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BACKGROUND: The effect of transdermal glyceryl trinitrate (GTN, a nitrovasodilator) on clinical outcome when administered before hospital admission in suspected stroke patients is unclear. Here, we assess the safety and efficacy of GTN in the prespecified subgroup of patients who had an ischaemic stroke within the Rapid Intervention with Glyceryl trinitrate in Hypertensive stroke Trial-2 (RIGHT-2). METHODS: RIGHT-2 was an ambulance-based multicentre sham-controlled blinded-endpoint study with patients randomised within 4 hours of onset. The primary outcome was a shift in scores on the modified Rankin scale (mRS) at day 90. Secondary outcomes included death; a global analysis (Wei-Lachin test) containing Barthel Index, EuroQol-5D, mRS, telephone interview for cognitive status-modified and Zung depression scale; and neuroimaging-determined brain frailty markers. Data were reported as n (%), mean (SD), median [IQR], adjusted common OR (acOR), mean difference or Mann-Whitney difference (MWD) with 95% CI. RESULTS: 597 of 1149 (52%) patients had a final diagnosis of ischaemic stroke; age 75 (12) years, premorbid mRS>2 107 (18%), Glasgow Coma Scale 14 (2) and time from onset to randomisation 67 [45, 108] min. Neuroimaging brain frailty was common: median score 2 [2, 3] (range 0-3). At day 90, GTN did not influence the primary outcome (acOR for increased disability 1.15, 95% CI 0.85 to 1.54), death or global analysis (MWD 0.00, 95% CI -0.10 to 0.09). In subgroup analyses, there were non-significant interactions suggesting GTN may be associated with more death and dependency in participants randomised within 1 hour of symptom onset and in those with more severe stroke. CONCLUSIONS: In patients who had an ischaemic stroke, ultra-acute administration of transdermal GTN in the ambulance did not improve clinical outcomes in a population with more clinical and radiological frailty than seen in previous in-hospital trials.

Summary: Vehicle utilization has increased on a broader scale in today's reality. Because of insufficient emergency services, increased motor traffic has resulted in the rise of traffic collisions, and widespread accidents lead to the demise of lives and property. Generally, the consequence death rate happens each year, originating from delays in rescue activities. However, vehicles are embedded with trend technology. Still, the accident count will rise day by day due to delays in transmitting the information to the concerned person or delays in rescue activities. The proposed work offers an effective solution to the aforementioned issue by assisting low‐power and long‐range (LoRa) architecture with edge node ultrasonic sensors for identifying the abnormalities and to provide an efficient transport ambulance from the unexpected mishap spot to the closest hospital where emergency well‐being can be provided with the help of cloud technology. Also, emergency information can be sent to the cloud immediately, and its response is the way of alerting the surroundings and notifying the appropriate hospital with the aid of a GPS‐enabled LoRa‐shield. Further, comparing the proposed technology with other LPWAN (low‐power wide area networks) in terms of coverage, cost, capacity, and energy consumption proves efficient communication in the development of intelligent vehicular networks towards a smart city. [ABSTRACT FROM AUTHOR]

Objective: To perform an economic evaluation to determine whether or not teledermatology (TD) units in primary care (PC) centers offer an alternative in terms of cost‐utility and cost per quality‐adjusted life years (QALYs) to conventional dermatology consultations (face‐to‐face dermatology [F‐F/D]) at the hospital from the perspective of the Public Health System (PHS) and the patients. Methods: This is a randomized, controlled, nonblinded, and multicenter study. During 6 months, data from 450 patients (TD: 225 vs. F‐F/D: 225) were collected. From both perspectives, costs, quality of life, and costs per QALYs were analyzed. The QALY scores were estimated from the EuroQol‐5D‐5L (EQ5D‐5L) questionnaire responses. Results: From the perspective of the PHS, the cost per patient was 53.04% lower in the TD group (p < 0.001). Hospital visits decreased by 72.43% in the TD group (p < 0.001). From the patients' perspective, TD reduced costs per patient by 77.59% (p < 0.001). The cost per QALY was 63.34% higher in the F‐F/D group (p < 0.001). The TD group's total costs were 56.34% lower (p < 0.001). Furthermore, patients in the TD group gained 0.05 QALYs more than those in the F‐F/D group (p = 0.004). Conclusions: This study shows that TD units in PC represent a significant cost‐effective alternative to conventional hospital follow‐up. To enhance TD in PC, it is important to introduce remote consultation platforms incorporating artificial intelligence for prediagnosis. This will enable general practitioners and nurses to make more accurate initial assessments. It is also crucial to provide thorough training to healthcare personnel using these technologies to ensure more efficient and personalized care. Public health nurses will benefit from gaining new skills in managing digital tools, which will help in the early identification of dermatological diseases and reduce unnecessary referrals to specialists. This will optimize resources and improve response times for patients. [ABSTRACT FROM AUTHOR]

The article discusses the South-to-South cooperation between Pakistan and Nepal in implementing a police-based CPR initiative. The Pakistan Life Savers Program has successfully trained laypersons in CPR and bleeding control, leading to significant milestones in lifesaving skills training. Lessons learned from Pakistan have been applied in Nepal, highlighting the potential for similar programs in South Asian countries with limited healthcare infrastructure. The collaboration between the two countries has paved the way for further expansion and mutual support, emphasizing the role of High-Income Country institutions in facilitating South-to-South cooperation in global health. [Extracted from the article]

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]

Aim: To illuminate from the perspective of nurses in ambulance services the experiences of using a web‐based advisory decision support system to assess care needs and refer patients. Design: Inductive and descriptive approaches. Method: Thirteen semi‐structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis. Results: The Swedish web‐based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self‐care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations. Conclusion: Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol‐driven. Implications for Profession and/or Patient Care: These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self‐care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ). Patient or Public Contribution: None. [ABSTRACT FROM AUTHOR]

A growing number of individuals with unmet mental health needs in the United States rely on emergency medical services during mental health crises, and 9-1-1 emergency medical dispatchers (EMD) are often a critical lifeline to help. Unfortunately, current industry-standard dispatching protocols and training required for EMD certification largely lack specificity for managing 9-1-1 calls related to mental health emergencies. The purpose of this report is to illustrate the value of additional targeted training for EMDs that enables them to more effectively assist callers struggling with mental illness or suicidal thoughts. We review a 9-1-1 call in which an EMD utilized specific strategies and language learned during a 3-day emergency mental health dispatch (EMHD) training course to assist a middle-aged male who was expressing suicidal intent with a firearm. Key principles and phrasing from the training were used successfully by the EMD to dissuade the caller from self-harm, and he was ultimately safely met by first responders on scene and transported for care. We also share post-call recollections and reactions from the EMD to demonstrate how in addition to reducing risks for callers and their families, EMHD training has the potential to reduce on-scene risks for field responders and may increase confidence and mitigate negative stress responses in EMDs. Emergency medical services systems in the United States should continue to explore enhanced training and protocols to improve care for 9-1-1 callers experiencing mental health crises. [ABSTRACT FROM AUTHOR]

