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In patients with out-of-hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post-ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced-based, goal-directed bundle of care targeting specified vital parameters in the immediate post-ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal-directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal-directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.

Background: Family presence during resuscitation is a controversial issue worldwide. The aim of this study was to investigate the self-confidence and attitudes of Emergency Medical Technicians (EMTs) towards family presence during resuscitation (FPDR). Methods: In this cross-sectional study, a random sample of 252 EMTs were selected from 110 prehospital emergency centers. Two main questionnaires were used to collect data on the EMTs' self-confidence and attitudes towards FPDR. Results: The results showed that the EMTs' attitudes towards FPDR were lower than the mean (43.69 ± 19.40). In addition, more than 85% of them stated that the resuscitation process was stressful for the patient's companions. There was a positive correlation between EMTs' self-confidence and attitudes towards FPDR (r = 0.52, p < 0.01). The results showed that the smaller number of family members present during resuscitation was associated with higher EMTs' self-confidence and more positive attitudes towards FPDR. Moreover, personnel with more experience, liability insurance, and advanced resuscitation training were significantly more self-confident than other personnel. Conclusion: A large number of the EMS personnel have a negative attitude towards FPDR, but EMTs, with higher self-confidence, have a more positive attitude. Therefore, it is possible to improve the EMTs attitudes towards FPDR and increase their self-confidence by training them to perform resuscitation in the presence of the family and by preventing people from gathering at resuscitation scenes. [ABSTRACT FROM AUTHOR]

Copyright of Arab Journal for Scientific Publishing is the property of Research & Development of Human Recourses Center (REMAH) 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: Many prehospital emergency patients receive suboptimal treatment for their moderate to severe pain. Various factors may contribute. We aim to systematically review literature pertaining to prehospital emergency adult patients with acute pain and the pain‐reducing effects, adverse events (AEs), and safety issues associated with inhaled analgetic agents compared with other prehospital analgesic agents. Methods: As part of an initiative from the Scandinavian Society of Anaesthesia and Intensive Care Medicine, we conducted a systematic review (PROSPERO CRD42018114399), applying the PRISMA guidelines, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and Cochrane methods, searching the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination, PubMed, and EMBASE databases (updated March 2024). Inclusion criteria were the use of inhaled analgesic agents in adult patients with acute pain in the prehospital emergency care setting. All steps were performed by minimum of two individual researchers. The primary outcome was pain reduction; secondary outcomes were speed of onset, duration of effect, and relevant AEs. Results: We included seven studies (56,535 patients in total) that compared inhaled agents (methoxyflurane [MF] and nitrous oxide [N2O]) to other drugs or placebo. Study designs were randomized controlled trial (1; n = 60), randomized non‐blinded study (1; n = 343), and randomized open‐label study (1; n = 270). The remaining were prospective or retrospective observational studies. The evidence according to GRADE was of low or very low quality. No combined meta‐analysis was possible. N2O may reduce pain compared to placebo, but not compared to intravenous (IV) paracetamol, and may be less effective compared to morphine and MF. MF may reduce pain compared to paracetamol, ketoprofen, tramadol, and fentanyl. Both agents may be associated with marked but primarily mild AEs. Conclusion: We found low‐quality evidence suggesting that both MF and N2O are safe and may have a role in the management of pain in the prehospital setting. There is low‐quality evidence to support MF as a short‐acting single analgesic or as a bridge to IV access and the administration of other analgesics. There may be occupational health issues regarding the prehospital use of N2O. [ABSTRACT FROM AUTHOR]

Purpose: Global warming is one of the critical problems affecting health, society, and the economy. High temperatures are linked to an increase in heat-related illnesses, which have significantly impacted the public health system, particularly emergency medical services (EMS). Analyzing the pattern of heat-related illness cases in EMS can improve resource utilization and preparedness within the public health system. Patients and Methods: A retrospective study was conducted on EMS data from Srinagarind Hospital, Thailand, covering the summer months (February to May) from 2020 to 2024. Patients with heat-related illnesses were identified in the EMS database using the 10th revision of the International Classification of Diseases (ICD-10) version 2019, specifically codes under "T67 Effects of Heat and Light", which include heat stroke, heat syncope, heat cramps, heat exhaustion, and heat fatigue. Results: A total of 136 EMS operations from the hospital's database were analyzed. In the summer 2024 group, 95.7% (N=44) of the patients were male. The majority of EMS triage cases required resuscitation (P = 0.020). Outdoor activity was identified as a significant factor related to heat illness, with rates of 83.3%, 92.9%, 93.3%, 97.1%, and 93.5% over the five years of the study. The activation time was 1.30 minutes for the summer of 2024 and 1.24 minutes for the summer of 2023. Notably, the average scene time in the summer 2024 group was significantly longer at 25.2 minutes, compared to 12.0 minutes in the summer 2020 group (P< 0.001). Conclusion: Outdoor activity was the most significant risk factor associated with increased heat-related illnesses. Other contributing factors included male gender, age between 20– 40 years, scene temperatures above 35°C, and prolonged scene times exceeding 15 minutes. [ABSTRACT FROM AUTHOR]

Abstract Background Family presence during resuscitation is a controversial issue worldwide. The aim of this study was to investigate the self-confidence and attitudes of Emergency Medical Technicians (EMTs) towards family presence during resuscitation (FPDR). Methods In this cross-sectional study, a random sample of 252 EMTs were selected from 110 prehospital emergency centers. Two main questionnaires were used to collect data on the EMTs’ self-confidence and attitudes towards FPDR. Results The results showed that the EMTs’ attitudes towards FPDR were lower than the mean (43.69 ± 19.40). In addition, more than 85% of them stated that the resuscitation process was stressful for the patient’s companions. There was a positive correlation between EMTs’ self-confidence and attitudes towards FPDR (r = 0.52, p

Abstract Background Violence against Emergency Medical Services (EMS) personnel vary between studies. Current studies are mainly based on self-reporting, thus other designs are needed to provide more perspective. The purpose of this study was to explore the rate and predictors of violent behavior targeted at EMS personnel by exploring the Electronic patient care records (ePCR) documentation by EMS personnel. Methods This was a retrospective cohort study of EMS patients in Finland. The data were collected from three regions between 1st June and 30th November 2018. Text mining and manual evaluation were used to identify and explore predictors of violence targeted at EMS personnel from the ePCR narratives. Multivariable logistic regressions were used to determine factors that were independently associated with violent behavior. The results are presented with odds ratios (ORs) with 95% confidence intervals (CIs). Results The EMS personnel reported experiences of violence in a total of 297 identified missions (0.7%) of all EMS missions (n = 40,263). The violence was mostly verbal (62.3%) and the most common violence perpetrator was the patient (98.0%). The police were alarmed to many missions where violence was reported (40.7%). Sometimes violence occurred suddenly although the police were present. The multivariable logistic regression model indicates that violence occurred typically in urban areas (OR 1.699; 95% CI 1.283 to 2.248), at weekend nights (OR 1.357; 95% CI 1.043 to 1.765), by male (OR 1.501; 95% CI 1.160 to 1.942), and patients influenced by alcohol (OR 3.464; 95% CI 2.644 to 4.538). A NEWS2 score of 3 in any parameter (vs. score 0–4, OR 2.386; 95% CI: 1.788 to 3.185) and ALS unit type (vs. BLS, OR 1.373; 95% CI: 1.009 to 1.866) increased the likelihood as well. Conclusions The documentation in ePCRs show low rates of violence targeted at EMS personnel. However, violence is a multidimensional phenomenon connected to unfamiliar patients, rushed situations, and an uncontrolled environment. This means that the EMS personnels’ safety cannot be ensured in all situations. Therefore, a balance between safety margins and treating patients needs to be considered.

