carried out a qualitative, thematic analysis of 28 video-recorded cases. We validated the resulting model by evaluating its recognizability with a peer content analysis utilizing semi-structured interviews., Results: Based on real-life observations, we were able to define and validate a model covering the distinct phases of an EMS deployment. We have introduced the acronym "SPART" to describe ten different phases: Start, Situation, Prologue, Presentation, Anamnesis, Assessment, Reasoning, Resolution, Treatment, and Transfer., Conclusions: The "SPART" model describes the EMS care process and helps to understand it. We expect it to facilitate identifying and addressing factors that influence both the care process and the clinical reasoning task embedded in this process., (© 2021. The Author(s).)

Background: A thorough handover in the emergency department (ED) is of great importance for improving the quality and safety in the chain of care. The satisfaction of handover may reflect the quality of handover. Research to discover the variables influencing the satisfaction of handovers is scarce. The goal of this study was to determine the factors influencing the satisfaction regarding handovers from ambulance and ED nurses., Methods: We performed a prospective observational study in the University Medical Center of Groningen. Data regarding prehospital-hospital handovers has been collected by observing handovers and assessing patient chart information. Data regarding the satisfaction has been collected with a questionnaire including a 5-point scale for the level of satisfaction., Results: In total, 97 handovers were observed and 97 ambulance nurses and 89 ED nurses completed the questionnaire. The satisfaction of ambulance nurses showed a negative correlation with the waiting time prior to handover (r = -.287, p = .004) and a positive correlation with the presence of a physician in the receiving team (r = .224, p = .028). The satisfaction of ED nurses showed a positive correlation with the use of the ABCDE (r = .288, p = .006) and AMPLE instrument (r = .208, p = .050)., Conclusion: The satisfaction of ambulance and ED nurses as sender or receiver of the handover is determined by different factors. The satisfaction of ambulance nurses is mainly affected by the waiting time and presence of a physician, while the satisfaction of ED nurses is affected by the use of handover instruments and the completeness of medical information.