Introduction: Ambulance staff play a crucial role in responding to mental health crises. However, negative regard toward patients with mental health conditions can hinder care. The Medical Condition Regard Scale (MCRS) assesses regards or attitudes but has not previously been validated for educated ambulance staff and has never been translated into Norwegian. This study aims to translate the instrument into Norwegian, test it on a population of ambulance staff, explore the psychometric properties of the Norwegian version, and measure regard for patients with psychosis. Method: The MCRS is an 11-item instrument with a Likert scale of 1–6. Possible sum scores range from 11 to 66 (higher score = more positive regards). We chose "psychosis" as the condition to investigate. Translation followed eight steps: (1) preparation, (2) forward translation, (3) backward translation, (4) first expert panel review, (5) harmonisation, (6) cognitive debriefing, (7) second expert panel review, and (8) writing of the final version. The instrument was tested and re-tested regarding the condition "psychosis" on a representative sample of 114 Norwegian ambulance staff in 2023, with a temporal gap of one month. We explored item scores and distribution, as well as floor and ceiling effects. We tested the internal consistency of the items using Cronbach's Alpha and consistency in answers over time (test and re-test) using the Paired Sample-T test. We used factor analyses to explore the inter-item relationships of the items. Results: The 114 participants had a mean sum score of 47, which is mid-range. The scale has a ceiling effect on five items, which was not described in detail earlier. Two items regarding the monetary spending on patients with the given condition had the largest ceiling effects. However, the Norwegian translation showed adequate internal consistency (Cronbach's Alpha = 0.82) and is reliable over time. Test and re-test showed no significant differences in the scale's total score (Paired sample T-test, p > 0.05). Exploratory and confirmatory factor analyses indicate that the scale should be used as a one-dimensional instrument in a Norwegian setting in ambulance staff populations. Conclusion: The Norwegian translation of the MCRS is a reliable instrument for ambulance staff measuring medical condition regards. However, the ceiling effect limits the ability to discern differences among high-scoring individuals. Ambulance staff's regard for patients with psychosis is medium positive (mid-range level), but slightly more positive than what is reported in the international literature regarding patients with mental health issues. [ABSTRACT FROM AUTHOR]

Background: Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this. Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics' current practice and experiences providing end-of-life care was undertaken. Methods: A cross-sectional online survey design. Quantitative data were analysed using descriptive statistics and qualitative free text responses using Framework Analysis. The survey link was distributed to registered paramedics employed by all 11 NHS Trusts employing paramedics in England, United Kingdom. Results: Nine hundred and twenty responses were received. They reported shortfalls in availability of healthcare professionals for advice and/or referral. Respondents often, always or sometimes: lacked patient medical history (91%, 839), access to existing advance care planning documentation (98%, 900) and specific medicines needed (80%, 737); encountered conflicting views (89%, 819); and reported lack of pre-registration training (81%, 743) or continuing professional development (77%, 708) influenced their ability to meet patient needs. Conclusions: This first national survey of paramedic practice and experiences in delivering end-of-life care provides new evidence and insight into the challenges faced by paramedics and the potential impact of these challenges on their perceived levels of competence and confidence. Respondents reported multiple challenges, which potentially impact their ability to provide good quality end-of-life care and increase the risk of hospital conveyance. Paramedic practice at end-of-life must be supported via improved access to: patient records; anticipatory medicines and authority to administer; 24/7 palliative care advice (for shared decision-making); and paramedic specific palliative and end-of-life care training and education (including via integrative ways of working between palliative care and ambulance services). Action is required to integrate paramedicine within the wider healthcare professional team, with robust education and training to support care delivery. [ABSTRACT FROM AUTHOR]

The document provides an update on the UK and Ireland Confidential Enquiries into Maternal Death and Morbidity for the years 2020-2022. It highlights an increase in the maternal death rate, with thrombosis and thromboembolism being the leading cause of maternal death. The report also addresses disparities in maternal mortality rates among women of different ethnic backgrounds and socioeconomic statuses. Additionally, it emphasizes the importance of addressing language barriers and cultural competency in maternity care to improve outcomes and prevent maternal deaths. [Extracted from the article]

Background: Paediatric mortality rates in low- and middle-income countries account for over 80% of the global burden. In South Africa, one in every 33 children will not reach the age of five. Despite the high mortality rate, there is a paucity of data describing the prehospital paediatric under-five emergency care burden in South Africa. Such data are essential to inform the development of local prehospital emergency care guidelines and targeted prevention strategies. Aim: This study describes the prehospital paediatric under-five emergency care burden managed by the Western Cape Government Health and Wellness (WCGHW) Emergency Medical Services (EMS) in South Africa. Methods: A retrospective review of the prehospital records was conducted, extracting epidemiological and clinical data from the WCGHW EMS patient record database. The review included all paediatric cases under-five, managed between 1 January 2022 and 31 December 2023, in the Western Cape of South Africa. Results: In the 87 457 cases, there was a similar distribution between the primary cases (50.7%) and interfacility transfers (49.3%). Most activations emanated from rural areas (47 980, 54.9%), with respiratory emergencies (30 934, 35.4%), non-cardiac pain (11 381, 13.0%) and trauma (10 831,12.4%) being the most common presenting complaints. Most cases were prioritised as priority 2 (46 034, 52.6%), with most of these being older children between one and five years old (29 008, 63.0). Low acuity cases accounted for 67.2% (58 818) of the sample, with the highest mortality occurring between 29 days and 12 months (190, 52.9.%). Most patients spent less than one hour in the prehospital setting (64 431, 73.7%), with advanced airway management (748, 43.1%) being the most common airway intervention. Conclusion: This first description of the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS reveals a unique burden, particularly regarding the high interfacility transfer rates. As illustrated in graphical abstract, these findings underscore critical considerations for healthcare planners and the prehospital training environment. Future research among this population should focus on characterising the reasons for the high interfacility transfer rates through assessments of healthcare access, EMS care quality and post-EMS follow-up. Key messages: • The study found a high rate of interfacility transfers (49.3%) among the prehospital paediatric under-five emergency care burden managed by the WCGHW EMS. This reflects the challenges of South Africa's tiered healthcare system and highlights a significant burden on EMS resources. • The predominance of medical emergencies over trauma: Unlike in high-income countries where trauma is often a leading cause of paediatric EMS activations, this study found that medical emergencies, particularly respiratory complaints (35.4%), were the most common reason for EMS usage. This aligns with WHO data on causes of paediatric morbidity and mortality in low- and middle-income countries. • A high proportion of low acuity cases: The majority (67.2%) of cases were categorized as low acuity (routine or non-urgent). This differs from patterns seen in high-income countries and suggests potential overuse of EMS for non-emergency situations, which has implications for resource allocation and healthcare system planning. [ABSTRACT FROM AUTHOR]

