Feedback to Emergency Medical Services Providers: The Good, the Bad, and the Ignored

AbstractHypothesis:To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel.Methods:Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale.Results:In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (<1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill.Conclusion:The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.

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The Danish prehospital emergency healthcare system and research possibilities

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-019-0676-5 ◽

2019 ◽

Vol 27 (1) ◽

Cited By ~ 10

Author(s):

Tim Alex Lindskou ◽

Søren Mikkelsen ◽

Erika Frischknecht Christensen ◽

Poul Anders Hansen ◽

Gitte Jørgensen ◽

...

Keyword(s):

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Record ◽

Healthcare System ◽

Emergency Care ◽

Medical Service ◽

Medical Services ◽

Emergency Medical Service System ◽

Emergency Medical ◽

Medical Healthcare

Abstract The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes. Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system. Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark’s extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.

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Comfort Level of Emergency Medical Service Providers in Responding to Weapons of Mass Destruction Events: Impact of Training and Equipment

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00004908 ◽

2007 ◽

Vol 22 (4) ◽

pp. 297-303 ◽

Cited By ~ 21

Author(s):

Michael J. Reilly ◽

David Markenson ◽

Charles DiMaggio

Keyword(s):

Public Health ◽

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Service Providers ◽

Weapons Of Mass Destruction ◽

Medical Services ◽

Mass Destruction ◽

Public Health Emergencies ◽

Emergency Medical

AbstractBackground:Numerous studies have suggested that emergency medical services (EMS) providers areill-prepared in the areas of training and equipment for response to events due to weapons of mass destruction(WMD) and other public health emergencies (epidemics, etc.).Methods:A nationally representative sample of basic and paramedic EMS providers in the United States wassurveyed to assess whether they had received training in WMD and/or public health emergencies as part of their initial provider training and as continuing medical education within the past 24 months. Providers also were surveyed as to whether their primary EMS agency had the necessary specialty equipment to respond to these specific events.Results:More than half of EMS providers had some training in WMD response. Hands-on training was associated with EMS provider comfort in responding to chemical, biological, and/or radiological events and public health emergencies (odds ratio (OR) = 3.2, 95% confidence interval (CI) 3.1, 3.3). Only 18.1% of providers surveyed indicated that their agencies had the necessary equipment to respond to a WMD event. Emergency medical service providers who only received WMD training reported higher comfort levels than those who had equipment, but no training.Conclusions:Lack of training and education as well as the lack of necessary equipment to respond to WMD events is associated with decreased comfort among emergency medical services providers in responding to chemical, biological, and/or radiological incidents. Better training and access to appropriate equipment may increase provider comfort in responding to these types of incidents.

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The Emergency Department Arrival Mode and Its Relations to ED Management and 30-Day Mortality in Acute Heart Failure: An Ancillary Analysis From The EURODEM Study

10.21203/rs.3.rs-139434/v1 ◽

2021 ◽

Author(s):

Pia Harjola ◽

Tuukka TARVASMÄKI ◽

Cinzia BARLETTA ◽

Richard BODY ◽

Jean CAPSEC ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Emergency Medical Services ◽

Emergency Medical Service ◽

Acute Heart Failure ◽

Medical Service ◽

Ventilatory Support ◽

Medical Services ◽

Heart Failure Patients ◽

Emergency Medical

Abstract Background: Acute heart failure patients are often encountered in emergency departments from 11% to 57 % using emergency medical services. Our aim was to evaluate the association of emergency department arrival mode with acute heart failure patients’ emergency department management and short-term outcomes. Methods: This was a sub-analysis of the European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from 66 European emergency departments. Patients with emergency department diagnosis of acute heart failure were categorized into two groups: those using emergency medical services and those self-presenting (non- emergency medical service patients). The independent association between emergency medical services use and 30-day mortality was evaluated with logistic regression. Results: Of the 500 acute heart failure patients, 309 (61.8 %) arrived at emergency department by emergency medical services. They were older (median age 80 vs. 75 years, p<0.001) and had more dementia (18.7 % vs. 7.2 %, p<0.001). On admission, emergency medical service patients had more often confusion (43 (14.2 %) vs. 4 (2.1 %), p<0.001) and higher respiratory rate (24/min vs. 21/min, p=0.014; respiratory rate > 30/min in 17.1 % patients vs. 7.5 %, p=0.005). The only difference in emergency department management appeared in the use of ventilatory support: 78.3 % of emergency medical services patients vs. 67.5% of non- emergency medical services patients received oxygen, p=0.007, non-invasive ventilation was administered to 12.5 % of emergency medical service patients vs. 4.2% non- emergency medical service patients, p=0.002. Emergency medical service patients were more often hospitalized (82.4 % vs. 65.9 %, p<0.001). The use of emergency medical services was an independent predictor of 30-day mortality (OR=2.96, 95% CI 1.27-6.92, p=0.012)Conclusion: Most acute heart failure patients arrive at emergency department by emergency medical services. These patients suffer from more severe respiratory distress and receive more often ventilatory support. Emergency medical service use is an independent predictor of 30-day mortality.

