scholarly journals (A17) Epidemiology of Non-Vehicular Trauma Patients in the Prehospital Setting in India

2011 ◽  
Vol 26 (S1) ◽  
pp. s5-s5
Author(s):  
N.A. Lodhia ◽  
M. Strehlow ◽  
E. Pirrotta ◽  
B.N.V. Swathi ◽  
A. Gimkala ◽  
...  
Keyword(s):  
Prehospital Care ◽  
Initial Study ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Care Providers ◽  
Elderly Age ◽  
Post Injury ◽  
Lower Socioeconomic ◽  
Prehospital Emergency

BackgroundNon-vehicular trauma (NVT) accounts for 8% of all calls to the GVK Emergency Management and Research Institute (EMRI), which provides prehospital emergency care to 85 million residents of Andhra Pradesh, India. This study describes the characteristics and outcomes of patients with NVT transported by GVK EMRI.MethodsAll patients with NVT were prospectively enrolled over 28 12-hour periods (equally distributed over each hour of the day and day of the week) during July/August 2010. Patients not found at the scene, refusing service, or reporting self-inflicted injuries were excluded. Real-time demographic and clinical data were collected from prehospital care providers using a standardized questionnaire. Follow-up patient information was collected at 48-hours and 30-days following injury.ResultsA total of 1,569 patients were enrolled. Follow-up rates were 72% at 48 hours and 71% at 30 days. The mean patient age was 40 (SD = 18) and 67% were male. Adults (ages 18–64) accounted for most patients (80%), followed by elderly (age > 64, 12%) and children (age < 18, 8%). Of the patients, 71% were from rural/tribal areas and 89% from lower socioeconomic strata. Eighty-two percent called within 1 hour of injury. Median call-to-scene time was 19 minutes (SD = 15) and scene-to-hospital time was 25 minutes (SD = 21). Most patients suffered blunt injuries (85%) with falls accounting for 43% of all injuries. Of the injuries, 56% were accidents and 43% assaults. Most injuries involved head/neck (48%) and extremities (44%). Cumulative mortality rates prior to hospital arrival, at 48-hours and at 30-days were 1.1%, 3.2%, and 4.9% respectively. Falls accounted for 69% of all deaths. Falls and age > 65 were predictors of mortality (p < 0.0001). Of NVT survivors, 56% returned to baseline function and 28% were in significant pain or bed bound at 30-days post-injury.ConclusionThis initial study of prehospital NVT patients in India reveals that falls and elderly age were highly associated with death.

scholarly journals (A314) Challenges Faced in Establishing the Emergency Prehospital Ambulance Service in North Central Sri Lanka: Developing Something from Nothing

2011 ◽  
Vol 26 (S1) ◽  
pp. s88-s88 ◽  
Author(s):  
L. Dassanayake
Keyword(s):  
Sri Lanka ◽  
Prehospital Care ◽  
Initial Period ◽  
Ambulance Service ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Infrastructure Development ◽  
North Central ◽  
Prehospital Emergency ◽  
Care System

The existence of a prehospital emergency care system signifies how secure an area is in aftermath of a health-related emergency. The systems save lives during most out-of-hospital health emergencies. Until 2010, there was no regular prehospital care system in Anuradhapura, or even in the entire north central region of Sri Lanka. Trauma patients were brought to the hospital generally with little or no prehospital care. They were transported to hospital by relatives or other people at the scene with using whatever vehicle was available at the time, which in many occasions was a trishaw. The concept of developing a prehospital emergency ambulance service to cover the municipality of Anuradhapura as a pilot project was formulated in 2009. The objectives were to: (1) provide emergency prehospital care in the municipality; (2) identify the difficulties; and (3) assess the feasibility of implementing it in the entire district. Some of the challenges faced in the process from the initial draft of the concept up to now include: 1. Studying an established emergency medical services (EMS) system; 2. Developing a pressure group in hospital; 3. Convincing the need to administration; 4. Funding in the initial period; 5. Selecting the proper team and supportive peers; 6. Providing standard training to selected staff; 7. Formulating duty norms and standard operating procedures; 8. Infrastructure development, acquiring instruments, and vehicles with limited fund capacities; 9. Cooperating with the trade unions and external/internal negative forces; 10. Rallying the collaborators with same interest; 11. Handling donors; 12. Getting the support of other key institutions (police/municipal council); 13. Utilizing local media to help promote the project; 14. Social mobilization to ensure sustainability; and 15. Ensuring worker satisfaction, encouragement, and liaison with other units of hospital.