This study addresses the location of emergency rescue vehicle bases in the western region of the city of Rio de Janeiro. The research aims to serve the greatest number of people within WHO parameters, which stipulates a maximum waiting time of 10 min. Various scenarios are explored, varying the number of rescue vehicles from 10 to 50 and the number of bases from 10 to 22. The study reveals that having an adequate number of rescue vehicles is crucial before determining the number and locations of the bases. Even in optimized scenarios with 5 or 8 bases, population coverage still falls short of the ideal, especially for 10‐min response times. However, increasing the number of bases, up to a maximum of 22, shows significant improvements in population coverage, especially when aiming for a 10‐min response time. Suggestions for future research include calculating the exact number of rescue vehicles needed to optimize the service and considering cost implications. This study highlights the importance of enhancing the emergency response system to meet the needs of the population. [ABSTRACT FROM AUTHOR]

Across the U.S, it is a documented fact that rural areas have longer ambulance response times and tend to have lower median income. The objective of this study was to test if the rural-urban emergency medical service (EMS) response time disparity was related to wealth disparity in the state of Connecticut. All mean EMS response times were sourced from the 2016 Office of Emergency Medical Services Data Report. Rural definitions were sourced from the Connecticut Office of Rural Health. Median income data was drawn from the Connecticut Office of Policy and Management. A Mann-Whitney U test determined if the average rural EMS response time was greater than the non-rural EMS response time. Pearson coefficients quantified the relationship between median income and EMS response time. A t-test ascertained if the average median income differed between the two datasets. The mean EMS response time was 12.98 min (SD = 3.36) rural and 8.26 min (SD = 2.12) non-rural. Rural mean response time and median income were not significantly correlated (r = -.148, p=.247); non-rural mean response time and median income were also not significantly related. No significant disparity was detected (t=0.478, p=.633) between the mean rural household income ($98,258) and mean non-rural household income ($95,706). Significant disparities in EMS response times can exist between rural and non-rural towns separate from median income trends, as is the case in Connecticut. These findings may have limited generalizability because of Connecticut's relatively high median income as compared to other states yet may be relevant to states with similar economic metrics. [ABSTRACT FROM AUTHOR]

The Save a Life (SAL) Maps addresses the challenge of traffic congestion affecting emergency services and provides swift response during life-critical situations. A path clearance algorithm is integrated into an application, which identifies the most optimal routes enabling emergency services to navigate efficiently. The algorithm incorporates a mechanism that uses micro services to facilitate path clearance for emergency services, provide fastest routes, assist general public in accessing emergency services, and notify the traffic police during high traffic congestion to assist by manually clearing out the path. Docker is employed to containerize the micro services, allowing for efficient deployment and management on the Google Kubernetes Engine platform. This micro services-based algorithm achieves enhanced efficiency, optimal resource utilization, real-time decision-making, scalability, adaptability and offers a reliable solution which highlight the importance of adopting path clearance algorithms and micro services architecture for ambulances enabling a more agile and responsive system. [ABSTRACT FROM AUTHOR]

Background: Ensuring patient safety is essential to prevent and minimize adverse events, and pre-hospital services play a vital role in the healthcare network, serving as the starting point for quality care. This study aimed to adapt the Emergency Medical Services Safety Attitudes Questionnaire to the Brazilian context and evaluate its psychometric properties. Methods: Beaton and colleagues' guidelines were used as a reference. Construct validity was evaluated by confirmatory factor analysis (CFA) based on the responses of 93 participants. Questions with reverse scoring were excluded in a further CFA. Results: The content validity index was 0.99, and Cronbach's alpha was 0.90. The initial CFA resulted in a Tucker–Lewis index (TLI) of 0.95 and a comparative fit index (CFI) of 0.951. After the exclusion of reverse-coded questions (Q4 and Q9), TLI increased to 0.96 and CFI to 0.97. Conclusions: The adapted instrument demonstrated good content, face, and construct validity, confirming its suitability for evaluating patient safety in prehospital services in Brazil. It can guide adjustments in care protocols, contributing to the safety and effectiveness of prehospital care while aligning with patient-centered best practices. [ABSTRACT FROM AUTHOR]

Purpose: The suicidal process contains both observable and non-observable phases, and patients have described the process as characterized by loneliness and darkness. Ambulance clinicians encounter patients in all phases of the suicidal process but little is known on what meaning this encounter has to the patients. The aim of this study was to elucidate meanings of encountering ambulance clinicians while being in a suicidal process. Methods: Data were collected through fifteen individual interviews with eight participants who had lived experiences of encountering ambulance clinicians. Inductive design using phenomenological hermeneutical approach was used. Findings: Patients are impacted by the clinicians, both in how they find their value in the situation, but also in expected trajectory. Three themes; 'Being impacted by representatives of society', 'Being unsure of one´s own value' and 'Regaining hope in moments of togetherness' generated the main theme ´Navigating oneself through the eyes of the other´. Conclusion: The way ambulance clinicians communicate impacts how patients navigate themselves in the ambivalence about living or dying, and the encounter either consolidate a feeling of being a burden, or instil hope of an endurable life. Through conversation, clinicians could support the patients in taking the first steps in the journey of recovery. [ABSTRACT FROM AUTHOR]

This research addresses the critical issue of identifying factors contributing to admissions to acute mental health (MH) wards for individuals presenting to the emergency department (ED) with MH concerns as their primary issue, notably suicidality. This study aims to leverage machine learning (ML) models to assess the likelihood of admission to acute MH wards for this vulnerable population. Data collection for this study used existing ED data from 1 January 2016 to 31 December 2021. Data selection was based on specific criteria related to the presenting problem. Analysis was conducted using Python and the Interpretable Machine Learning (InterpretML) machine learning library. InterpretML calculates overall importance based on the mean absolute score, which was used to measure the impact of each feature on admission. A person's 'Age' and 'Triage category' are ranked significantly higher than 'Facility identifier', 'Presenting problem' and 'Active Client'. The contribution of other presentation features on admission shows a minimal effect. Aligning the models closely with service delivery will help services understand their service users and provide insight into financial and clinical variations. Suicidal ideation negatively correlates to admission yet represents the largest number of presentations. The nurse's role at triage is a critical factor in assessing the needs of the presenting individual. The gap that emerges in this context is significant; MH triage requires a complex understanding of MH and presents a significant challenge in the ED. Further research is required to explore the role that ML can provide in assisting clinicians in assessment. [ABSTRACT FROM AUTHOR]