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Need of Improvement in Emergency Medical Service in Urban Cities

Journal of Nepal Medical Association ◽

10.31729/jnma.230 ◽

2009 ◽

Vol 48 (174) ◽

pp. 139-43 ◽

Cited By ~ 1

Author(s):

Rajesh Gongal ◽

B Dhungana ◽

S Regmi ◽

M Nakarmi ◽

B Yadav

Keyword(s):

Emergency Medical Service ◽

Emergency Departments ◽

Medical Service ◽

Service Providers ◽

Ambulance Service ◽

Capital City ◽

Emergency Medical Service System ◽

Emergency Medical ◽

Triage Category ◽

Number Of Patients

Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1Dhungana B,1Regmi S,1Nakarmi M,2Yadav B11Patan Hospital, Lalitpur, Nepal, 2Health Care Foundation, Kathmandu, NepalCorrespondence:Dr. Rajesh GongalDepartment of SurgeryPatan Hospital, Patan, Nepal.Email: [email protected] ARTICLE J Nepal Med Assoc 2009;48(174):139-43INTRODUCTIONThe sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas.1-5 Although inadquate ambulance services are available in the capital city of Nepa

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The emergency medical system

The ESC Textbook of Intensive and Acute Cardiovascular Care ◽

10.1093/med/9780198849346.003.0008 ◽

2021 ◽

pp. 65-75

Author(s):

Olivier Hoogmartens ◽

Michiel Stiers ◽

Koen Bronselaer ◽

Marc Sabbe

Keyword(s):

Medical Care ◽

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Tertiary Care ◽

Medical Services ◽

High Quality ◽

Emergency Medical ◽

High Quality Medical Care ◽

The Moment

The mission of the emergency medical services is to promote and support a system that provides timely, professional and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time and any location. A medical emergency has five different phases, namely: population awareness and behaviour, occurrence of the problem and its detection, alarming of trained responders and help rendered by bystanders and trained pre-hospital providers, transport to the nearest or most appropriate hospital, and, if necessary, admission or transfer to a tertiary care centre which provides a high degree of subspecialty expertise. In order to meet these goals, emergency medical services must work aligned with local, state officials; with fire and rescue departments; with other ambulance providers, hospitals, and other agencies to foster a high performance network. The term emergency medical service evolved to reflect a change from a straightforward system of ambulances providing nothing but transportation, to a complex network in which high-quality medical care is given from the moment the call is received, on-scene with the patient and during transportation. Medical supervision and/or participation of emergency medicine physicians (EP) in the emergency medical service systems contributes to the quality of medical care. This emergency medical services network must be capable to respond instantly and to maintain efficacy around the clock, with well-trained, well-equipped personnel linked through a strong communication system. Research plays a pivotal role in defining necessary resources and in continuously improving the delivery of high-quality care. This chapter gives an overview of the different aspects of emergency medical services and calls for high quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

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Structured evaluation of stress triggers in prehospital emergency medical care

Der Anaesthesist ◽

10.1007/s00101-021-00968-x ◽

2021 ◽

Author(s):

Hendrik Eismann ◽

Lion Sieg ◽

Thomas Palmaers ◽

Vera Hagemann ◽

Markus Flentje

Keyword(s):

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Organizational Factors ◽

Professional Group ◽

Stress Factors ◽

Medical Services ◽

Professional Groups ◽

Emergency Medical ◽

Advanced Paramedics

Abstract Background Emergency medical services work in the environment of high responsibility teams and have to act under unpredictable working conditions. Stress occurs and has potential of negative effects on tasks, teamwork, prioritization processes and cognitive control. Stress is not exclusively dictated by the situation—the individuals rate the situation of having the necessary skills that a particular situation demands. There are different occupational groups in the emergency medical services in Germany. Training, tasks and legal framework of these groups vary. Objective The aim of this study was to identify professional group-specific stressors for emergency medical services. These stress situations can be used to design skills building tools to enable individuals to cope with these stressors. Material and methods The participants were invited to the study via posters and social media. An expert group (minimum 6 months of experience) developed a set of items via a two-step online Delphi survey. The experts were recruited from all professional groups represented in the German emergency medical service. We evaluated the resulting parameters for relevance and validity in a larger collective. Lastly, we identified stress factors that could be grouped in relevant scales. In total 1017 participants (paramedics, physicians) took part in the final validation survey. Results After validation, we identified a catalogue of stressors with 7 scales and 25 items for EMT (Emergency Medical Technician) paramedics (KMO [Kayser-Meyer-Olkin criterion] 0.81), 6 scales and 24 items for advanced paramedics (KMO 0.82) and 6 scales and 24 items for EMS (Emergency Medical Service) physicians (KMO 0.82). For the professional group of EMT basic, the quality parameters did not allow further processing of the items. Professional group-specific scales for EMT paramedics are “professional limitations”, “organizational framework”, “expectations” and “questions of meaning”. For advanced paramedics “appreciation”, “exceptional circumstances” and “legal certainty” were identified. The EMT physicians named “handling third parties”, “tolerance to ambiguity”, “task management” and “pressure to act”. A scale that is representative for all professional groups is “teamwork”. Organizational circumstances occur in all groups. The item “unnecessary missions” for EMT paramedics and “legal concerns with the application of methods” for advanced paramedics are examples. Discussion Different stressors are relevant for the individual professional groups in the German emergency medical service. The developed catalogue can be used in the future to evaluate the subjective stress load of emergency service professionals. There are stressors that are inherent in the working environment (e.g. pressure to act) and others that can be improved through training (teamwork). We recommend training of general resistance as well as training of specific items (e.g., technical, nontechnical skills). All professionals mentioned items with respect to organizational factors. The responsible persons can identify potential for improvement based on the legal and organizational items. The EMT basic requires further subdivision according to task areas due to its variable applicability.

