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 Emergency Medical Services in Lebanon: Overview and Prospects

2012 ◽  
Vol 28 (2) ◽  
pp. 163-165 ◽  
Author(s):  
Mazen J. El Sayed ◽  
Jamil D. Bayram
Keyword(s):  
Emergency Medical Services ◽  
Prehospital Care ◽  
Public Access ◽  
Medical Services ◽  
Publication Type ◽  
Provider Training ◽  
Equipment And Supplies ◽  
Emergency Medical ◽  
History Of ◽  
Prehospital Emergency

AbstractPrehospital emergency medical services in Lebanon are based on volunteer systems with multiple agencies. In this article, a brief history of the development of prehospital care in Lebanon is presented with a description of existing services. Also explored are the different aspects of prehospital care in Lebanon, including funding, public access and dispatch, equipment and supplies, provider training and certification, medical direction, and associated hospital-based emergency care.El Sayed MJ, Bayram JD. Prehospital Emergency Medical Services in Lebanon: overview and prospects. Prehosp Disaster Med. 2013;28(2):1-3.

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.

scholarly journals A Comparison Between Differently Skilled Prehospital Emergency Care Providers in Major-Incident Triage in South Africa

2018 ◽  
Vol 33 (6) ◽  
pp. 575-580 ◽  
Author(s):  
Annet Ngabirano Alenyo ◽  
Wayne P. Smith ◽  
Michael McCaul ◽  
Daniel J. Van Hoving
Keyword(s):  
South Africa ◽  
Emergency Care ◽  
Life Support ◽  
Major Incident ◽  
Prehospital Emergency Care ◽  
Care Providers ◽  
Publication Type ◽  
Cross Sectional ◽  
Prehospital Emergency ◽  
Level Of Training

AbstractIntroductionMajor-incident triage ensures effective emergency care and utilization of resources. Prehospital emergency care providers are often the first medical professionals to arrive at any major incident and should be competent in primary triage. However, various factors (including level of training) influence their triage performance.Hypothesis/ProblemThe aim of this study was to determine the difference in major-incident triage performance between different training levels of prehospital emergency care providers in South Africa utilizing the Triage Sieve algorithm.MethodsThis was a cross-sectional study involving differently trained prehospital providers: Advanced Life Support (ALS); Intermediate Life Support (ILS); and Basic Life Support (BLS). Participants wrote a validated 20-question pre-test before completing major-incident training. Two post-tests were also completed: a 20-question written test and a three-question face-to-face evaluation. Outcomes measured were triage accuracy and duration of triage. The effect of level of training, gender, age, previous major-incident training, and duration of service were determined.ResultsA total of 129 prehospital providers participated. The mean age was 33.4 years and 65 (50.4%) were male. Most (n=87; 67.4%) were BLS providers. The overall correct triage score pre-training was 53.9% (95% CI, 51.98 to 55.83), over-triage 31.4% (95% CI, 29.66 to 33.2), and under-triage 13.8% (95% CI, 12.55 to 12.22). Post-training, the overall correct triage score increased to 63.6% (95% CI, 61.72 to 65.44), over-triage decreased to 17.9% (95% CI, 16.47 to 19.43), and under-triage increased to 17.8% (95% CI, 16.40 to 19.36). The ALS providers had both the highest likelihood of a correct triage score post-training (odds ratio 1.21; 95% CI, 0.96-1.53) and the shortest duration of triage (median three seconds, interquartile range two to seven seconds; P=.034). Participants with prior major-incident training performed better (P=.001).ConclusionAccuracy of major-incident triage across all levels of prehospital providers in South Africa is less than optimal with non-significant differences post-major-incident training. Prior major-incident training played a significant role in triage accuracy indicating that training should be an ongoing process. Although ALS providers were the quickest to complete triage, this difference was not clinically significant. The BLS and ILS providers with major-incident training can thus be utilized for primary major-incident triage allowing ALS providers to focus on more clinical roles.AlenyoAN, SmithWP, McCaulM, Van HovingDJ. A comparison between differently skilled prehospital emergency care providers in major-incident triage in South Africa. Prehosp Disaster Med. 2018;33(6):575–580.

