Preventable injury deaths: identifying opportunities to improve timeliness and reach of emergency healthcare services in New Zealand

2017 ◽  
Vol 24 (5) ◽  
pp. 384-389 ◽  
Author(s):  
Rebbecca Lilley ◽  
Bridget Kool ◽  
Gabrielle Davie ◽  
Brandon de Graaf ◽  
Shanthi N Ameratunga ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Care ◽  
Healthcare Services ◽  
Care Providers ◽  
Cross Sectional ◽  
Advanced Level ◽  
Fatal Injury ◽  
Timely Access ◽  
Serious Injury ◽  
Level Hospital

BackgroundTraumatic injury is a leading cause of premature death and health loss in New Zealand. Outcomes following injury are very time sensitive, and timely access of critically injured patients to advanced hospital trauma care services can improve injury survival.ObjectiveThis cross-sectional study will investigate the epidemiology and geographic location of prehospital fatal injury deaths in relation to access to prehospital emergency services for the first time in New Zealand.Design and study populationElectronic Coronial case files for the period 2008–2012 will be reviewed to identify cases of prehospital fatal injury across New Zealand.MethodsThe project will combine epidemiological and geospatial methods in three research phases: (1) identification, enumeration, description and geocoding of prehospital injury deaths using existing electronic injury data sets; (2) geocoding of advanced hospital-level care providers and emergency land and air ambulance services to determine the current theoretical service coverage in a specified time period and (3) synthesising of information from phases I and II using geospatial methods to determine the number of prehospital injury deaths located in areas without timely access to advanced-level hospital care.DiscussionThe findings of this research will identify opportunities to optimise access to advanced-level hospital care in New Zealand to increase the chances of survival from serious injury. The resulting epidemiological and geospatial analyses will represent an advancement of knowledge for injury prevention and health service quality improvement towards better patient outcomes following serious injury in New Zealand and similar countries.

Potential survivability of prehospital injury deaths in New Zealand: a cross-sectional study

2020 ◽  
pp. injuryprev-2019-043408
Author(s):  
Bridget Kool ◽  
Rebbecca Lilley ◽  
Gabrielle Davie ◽  
Brandon de Graaf ◽  
Pararangi Reid ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Care ◽  
Cross Sectional Study ◽  
Insufficient Information ◽  
Injury Death ◽  
Cross Sectional ◽  
Advanced Level ◽  
Physical Injuries ◽  
Level Hospital ◽  
Do So

IntroductionAcknowledging a notable gap in available evidence, this study aimed to assess the survivability of prehospital injury deaths in New Zealand.MethodsA cross-sectional review of prehospital injury death postmortems (PM) undertaken during 2009–2012. Deaths without physical injuries (eg, drownings, suffocations, poisonings), where there was an incomplete body, or insufficient information in the PM, were excluded. Documented injuries were scored using the AIS and an ISS derived. Cases were classified as survivable (ISS <25), potentially survivable (ISS 25–49) and non-survivable (ISS >49).ResultsOf the 1796 cases able to be ISS scored, 11% (n=193) had injuries classified as survivable, 28% (n=501) potentially survivable and 61% (n=1102) non-survivable. There were significant differences in survivability by age (p=0.017) and intent (p<0.0001). No difference in survivability was observed by sex, ethnicity, day of week, seasonality or distance to advanced-level hospital care. ‘Non-survivable’ injuries occurred more commonly among those with multiple injuries, transport-related injuries and aged 15–29 year. The majority of ‘survivable’ cases were deceased when found. Among those alive when found, around half had received either emergency medical services (EMS) or bystander care. One in five survivable cases were classified as having delays in receiving care.DiscussionIn New Zealand, the majority of injured people who die before reaching hospital do so from non-survivable injuries. More than one third have either survivable or potentially survivable injuries, suggesting an increased need for appropriate bystander first aid, timeliness of EMS care and access to advanced-level hospital care.

scholarly journals Geographical and population disparities in timely access to prehospital and advanced level emergency care in New Zealand: a cross-sectional study