Background. Studies have shown that the application of motorcycles in the pre-hospital emergency services in an urban environment improves the time index and the quality of services. The present study aimed to evaluate the performance of the services provided by motorlance in the Tabriz metropolis between 2018-2021. Methods. In this cross-sectional study conducted in the Tabriz pre-hospital emergency center, the recorded data about the patients using motorlance between 2018-2021 were collected and examined. The collected variables included the age, sex, chief complaint of the patients, vital signs of the patients, and final result of the mission in the pre-hospital setting. Two important indices of reaction time and response time in all the missions were evaluated. Results. A total of 9866 motorlance missions were completed during the study period. The mean reaction time was 68.24±62.91 seconds, and the mean response time was 641.70±304.48 seconds. Examination of the patients' chief complaint revealed that the lowest reaction time was for patients with abdominal pain (mean 44.90), and the lowest response time was for patients with cardiopulmonary arrest (mean 550.52). Conclusion. It was concluded that the timing indicators of motorlance missions were within the acceptable range for ambulances. Practical Implications. It was found necessary to increase the number of motorlance in metropolitan cities and employ experienced and knowledgeable personnel in motorlance in order to improve the existing situation and the quality of services.

Abstract Background Prehospital management of severely burned patients is extremely challenging. It should include adequate analgesia, decision-making on the necessity of prehospital endotracheal intubation and the administration of crystalloid fluids. Guidelines recommend immediate transport to specialised burn centres when certain criteria are met. To date, there is still insufficient knowledge on the characteristics of prehospital emergency treatment. We sought to investigate the current practice and its potential effects on patient outcome. Methods We conducted a single centre, retrospective cohort analysis of severely burned patients (total burned surface area > 20%), admitted to the Berlin burn centre between 2014 and 2019. The relevant data was extracted from Emergency Medical Service reports and digital patient charts for exploratory data analysis. Primary outcome was 28-day-mortality. Results Ninety patients (male/female 60/30, with a median age of 52 years [interquartile range, IQR 37–63], median total burned surface area 36% [IQR 25–51] and median body mass index 26.56 kg/m2 [IQR 22.86–30.86] were included. The median time from trauma to ED arrival was 1 h 45 min; within this time, on average 1961 ml of crystalloid fluid (0.48 ml/kg/%TBSA, IQR 0.32–0.86) was administered. Most patients received opioid-based analgesia. Times from trauma to ED arrival were longer for patients who were intubated. Neither excessive fluid treatment (> 1000 ml/h) nor transport times > 2 h was associated with higher mortality. A total of 31 patients (34,4%) died within the hospital stay. Multivariate regression analysis revealed that non-survival was linked to age > 65 years (odds ratio (OR) 3.5, 95% CI: 1.27–9.66), inhalation injury (OR 3.57, 95% CI: 1.36–9.36), burned surface area > 60% (OR 5.14, 95% CI 1.57–16.84) and prehospital intubation (5.38, 95% CI: 1.92–15.92). Conclusion We showed that severely burned patients frequently received excessive fluid administration prehospitally and that this was not associated with more hemodynamic stability or outcome. In our cohort, patients were frequently intubated prehospitally, which was associated with increased mortality rates. Further research and emergency medical staff training should focus on adequate fluid application and cautious decision-making on the risks and benefits of prehospital intubation. Trial registration German Clinical Trial Registry (ID: DRKS00033516).

Background: Violence against Emergency Medical Services (EMS) personnel vary between studies. Current studies are mainly based on self-reporting, thus other designs are needed to provide more perspective. The purpose of this study was to explore the rate and predictors of violent behavior targeted at EMS personnel by exploring the Electronic patient care records (ePCR) documentation by EMS personnel. Methods: This was a retrospective cohort study of EMS patients in Finland. The data were collected from three regions between 1st June and 30th November 2018. Text mining and manual evaluation were used to identify and explore predictors of violence targeted at EMS personnel from the ePCR narratives. Multivariable logistic regressions were used to determine factors that were independently associated with violent behavior. The results are presented with odds ratios (ORs) with 95% confidence intervals (CIs). Results: The EMS personnel reported experiences of violence in a total of 297 identified missions (0.7%) of all EMS missions (n = 40,263). The violence was mostly verbal (62.3%) and the most common violence perpetrator was the patient (98.0%). The police were alarmed to many missions where violence was reported (40.7%). Sometimes violence occurred suddenly although the police were present. The multivariable logistic regression model indicates that violence occurred typically in urban areas (OR 1.699; 95% CI 1.283 to 2.248), at weekend nights (OR 1.357; 95% CI 1.043 to 1.765), by male (OR 1.501; 95% CI 1.160 to 1.942), and patients influenced by alcohol (OR 3.464; 95% CI 2.644 to 4.538). A NEWS2 score of 3 in any parameter (vs. score 0–4, OR 2.386; 95% CI: 1.788 to 3.185) and ALS unit type (vs. BLS, OR 1.373; 95% CI: 1.009 to 1.866) increased the likelihood as well. Conclusions: The documentation in ePCRs show low rates of violence targeted at EMS personnel. However, violence is a multidimensional phenomenon connected to unfamiliar patients, rushed situations, and an uncontrolled environment. This means that the EMS personnels' safety cannot be ensured in all situations. Therefore, a balance between safety margins and treating patients needs to be considered. [ABSTRACT FROM AUTHOR]

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.)

Background: Prehospital management of severely burned patients is extremely challenging. It should include adequate analgesia, decision-making on the necessity of prehospital endotracheal intubation and the administration of crystalloid fluids. Guidelines recommend immediate transport to specialised burn centres when certain criteria are met. To date, there is still insufficient knowledge on the characteristics of prehospital emergency treatment. We sought to investigate the current practice and its potential effects on patient outcome. Methods: We conducted a single centre, retrospective cohort analysis of severely burned patients (total burned surface area > 20%), admitted to the Berlin burn centre between 2014 and 2019. The relevant data was extracted from Emergency Medical Service reports and digital patient charts for exploratory data analysis. Primary outcome was 28-day-mortality. Results: Ninety patients (male/female 60/30, with a median age of 52 years [interquartile range, IQR 37–63], median total burned surface area 36% [IQR 25–51] and median body mass index 26.56 kg/m2 [IQR 22.86–30.86] were included. The median time from trauma to ED arrival was 1 h 45 min; within this time, on average 1961 ml of crystalloid fluid (0.48 ml/kg/%TBSA, IQR 0.32–0.86) was administered. Most patients received opioid-based analgesia. Times from trauma to ED arrival were longer for patients who were intubated. Neither excessive fluid treatment (> 1000 ml/h) nor transport times > 2 h was associated with higher mortality. A total of 31 patients (34,4%) died within the hospital stay. Multivariate regression analysis revealed that non-survival was linked to age > 65 years (odds ratio (OR) 3.5, 95% CI: 1.27–9.66), inhalation injury (OR 3.57, 95% CI: 1.36–9.36), burned surface area > 60% (OR 5.14, 95% CI 1.57–16.84) and prehospital intubation (5.38, 95% CI: 1.92–15.92). Conclusion: We showed that severely burned patients frequently received excessive fluid administration prehospitally and that this was not associated with more hemodynamic stability or outcome. In our cohort, patients were frequently intubated prehospitally, which was associated with increased mortality rates. Further research and emergency medical staff training should focus on adequate fluid application and cautious decision-making on the risks and benefits of prehospital intubation. Trial registration: German Clinical Trial Registry (ID: DRKS00033516). [ABSTRACT FROM AUTHOR]