Withholding CPR in the Prehospital Setting

1990 ◽  
Vol 5 (1) ◽  
pp. 45-46 ◽  
Author(s):  
Samuel J. Stratton
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Prehospital Setting ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Care Community ◽  
Social And Emotional ◽  
Number Of Factors ◽  
Prehospital Emergency ◽  
Law And Science

The expansion of hospices and recognition of living wills have made it necessary for emergency care providers to re-evaluate the appropriateness of universal application of cardiopulmonary resuscitation (CPR) in the field. The prehospital care community is coming to realize that CPR is beneficial only in certain specific situations. Some believe that when CPR is not likely to be beneficial, it should be withheld. Withholding CPR seems to be a simple matter of law and science, but a number of factors complicate the issue, especially in the prehospital setting: What are the definitive signs of irreversible, sudden death? When is the application of CPR futile? What are the responsibilities of the prehospital emergency care provider who announce someone dead? What is the lay public's perception of stopping or withholding CPR? Withholding CPR in this environment is a complicated social and emotional issue as well as a scientific and legal one.

Vehicle Crash Rescue Skills and Residency Training in Emergency Medicine

1985 ◽  
Vol 1 (S1) ◽  
pp. 103-104
Author(s):  
Robert R. Harrison ◽  
Kimball I. Maull ◽  
C. Paul Boyan
Keyword(s):  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Hospital Environment ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Accident Victim ◽  
Prehospital Emergency ◽  
Time Required ◽  
Injured Patients

Recent advances in the resuscitation and stabilization skills of prehospital emergency care providers have done much to improve the quality of immediate care provided to suddenly ill or injured patients. Although much of the innovation and leadership in this area has been provided by emergency department physicians, most of them still lack an adequate appreciation of the circumstances under which these skills are executed. While many physicians participate in prehospital care teaching and evaluation of the system, most have not gained personal experience in those aspects of care foreign to hospital environment. They are particularly unacquainted with the intricacies of rescuing patients from automobile accidents and similar entrapments. It is not unusual, however, for an accident victim to spend half of the time required for the prehospital phase of emergency medical care undergoing extrication, and in many cases this must be done before full advanced life support measures may be initiated.

Developing a Lay First Responder Program in Chad: A 12-Month Follow-Up Evaluation of a Rural Prehospital Emergency Care Program

2020 ◽  
Vol 35 (5) ◽  
pp. 546-553 ◽  
Author(s):  
Canaan J. Hancock ◽  
Peter G. Delaney ◽  
Zachary J. Eisner ◽  
Eric Kroner ◽  
Issa Mahamet-Nuur ◽  
...  
Keyword(s):  
Knowledge Acquisition ◽  
Emergency Care ◽  
Prehospital Emergency Care ◽  
Voluntary Participation ◽  
First Responder ◽  
Taxi Drivers ◽  
Post Test ◽  
Prehospital Emergency ◽  
Motorcycle Taxi

AbstractIntroduction:The World Health Organization (WHO; Geneva, Switzerland) recommends lay first responder (LFR) programs as a first step toward establishing formal Emergency Medical Services (EMS) in low- and middle-income countries (LMICs) to address injury. There is a scarcity of research investigating LFR program development in predominantly rural settings of LMICs.Study Objective:A pilot LFR program was launched and assessed over 12 months to investigate the feasibility of leveraging pre-existing transportation providers to scale up prehospital emergency care in rural, low-resource settings of LMICs.Methods:An LFR program was established in rural Chad to evaluate curriculum efficacy, using a validated 15-question pre-/post-test to measure participant knowledge improvement. Pre-/post-test score distributions were compared using a Wilcoxon Signed-Rank test. For test evaluation, each pre-test question was mapped to its corresponding post-test analog and compared using McNemar’s Chi-Squared Test to examine knowledge acquisition on a by-question basis. Longitudinal prehospital care was evaluated with incident reports, while program cost was tracked using a one-way sensitivity analysis. Qualitative follow-up surveys and semi-interviews were conducted at 12 months, with initial participants and randomly sampled motorcycle taxi drivers, and used a constructivist grounded theory approach to understand the factors motivating continued voluntary participation to inform future program continuity. The consolidated criteria for reporting qualitative research (COREQ) checklist was used to guide design, analysis, and reporting the qualitative results.Results:A total of 108 motorcycle taxi participants demonstrated significant knowledge improvement (P <.001) across three of four curricular categories: scene safety, airway and breathing, and bleeding control. Lay first responders treated 71 patients over six months, encountering five deaths, and provided patient transport in 82% of encounters. Lay first responders reported an average confidence score of 8.53/10 (n = 38). In qualitative follow-up surveys and semi-structured interviews, the ability to care for the injured, new knowledge/skills, and the resultant gain in social status and customer acquisition motivated continued involvement as LFRs. Ninety-six percent of untrained, randomly sampled motorcycle taxi drivers reported they would be willing to pay to participate in future training courses.Conclusion:Lay first responder programs appear feasible and cost-effective in rural LMIC settings. Participants demonstrate significant knowledge acquisition, and after 12 months of providing emergency care, report sustained voluntary participation due to social and financial benefits, suggesting sustainability and scalability of LFR programs in low-resource settings.