Exposure to traumatic and/or violent events is an inherent part of the first responder role, which increases the risk of developing acute and chronic mental health symptoms and conditions. Suicidality for Australian first responders have recently increased with prevalence considered much higher compared with the general population. To inform specific recommendations for Australian first responders, there is a need to establish what evidence is available regarding these issues within the Australian context. The aim of this scoping review was to explore the impacts of trauma on the mental health of Australian first responders, the strategies recommended to address these issues and any unique needs in rural contexts. A scoping review was undertaken following PRISMA guidelines for scoping reviews. Peer‐reviewed articles on Australian first responder mental health from seven databases were screened for inclusion. This review highlights that despite available evidence on the types of traumas and adverse mental health outcomes experienced, less evidence exists pertaining to intervention effectiveness. There are major gaps in evidence within rural and remote contexts which hinders effective planning and delivery of support for rural and regional first responders. Clinicians such as mental health nurses, particularly in rural areas, need to be aware of these gaps which impact planning and delivery of support and are in prime position to ensure screening, interventions and strategies are used and evaluated to determine their suitability for rural first responders. [ABSTRACT FROM AUTHOR]

Objective: To profile the initial 6‐month experience at the Victorian Heart Hospital (VHH) cardiac emergency (CE). The primary objective was to describe VHH CE patient characteristics, including presenting complaint, final diagnosis and disposition. Secondary objectives were to report on patient numbers, patient source and quality indicator performance including ambulance off‐load by 40 min, waiting time and length of stay (LOS). Methods: A retrospective review included all patients who presented to the VHH CE from 9 March 2023 to 8 September 2023. Patient reports containing the relevant clinical information were generated from the CE electronic medical record system. Diagnoses of MI were checked for accuracy by full record review. Results: There were 3303 CE presentations in the first 6 months of operation, of which 6% were transferred from other sites. Median age was 65 years (interquartile range [IQR]: 53–77), 56% were males; the most common presenting complaints were presumed cardiac chest pain (67%) and arrhythmia (17%). The admission, discharge and transfer rates were 38%, 54% and 8%, respectively. In total, 15% were diagnosed with MI. The most common diagnoses for discharged and admitted patients were non‐specific chest pain (57%) and ST‐elevation MI (22%), respectively. Ambulance off‐load by 40 min was met for 96%. Median waiting time was 6 min (IQR: 3–10). Median CE LOS for discharged and admitted patients was 3.2 h (IQR: 2.5–4.0) and 3.7 h (IQR: 1.8–6.0), with 75% and 56% being <4 h, respectively. Conclusions: The population predominantly had cardiovascular disease as expected. Some performance indicators, including ED LOS, were identified as requiring intervention. [ABSTRACT FROM AUTHOR]

Objective: Cervical spinal immobilisation procedures often include rigid cervical collars which, despite associated complications, may provide less immobilisation than previously thought. The present study reports the incidence of worsening neurological outcomes following soft collar application, and additionally reports patient comfort, compliance with spinal immobilisation, and paramedic perspectives on usage. Methods: This was an observational cohort study conducted in selected metropolitan and regional areas of NSW Ambulance between 1 May 2022 and 31 March 2023. Soft collars were used exclusively in place of rigid collars. The SPEED (SPinal Emergency Evaluation of Deficits) tool was used to evaluate new or worsening neurological deficits following pre‐hospital soft collar application. Secondary outcomes included patient‐reported comfort of the device, and paramedic assessment of efficacy. Results: Overall, 2098 soft collars were applied, of which 74 patients (3.5%) were subsequently found to have a cervical spine injury. Eight patients had a spinal cord injury, of which two experienced a worsening neurological deficit after soft collar application. In both instances, comprehensive case reviews determined that this was unlikely to have been attributable to the soft collar. The majority of patients found the soft collar comfortable, and they were well‐tolerated by patients who generally complied with immobility directions. Paramedics found the collar easy to apply, and felt it assisted in minimising patient movement. Conclusions: Pre‐hospital use of soft collars does not appear to increase the risk of significant injury. Patients found these devices relatively comfortable, and clinicians reported overall ease of use with good patient compliance with immobility directives. [ABSTRACT FROM AUTHOR]

Aim: To describe ambulance clinicians' experiences of self‐determination in older patients. Design: The study had an inductive and explorative design, guided from a life‐world perspective. Methods: Thirty‐two Swedish ambulance clinicians were interviewed in six focus groups in November 2019. The data were analysed with content analysis, developing manifest categories and latent themes. Findings: The ambulance clinicians assessed the older patients' exercise of self‐determination by engaging in conversation and by being visually alert, to eventually gain an overall picture of their decision‐making capacity. This assessment was used as a platform when informing older patients of their rights, thus promoting their participation in care. Having limited time and narrow guidelines counteracted ambulance clinicians' ambitions to support older patients' general desire to avoid hospitalization, which resulted in an urge to displace their responsibility to external decision‐makers. Conclusion: Expectations that older patients with impaired decision‐making ability will give homogeneous responses mean an increased risk of ageist attitudes with a simplified view of patient autonomy. Such attitudes risk the withholding of information about options that healthcare professionals do not wish older patients to choose. When decision‐making is difficult, requests for expanded guidelines may paradoxically risk alienation from the professional nursing role. Implications and Impact: The findings show ambulance clinicians' unwillingness to shoulder their professional responsibility when encountering older patients with impaired decision‐making ability. In assuming that all older patients reason in the same way, ambulance clinicians tend to adopt a simplistic and somewhat ageist approach when it comes to patient autonomy. This points to deficiencies in ethical competence, which is why increased ethics support is deemed suitable to promote and develop ethical competence. Such support can increase the ability to act as autonomous professionals in accordance with professional ethical codes. Reporting Method: This study adhered to COREQ guidelines. Patient and Public Contribution: None. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: Involuntary detention is a legislative power that allows people to be taken against their will for a mandatory mental health assessment and is known to be a restrictive and traumatizing process for patients.While there is some literature examining police/ambulance and mental health worker co‐response models, the conclusions are mixed as to whether they reduce rates of involuntary detentions in mentally ill people.The Police, Ambulance, Clinician Early Response (PACER) model is an example of a tri‐response mental health crisis response team whose role is to respond and assess people thought to be experiencing a mental health crisis.There is little literature to determine whether PACER tri‐response model reduces incidents of involuntary detention when compared with standard police and/or ambulance responses. What this paper adds to existing knowledge?: This paper describes the outcomes of patients assessed by a PACER team, compared with patients who were assessed by police or ambulance.It demonstrates that PACER may reduce unnecessary involuntary detentions through expert mental health assessment for patients coming to emergency services for assistance. It is one of only two published studies examining a tri‐response model. What are the implications for practice?: The results of this study may support health and policing policymakers to implement PACER models as a means of reducing involuntary detentions, reducing demand for emergency departments, reducing time spent by emergency services responding to people experiencing mental health crisis and improving outcomes for people with mental illness. Background: Involuntary detention is a common method of enforcing mental health assessment and treatment; however, it is associated with poor patient outcomes and high emergency service and hospital demand. Aim: To examine the association between (1) Police, Ambulance, Clinician, Early Response (PACER) model, (2) police or (3) ambulance response and rates of involuntary detention of mentally ill people. Methods: A retrospective observational study using routine administrative data in an Australian City, over a 12‐month period (2019–2020). Results: Over a 12‐month period, 8577 people received crisis mental health intervention in the study setting. We observed an 18% increase in the relative risk of being involuntarily detained by police, and a 640% increase in the relative risk of being detained by ambulance. The PACER team detained 10% of their total presentations, as compared with 12% by police and 74% by ambulance. Involuntary detentions enacted by PACER were more likely to convert to a post‐detention hospitalization (72%), when compared with police (27%) and ambulance (17%). Discussion: PACER was associated with lower rates of involuntary detention and higher rates of post‐detention hospitalization when compared to police and ambulance response. Implications for Practice: PACER cohort experience more positive outcomes than with police or ambulance cohorts. [ABSTRACT FROM AUTHOR]