Abstract In patients with out‐of‐hospital cardiac arrest (OHCA) who attain return of spontaneous circulation (ROSC), rearrest while in the prehospital setting represents a significant barrier to survival. To date, there are limited data to guide prehospital emergency medical services (EMS) management immediately following successful resuscitation resulting in ROSC and prior to handoff in the emergency department. Post‐ROSC care encompasses a multifaceted approach including hemodynamic optimization, airway management, oxygenation, and ventilation. We sought to develop an evidenced‐based, goal‐directed bundle of care targeting specified vital parameters in the immediate post‐ROSC period, with the goal of decreasing the incidence of rearrest and improving survival outcomes. Here, we describe the rationale and development of this goal‐directed bundle of care, which will be adopted by several EMS agencies within California. We convened a group of EMS experts, including EMS Medical Directors, quality improvement officers, data managers, educators, EMS clinicians, emergency medicine clinicians, and resuscitation researchers to develop a goal‐directed bundle of care to be applied in the field during the period immediately following ROSC. This care bundle includes guidance for prehospital personnel on recognition of impending rearrest, hemodynamic optimization, ventilatory strategies, airway management, and diagnosis of underlying causes prior to the initiation of transport.

Aim: This study aims to identify the organizational climate and culture among nurses working in Immediate Life Support Ambulances (ILSA). Methods: A descriptive, quantitative, and cross-sectional study was conducted with 81 Portuguese nurses working in Immediate Life Support Ambulances at the National Medical Emergency Institute (INEM). The data was analyzed using the Principal Component Analysis (PCA) method, followed by a Varimax rotation, and the models were validated using the Kaiser-Meyer-Olkin test and Bartlett’s test of sphericity. Findings: Factorial analysis yielded four factors, namely: Support (24.5%), Objectives (13.6%), Rules (9.7%), and Innovation (8.01%), associated with organizational climate and culture. Nurses with an undergraduate degree perceived significantly more support than those with higher qualifications. Support also varied according to relationship status, revealing that married nurses had a higher perception than those cohabiting. Conclusion: Organizational climate and culture unequivocally contribute to developing a healthy and safe work environment and are decisive for the quality of nursing care.

Background: Participation in care is considered to promote safe and qualitative care. Care‐dependent older persons ageing in place have increased emergency care needs, which initiate inter‐organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations. Aim: This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care‐dependent older persons experiencing acute illness at home. Design: This study has a qualitative design with a lifeworld approach. Method: A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care‐dependent persons aged 70–93 years. Results: Care‐dependent older persons' participation in prehospital emergency care means 'Entrusting life to professional caregivers' when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain. Conclusion: Care‐dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well‐being and continued living. Implications for practice: Prehospital emergency care from the perspective of care‐dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld‐led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care. [ABSTRACT FROM AUTHOR]

Objective: Traumatic brain injury (TBI) is among the leading causes of death and disability globally. Identifying and assessing the risk of in-hospital mortality in traumatic brain injury patients at an early stage is challenging. This study aimed to develop a model for predicting in-hospital mortality in TBI patients using prehospital data from China. Methods: We retrospectively included traumatic brain injury patients who sustained injuries due to external forces and were treated by pre-hospital emergency medical services (EMS) at a tertiary hospital. Data from the pre-hospital emergency database were analyzed, including demographics, trauma mechanisms, comorbidities, vital signs, clinical symptoms, and trauma scores. Eligible patients were randomly divided into a training set (241 cases) and a validation set (104 cases) at a 7:3 ratio. Least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression were employed to identify independent risk factors. Analyzed the discrimination, calibration, and net benefit of the nomogram across both groups. Results: 17.40 % (42/241) of TBI patients died in the hospital in the training set, while 18.30 % (19/104) in the validation set. After analysis, chest trauma (odds ratio [OR] = 4.556, 95 % confidence interval [CI] = 1.861–11.152, P = 0.001), vomiting (OR = 2.944, 95%CI = 1.194–7.258, P = 0.019), systolic blood pressure (OR = 0.939, 95%CI = 0.913–0.966, P

Background: Due to the nature of their work, prehospital personnel face various ethical challenges that can lead to moral distress. Compared to hospital nurses, the interaction of personnel in the pre-hospital environment is closer, and the ethical climate can affect the reaction of pre-hospital personnel in the face of moral challenges and distress. This study determines the relationship between moral distress and ethical climate among prehospital personnel. Materials and Methods: This cross-sectional correlational study was conducted on 136 emergency medical services personnel selected via census sampling. To collect the data, two instruments were used, namely the revised moral distress and Victor and Cullen’s standard ethical climate. The data were analyzed using descriptive statistics and Pearson correlation in the SPSS software, version 23. Results: According to the results, the mean score of moral distress intensity (MDI) was high (3.65±1.14) and the mean score of moral distress frequency (MDF) was moderate (1.83±0.53) among emergency medical services personnel. The mean ethical climate was moderate (2.96±1.02). The study found a negative and significant relationship between ethical climate and MDI among emergency medical services staff (r=-0.34, P0.05). This study also found a significant relationship between MDI and personal characteristics, such as age, work experience, and history of referral to the board of inquiry (P0.05). Conclusion: Considering the positive effect of the ethical climate on reducing emergency medical services providers’ moral distress, more attention is essential to the factors affecting moral distress.

Abstract Background Skydiving is the fastest nonmotorized sport; and consequently is not without risk. In the last decades, skydiving has become considerably safer but injuries and fatalities still occur. Incidents are reported to and administered by the Royal Netherlands Aeronautical Association (KNVvL). From 1995 to 2020, 2715 incidents were reported; of which 1503 resulted in injury and 26 in fatality. There is a need for more information available on the particular type, severity, and factors which contribute to skydiving-related injuries worldwide. This study aims to investigate patterns in occurrence rates, examine demographic and skydiving-related factors linked to injuries, and analyze the types and severity of injuries relating to these contributing factors. Methods The Dutch KNVvL database – covering more than 25 years of data – was examined for contributing factors. An analysis of the severity and types of injury resulting from incidents over the last five years were matched with a search of hospital databases. Results The rate of injuries pattern increases starting from 2016, with novice jumpers having the highest risk of injury. Most injuries occur during the landing phase. The lower extremities and the spine are most affected, with fractures being the most prevalent type of injury. More than half of the patients were admitted to hospital, with 10% requiring surgery, resulting in months of rehabilitation. Conclusion This study is the first in the Netherlands, and only the second worldwide to analyze technical incident databases in combination with data from medical information systems. Skydiving accidents of experienced jumpers should be considered as ‘high-energy trauma,’ therefore treatment should follow standard trauma guidelines. In less experienced skydivers, it is critical to conduct a secondary survey to assess the extremities adequately. Clinicians should also pay attention to friction burns that can arise due to friction between the skin and skydive equipment, a phenomenom that is already known in road traffic accidents.