Challenges to Prehospital Care in Honduras

2018 ◽  
Vol 33 (6) ◽  
pp. 637-639
Author(s):  
Haley E. Bast ◽  
J. Lee Jenkins
Keyword(s):  
Health Care Services ◽  
Resource Constraints ◽  
Prehospital Care ◽  
Public Access ◽  
Public Health Care ◽  
Prehospital Emergency Care ◽  
Publication Type ◽  
Rural And Urban ◽  
Private And Public ◽  
Prehospital Emergency

AbstractThrough a longitudinal field experience and interviews with rural and urban clinic workers in Honduras, the following data were collated regarding the challenges to prehospital Emergency Medical Services (EMS) in this country. In Honduras, both private and public organizations provide prehospital emergency care for citizens and face both financial and resource constraints. These constraints manifest in operational concerns such as challenges of integration of EMS systems with each other, differences in medical direction oversight, and barriers to public access. Despite the availability of public health care services, authorities and locals alike do not recommend using the public systems due to lack of needed resources and time of emergency response.Private volunteer EMS organizations are scattered throughout the country and each operates as their own separate system. There is no single dispatch center available, nor is there a guarantee that calling for EMS will result in the patient’s desired response. In this report, the challenges are discussed with possible solutions presented.BastHE, JenkinsJL. Challenges to prehospital care in Honduras. Prehosp Disaster Med. 2018;33(6):637–639.

Prehospital Care for Patients with Head Injury and its Relevance to Post Traumatic Prognosis

1987 ◽  
Vol 3 (2) ◽  
pp. 15-20
Author(s):  
G. Singbartl
Keyword(s):  
Head Injury ◽  
Prehospital Care ◽  
Head Injuries ◽  
Cerebral Injury ◽  
Prehospital Emergency Care ◽  
Secondary Brain Damage ◽  
Thorax Trauma ◽  
Prehospital Emergency ◽  
Post Traumatic ◽  
Polytrauma Patients

Head injury has been demonstrated to be one of the most important lesions in polytrauma patients and of very decisive relevance to the posttraumatic prognosis. Moreover, other lesions and their sequelae (e.g. shock, thorax trauma) are known to worsen the primary cerebral injury by causing secondary brain damage due to hypotension and hypoxemia. This study considers the influence of prehospital emergency care to the posttraumatic prognosis in severe head injuries.

Update on prehospital emergency care of severe trauma patients

2013 ◽  
Vol 32 (7-8) ◽  
pp. 477-482 ◽  
Author(s):  
K. Tazarourte ◽  
E. Cesaréo ◽  
D. Sapir ◽  
A. Atchabahian ◽  
J.-P. Tourtier ◽  
...  
Keyword(s):  
Emergency Care ◽  
Severe Trauma ◽  
Prehospital Emergency Care ◽  
Trauma Patients ◽  
Prehospital Emergency

Opportunity for Seatbelt Usage by ALS Providers

1991 ◽  
Vol 6 (4) ◽  
pp. 469-471 ◽  
Author(s):  
Richard T. Cook ◽  
Steven A. Meador ◽  
Barry D. Buckingham ◽  
Lee V. Groff
Keyword(s):  
Cardiac Arrest ◽  
Time Management ◽  
Prehospital Care ◽  
Seat Belt ◽  
Cardiac Arrest Patient ◽  
Trauma Patients ◽  
Care Providers ◽  
Seat Belts ◽  
Additional Information ◽  
The Mean

AbstractPurpose:Prehospital care providers commonly indicate that they cannot wear seat belts owing to their need to be unrestrained while delivering care to the patient in the back of the ambulance. Each year, providers are injured in situations in which seat belts have been shown to be protective. Are ALS providers able to wear a seat belt and provide care in an ambulance?Methods:The ALS providers were asked to complete a form following calls during which they rode with a patient in the back of an ambulance. They indicated the amount of time which they felt they would have needed to have been unrestrained by seat belts and the reasons. There were no attempts to regulate or quantify seat belt usage. Additional information was gathered from the trip report.Results:The percentage of the time of each trip during which they felt they needed to be unrestrained was calculated for each trip. The mean was 41%. The mean transport time was 14.7 minutes. Sub-groupings by protocol type, showed that for cardiac arrest patients, providers felt they needed to be unrestrained for 82% of the duration of transport, for patients with “chest pain or cardiac dysrhythmia” 63%, for “shortness of breath” 38%, and for trauma patients 41%. Excluding cardiac arrest patients, the nine patients were assigned by the providers to have the most critical level of case severity required unrestrained time of 72%. Those nine patients with the lowest severity level requires that the provider by unrestrained only 18% of the time. Management of intravenous line and patient assessments most frequently were cited as reasons for needing to be unrestrained.Conclusion:Perceived need of ALS providers to be unrestrained varied with respect to the type of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of call, with cardiac arrest patient transports having the greatest need to be unrestrained. However, on the average, providers felt they needed to be unrestrained only 41% of the time; markedly less on some types of calls. The ALS providers should be able to wear seat belts for at least part of the time, on most ALS calls.

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