Quality of analgesia in physician-operated telemedical prehospital emergency care is comparable to physician-based prehospital care - a retrospective longitudinal study

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.

Download Full-text

Ethical Conflicts in Prehospital Emergency Care

Nursing Ethics ◽

10.1177/0969733006069694 ◽

2006 ◽

Vol 13 (6) ◽

pp. 592-607 ◽

Cited By ~ 35

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.

Download Full-text

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

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2017-000896 ◽

2018 ◽

Vol 165 (3) ◽

pp. 188-192 ◽

Cited By ~ 5

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.

Download Full-text

Putting Culture into Prehospital Emergency Care: A Systematic Narrative Review of Literature from Lower Middle-Income Countries

Prehospital and Disaster Medicine ◽

10.1017/s1049023x19004709 ◽

2019 ◽

Vol 34 (05) ◽

pp. 510-520 ◽

Cited By ~ 4

Author(s):

Thanh Tam Tran ◽

Janice Lee ◽

Adrian Sleigh ◽

Cathy Banwell

Keyword(s):

Health System ◽

Emergency Care ◽

Information Exchange ◽

Prehospital Care ◽

Prehospital Emergency Care ◽

Sociocultural Factors ◽

Middle Income ◽

Middle Income Countries ◽

Prehospital Emergency ◽

Pathway To Care

AbstractBackground:Prehospital emergency care is cost-effective for improving morbidity and mortality of emergency conditions. However, such care has been discounted in the public health system of many lower middle-income countries (LMICs). Where it exists, the Emergency Medical Service (EMS) system is grossly inadequate, unpopular, and misrepresented. Many EMS reviews in developing countries have identified systemic problems with infrastructure and human resources, but they neglected impacts of sociocultural factors. This study examines the sociocultural dimensions of LMICs’ prehospital emergency systems in order to improve the quality and impact of emergency care in those countries.Methods:Qualitative studies on EMS systems in LMICs were systematically reviewed and analyzed using Kleinman’s health system theory of folk, popular, and professional health sectors. Also, the three-delay model of emergency care – seeking, reaching, and receiving – provided a guiding framework.Results:The search yielded over 3,000 papers and the inclusion criteria eventually selected 14, with duplicates and irrelevant papers as the most frequent exclusion. Both user and provider experiences with emergency conditions and the processes of prehospital care were described. Sociocultural factors such as trust and beliefs underlay the way emergency care was experienced. Attitudes of family and community shaped service-seeking behaviors. Traditional medicine was often the first point of care. Private vehicles were the main transportation for accessing care due to distrust and misunderstanding of ambulance services.Conclusion:The findings led to the discussion on how culture is woven into the patients’ pathway to care, and the recommendation for any future development to place a far greater emphasis on this aspect. Instead of relying purely on the biomedical sector, the health system should acknowledge and show respect for popular knowledge and folk belief. Such strategies will improve trust, facilitate information exchange, and enable stronger healer-patient relationships.

Download Full-text

Withholding CPR in the Prehospital Setting

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00026509 ◽

1990 ◽

Vol 5 (1) ◽

pp. 45-46 ◽

Cited By ~ 8

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.

Download Full-text

The role of the emergency medical dispatch centre (EMDC) and prehospital emergency care safety: results from an incident report (IR) system

CJEM ◽

10.1017/cem.2014.74 ◽

2015 ◽

Vol 17 (4) ◽

pp. 411-419 ◽

Cited By ~ 3

Author(s):

Alberto Mortaro ◽

Diana Pascu ◽

Tamara Zerman ◽

Enrico Vallaperta ◽

Alberto Schönsberg ◽

...

Keyword(s):

Emergency Care ◽

Prehospital Care ◽

Prehospital Setting ◽

Prehospital Emergency Care ◽

Incident Report ◽

Emergency Medical Dispatch ◽

Emergency Medical ◽

Dispatch Centre ◽

Prehospital Emergency

AbstractIntroductionThe role of the emergency medical dispatch centre (EMDC) is essential to ensure coordinated and safe prehospital care. The aim of this study was to implement an incident report (IR) system in prehospital emergency care management with a view to detecting errors occurring in this setting and guiding the implementation of safety improvement initiatives.MethodsAn ad hoc IR form for the prehospital setting was developed and implemented within the EMDC of Verona. The form included six phases (from the emergency call to hospital admission) with the relevant list of potential error modes (30 items). This descriptive observational study considered the results from 268 consecutive days between February and November 2010.ResultsDuring the study period, 161 error modes were detected. The majority of these errors occurred in the resource allocation and timing phase (34.2%) and in the dispatch phase (31.0%). Most of the errors were due to human factors (77.6%), and almost half of them were classified as either moderate (27.9%) or severe (19.9%). These results guided the implementation of specific corrective actions, such as the adoption of a more efficient Medical Priority Dispatch System and the development of educational initiatives targeted at both EMDC staff and the population.ConclusionsDespite the intrinsic limits of IR methodology, results suggest how the implementation of an IR system dedicated to the emergency prehospital setting can act as a major driver for the development of a “learning organization” and improve both efficacy and safety of first aid care.