BACKGROUND: Pre-hospital emergency medical services (PHEMS) training system is an integral part of the health system of any country. Therefore, knowing the status of graduates of this field can provide a new analysis for the policymakers of the National Health System. The purpose of this study was to analyze the status of PHEMS graduates in Iran. MATERIALS AND METHODS: The present survey research was conducted with the participation of 437 pre-hospital emergency medicine graduates of Iranian medical science universities in spring and summer of 2022. Sampling in this study was convenience. The documents of the National Organization of Educational Testing were used as well. The data collection tool was a researcher-made questionnaire. Statistical analyses were performed by SPSS25 software using descriptive statistics and analytical statistics. RESULTS: Among the graduates, the largest number (41.5%) was reported to be in the associate degree. According to the emergency system structure in Iran, graduates were employed in operational, communication, and headquarters areas, respectively, of which 76.8% were working in government centers. Most of the graduates were from the medical sciences universities of Zone 2 (35.6%) in the eastern area of Iran, while most of the workers were related to the medical sciences universities of Zone 1 (27.9%) in the capital region. CONCLUSION: Our findings revealed that the distribution of EMS graduates was not proportional to the distribution of the population and geographical area. Therefore, it is suggested that the policymakers of the country’s health system should make changes in the recruitment of students in each medical zone.

INTRODUCTION: The majority of pediatric medications are dosed according to weight and therefore accurate weight assessment is essential. However, this can be difficult in the unpredictable and peripatetic prehospital care setting, and medication errors are common. The Handtevy method and the Broselow tape are two systems designed to guide Emergency Medical Services (EMS) providers in both pediatric patient weight estimation and medication dosing. The accuracy of the Handtevy method of weight estimation as practiced in the field by EMS has not been previously examined. STUDY OBJECTIVE: The primary objective of this study was to examine the field performance of the Handtevy method and the Broselow tape with respect to prehospital patient weight estimation. METHODS: This was a retrospective chart review of trauma and non-trauma patients transported by EMS to the emergency department (ED) of a quaternary care childrens hospital from January 1, 2021 through June 30, 2021. Demographic data, ED visit information, prehospital weight estimation, and medication dosing were collected and analyzed. Scale-based weight from the ED was used as the standard for comparison. RESULTS: A total of 509 patients

Introduction: Every year, five million people around the world experience an out-of-hospital cardiac arrest (OHCA) and less than 40 % receive any assistance before the arrival of the Emergency Medical Services (EMS). Ambulance operators (AO) take care of people experiencing an OHCA, stabilize and then transfer them. In Medellín, Colombia, there is a public AO and several private providers, but the information about an OHCA and the operational characteristics during the response to the event are limited. Objective: To estimate the incidence of OHCA and to explore the factors associated with survival after the event in Medellín city. Methods: Retrospective, population-based cohort study. All the medical records of patients experiencing an OHCA who were assessed and treated by ambulance operators, (AO) of the Emergency Medical Services (EMS) and private agencies in Medellin city were reviewed. Descriptive statistics were used for data analysis and the annual incidence of the event standardized for the general population was estimated. Potential survival-associated factors reported as OR with their corresponding 95% CI were explored. Results: A total of 1,447 patient records with OHCA between 2018 and 2019 were analyzed. The event incidence rate for the number of cases assessed was 28.1 (95 % CI 26.0-30.3) and 26.9 (95 % CI 24.9- 29.1) cases per 100,000 inhabitants/year for 2018 and 2019, respectively; the incidence rate of treated OHCA was 2.6 (95 % CI 2.0-3.3) and 3.2 (95 % CI 2.5-4.0) per 100,000 inhabitants/year, for 2018 and 2019. Survival on arrival at hospitals of treated cases was 14.2 % (95 % CI 5.5-22.8) and 15.5 % (95 % CI 7.4-23.5) for 2018 and 2019, respectively. Conclusions: This study portrays the operating and care characteristics of the population experiencing OHCA in Medellín city. The incidence rate of the event and the survival were lower than those reported in the literature. [ABSTRACT FROM AUTHOR]

Background: Due to the nature of their work, prehospital personnel face various ethical challenges that can lead to moral distress. Compared to hospital nurses, the interaction of personnel in the pre-hospital environment is closer, and the ethical climate can affect the reaction of pre-hospital personnel in the face of moral... [ABSTRACT FROM AUTHOR]

Purpose: Prehospital telecardiology facilitates early ST-elevation myocardial infarction (STEMI) detection, yet its widespread implementation remains challenging. Extracting digital STEMI biomarkers from printed electrocardiograms (ECGs) using phone cameras could offer an affordable and scalable solution. This study assessed the feasibility of this approach with real-world prehospital ECGs. Materials and Methods: Patients suspected of having STEMI by emergency medical technicians (EMTs) were identified from a policy research dataset. A deep learning-based ECG analyzer (QCGTM analyzer) extracted a STEMI biomarker (qSTEMI) from prehospital ECGs. The biomarker was compared to a group of human experts, including five emergency medical service directors (boardcertified emergency physicians) and three interventional cardiologists based on their consensus score (number of participants answering "yes" for STEMI). Non-inferiority of the biomarker was tested using a 0.100 margin of difference in sensitivity and specificity. Results: Among 53 analyzed patients (24 STEMI, 45.3%), the area under the receiver operating characteristic curve of qSTEMI and consensus score were 0.815 (0.691-0.938) and 0.736 (0.594-0.879), respectively (p=0.081). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of qSTEMI were 0.750 (0.583-0.917), 0.862 (0.690-0.966), 0.826 (0.679-0.955), and 0.813 (0.714-0.929), respectively. For the consensus score, sensitivity, specificity, PPV, and NPV were 0.708 (0.500-0.875), 0.793 (0.655-0.966), 0.750 (0.600-0.941), and 0.760 (0.655-0.880), respectively. The 95% confidence interval of sensitivity and specificity differences between qSTEMI and consensus score were 0.042 (-0.099-0.182) and 0.103 (-0.043-0.250), respectively, confirming qSTEMI's non-inferiority. Conclusion: The digital STEMI biomarker, derived from printed prehospital ECGs, demonstrated non-inferiority to expert consensus, indicating a promising approach for enhancing prehospital telecardiology. [ABSTRACT FROM AUTHOR]

Accurate estimation of ambulance transport time from the scene of incident to arrival at the emergency department (ED) is important for effective resource management and emergency care system planning. Further, differences in transport times between different urgency levels highlight the benefits of ambulance transports with highest urgency level in a setting where ambulances are allowed to not follow standard traffic rules. The objective of the study is to compare ambulance urgency level on the differences in estimates of ambulance transport times generated by Google Maps and the observed transport times in a prehospital setting where emergency vehicles have their own traffic laws. The study was designed as a natural experiment and register study. Ambulance transports dispatched with different levels of urgency (Level A and B) were included in the Central Denmark Region (a mixed urban and rural area) from March 10 to June 11, 2021. Ambulance transports for highest urgency level were compared to lowest urgency level with Google Maps estimated transport times as reference. We analyzed 1981 highest urgency level and 8.958 lowest urgency level ambulance transports. Google Maps significantly overestimated the duration of transports operating at highest level of urgency (Level A) by 1.9 min/10 km (95% CI 1.8; 2.0) in average and 4.8 min/10 km (95% CI 3.9; 5.6) for the first driven 10 km. Contrary, Google Maps significantly underestimated the duration of transports operating at lowest level of urgency (Level B) by −1.8 min/10 km (95% CI −2.1; −1.5) in average and −4.4 min/10 km (95% CI −5.4; −3.5) for the first driven 10 km. Google Maps systematically overestimates transport times of ambulance transports driven with Level A, the highest level of urgency in a setting where ambulances are allowed to not follow standard traffic rules. The results highlight the benefit of using urgency Level A and provide valuable information for emergency care management. [ABSTRACT FROM AUTHOR]