A systematic review of prehospital telehealth utilization

2017 ◽  
Vol 24 (7) ◽  
pp. 473-481 ◽  
Author(s):  
Andrew S Winburn ◽  
Juliana J Brixey ◽  
James Langabeer ◽  
Tiffany Champagne-Langabeer
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Feasibility Studies ◽  
The United States ◽  
Prehospital Emergency Care ◽  
Positive Trend ◽  
Prehospital Emergency ◽  
Store And Forward ◽  
Meta Analyses ◽  
Future Work

Objective There has been moderate evidence of telehealth utilization in the field of emergency medicine, but less is known about telehealth in prehospital emergency medical services (EMS). The objective of this study is to explore the extent, focus, and utilization of telehealth for prehospital emergency care through the analysis of published research. Methods The authors conducted a systematic literature review by extracting data from multiple research databases (including MEDLINE/PubMed, CINAHL Complete, and Google Scholar) published since 2000. We used consistent key search terms to identify clinical interventions and feasibility studies involving telehealth and EMS, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results We identified 68 articles focused specifically on telehealth interventions in prehospital care. The majority (54%) of the studies involved stroke and acute cardiovascular care, while only 7% of these (4) focused on telehealth for primary care. The two most common delivery methods were real-time video-conferencing capabilities (38%) and store and forward (25%); and this variation was based upon the clinical focus. There has been a significant and positive trend towards greater telehealth utilization. European telehealth programs were most common (51% of the studies), while 38% were from the United States. Discussion and Conclusions Despite positive trends, telehealth utilization in prehospital emergency care is fairly limited given the sheer number of EMS agencies worldwide. The results of this study suggest there are significant opportunities for wider diffusion in prehospital care. Future work should examine barriers and incentives for telehealth adoption in EMS.

Ethical Conflicts in Prehospital Emergency Care

2006 ◽  
Vol 13 (6) ◽  
pp. 592-607 ◽  
Author(s):  
Lars Sandman ◽  
Anders Nordmark
Keyword(s):  
Emergency Care ◽  
Prehospital Care ◽  
Self Determination ◽  
Prehospital Emergency Care ◽  
Best Interest ◽  
Focus Group Interviews ◽  
Self Identity ◽  
Ethical Conflicts ◽  
Prehospital Emergency ◽  
Group Interviews

This article analyses and presents a survey of ethical conflicts in prehospital emergency care. The results are based on six focus group interviews with 29 registered nurses and paramedics working in prehospital emergency care at three different locations: a small town, a part of a major city and a sparsely populated area. Ethical conflict was found to arise in 10 different nodes of conflict: the patient/carer relationship, the patient’s self-determination, the patient’s best interest, the carer’s professional ideals, the carer’s professional role and self-identity, significant others and bystanders, other care professionals, organizational structure and resource management, societal ideals, and other professionals. It is often argued that prehospital care is unique in comparison with other forms of care. However, in this article we do not find support for the idea that ethical conflicts occurring in prehospital care are unique, even if some may be more common in this context.

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.

Prehospital Emergency Care Training Practices Regarding Lesbian, Gay, Bisexual, and Transgender Patients in Maryland (USA)

2015 ◽  
Vol 30 (2) ◽  
pp. 163-166 ◽  
Author(s):  
Sara Jalali ◽  
Matthew J. Levy ◽  
Nelson Tang
Keyword(s):  
Emergency Care ◽  
Cultural Sensitivity ◽  
Educational Program ◽  
National Level ◽  
Program Directors ◽  
Prehospital Emergency Care ◽  
Publication Type ◽  
Bisexual And Transgender ◽  
Prehospital Emergency ◽  
Care Training

AbstractIntroductionPrehospital Emergency Medical Services (EMS) providers are expected to treat all patients the same, regardless of race, gender identity, sexual orientation, or religion. Some EMS personnel who are poorly trained in working with lesbian, gay, bisexual, and transgender (LGBT) patients are at risk for managing such patients incompletely and possibly incorrectly. During emergency situations, such mistreatment has meant the difference between life and death.MethodsAn anonymous survey was electronically distributed to EMS educational program directors in Maryland (USA). The survey asked participants if their program included training cultural sensitivity, and if so, by what modalities. Specific questions then focused on information about LGBT education, as well as related topics, that they, as program directors, would want included in an online training module.ResultsA total of 20 programs met inclusion criteria for the study, and 16 (80%) of these programs completed the survey. All but one program (15, 94%) included cultural sensitivity training. One-third (6, 38%) of the programs reported already teaching LGBT-related issues specifically. Three-quarters of the programs that responded (12, 75%) were willing to include LGBT-related material into their curriculum. All programs (16, 100%) identified specific aspects of LGBT-related emergency health issues they would be interested in having included in an educational module.ConclusionMost EMS educational program directors in Maryland are receptive to including LGBT-specific education into their curricula. The information gathered in this survey may help guide the development of a short, self-contained, open-access module for EMS educational programs. Further research, on a broader scale and with greater geographic sampling, is needed to assess the practices of EMS educators on a national level.JalaliS, LevyMJ, TangN. Prehospital emergency care training practices regarding lesbian, gay, bisexual, and transgender patients in Maryland (USA). Prehosp Disaster Med. 2015;30(2):1-4.