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Awareness, Perspective, and Reasons Behind Patients’ Rejection of Emergency Medical Services in Thailand

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19002176 ◽

2019 ◽

Vol 34 (s1) ◽

pp. s104-s104

Author(s):

Teera Sirisamutr ◽

Porntip Wachiradilok

Keyword(s):

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Public Awareness ◽

Survival Rates ◽

Emergency Situation ◽

Medical Services ◽

Private Hospitals ◽

Emergency Medical ◽

Personal Transportation

Introduction:Emergency Medical Service (EMS) increases survival rates and reduces possible disability among emergency patients. However, the number of requests is relatively low in Thailand.Aim:To inspect the awareness, perspective, and reasons behind the rejection of EMS by patients or their relatives who visit the emergency room.Methods:Responses were analyzed in 45 government, university, and private hospitals from December 2015 to February 2016. The hospitals were scattered in 7 provinces with the sample group including 2,028 patients, whereby 646 patients visited using EMS and 1,368 did not. The key reasons for self-visit or other means are the convenience of personal transportation (76.0%), not wanting to wait for an ambulance (31.0%), and anxiety caused by the emergency situation (28.9%). Most misconceptions about the service include; 1) Ambulances are used only for casualties from accidents and 2) Ambulance service are not free. In terms of perspective, most patients or relatives hold a negative view towards the emergency medical service, especially the idea that they can help themselves when the condition is not severe or if there are medications or relief devices available. Another view is that the service will delay them from getting to the hospital. These perspectives are from non-users.Discussion:The study indicated that the cause of non-user involved misunderstandings, poor perspectives, lack of awareness, and the ignorance of the threat of the particular emergency condition. Thus, they do not realize the benefit of using EMS. As a result, regional agencies, the National Institute of Emergency Medicine, and the Ministry of Public Health should discuss the solutions to raise public awareness and improve the perspective towards emergency medical services to promote more usage.

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Description of Emergency Medical Services, treatment of cardiac arrest patients and cardiac arrest registries in Europe

10.21203/rs.3.rs-28875/v1 ◽

2020 ◽

Author(s):

Ingvild Beathe Myrhaugen Tjelmeland ◽

Siobhan Masterson ◽

Johan Herlitz ◽

Jan Wnent ◽

Leo Bossaert ◽

...

Keyword(s):

Cardiac Arrest ◽

Emergency Medical Services ◽

Emergency Medical Service ◽

Medical Service ◽

Data Availability ◽

European Countries ◽

Medical Services ◽

Monitoring Methods ◽

Emergency Medical ◽

Hospital Cardiac Arrest

Abstract Background Variation in the incidence, survival rate and factors associated with survival after cardiac arrest in Europe is reported. Some studies have tried to fill the knowledge gap regarding the epidemiology of out-of-hospital cardiac arrest in Europe but were unable to identify reasons for the reported differences. Therefore, the purpose of this study was to describe European Emergency Medical Systems, particularly from the perspective of country and ambulance service characteristics, cardiac arrest identification, dispatch, treatment, and monitoring. Methods An online questionnaire with 51 questions about ambulance and dispatch characteristics, on-scene management of cardiac arrest and the availability and dataset in cardiac arrest registries, was sent to all national coordinators who participated in the European Registry of Cardiac Arrest studies. In addition, individual invitations were sent to the remaining European countries. Results Participants from 28 European countries responded to the questionnaire. Results were combined with official information on population density. Overall, the number of Emergency Medical Service missions, level of training of personnel, availability of Helicopter Emergency Medical Services and the involvement of first responders varied across and within countries. There were similarities in team training, availability of key resuscitation equipment and permission for ongoing performance of cardiopulmonary resuscitation during transported. The quality of reporting to cardiac arrest registries varied, as well as the data availability in the registries. Conclusions Throughout Europe there are important differences in Emergency Medical Service systems and the response to out-of-hospital cardiac arrest. Explaining these differences is complicated due to significant variation in how variables are reported to and used in registries.

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