Background: Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. Materials and Methods: A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected. Results: The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization. Conclusion: The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care. [ABSTRACT FROM AUTHOR]

The benefits of emergency care systems in low- and middle-income countries are well-described. Passed in the wake of the coronavirus disease 2019 (COVID-19) pandemic, the World Health Assembly (WHA) Resolution 76.2 emphasizes the importance of communication, transportation and referral mechanisms, and the linkages between communities, primary care, and hospital care. Literature describing prehospital care and ambulance system development is scarce, with little data on the effectiveness and cost effectiveness of different options. Prehospital care systems in Pacific Island countries are under-developed. In Fiji, out-of-hospital care is fragmented with an uncoordinated patchwork of ambulance providers. There is no scope of practice or training requirement for providers and no patient care records. There are no data relating to demand, access, and utilization of ambulance services. In response to a surge of COVID-19 cases in 2021, the Fiji government created a Prehospital Emergency Care Coordination Center (PHECCC) in the capital Suva, which was operational from July-October 2021. Access was via a toll-free number, whereby the public could receive a medical consultation followed by phone advice or dispatch of an ambulance for a home assessment, followed by transportation to hospital, if required. The PHECCC also provided coordination of inter-facility transport and retrieval of the critically ill. The system that was created met many of the prehospital care standards set by emergency care leaders in the region and created the first dataset relating to ambulance demand and utilization. This is the first article to document prehospital system development in the Pacific region. [ABSTRACT FROM AUTHOR]

Background: Stroke is considered as one of the most important causes of emergency medical services (EMS) dispatch worldwide. Stroke is a time-sensitive condition and rapid transport of the patients improves the prognosis. In this study, we described prehospital emergency response times for stroke patients in Isfahan, Iran. Methods: In the current cross-sectional descriptive study, suspected stroke patients who were transported by EMS in Isfahan, Iran, from June 2022 to June 2023 were included. The data was extracted from patients’ files. The time interval between the receipt of a call and the EMS arrival at the scene (arrival time), the time interval between on-scene EMS arrival and the ambulance departure to the medical center (stroke scene time), and the time it takes to reach the medical center (transport time) were collected. Results: Overall, 79 patients with a mean age of 71.56 ± 12.03 were included. EMS diagnosed 63 (79.75%) of the patients with a definite diagnosis and 14 (17.72%) with probable stroke. Two false negative results were found. The average arrival time, was 11.56 ± 6.60 minutes, on-scene stroke time was 13.85 ± 7.23 minutes and the average transport time was 11.90 ± 6.08 minutes. The mean total EMS response time was 37.90 ±11.29 minutes. Conclusion: Overall, our study showed that while the EMS transport time is longer than ideal, the total time to transport to the hospital is short enough not to affect the outcome. EMS was also found to be adept at spotting the signs of stroke and rapidly starting the process of treatment.

ObjectiveFull compliance with American Heart Association (AHA) recommendations for prehospital care of stroke patients remains low. This study aims to identify components of prehospital care associated with shorter door-to-computed tomography (CT) times.MethodsData from a comprehensive stroke center's Get with the Guidelines-Stroke registry were supplemented by prehospital medical records for ischemic stroke patients between January 1, 2018, and December 31, 2020. Descriptive statistics and multivariable linear regression modeling was used to evaluate door-to-CT times for encounters compliant with AHA recommendations.ResultsThere were 621 ischemic stroke patients who presented via a prehospital provider, 452 of whom presented from the scene. Without adjusting for potential confounders, shorter door-to-CT times were observed with emergency medical services' documentation of a last-known well time, measurement of a blood glucose level, prenotification of a suspected stroke, or full compliance with AHA recommendations. Documentation of classic stroke signs, but not of a prehospital stroke scale, was also observed to have shorter door-to-CT times compared to encounters in which this did not occur.ConclusionDuring prehospital care of stroke, documentation of classic symptoms, obtaining a last-known well time or time of symptom onset, obtaining a blood glucose level, prenotifying the receiving hospital of suspected stroke, and complying fully with guidelines are associated with shorter door-to-CT times. Further studies are needed to understand if a shift in prehospital provider education, focusing on these key components of care, could lead to earlier diagnosis and treatment of acute stroke.

Background: Management of trauma patients includes prevention, prehospital care, appropriate resuscitation at a hospital, definitive treatment, and rehabilitation. Timely and adequate care for a trauma patient is paramount, which can dramatically impact survival. This study was planned to assess the proportion of patients who failed to receive adequate prehospital care before reaching our institute. Materials and Methods: A retrospective study was conducted in the trauma and emergency department of a level-1 trauma center in eastern India from February to April 2022. The demographic profile, vital parameters, injury, mode of transport, travel duration, referring hospital, and any interventions as per airway/breathing/circulation/hypothermia were collected. Results: The records of a hundred-two patients who were brought to the trauma and emergency department in the study period were reviewed. Road traffic accident involving two wheelers was the leading cause of injury. Eighty-three percent of the patients were referred from other health centers, of which 49 were referred from district headquarters hospitals. Only three patients out of 14 had been provided with an oropharyngeal airway for whom endotracheal intubation was indicated. Only one among the 41 patients needing Philadelphia collar actually received. Sixteen patients were provided supplemental oxygen out of the 35 for whom it was indicated. Out of 68 patients in whom intravenous cannulation and fluid administration were indicated, only 35 patients had received it. Out of 31 patients with fractures, none were provided immobilization. Conclusion: The care of the trauma patients with respect to airway, breathing, circulation, and fracture immobilization was found to be grossly inadequate, emphasizing the need of structured and protocol based prehospital trauma care.

Abstract Background Working in rural areas involves tackling long distances and occasional lack of supportive resources. Ambulance nurses are faced with the responsibility of making immediate autonomous decisions and providing extended care to critically ill patients during prolonged ambulance transport to reach emergency medical facilities. This study aims to expose the experiences of ambulance nurses acting as primary caregivers for critically ill patients during lengthy ambulance transfers in rural regions. Method Fifteen nurses employed in an ambulance service within sparsely populated rural areas were subjected to semi-structured interviews. The collected data underwent qualitative content analysis. Result The analysis resulted in one overarching theme with two categories. The theme is ‘Safety in the Professional Role,’ and the two categories are ‘Working in sparsely populated areas presents challenges’ and ‘Rare events: when routine cannot be established.’ The findings suggest that working as an ambulance nurse in a rural setting poses various challenges that can be highly stressful. Delivering care to critically ill patients during extended ambulance transports requires the knowledge, experience, and careful planning of the healthcare provider in charge. Conclusions The findings underscore the necessity for thorough planning and adaptable thinking when attending to critically ill patients during extended transport scenarios. The absence of supporting resources can render the task demanding. Nevertheless, participants reported an inherent tranquility that aids them in maintaining focus amid their responsibilities.