Download Full-text

P093: Evaluating factors related to effective interpersonal communication during mandatory paramedic patches

CJEM ◽

10.1017/cem.2020.299 ◽

2020 ◽

Vol 22 (S1) ◽

pp. S98-S98

Author(s):

D. Kelton ◽

S. Doran ◽

M. Davis ◽

K. Van Aarsen ◽

J. Momic

Keyword(s):

Interpersonal Communication ◽

Prehospital Care ◽

Prehospital Emergency Care ◽

Time Intervals ◽

Audio Recordings ◽

Prehospital Emergency ◽

Potential Improvement ◽

First Contact ◽

Mean Time

Introduction: Delegation of controlled medical acts by physicians to paramedics is an important component of the prehospital care framework. Where directives indicate that physician input is needed before proceeding with certain interventions, online medical control (a “patch”) exists to facilitate communication between a paramedic and a Base Hospital Physician (BHP) to request an order to proceed with that intervention. Many factors contribute to success or failure of effective interpersonal communication during a patch call. The aim of this study was to examine areas of potential improvement in communication between paramedics and physicians during the patch call. Methods: Prehospital paramedic calls that included a mandatory patch point (excluding requests for termination of resuscitation and those records which were unavailable) were identified through review of all patch records from January 1, 2014 to December 31, 2017 for Paramedic Services in our region. Written Ambulance Call Reports (ACRs) and audio recordings of paramedic patches were obtained and reviewed. Pre-specified time intervals, clinical factors, specific patch requests and resulting orders from the BHP to the paramedics were extracted. Differences between groups were compared using t-tests. Results: 214 records were initially identified and screened. 91 ACRs and audio patch records were included in the analysis. 51/91 (56%) of patch order requests for interventions were granted by the BHP. Clarification of information provided by the paramedic or reframing of the paramedic's request was required less often, but not statistically significant, in calls ultimately resulting in granted requests versus those that were not granted (mean 1.4 versus 1.7, Δ-0.28; 95% CI -0.75-0.18 p = 0.64). The mean time from first contact with the BHP to statement of the request was similar in patches where the request was granted and not granted (44.9 versus 46.3, Δ-1.4; 95% CI -12.9-10.2, p = 0.49). Conclusion: The communication between BHPs and paramedics is an important and under-investigated component of prehospital emergency care. This retrospective review presents some novel targets for further research and potential education in patch communication to improve efficiency and quality of prehospital care for patients.

Download Full-text

Prehospital emergency care of patients exposed to poisoning: Assessment of epidemiological, clinical characteristics and quality of care

Anales de Pediatría (English Edition) ◽

10.1016/j.anpede.2019.03.003 ◽

2020 ◽

Vol 92 (1) ◽

pp. 37-45

Author(s):

Lidia Martínez-Sánchez ◽

Vicenç Ferrés-Padró ◽

Daniel Martínez-Millán ◽

Carmen Fernández-Calabria ◽

Montserrat Amigó-Tadín ◽

...

Keyword(s):

Quality Of Care ◽

Emergency Care ◽

Clinical Characteristics ◽

Prehospital Emergency Care ◽

Prehospital Emergency

Download Full-text

Twenty Years of Military Prehospital Care in the Eastern Sovereign Base Area, Cyprus

Journal of the Royal Army Medical Corps ◽

10.1136/jramc-2019-001221 ◽

2019 ◽

pp. jramc-2019-001221

Author(s):

James Michael Halle-Smith ◽

T Ahmad ◽

G Mason ◽

A Barlow ◽

S Gout

Keyword(s):

Emergency Care ◽

Service Provision ◽

Prehospital Care ◽

Service Evaluation ◽

Prehospital Emergency Care ◽

Base Area ◽

Comprehensive Service ◽

Prehospital Emergency ◽

Reported Data

IntroductionThe Medical Reception Station (MRS) in Dhekelia provides a prehospital emergency care (PHEC) service for the Eastern Sovereign Base Area and surrounding Cypriot towns. This service has been evaluated previously but some important aspects of care have not yet been measured. The primary aim of this study was to undertake the most comprehensive service evaluation of the demand for the PHEC service at MRS Dhekelia over a 12-month period. The secondary aim of this study was to compare findings in 2018 to those in 1995–1998 and 2013–2016.MethodsAll calls to the PHEC team between 01/07/2017 and 30/06/2018 were reviewed and compared with previously reported data from 1995 to 1998 and 2013 to 2016. Data were collected from the occurrence book, the logbook used by the PHEC team to record the details of each call.ResultsThere were 164 calls to the PHEC service during the current study period. The number of activations has decreased since the 2013–2016 period but remains greater than 1995–1998. In every month there was a call to a scene where more than one casualty was present, with the highest number being nine patients at one call. More calls were received during the day (55%). There were more calls because of trauma than medical complaints (55% vs 45%). Trauma calls have reduced over 20 years. The frequency of neurological and psychiatric complaints has increased over 20 years.ConclusionsThe PHEC service at MRS Dhekelia is frequently used. The team consistently face with scenes with more than one casualty. Trauma is becoming less frequent but psychiatric and neurological complaints are increasingly common. These findings are important for training and service provision.

Download Full-text