This collaborative study by The Australasian College of Paramedicine's Clinical Practice Guidelines (CPG) Working Group aimed to examine CPG development practices in Australian and New Zealand ambulance services. Employing a qualitative descriptive design, the research utilised thematic analysis to extract insights from interviews with eleven experts actively involved in CPG development. The study embraced a nominalist and constructivist approach, recognising the intricate connection between individual experiences and the realities of CPG development in the paramedic field. Key findings revealed significant heterogeneity in CPG development practices, emphasising a lack of formal training and a substantial reliance on existing guidelines. The study highlighted challenges in project management flexibility, limited research capacity, and inconsistencies in external consultations and resource utilisation. The study recommends adopting project management frameworks, investing in training, and utilising evidence evaluation methodologies like GRADE. It emphasises the need for multidisciplinary teams and formal expertise in evidence synthesis, advocating for targeted training programs. Funding challenges highlight the importance of dedicated budgets and collaborative efforts for resource allocation. Knowledge translation and implementation issues underscore the significance of training programs for evidence evaluation and knowledge translation in overcoming these challenges. [ABSTRACT FROM AUTHOR]

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This study examines the barriers to integrating portable Magnetic Resonance Imaging (MRI) systems into ambulance services to enable effective triaging of patients to the appropriate hospitals for timely stroke care and potentially reduce door-to-needle time for thrombolytic administration. The study employs a qualitative methodology using a digital twin of the patient handling process developed and demonstrated through semi-structured interviews with 18 participants, including 11 paramedics from an Emergency Medical Services system and seven neurologists from a tertiary stroke care centre. The interview transcripts were thematically analysed to determine the barriers based on the Systems Engineering Initiative for Patient Safety framework. Key barriers include the need for MRI operation skills, procedural complexities in patient handling, space constraints, and the need for training and policy development. Potential solutions are suggested to mitigate these barriers. The findings can facilitate implementing MRI systems in ambulances to expedite stroke treatment. PRACTITIONER SUMMARY: This study investigates the challenges of integrating portable MRI systems into ambulances for faster stroke care. It identifies key barriers such as operational skills, procedural complexities, space constraints, and policy development needs, and offers a few solutions to improve emergency stroke treatment. [ABSTRACT FROM AUTHOR]

Emergency Medical Services (EMS) are vital for providing timely out‐of‐hospital care during medical emergencies. This research aims to optimize ambulance services by strategically allocating resources to minimize response time. A modified Whale Optimization Algorithm (mWOA) is introduced to achieve this goal, focusing on providing 24 × 7 services to every patient in need. The, conducted in Southern Delhi, India, considers the uncertain and stochastic nature of demand and traffic. The results demonstrate a 14.6% improvement in average EMS‐based response time, highlighting the effectiveness of the mWOA algorithm in enhancing ambulance allocation strategies. The results obtained using different algorithms are compared with those obtained using mWOA. The experiment outcomes demonstrate that the mWOA has higher efficiency and superiority than alternative algorithms regarding convergence rate and stability. [ABSTRACT FROM AUTHOR]

The article discusses how the requirement for police reports before providing emergency medical care in Nigeria, particularly for gunshot victims, leads to delays in treatment, impacting the nation's progress towards Universal Health Coverage (UHC). The law mandating police reports often results in avoidable fatalities due to treatment delays, disproportionately affecting vulnerable populations who may mistrust law enforcement. Healthcare providers face ethical dilemmas balancing legal obligations with the need to protect life, highlighting the need for public education, legislative changes, and improved healthcare facilities to prioritize life-saving care and advance UHC in Nigeria. [Extracted from the article]

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/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 global strain on Emergency Medical Services (EMS) is reflected in the increasing number of emergency ambulance dispatches. Shorter EMS response times have demonstrated some effect on very specific and rare conditions. It is unknown if the increased number of ambulance dispatches compromises response times. This study aimed to describe trends in emergency ambulance dispatches and response times from 2013 to 2022 in Region Zealand, Denmark. Additionally, it aimed to outline the demographic profile of emergency ambulance patients, including age and comorbidities. Methods: Using administrative data from the Region Zealand emergency medical dispatch center, a register-based study spanning from January 1, 2013, to December 31, 2022, was conducted. Data were linked with nationwide registries and priority A (emergency), or B (urgent) ambulance dispatches were included. Trends were examined overall and stratified by catchment areas corresponding to the hospitals with emergency departments in the region. Poisson and ordinal logistic regressions were used to analyze data. Results: The study encompassed 678,789 emergency ambulance dispatches, with 55.0% priority A and 45.0% priority B. Among these, 667,788 had a valid personal identification number allowing for further analysis. Within the study population, females comprised 48.5%, while 49.1% of patients were 65 years or more. Overall, 47.5% of patients had no comorbidities, while 7.7% and 44.8% had mild and severe comorbidities, respectively. Emergency ambulance dispatches increased from 56,867 in 2013 to 81,080 in 2022 (143%). Correspondingly, the dispatch incidence rate per 1,000 residents per year increased from 69.2 to 95.5. Stratification by catchment areas revealed significant disparities. The median response time for priority A dispatches increased from 7 min:14 s in 2013 to 8 min:20 s in 2022 and for priority B dispatches from 12 min:23 s to 15 min:6 s. Conclusions: From 2013 to 2022, emergency ambulance dispatches both priorities A and B increased in absolute numbers and per 1000 residents per year. Ambulance response times also increased for both priorities during the study period. The study shows regional disparities regarding to the rate of emergency ambulance dispatches and response times indicating challenges in resource distribution in the future for maintaining emergency care standards. [ABSTRACT FROM AUTHOR]