Abstract Background Prolonged prehospital time is a major global problem in the emergency medical system (EMS). Although factors related to prolonged on-scene times (OSTs) have been reported in patients with trauma and critical medical conditions, those in patients with minor diseases or injuries remain unclear. We examined factors associated with prolonged OSTs in patients with minor diseases or injuries. Methods This population-based observational study used the ambulance transportation and request call record databases of the Higashihiroshima Fire Department, Japan, between January 1, 2016, and December 31, 2022. The participants were patients with minor diseases or injuries during the study period. We performed a multivariable logistic regression analysis with robust error variance to examine the association between patient age, sex, severity, accident type, date and time of ambulance call, and the coronavirus disease 2019 (COVID-19) pandemic with prolonged OSTs. Prolonged OST was defined as ≥ 30 min from the ambulance arrival at the scene to departure. Results Of the 60,309 people transported by ambulance during the study period, 20,069 with minor diseases or injuries were included in the analysis. A total of 1,241 patients (6.2%) experienced prolonged OSTs. Fire accidents (adjusted odds ratio [aOR]: 7.77, 95% confidence interval [CI]: 3.82–15.79), natural disasters (aOR: 28.52, 95% CI: 2.09–389.76), motor vehicle accidents (aOR: 1.63, 95% CI: 1.30–2.06), assaults (aOR: 2.91, 95% CI: 1.86–4.53), self-injuries (aOR: 5.60, 95% CI: 3.37–9.32), number of hospital inquiries ≥ 4 (aOR: 77.34, 95% CI: 53.55–111.69), and the COVID-19 pandemic (aOR: 2.01, 95% CI: 1.62–2.50) were associated with prolonged OSTs. Moreover, older and female patients had prolonged OSTs (aOR: 1.18, 95% CI: 1.01–1.36 and aOR: 1.12, 95% CI: 1.08–1.18, respectively). Conclusions Older age, female sex, fire accidents, natural disasters, motor vehicle accidents, assaults, self-injuries, number of hospital inquiries ≥ 4, and the COVID-19 pandemic influenced prolonged OSTs among patients with minor diseases or injuries. To improve community EMS, we should reconsider how to intervene with potentially modifiable factors, such as EMS personnel performance, the impact of the presence of allied services, hospital patient acceptance systems, and cooperation between general emergency and psychiatric hospitals.

Thongpitak Huabbangyang,1 Thanidtha Nomrabporn,2 Watcharan Chiraratchawarich,2 Rapeeporn Rojsaengroeng3 1Department of Disaster and Emergency Medical Operation, Faculty of Science and Health Technology, Navamindradhiraj University, Bangkok, Thailand; 2Division of Emergency Medical Service and Disaster, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand; 3Department of Emergency Medicine, Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, ThailandCorrespondence: Rapeeporn Rojsaengroeng, Tel +66 2443000, Email rapeeporn@nmu.ac.thBackground: Hazardous areas are places emitting hazardous materials, terrorist- or war-related, which lead to public health risks in developed and developing countries globally. Hence, prehospital emergency medical personnel who work as frontliners should be trained.Patients and Methods: Data via pretest, posttest, and questionnaire surveys regarding the HART’s knowledge of and confidence in operational skills were collected using the 5-point Likert scale. The cohort included prehospital emergency medical personnel aged > 18 years. The training program comprised lectures, practicals, and examinations and included three subcourses: emergency medicine in the chemical, biological, radiation, and nuclear hazardous area (EM-CBRN) course; Thailand Tactical Emergency Medical Service (TTEMS) course; and cooperation and preparation for disaster (CPD) course.Results: The HART’s mean multiple choice question (MCQ) posttest knowledge score (12.80± 3.11) was significantly higher (p< 0.001) than the mean pretest knowledge score (7.74± 3.71) for the EM-CBRN course. The HART’s mean MCQ posttest knowledge score (24.04± 2.79) was significantly higher (p< 0.001) than the mean pretest knowledge score (14.34± 3.92) for the TTEMS course. Further, the HART’s mean MCQ posttest knowledge score (21.03± 3.49) was significantly higher (p< 0.001) than the mean pretest knowledge score (14.40± 5.08) for the CPD course. The HART’s mean confidence in operational skill score for the EM-CBRN course was significantly higher (p< 0.001) after training (4.45± 0.59) than before training (2.77± 0.90). The HART’s mean confidence in operational skill score for the TTEMS course was significantly higher (p< 0.001) after training (4.55± 0.59) than before training (2.78± 0.98). The HART’s mean confidence in operational skill score for the CPD course was significantly higher (p< 0.001) after training (4.70± 0.41) than before training (3.03± 0.90).Conclusion: The HART training program significantly affected the HART’s knowledge development and confidence in operational skills, particularly the frontline prehospital emergency medical personnel. Therefore, prehospital emergency medical personnel should undergo training, and learning activities must be developed to reinforce capacity and improve knowledge and confidence.Keywords: education, emergency medical service, hazardous substances, knowledge, prehospital emergency care

Abstract Background Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. Method This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. Results Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved (“fire alarm system” 0.6%, “fire with emergency medical services” 5.4%) and “personal emergency response system active alarm” (18.6%). The highest transport rates were observed for emergencies involving “childbirth/delivery” (96.9%) and “trauma” (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98–2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to “fire alarm system” (9.0 min) and “personal emergency response system active alarm” (10.6 min). Conclusion This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study “Rettungswageneinsatz ohne Transport” [“Ambulance deployment without transport”] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.

Abstract Introduction The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. Methods Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. Results The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P

Abstrac Background Treatment of acute pain is an essential element of pre-hospital care for injured and critically ill patients. Clinical studies indicate the need for improvement in the prehospital analgesia. Objective The aim of this study is to assess the current situation in out of hospital pain management in Germany regarding the substances, indications, dosage and the delegation of the use of analgesics to emergency medical service (EMS) staff. Material and methods A standardized survey of the medical directors of the emergency services (MDES) in Germany was carried out using an online questionnaire. The anonymous results were evaluated using the statistical software SPSS (Chi-squared test, Mann-Whitney-U test). Results Seventy-seven MDES responsible for 989 rescue stations and 397 EMS- physician bases in 15 federal states took part in this survey. Morphine (98.7%), Fentanyl (85.7%), Piritramide (61%), Sufentanil (18.2%) and Nalbuphine (14,3%) are provided as opioid analgesics. The non-opioid analgesics (NOA) including Ketamine/Esketamine (98,7%), Metamizole (88.3%), Paracetamol (66,2%), Ibuprofen (24,7%) and COX-2-inhibitors (7,8%) are most commonly available. The antispasmodic Butylscopolamine is available (81,8%) to most rescue stations. Fentanyl is the most commonly provided opioid analgesic for treatment of a traumatic pain (70.1%) and back pain (46.8%), Morphine for visceral colic-like (33.8%) and non-colic pain (53.2%). In cases of acute coronary syndrome is Morphine (85.7%) the leading analgesic substance. Among the non-opioid analgesics is Ketamine/Esketamine (90.9%) most frequently provided to treat traumatic pain, Metamizole for visceral colic-like (70.1%) and non-colic (68.6%) as well as back pain (41.6%). Butylscopolamine is the second most frequently provided medication after Metamizole for “visceral colic-like pain” (55.8%). EMS staff (with or without a request for presence of the EMS physician on site) are permitted to use the following: Morphine (16.9%), Piritramide (13.0%) and Nalbuphine (10.4%), and of NOAs for (Es)Ketamine (74.1%), Paracetamol (53.3%) and Metamizole (35.1%). The dosages of the most important and commonly provided analgesic substances permitted to independent treatment by the paramedics are often below the recommended range for adults (RDE). The majority of medical directors (78.4%) of the emergency services consider the independent application of analgesics by paramedics sensible. The reason for the relatively rare authorization of opioids for use by paramedics is mainly due to legal (in)certainty (53.2%). Conclusion Effective analgesics are available for EMS staff in Germany, the approach to improvement lies in the area of application. For this purpose, the adaptations of the legal framework as well as the creation of a guideline for prehospital analgesia are useful.