A Paramedic Field Supervisor's Situational Awareness in Prehospital Emergency Care

2014 ◽  
Vol 29 (2) ◽  
pp. 151-159 ◽  
Author(s):  
Teija Norri-Sederholm ◽  
Rauno Kuusisto ◽  
Jouni Kurola ◽  
Kaija Saranto ◽  
Heikki Paakkonen
Keyword(s):  
Emergency Care ◽  
Information Exchange ◽  
Situational Awareness ◽  
Real Life ◽  
Prehospital Emergency Care ◽  
Structured Interviews ◽  
Publication Type ◽  
Prehospital Emergency ◽  
The Right ◽  
Field Supervisors

AbstractIntroductionSituational awareness (SA), or being aware of what is going on and what might happen next, is essential for the successful management of prehospital emergency care. However, far too little attention has been paid to the flow of information. Having the right information is important when formulating plans and actions.ProblemThe aim of this study was to analyze and describe the type of information that is meaningful for SA in the work of paramedic field supervisors, and to create an information profile for them in the context of prehospital emergency care.MethodsData were collected from January through March 2012 from semi-structured interviews with ten paramedic field supervisors representing four rescue departments in Finland. The interviews were based on three different types of real-life scenarios in the context of prehospital emergency care, and deductive content analysis was employed according to the information exchange meta-model. Data management and analysis were performed using Atlas.ti 7.ResultsA paramedic field supervisor information interest profile was formulated. The most important information categories were Events, Means, Action Patterns, and Decisions. The profile showed that paramedic field supervisors had four roles – situation follower, analyzer, planner and decision maker – and they acted in all four roles at the same time in the planning and execution phases.ConclusionParamedic field supervisors are multitasking persons, building SA by using the available data, combining it with extensive know-how from their working methods and competencies, and their tacit knowledge. The results can be used in developing work processes, training programs, and information systems.Norri-SederholmT,KuusistoR,KurolaJ,SarantoK,PaakkonenH.A paramedic field supervisor's situational awareness in prehospital emergency care.Prehosp Disaster Med.2014;29(2):1-9.

Emergency Medical Services in India: The Present and Future

2014 ◽  
Vol 29 (3) ◽  
pp. 307-310 ◽  
Author(s):  
Mohit Sharma ◽  
Ethan S. Brandler
Keyword(s):  
Emergency Medical Services ◽  
Emergency Services ◽  
Prehospital Care ◽  
Emergency Medical Technician ◽  
Medical Services ◽  
Prehospital Emergency Care ◽  
Publication Type ◽  
Emergency Medical ◽  
Trauma Service ◽  
Care System

AbstractIndia is the second most populous country in the world. Currently, India does not have a centralized body which provides guidelines for training and operation of Emergency Medical Services (EMS). Emergency Medical Services are fragmented and not accessible throughout the country. Most people do not know the number to call in case of an emergency; services such as Dial 108/102/1298 Ambulances, Centralized Accident and Trauma Service (CATS), and private ambulance models exist with wide variability in their dispatch and transport capabilities. Variability also exists in EMS education standards with the recent establishment of courses like Emergency Medical Technician-Basic/Advanced, Paramedic, Prehospital Trauma Technician, Diploma Trauma Technician, and Postgraduate Diploma in EMS. This report highlights recommendations that have been put forth to help optimize the Indian prehospital emergency care system, including regionalization of EMS, better training opportunities, budgetary provisions, and improving awareness among the general community. The importance of public and private partnerships in implementing an organized prehospital care system in India discussed in the report may be a reasonable solution for improved EMS in other developing countries.SharmaM, BrandlerES. Emergency Medical Services in India: the present and future. Prehosp Disaster Med. 2014;29(3):1-4.

Military Prehospital Emergency Care: defining and professionalising the levels of care provided along the Operational Patient Care Pathway

2018 ◽  
Vol 165 (3) ◽  
pp. 188-192 ◽  
Author(s):  
Danny Sharpe ◽  
J McKinlay ◽  
S Jefferys ◽  
C Wright
Keyword(s):  
Patient Care ◽  
Emergency Care ◽  
Care Pathway ◽  
Prehospital Care ◽  
The Body ◽  
Prehospital Emergency Care ◽  
Levels Of Care ◽  
Prehospital Emergency ◽  
The Right ◽  
Care Support

The Defence Medical Services aims to provide gold standard care to ill and injured personnel in the deployed environment and its prehospital emergency care (PHEC) systems have been proven to save lives. The authors have set out to demonstrate, using existing literature, consensus and doctrine that the NHS Skills for Health framework can be reflected in military prehospital care and provides an existing model for defining the levels of care our providers can offer. In addition, we have demonstrated how these levels of care support the Operational Patient Care Pathway and add to the body of evidence for the use of specialist PHEC teams to allow the right patient to be transported on the right platform, with the right medical team, to the right place. These formalised levels allow military planners to consider the scope of practice, amount of training and appropriate equipment required to support deployed operations.

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