The document deals with the right of health insurance companies to access criminal records against contracted physicians. It discusses whether health insurance companies have the right to information from investigation files in order to verify the legality of billing in outpatient care. It also talks about ambulance transport costs for transfers within the same hospital. It is determined that internal ambulance transports are not covered by the benefits of GKV-insured persons and therefore there is no separate compensation from the health insurance company. [Extracted from the article]

Introduction: There are several options for receiving acute care besides emergency departments (ED), such as primary care physician (PCP) offices, urgent care centers (UCC), and telehealth services. It is unknown whether these alternative modes of care have decreased the number of ED visits for patients or whether they are considered before visiting the ED. A comprehensive study considering all potential methods of care is needed to address the evolving landscape of healthcare. Our goal was to identify any factors or barriers that may have influenced a patient’s choice to visit the ED as opposed to a UCC, PCP, another local ED, or use telehealth services. Methods: We surveyed ED patients between three hospital sites in the greater Buffalo, NY, area. The survey consisted of questions regarding the patients’ reasons and rationale for choosing the ED over the alternative care options. The study also involved a health record review of the patients’ diagnoses, tests/ procedures, consults, and final disposition after completion of the survey. Results: Of the 590 patients consented and surveyed, 152 (25.7%) considered seeking care at a UCC, 18 (3.1%) considered telehealth services, and 146 (24.7%) attempted to contact their PCP. On the recommendation of their PCP, patients presented to the ED 110 (20.7%) times and on the recommendation of the clinician at the UCC 54 (9.2%) times. Patients’ perceived seriousness of their condition was the most common reason for their selected mode of transport to the ED and reason for choosing the ED as opposed to alternative care sites (PCP, UCC, telehealth). Based on criteria for an avoidable ED visit, 83 (14.1%) ED patients met these criteria. Conclusion: Individuals prioritize the perceived severity of their condition when deciding where to seek emergency care. While some considered alternatives (PCP, UCC, telehealth services), uncertainties about their condition and recommendations from other clinicians led many to opt for ED care. Our findings suggest a potential gap in understanding the severity of symptoms and determining the most suitable place to seek medical care for these particular conditions. [ABSTRACT FROM AUTHOR]

Why you should read this article: • To recognise that overcrowded emergency departments result in ambulance handover delays causing avoidable harm to patients awaiting assessment • To identify how forward planning and anticipatory escalation processes can reduce the potential for patients to experience avoidable harm • To learn how a strategic quality improvement project improved patient safety and the working lives of front-line healthcare professionals. Ambulance handover delays arise when emergency departments become overcrowded as patients waiting prolonged periods for admission occupy clinical cubicles designed to facilitate the assessment and treatment of emergency arrivals. In response, many organisations become reliant on temporarily lodging acutely unwell patients awaiting admission in undesignated areas for care such as corridors, to provide additional space. This results in a significant risk of avoidable harm, indignity and psychological trauma for patients and has a negative effect on the well-being of healthcare professionals, since unacceptable standards of care become normalised. A two-phase strategic quality improvement project was implemented at the authors’ acute trust. Ambulance handover data from between 2 November 2020 and 26 July 2021 provided a benchmark for the project. The first phase was implemented between 2 November 2021 and 26 July 2022 and aimed to reduce 60-minute ambulance handover delays. The second phase was implemented between 2 November 2022 and 26 July 2023 and aimed to eradicate 60-minute ambulance handover delays and improve overall performance. Phase one resulted in a 32% reduction in 60-minute ambulance handover delays. Phase two resulted in a 97% reduction in 60-minute ambulance handover delays. Over the course of the project there was a 24% increase in handovers completed within 15 minutes. This project demonstrates how strategic planning and collaboration between healthcare teams can reduce the potential for avoidable patient harm, while simultaneously promoting workforce well-being and retention. [ABSTRACT FROM AUTHOR]

Ambulance-based telestroke may be a promising solution to improving stroke care. We assessed the technical feasibility and reliability of prehospital evaluations using commercial mobile phones with fifth-generation wireless communication technology. Six standardized patients portrayed scripted stroke scenarios during ambulance transport in an urban city and were remotely evaluated by independent raters using tablets (three neurologists and three emergency physicians) in a hospital, assisted by paramedics (trained in National Institute of Health Stroke Scale [NIHSS] assessment) in the ambulance; commercial cellular networks were utilized for videoconferencing transmission. The primary outcomes were mean difference (MD) and correlation of NIHSS scores between the face-to-face and remote assessments. We also examined the Bland-Altman plot for itemized NIHSS components, and Kaplan–Meier curves were used to compare the differences in the duration of the two evaluations between neurologists and emergency physicians. We conducted 32 ambulance runs and successfully completed all NIHSS examinations. No significant difference was found between the face-to-face and remote evaluations (MD, 0.782; 95% confidence interval [CI], −0.520–0.395). The correlation of NIHSS scores between the two methods was 0.994 (95% CI, 0.945–1.026), and three items exhibited the highest frequency of runs, with score differences between the two methods. There were no significant differences between neurologists and emergency physicians in the mean evaluation duration and NIHSS scores for the two methods. Prehospital evaluation using commercial mobile phones with fifth-generation wireless communication technology is feasible and reliable during ambulance transport in urban areas. Emergency physicians and neurologists performed similarly in stroke evaluations. [ABSTRACT FROM AUTHOR]

Emergency medical services (EMS) is a system that provides emergency medical care for incidents involving serious illness or injury. The location of EMS stations plays an essential role in delivering effective and efficient medical services. Numerous location models have been developed for locating and sizing EMS stations. However, it remains challenging to satisfy all EMS planning criteria within a single location model. In this study, a multi-period capacitated facility location problem with maximum travel time and backup service (EMSLSP) is proposed for locating and sizing EMS stations. The most important criteria for EMS planning are taken into account in EMSLSP: the demand changes due to population mobility, the maximum service capacity of an ambulance, the maximum number of ambulances at each EMS station, the maximum travel time from each EMS station to the locations it serves, the full coverage of dynamic demand, the minimum percent of population covered by EMS service in a specific travel time, and a backup station for each demand location in case of need. A case study in Zhengzhou, a large city in China, demonstrates that effective and efficient locations and sizes of EMS stations can be determined by solving the EMSLSP with various planning parameters. Compared with the existing EMS systems, the average ambulance travel time and the percentage of the population served are significantly improved. Simulations of ambulance scheduling confirm that the relocated and resized EMS stations perform better than those in the existing system. The evaluation-optimization-simulation method outlined in this paper provides a comprehensive and effective approach for EMS station planning. [ABSTRACT FROM AUTHOR]