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026026 ◽  
Author(s):  
Rebbecca Lilley ◽  
Brandon de Graaf ◽  
Bridget Kool ◽  
Gabrielle Davie ◽  
Papaarangi Reid ◽  
...  
Keyword(s):  
New Zealand ◽  
Population Density ◽  
Hospital Care ◽  
Advanced Level ◽  
Zealand Population ◽  
Rapid Access ◽  
Emergency Medical ◽  
Geographical Access ◽  
Timely Access ◽  
Level Hospital

ObjectiveRapid access to advanced emergency medical and trauma care has been shown to significantly reduce mortality and disability. This study aims to systematically examine geographical access to prehospital care provided by emergency medical services (EMS) and advanced-level hospital care, for the smallest geographical units used in New Zealand and explores national disparities in geographical access to these services.DesignObservational study involving geospatial analysis estimating population access to EMS and advanced-level hospital care.SettingPopulation access to advanced-level hospital care via road and air EMS across New Zealand.ParticipantsNew Zealand population usually resident within geographical census meshblocks.Primary and secondary outcome measuresThe proportion of the resident population with calculated EMS access to advanced-level hospital care within 60 min was examined by age, sex, ethnicity, level of deprivation and population density to identify disparities in geographical access.ResultsAn estimated 16% of the New Zealand population does not have timely EMS access to advanced-level hospital care via road or air. The 700 000 New Zealanders without timely access lived mostly in areas of low-moderate population density. Indigenous Māori, New Zealand European and older New Zealanders were less likely to have timely access.ConclusionsThese findings suggest that in New Zealand, geographically marginalised groups which tend to be rural and remote communities with disproportionately more indigenous Māori and older adults have poorer EMS access to advanced-level hospitals. Addressing these inequities in rapid access to medical care may lead to improvements in survival that have been documented for people who experience medical or surgical emergencies.

Access to advanced-level hospital care: differences in prehospital times calculated using incident locations compared with patients’ usual residence

2021 ◽  
pp. injuryprev-2021-044351
Author(s):  
Gabrielle Davie ◽  
Rebbecca Lilley ◽  
Brandon de Graaf ◽  
Bridget Dicker ◽  
Charles Branas ◽  
...  
Keyword(s):  
Hospital Care ◽  
Injury Incidence ◽  
Industrial Construction ◽  
Advanced Level ◽  
Home Location ◽  
Home Address ◽  
Usual Residence ◽  
Timely Access ◽  
The Usa ◽  
Level Hospital

Studies estimate that 84% of the USA and New Zealand’s (NZ) resident populations have timely access (within 60 min) to advanced-level hospital care. Our aim was to assess whether usual residence (ie, home address) is a suitable proxy for location of injury incidence. In this observational study, injury fatalities registered in NZ’s Mortality Collection during 2008–2012 were linked to Coronial files. Estimated access times via emergency medical services were calculated using locations of incident and home. Using incident locations, 73% (n=4445/6104) had timely access to care compared with 77% when using home location. Access calculations using patients’ home locations overestimated timely access, especially for those injured in industrial/construction areas (18%; 95% CI 6% to 29%) and from drowning (14%; 95% CI 7% to 22%). When considering timely access to definitive care, using the location of the injury as the origin provides important information for health system planning.

Quality of hospital care for Māori patients in New Zealand: retrospective cross-sectional assessment

The Lancet ◽  
2006 ◽  
Vol 367 (9526) ◽  
pp. 1920-1925 ◽  
Author(s):  
Peter Davis ◽  
Roy Lay-Yee ◽  
Lorna Dyall ◽  
Robin Briant ◽  
Andrew Sporle ◽  
...  
Keyword(s):  
New Zealand ◽  
Hospital Care ◽  
Cross Sectional

Sexual Activity, Interest and Satisfaction in Older Women in Iran

2019 ◽  
Author(s):  
Afrouz Mardi ◽  
Zahra Behboodi Moghadam ◽  
Faezeh Ghafoori ◽  
Soheila Refahi
Keyword(s):  
Health Care ◽  
Sexual Activity ◽  
Older Women ◽  
Health Care Providers ◽  
Sexual Satisfaction ◽  
Healthcare Services ◽  
Cross Sectional Study ◽  
Care Providers ◽  
Northern Iran ◽  
Cross Sectional

