Can ambulance dispatch categories discriminate traffic incidents that do/do not require a lights and sirens response?

PurposeTraffic incidents vary considerably in their severity, and the dispatch categories assigned during emergency ambulance calls aim to identify those incidents in greatest need of a lights and sirens (L&S) response. The purpose of this study was to determine whether dispatch categories could discriminate between those traffic incidents that do/do not require an L&S response.Design/methodology/approachA retrospective cohort study of ambulance records was conducted. The predictor variable was the Traffic/Transportation dispatch categories assigned by call-takers. The outcome variable was whether each incident required an L&S response. Possible thresholds for identifying dispatch categories that require an L&S response were developed. Sensitivity and specificity were calculated for each threshold.FindingsThere were 17,099 patients in 13,325 traffic incidents dispatched as Traffic/Transportation over the study period. “Possible death at scene” ‘had the highest odds (OR 22.07, 95% CI 1.06–461.46) and “no injuries” the lowest odds (OR 0.28 95% CI 0.14–0.58) of requiring an L&S response compared to the referent group. The area under the ROC curve was 0.65, 95% CI [0.64, 0.67]. It was found that Traffic/Transportation dispatch categories allocated during emergency ambulance calls had limited ability to discriminate those incidents that do/do not require an L&S response to the scene of a crash.Originality/valueThis research makes a unique contribution, as it considers traffic incidents not as a single entity but rather as a number of dispatch categories which has practical implications for those emergency medical services dispatching ambulances to the scene.

Assessment and management of issues in early pregnancy

Approximately 5% of the workload of UK emergency ambulance services involves managing obstetric patients. This places pregnancy firmly within the scope of prehospital care but training often focuses on critical illness during pregnancy rather than the range of presentations seen. This clinical review aims to discuss the implications of early pregnancy with a focus on ectopic pregnancy, rhesus incompatibility, miscarriage and hyperemesis gravidarum. Normal presentations of pregnancy and alternative management strategies, including early pregnancy units, are also discussed.

Towards a Distributed SMA-based Solution for the Interoperability of Hospital Information Systems for Better Routing of Emergency Ambulances

Multi-agent systems MASs have been widely used to interoperate hospital information systems (HISs). The use of MASs for HISs interoperability has become a central solution, especially in the field of emergency medicine. In emergencies, the notion of delay is relative, because responders only have a few minutes to react. This emergency response time has an important role in the event that an accident occurs on the road. Existing procedures for the emergency ambulance (EA) dispatch strategy are based on manual dispatch. In this work, we are introducing a distributed emergency ambulance (DEA) routing system to control emergency latency time, which includes driving route planning to guide emergency vehicles and the allocation of distributed emergency resources (emergency ambulances and hospitals) to reduce the EA response time caused by traffic or the wrong human decision to transport ambulance to the accident site. The allocation of resources (hospitals) is ensured through a recommendation system based on the interoperability of several interconnected HISs using a multi-agent system. The proposed solution takes into consideration dynamic traffic flow information during the day to build dynamic paths for EA. The improved method is based on a distributed architecture to calculate and find the optimal pathway for a set of emergency vehicles based on ACO ant colony optimization techniques. The results of the simulation show that the proposed method can decrease the total travel time of the ambulance to reach the accident position compared to conventional methods that use lights and sirens to warn other vehicles to free up the road for the ambulance or use a traditional approach based on the vision/reflection of the driver to choose in a random way the paths to take. Based on such a solution, ambulance staff will be able to save lives by optimizing the total journey with the minimum travel.

Effectiveness of a Humor-Based Training for Reducing Employees’ Distress

An increasing number of studies have demonstrated that humor can impact interpersonal relationships in organizations and employee well-being. However, there is little evidence coming from intervention studies in organizational settings. In response, we developed a training following the principles of positive psychology that aims at improving employees’ adaptive use of humor as a successful mechanism to deal with stress. In this study, we assess the effectiveness of such training and its impact on employee well-being. Results from this one-group intervention study in an emergency ambulance service (N = 58) revealed that the participants reported higher levels of cheerfulness (Z = −3.93; p < 0.001) and lower levels of seriousness (Z = −3.32; p < 0.001) after being exposed to the training. Indeed, the participants reported lower scores on psychological distress after the training (Z = −3.35; p < 0.001). The effect size of the training was medium (r = 0.31 to 0.36), suggesting that interventions to improve adaptive humor at work can be a useful resource to deal with workplace stress and foster employee well-being. These results may have interesting implications for designing and implementing positive interventions as well as for developing healthy organizations.

Methoxyflurane in Non-Life-Threatening Traumatic Pain—A Retrospective Observational Study

Pain management is a key issue in prehospital trauma. In Switzerland, paramedics have a large panel of analgesic options. Methoxyflurane was recently introduced into Switzerland, and the goal of this study was to describe both the effect of this medication and the satisfaction of its use. This was a retrospective cohort study, performed in one emergency ambulance service. It included adult patients with traumatic pain and a self-assessment of 3 or more on the visual analogue scale or verbal numerical rating scale. The primary outcome was the reduction in pain between the start of the care and the arrival at the hospital. Secondary outcomes included successful analgesia and staff satisfaction. From December 2018 to 4 June to October 2020, 263 patients were included in the study. Most patients had a low prehospital severity score. The median pain at arrival on site was 8 and the overall decrease in pain observed was 4.2 (95% CI 3.9–4.5). Regarding secondary outcomes, almost 60% had a successful analgesia, and over 70% of paramedics felt satisfied. This study shows a reduction in pain, following methoxyflurane, similar to outcomes in other countries, as well as the attainment of a satisfactory level of pain reduction, according to paramedics, with the advantage of including patients in their own care.