Aim: The purpose of this study was to provide an overview of the evolution of emergency medical services (EMS) in Saudi Arabia to describe its history, organisational service providers, governance, EMS statistics and the educational development of the field with the disparity of educational approaches. Background: The EMS is an important part of the healthcare system as it is often the first point of contact for medical emergencies. The EMS in Saudi Arabia has seen a number of positive changes over the past decade, some of which include the development of several university and college programs dedicated to teaching EMS, the evaluation of the profession from a post-employment first aid model into a pre-employment bachelor's degree model, the generous governmental scholarship grants overseas and the official accreditation of EMS as a profession. It has been approximately nine years since the first EMS bachelor's degree programs were developed in Saudi Arabia, some of which were directly adopted from universities in developed countries such as Australia. Despite these positive changes, the current EMS system in Saudi is faced with many challenges, both organisational and educational, including the lack of research, community involvement, the educational status of practitioners and the inconsistencies of statistics relating to response time and rate of transfer. This paper describes the history of EMS in Saudi Arabia with a specific focus on identifying the disparity in the educational outcomes and approaches adopted by colleges and universities in the Kingdom. Methods: The data utilised for the research of the EMS profession in Saudi Arabia were obtained from the literature using search tools such as MEDLINE, Google Scholar, Saudi health journals, Saudi university websites, government reports and statistics. Conclusion: The EMS profession in Saudi Arabia has advanced greatly in the past 12 years. Yet there is still scope for considerable improvement, especially with regards to developing empirically identified core competencies for EMS bachelor's degree graduates. There is also the need for providing more outreach to the public to improve awareness of current services and available training, building more collaboration between the industry employers and academic institutions and investing further in EMS research through the development of Saudi-based postgraduate master's and PhD EMS degrees. This paper is the first to provide an overview of the EMS service in Saudi Arabia, for institutions and researchers to gain a better understanding of the history and current standing of the service from an educational and operational perspective. [ABSTRACT FROM AUTHOR]

Background: Patient-centered care is a foundation for high-quality healthcare delivery and is recognized by the Institute of Medicine as one of the six key elements of healthcare quality. It is fundamental to improving health outcomes, patient satisfaction, and overall healthcare system performance. In contemporary healthcare, we are encouraged to optimize our practices and deliver patient-centered care by actively seeking and analyzing patient feedback. This study explored patients' decision to refuse transportation to a medical facility after receiving on-scene pre-hospital emergency treatment. Methods: A qualitative analysis approach was applied using semi-structured telephone interviews with 210 patients who had requested Hamad Medical Corporation Ambulance Service pre-hospital emergency care from June 15 to August 1, 2023 and decided not to proceed with hospital conveyance. A thematic analysis with inductive coding of the open-ended feedback was performed using Nvivow software version 12. Results: Data saturation was achieved with 32 responses. The thematic analysis revealed five critical themes: "Rationales for using 999 emergency services", which primarily focused on acute medical needs and the absence of alternative healthcare solutions; "Reasons for declining hospital conveyance", which included family obligations and previous unsatisfactory encounters at the hospital; "Subsequent steps after declining hospital transportation", which disclosed that most respondents remained at home after the intervention, while a minority sought further medical consultation through alternative means; "Service satisfaction level", which was predominantly positive; and "Language barriers", which highlighted specific challenges during the emergency call-taking process. Conclusion: The study provided an understanding of the factors influencing patient decision-making in emergency medical contexts. It advocated targeted quality improvement interventions such as gender-responsive services and linguistic inclusivity. These findings highlighted the need for an integrative, patient-centered model that is attuned to the cultural and linguistic intricacies, thereby informing policy and practice to increase the efficacy of emergency medical services in Qatar. [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]

Objective: Many patients who are attended by paramedics do not require conveyance to an emergency department (ED). Our study focuses on comparing the characteristics and outcomes of patients who were advised to follow up with a general practitioner (GP) by an attending paramedic with those of patients who were discharged at scene or transported to hospital. Methods: This was a retrospective data linkage cohort study of ambulance, ED, hospital admission, and death records for all adults attended by paramedics in Victoria, Australia between the 1st of January 2015 and 30th of June 2019. Patients were excluded if they presented in cardiac arrest, resided in a residential aged care facility, or were receiving palliative care services. Outcomes of interest included reattendance by ambulance, ED presentation; and, a high acuity outcome which we defined as a patient who (1) presented to ED and received an Australasian Triage Scale of category 1 (Resuscitation) or 2 (Emergency) AND was admitted to a ward OR (2) was admitted to an Intensive Care Unit, Coronary Care Unit or Catheter laboratory (regardless of triage category) OR (3) died. Outcomes of interest were considered within 48-h of initial EMS attendance. Results: A total of 1,777,950 cases were included in the study of which 3.1% were referred to a GP, 9.0% were discharged at scene without a follow-up recommendation, and 87.9% were transported to hospital. Patients referred to a GP were more likely than those discharged at scene to subsequently present to an ED within 48 h of their attendance (5.3% vs 3.8%). However, GP referral was not associated with any change to high acuity outcome (0.3% vs 0.2%) or ambulance reattendance (6.0% vs 6.0%) compared to discharge at scene. The only factors that were associated with ambulance reattendance, ED presentation, and a high acuity outcome were male gender and elevated temperature. Conclusions: Despite increasing low and medium-acuity casework in this EMS system, paramedic referral to a GP is not common practice. Referring a patient to a GP did not reduce the likelihood of patients experiencing a high acuity outcome or recalling an ambulance within 48 h, suggesting opportunity exists to refine paramedic to GP referral practices. [ABSTRACT FROM AUTHOR]