Martin Gude,1 Hans Kirkegaard,1,2 Rolf Blauenfeldt,3 Anne Behrndtz,3 Jeppe Mainz,3 Ingunn Riddervold,4 Claus Z Simonsen,2,3 Niels Hjort,2,3 Søren P Johnsen,5 Grethe Andersen,2,3 Jan Brink Valentin5 1Department of Research and Development, Prehospital Emergency Medical Services, Central Denmark Region; and Aarhus University Hospital, Aarhus, Denmark; 2Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; 3Danish Stroke Center, Department of Neurology, Aarhus University Hospital, Aarhus, Denmark; 4Norwegian Air Ambulance Foundation, Oslo, Norway; 5Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, DenmarkCorrespondence: Martin Gude, Prehospital Emergency Medical Services, Central Denmark Region and Aarhus University Hospital, Aarhus, Denmark, Email gude@dadlnet.dkObjective: To examine the agreement between emergency medical service (EMS) providers, neurology residents and neurology consultants, using the Cincinnati Prehospital Stroke Scale (CPSS) and the Prehospital Acute Stroke Severity Scale (PASS).Methods: Patients with stroke, transient ischemic attack (TIA) and stroke mimic were included upon primary stroke admission or during rehabilitation. Patients were included from June 2018 to September 2019. Video recordings were made of patients being assessed with CPSS and PASS. The recordings were later presented to the healthcare professionals. To determine relative and absolute interrater reliability in terms of inter-rater agreement (IRA), we used generalisability theory. Group-level agreement was determined against a gold standard and presented as an area under the curve (AUC). The gold standard was a consensus agreement between two neurology consultants.Results: A total of 120 patient recordings were assessed by 30 EMS providers, two neurology residents and two neurology consultants. Using the CPSS and the PASS, a total of 1,800 assessments were completed by EMS providers, 240 by neurology residents and 240 by neurology consultants. The overall relative and absolute IRA for all items combined from the CPSS and PASS score was 0.84 (95% CI 0.80; 0.87) and 0.81 (95% CI 0.77; 0.85), respectively. Using the CPSS, the agreement on a group-level resulted in AUCs of 0.83 (95% CI 0.78; 0.88) for the EMS providers and 0.86 (95% CI 0.82; 0.90) for the neurology residents when compared with the gold standard. Using the PASS, the AUC was 0.82 (95% CI 0.77; 0.87) for the EMS providers and 0.88 (95% CI 0.84; 0.93) for the neurology residents.Conclusion: The high relative and absolute inter-rater agreement underpins a high robustness/generalisability of the two scales. A high agreement exists across individual raters and different groups of healthcare professionals supporting widespread applicability of the stroke scales.Plain Language Summary: Early stroke identification is pivotal to enable faster treatment. To aid this identification, many symptom-based stroke scales have been constructed for both stroke screening and severity assessment. In the prehospital environment, several scales have been evaluated on performance, but only few studies have evaluated the agreement between the ambulance personnel (emergency medical service (EMS) providers) and stroke physicians when interpreting the assessed symptoms in the scales. It is of great importance to know how EMS providers interpret symptoms seen in connection with the use of the scales to focus the continuous training of the EMS providers but also to aid the decision on which scale to implement in ambulances. From previous studies, we know that complex stroke scales are used to a considerably lesser extent than more simple scales, which could be caused by difficulties interpreting specific symptoms. In this study, a variety of methods was applied to determine the inter-rater agreement for two simple stroke scales using dichotomously evaluated symptoms. High inter-rater agreement between EMS providers and Stroke Neurologists exists both between individual raters and between raters grouped according to their profession and seniority. Previous studies have also found high inter-rater agreement for simple stroke scales but lesser agreement for more advanced scales. In conclusion, simple stroke scales seem to produce the highest agreement.Keywords: observer variation, prehospital emergency care, emergency medical service provider, neurologists, stroke

Recent research has yielded conflicting results on the use of spinal stabilization in prehospital care, with some guidelines expressing concerns about its potential lack of benefit or harm. Transportation on a backboard can cause pain, discomfort, and pressure ulcers, whereas the log-roll technique can cause unnecessary movement and aggravate existing injuries. The scoop stretcher and vacuum mattress provide comparable or better immobilization and comfort than the backboard. Prehospital time is critical, and patients with life-threatening conditions should undergo rapid stabilization procedures. Despite this, some studies have overlooked the scoop stretcher as a spinal stabilization device. The primary goal was to compare the time required to achieve spinal stabilization using a scoop stretcher versus a vacuum mattress. This was a monocentric, parallel, randomized (sealed envelope), superiority, open-label, controlled simulation experiment. All student paramedics, registered paramedics, and EMTs who work in the participating EMS were eligible to participate in the study apart of the study team. The experimental group had to use a scoop stretcher, whereas the control group used a vacuum mattress. Fifteen participants were included. The scoop stretcher group required less time to complete the stabilization procedure (median [Q1; Q3]: 127 seconds [111;145] versus 212 [156;237], p=0.005). Using a scoop stretcher for spinal stabilization is more time-efficient than a vacuum mattress, making it a viable option for unstable trauma patients in the prehospital setting. More research is needed to determine its efficacy in actual clinical practice.

BackgroundPrehospital emergency care is a critical but often understudied aspect of healthcare. Patient vulnerability in this setting can significantly impact outcomes. The aim of this study was to investigate the vulnerability status and to determine associated affect factors among prehospital emergency patients in China.MethodsIn this cross-sectional study conducted in China, from April 2023 to July 2023, we assessed the vulnerability of prehospital emergency patients using the Safety in Prehospital Emergency Care Index (SPECI) scale. We conducted a detailed questionnaire-based survey to gather demographic and disease-related information. We employed the SPECI scale, consisting of two subscales, to evaluate patient vulnerability. Statistical analyses, including t-tests, ANOVA, and multiple linear regression, were used to identify factors associated with vulnerability.ResultsThe study included a total of 973 prehospital emergency patients, with a response rate of 81.9%. These patients exhibited a low-to-moderate level of vulnerability, with an average SPECI score of 14.46 out of 40. Vulnerability was significantly associated with age (particularly those aged 60 and above), disease severity (severe conditions increased vulnerability), disease type (circulatory diseases correlated with higher vulnerability), alterations in consciousness, and chronic diseases. Unexpectedly, digestive system diseases were negatively correlated with vulnerability.ConclusionAddressing patient vulnerability in prehospital care is essential. Tailored interventions, EMS provider training, and interdisciplinary collaboration can mitigate vulnerability, especially in older patients and those with severe conditions.

Recent research has yielded conflicting results on the use of spinal stabilization in prehospital care, with some guidelines expressing concerns about its potential lack of benefit or harm. Transportation on a backboard can cause pain, discomfort, and pressure ulcers, whereas the log-roll technique can cause unnecessary movement and aggravate existing injuries. The scoop stretcher and vacuum mattress provide comparable or better immobilization and comfort than the backboard. Prehospital time is critical, and patients with life-threatening conditions should undergo rapid stabilization procedures. Despite this, some studies have overlooked the scoop stretcher as a spinal stabilization device. The primary goal was to compare the time required to achieve spinal stabilization using a scoop stretcher versus a vacuum mattress. This was a monocentric, parallel, randomized (sealed envelope), superiority, open-label, controlled simulation experiment. All student paramedics, registered paramedics, and EMTs who work in the participating EMS were eligible to participate in the study apart of the study team. The experimental group had to use a scoop stretcher, whereas the control group used a vacuum mattress. Fifteen participants were included. The scoop stretcher group required less time to complete the stabilization procedure (median [Q1; Q3]: 127 seconds [111;145] versus 212 [156;237], p=0.005). Using a scoop stretcher for spinal stabilization is more time-efficient than a vacuum mattress, making it a viable option for unstable trauma patients in the prehospital setting. More research is needed to determine its efficacy in actual clinical practice. [ABSTRACT FROM AUTHOR]