Introduction: The world's population is aging and the issue of sexual activity in elderly people is still a taboo in many cultures. The purpose of this study was to examine the sexual activity, interest and satisfaction in older women attended the Health Care Centers in the city of Ardabil-Northern Iran. Method This Cross-sectional study was conducted on 380 married women over 60 years old who had been selected by convenient sampling method. Data were gathered anonymously by three questionnaires (Goldberg general health, FSFI and demographic information Questionnaires) and analyzed using SPSS software. Results: This study indicated that the mean age of participants was 71±6.8 years, 60% of the studied women had sexual activity and about half of them had interest in sex. Sexually active women were significantly younger (p<0.05) and more educated (p<0.001) than sexually inactive women. The participants’ sexual activity, interest in sex, emotional intimacy and sexual satisfaction with their husbands were significantly affected by the presence of children at home regardless of whether they are single or married (p<0.05).. Conclusion: This study approved that despite misconceptions, older age and sexuality do not contradict each other and high education and having a private environment facilitate the intimate relationships and elevate their sexual satisfaction. The result of this study could help health care providers to provide appropriate and effective sexual healthcare services to older women.

scholarly journals Does the current New Zealand case definition of serious non-fatal injury miss a material number of serious injury cases?

2010 ◽  
Vol 16 (Supplement 1) ◽  
pp. A141-A142
Author(s):  
C. Cryer ◽  
P. Gulliver ◽  
J. Langley ◽  
G. Davie ◽  
A. Samaranayaka
Keyword(s):  
New Zealand ◽  
Case Definition ◽  
Fatal Injury ◽  
Serious Injury ◽  
Definition Of

scholarly journals Risk Factors for Positive Appraisal of Mistreatment during Childbirth among Ethiopian Midwifery Students

2020 ◽  
Vol 17 (8) ◽  
pp. 2682
Author(s):  
Rena Bakker ◽  
Ephrem D. Sheferaw ◽  
Tegbar Yigzaw ◽  
Jelle Stekelenburg ◽  
Marlou L. A. de Kroon
Keyword(s):  
Risk Factors ◽  
Linear Regression Analysis ◽  
Maternal Mortality Ratio ◽  
Healthcare Services ◽  
Educational Interventions ◽  
Self Esteem ◽  
Care Providers ◽  
Cross Sectional ◽  
Multivariable Linear Regression Analysis ◽  
Mortality Ratio

The maternal mortality ratio and neonatal mortality rate remain high in Ethiopia, where few births are attended by qualified healthcare staff. This is partly due to care providers’ mistreatment of women during childbirth, which creates a culture of anxiety that decreases the use of healthcare services. This study employed a cross-sectional design to identify risk factors for positive appraisal of mistreatment during childbirth. We asked 391 Ethiopian final year midwifery students to complete a paper-and-pen questionnaire assessing background characteristics, prior observation of mistreatment during education, self-esteem, stress, and mistreatment appraisal. A multivariable linear regression analysis indicated age (p = 0.005), stress (p = 0.019), and previous observation of mistreatment during education (p < 0.001) to be significantly associated with mistreatment appraisal. Younger students, stressed students, and students that had observed more mistreatment during their education reported more positive mistreatment appraisal. No significant association was observed for origin (p = 0.373) and self-esteem (p = 0.445). Findings can be utilized to develop educational interventions that counteract mistreatment during childbirth in the Ethiopian context.

Prehospital Sepsis Project (PSP): Knowledge and Attitudes of United States Advanced Out-of-Hospital Care Providers

2013 ◽  
Vol 28 (2) ◽  
pp. 104-106 ◽  
Author(s):  
Amado Alejandro Báez ◽  
Priscilla Hanudel ◽  
Maria Teresa Perez ◽  
Ediza M. Giraldez ◽  
Susan R. Wilcox
Keyword(s):  
United States ◽  
Hospital Care ◽  
Statistical Significance ◽  
Care Providers ◽  
Learning Program ◽  
Publication Type ◽  
Cross Sectional ◽  
Diagnosis And Management ◽  
Knowledge And Attitudes ◽  
Clinical Scenarios