Abstract Background Global demand for care during the last year of life (end-of-life) is rising and with shortfalls in community healthcare services, paramedics are increasingly called on to deliver this. Despite this growing demand on the paramedic workforce, little large-scale or detailed empirical research has evaluated current practice and paramedic experiences of attending this patient group. Therefore, as part of a wider study evaluating paramedic delivery of end-of-life care, a large-scale survey in England describing paramedics’ current practice and experiences providing end-of-life care was undertaken. Methods A cross-sectional online survey design. Quantitative data were analysed using descriptive statistics and qualitative free text responses using Framework Analysis. The survey link was distributed to registered paramedics employed by all 11 NHS Trusts employing paramedics in England, United Kingdom. Results Nine hundred and twenty responses were received. They reported shortfalls in availability of healthcare professionals for advice and/or referral. Respondents often, always or sometimes: lacked patient medical history (91%, 839), access to existing advance care planning documentation (98%, 900) and specific medicines needed (80%, 737); encountered conflicting views (89%, 819); and reported lack of pre-registration training (81%, 743) or continuing professional development (77%, 708) influenced their ability to meet patient needs. Conclusions This first national survey of paramedic practice and experiences in delivering end-of-life care provides new evidence and insight into the challenges faced by paramedics and the potential impact of these challenges on their perceived levels of competence and confidence. Respondents reported multiple challenges, which potentially impact their ability to provide good quality end-of-life care and increase the risk of hospital conveyance. Paramedic practice at end-of-life must be supported via improved access to: patient records; anticipatory medicines and authority to administer; 24/7 palliative care advice (for shared decision-making); and paramedic specific palliative and end-of-life care training and education (including via integrative ways of working between palliative care and ambulance services). Action is required to integrate paramedicine within the wider healthcare professional team, with robust education and training to support care delivery.

Abstract Introduction Ambulance staff play a crucial role in responding to mental health crises. However, negative regard toward patients with mental health conditions can hinder care. The Medical Condition Regard Scale (MCRS) assesses regards or attitudes but has not previously been validated for educated ambulance staff and has never been translated into Norwegian. This study aims to translate the instrument into Norwegian, test it on a population of ambulance staff, explore the psychometric properties of the Norwegian version, and measure regard for patients with psychosis. Method The MCRS is an 11-item instrument with a Likert scale of 1–6. Possible sum scores range from 11 to 66 (higher score = more positive regards). We chose “psychosis” as the condition to investigate. Translation followed eight steps: (1) preparation, (2) forward translation, (3) backward translation, (4) first expert panel review, (5) harmonisation, (6) cognitive debriefing, (7) second expert panel review, and (8) writing of the final version. The instrument was tested and re-tested regarding the condition “psychosis” on a representative sample of 114 Norwegian ambulance staff in 2023, with a temporal gap of one month. We explored item scores and distribution, as well as floor and ceiling effects. We tested the internal consistency of the items using Cronbach’s Alpha and consistency in answers over time (test and re-test) using the Paired Sample-T test. We used factor analyses to explore the inter-item relationships of the items. Results The 114 participants had a mean sum score of 47, which is mid-range. The scale has a ceiling effect on five items, which was not described in detail earlier. Two items regarding the monetary spending on patients with the given condition had the largest ceiling effects. However, the Norwegian translation showed adequate internal consistency (Cronbach’s Alpha = 0.82) and is reliable over time. Test and re-test showed no significant differences in the scale’s total score (Paired sample T-test, p > 0.05). Exploratory and confirmatory factor analyses indicate that the scale should be used as a one-dimensional instrument in a Norwegian setting in ambulance staff populations. Conclusion The Norwegian translation of the MCRS is a reliable instrument for ambulance staff measuring medical condition regards. However, the ceiling effect limits the ability to discern differences among high-scoring individuals. Ambulance staff’s regard for patients with psychosis is medium positive (mid-range level), but slightly more positive than what is reported in the international literature regarding patients with mental health issues.

Abstract Across the U.S, it is a documented fact that rural areas have longer ambulance response times and tend to have lower median income. The objective of this study was to test if the rural-urban emergency medical service (EMS) response time disparity was related to wealth disparity in the state of Connecticut. All mean EMS response times were sourced from the 2016 Office of Emergency Medical Services Data Report. Rural definitions were sourced from the Connecticut Office of Rural Health. Median income data was drawn from the Connecticut Office of Policy and Management. A Mann-Whitney U test determined if the average rural EMS response time was greater than the non-rural EMS response time. Pearson coefficients quantified the relationship between median income and EMS response time. A t-test ascertained if the average median income differed between the two datasets. The mean EMS response time was 12.98 min (SD = 3.36) rural and 8.26 min (SD = 2.12) non-rural. Rural mean response time and median income were not significantly correlated (r = -.148, p=.247); non-rural mean response time and median income were also not significantly related. No significant disparity was detected (t=0.478, p=.633) between the mean rural household income ($98,258) and mean non-rural household income ($95,706). Significant disparities in EMS response times can exist between rural and non-rural towns separate from median income trends, as is the case in Connecticut. These findings may have limited generalizability because of Connecticut’s relatively high median income as compared to other states yet may be relevant to states with similar economic metrics.

Abstract Background The global strain on Emergency Medical Services (EMS) is reflected in the increasing number of emergency ambulance dispatches. Shorter EMS response times have demonstrated some effect on very specific and rare conditions. It is unknown if the increased number of ambulance dispatches compromises response times. This study aimed to describe trends in emergency ambulance dispatches and response times from 2013 to 2022 in Region Zealand, Denmark. Additionally, it aimed to outline the demographic profile of emergency ambulance patients, including age and comorbidities. Methods Using administrative data from the Region Zealand emergency medical dispatch center, a register-based study spanning from January 1, 2013, to December 31, 2022, was conducted. Data were linked with nationwide registries and priority A (emergency), or B (urgent) ambulance dispatches were included. Trends were examined overall and stratified by catchment areas corresponding to the hospitals with emergency departments in the region. Poisson and ordinal logistic regressions were used to analyze data. Results The study encompassed 678,789 emergency ambulance dispatches, with 55.0% priority A and 45.0% priority B. Among these, 667,788 had a valid personal identification number allowing for further analysis. Within the study population, females comprised 48.5%, while 49.1% of patients were 65 years or more. Overall, 47.5% of patients had no comorbidities, while 7.7% and 44.8% had mild and severe comorbidities, respectively. Emergency ambulance dispatches increased from 56,867 in 2013 to 81,080 in 2022 (143%). Correspondingly, the dispatch incidence rate per 1,000 residents per year increased from 69.2 to 95.5. Stratification by catchment areas revealed significant disparities. The median response time for priority A dispatches increased from 7 min:14 s in 2013 to 8 min:20 s in 2022 and for priority B dispatches from 12 min:23 s to 15 min:6 s. Conclusions From 2013 to 2022, emergency ambulance dispatches both priorities A and B increased in absolute numbers and per 1000 residents per year. Ambulance response times also increased for both priorities during the study period. The study shows regional disparities regarding to the rate of emergency ambulance dispatches and response times indicating challenges in resource distribution in the future for maintaining emergency care standards.