Background: Critical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral perfusion, whilst avoiding extreme haemodynamic fluctuations are the cornerstones of reducing secondary brain injury. The aim of this study was to report the differential determinants of post-PHEA critical hypertension in a large regional dataset of trauma patients across three Helicopter Emergency Medical Service (HEMS) organisations. Methods: A multi-centre retrospective observational study of consecutive adult trauma patients undergoing PHEA across three HEMS in the United Kingdom; 2015–2022. Critical hypertension was defined as a new systolic blood pressure (SBP) > 180mmHg within 10 min of induction of anaesthesia, or > 10% increase if the baseline SBP was > 180mmHg prior to induction. Purposeful logistical regression was used to explore variables associated with post-PHEA critical hypertension in a multivariable model. Data are reported as number (percentage), and odds ratio (OR) with 95% confidence interval (95%CI). Results: 30,744 patients were attended by HEMS during the study period; 2161 received PHEA and 1355 patients were included in the final analysis. 161 (11.9%) patients had one or more new episode(s) of critical hypertension ≤ 10 min post-PHEA. Increasing age (compared with 16–34 years): 35–54 years (OR 1.76, 95%CI 1.03–3.06); 55–74 years (OR 2.00, 95%CI 1.19–3.44); ≥75 years (OR 2.38, 95%CI 1.31–4.35), pre-PHEA Glasgow Coma Scale (GCS) motor score four (OR 2.17, 95%CI 1.19–4.01) and five (OR 2.82, 95%CI 1.60–7.09), patients with a pre-PHEA SBP > 140mmHg (OR 6.72, 95%CI 4.38–10.54), and more than one intubation attempt (OR 1.75, 95%CI 1.01–2.96) were associated with post-PHEA critical hypertension. Conclusion: Delivery of PHEA to seriously injured trauma patients risks haemodynamic fluctuation. In adult trauma patients undergoing PHEA, 11.9% of patients experienced post-PHEA critical hypertension. Increasing age, pre-PHEA GCS motor score four and five, patients with a pre-PHEA SBP > 140mmHg, and more than intubation attempt were independently associated with post-PHEA critical hypertension. [ABSTRACT FROM AUTHOR]

Background: Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. Method: This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. Results: Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved ("fire alarm system" 0.6%, "fire with emergency medical services" 5.4%) and "personal emergency response system active alarm" (18.6%). The highest transport rates were observed for emergencies involving "childbirth/delivery" (96.9%) and "trauma" (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98–2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to "fire alarm system" (9.0 min) and "personal emergency response system active alarm" (10.6 min). Conclusion: This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study "Rettungswageneinsatz ohne Transport" ["Ambulance deployment without transport"] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758. [ABSTRACT FROM AUTHOR]

After an earthquake or an industrial chemical release, a timely and effective response is crucial and can prevent or significantly reduce the risk of casualties. To this end, first responders and rescue teams have been equipped with state-of-the-art tools and specialised instruments to improve their capabilities in terms of accuracy, rapid location, and reduction of false alarms. The European Union-funded Search and Rescue project (Emerging technologies for the Early location of Entrapped victims under Collapsed Structures and Advanced Wearables for risk assessment and First Responders Safety in SAR operations) has designed, implemented and tested a highly compatible open architecture platform for first responders in a pilot case study of a chemical incident. An analysis of major chemical accidents classified by the eMars database (Major Accident Reporting System, established by the European Seveso Directive) was carried out; it has determined the types of companies that have suffered chemical accidents with the highest number of injuries and fatalities. Based on this previous analysis, a chemical spill pilot study was devised to test advanced user equipment systems and backup applications, improving first responders' decision-making and providing a common, dynamic operational perspective of the disaster. The Lean Method was used to evaluate processes, identify waste, test new solutions and, finally, increase the value of the product and service produced. [ABSTRACT FROM AUTHOR]

Introduction: Pain has been identified as the most common reason for emergency medical service (EMS) calls. Despite many years of pain research, it is still true that oligoanalgesia is an ongoing phenomenon. This demonstrates the need for the implementation of new solutions and for further analyses on the causes of inadequate pain treatment. The study was undertaken to analyze analgesic treatment implemented in specialist "S" and basic "P" Emergency Medical Teams (EMTs). Methods: This retrospective study was based on the analysis of medical records using the emergency medical service card. A total of 1333 medical files were analyzed, of which 539 cases were qualified for the study according to the inclusion and exclusion criteria. Results: The analysis has shown that the majority of interventions were undertaken by basic emergency medical teams and that acute pain was the most common reason for contacting the EMS. However, only 62.52% of patients received analgesia. It was shown that the frequency of administering paracetamol, metamizole, and ketoprofen was proportional to the increase in pain intensity. Similar correlations were identified in the cases of morphine, fentanyl, and drotaverine, which were most often administered to patients with the most severe pain. Conclusions: The nature and location of pain, as well as its intensity, affected the choice of analgesia. Opioids were administered more frequently with more extensive injuries and at greater pain intensity. Significant differences were found in the frequency at which acetylsalicylic acid was administered more often in "S" EMTs and drotaverine more often in "P" EMTs. The intravenous route was found to be the most common route of analgesia administration in EMTs. [ABSTRACT FROM AUTHOR]

Introduction: The unpredictability of prehospital emergencies combined with constantly changing circumstances can lead to increased stress and mental health issues among Emergency Medical Technicians (EMTs). To accurately determine the stress-inducing factors in the prehospital environment, it is important to first identify the stressful events that occur in this environment. Therefore, this study strives to provide a thorough analysis of the stressors in the prehospital environment. Methods: Sequential explanatory mixed methods were conducted in Hamadan prehospital emergency centers in 2022. The study included 251 EMTs, who were selected through a method in the quantitative phase. The quantitative part used a questionnaire consisting of basic information and the Posttraumatic Stress Questionnaire (PCL-5). In the qualitative phase, 17 with extensive experience in dealing with prehospital stressors were selected based on their PCL-5 scores (above 33). The qualitative phase analysis was carried out using the contractual content method using the Graneheim and Ladman's approach. Statistical analyzes for the quantitative and qualitative phases were performed using SPSS 21 and maxqda 10, respectively. Results: The study revealed that the EMTs had an average PTSD score of 21. 60 ± 11. 45. Multivariate linear regression analysis showed that the number of shifts had a statistically significant relationship with PTSD scores (t = 26.38, P < 0.001). The qualitative phase of the study included 17 interviews, resulting in 14 subcategories, which consisted of four categories: "the overall impact of the stress crisis on technicians," "missing links in the communication network in incident management," "professional shortcomings in pre-hospital care," and "the complex and multifaceted context of stressful pre-hospital emergencies." Additionally, the study's theme was centered around "surveying the experiences of EMTs in stressful environments." Conclusion: As the number of shifts increased, the primary cause of the high prevalence of PTSD in EMTs was revealed. Prehospital emergency stress can be reduced and managed more skillfully by adjusting various factors such as shortening workdays, offering continuous training, augmenting workforce, supplying ambulance equipment insurance, refraining from hiring personnel devoid of clinical training, hiring psychologists, hiring midwives in an emergency, updating prehospital protocols and guidelines, encouraging cooperation between EMTs and other relief groups, and utilizing cutting-edge technologies. [ABSTRACT FROM AUTHOR]

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