AbstractIntroductionSevere sepsis and septic shock are common and often fatal medical problems. The Prehospital Sepsis Project is a multifaceted study that aims to improve the out-of-hospital care of patients with sepsis by means of education and enhancement of skills. The objective of this Project was to assess the knowledge and attitudes in the principles of diagnosis and management of sepsis in a cohort of United States out-of-hospital care providers.MethodsThis was cross-sectional study. A 15-item survey was administered via the Web and e-mailed to multiple emergency medical services list-servers. The evaluation consisted of four clinical scenarios as well as questions on the basics of sepsis. For intra-rater reliability, the first and the fourth scenarios were identical. Chi-square and Fisher's Exact testing were used to assess associations. Relative risk (RR) was used for strength of association. Statistical significance was set at .05.ResultsA total of 226 advanced EMS providers participated with a 85.4% (n = 193) completion rate, consisting of a 30.7% rural, 32.3% urban, and 37.0% suburban mix; 82.4% were paramedics and 72.5% had worked in EMS >10 years. Only 57 (29.5%) participants scored both of the duplicate scenarios correctly, and only 19 of the 193 (9.8%) responded to all scenarios correctly. Level of training was not a predictor of correctly scoring scenarios (P = .71, RR = 1.25, 95% CI = 0.39-4.01), nor was years of service (P = .11, RR = 1.64, 95% CI = 0.16-1.21).ConclusionsPoor understanding of the principles of diagnosis and management of sepsis was observed in this cohort, suggesting the need for enhancement of education. Survey items will be used to develop a focused, interactive Web-based learning program. Limitations include potential for self-selection and data accuracy.Báez AA, Hanudel P, Perez MT, Giraldez EM, Wilcox SR. Prehospital sepsis project (PSP): knowledge and attitudes of United States advanced out-of-hospital care providers. Prehosp Disaster Med. 2013;28(2):1-3.

scholarly journals Health system factors associated with post-trauma mortality at the prehospital care level in Africa: a scoping review

2020 ◽  
Vol 5 (1) ◽  
pp. e000530
Author(s):  
Gilbert Koome ◽  
Martin Atela ◽  
Faith Thuita ◽  
Thaddaeus Egondi
Keyword(s):  
Health System ◽  
Hospital Care ◽  
Qualitative Studies ◽  
Care Providers ◽  
Cross Sectional ◽  
Care Level ◽  
Factors Associated ◽  
Trauma Mortality ◽  
System Factors ◽  
Delphi Studies

BackgroundAfrica accounts forabout 90% of the global trauma burden. Mapping evidence on health systemfactors associated with post-trauma mortality is essential in definingpre-hospital care research priorities and mitigation of the burden. The studyaimed to map and synthesize existing evidence and research gaps on healthsystem factors associated with post-trauma mortality at the pre-hospital carelevel in Africa.MethodsA scoping review of published studies and grey literature was conducted. The search strategy utilized electronic databases comprising of Medline, Google Scholar, Pub-Med, Hinari and Cochrane Library. Screening and extraction of eligible studies was done independently and in duplicate.ResultsA total of 782 study titles and or abstracts were screened. Of these, 32 underwent full text review. Out of the 32, 17 met the inclusion criteria for final review. The majority of studies were literature reviews (24%) and retrospective studies (23%). Retrospective and qualitative studies comprised 6% of the included studies, systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%), systematic reviews (6%), cross-sectional studies (17%), Delphi studies (6%), panel reviews (6%) and qualitative studies (12%). Reported post-trauma mortality ranged from 13% in Ghana to 40% in Nigeria. Reported preventable mortality is as high as 70% in South Africa, 60% in Ghana and 40% in Nigeria. Transport mode is the most studied health system factor (reported in 76% of the papers). Only two studies (12%) included access to pre-hospital care interventions aspects, nine studies (53%) included care providers aspects and three studies (18%) included aspects of referral pathways. The types of transport mode and referral pathway are the only factors significantly associated with post-trauma mortality, though the findings were mixed. None of the included studies reported significant associations between pre-hospital care interventions, care providers and post-trauma mortality.DiscussionAlthough research on health system factors and its influence on post-trauma mortality at the pre-hospital care level in Africa are limited, anecdotal evidence suggests that access to pre-hospital care interventions, the level of provider skills and referral pathways are important determinants of mortality outcomes. The strength of their influence will require well designed studies that could incorporate mixed method approaches. Moreover, similar reviews incorporating other LMICs are also warranted. Key Words: Health System Factors, Emergency Medical Services [EMS], Pre-hospital Care, Post-Trauma mortality, Africa.

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