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

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.

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

BMJ Open ◽

10.1136/bmjopen-2018-026026 ◽

2019 ◽

Vol 9 (7) ◽

pp. e026026 ◽

Cited By ~ 3

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.

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

Injury Prevention ◽

10.1136/injuryprev-2016-042304 ◽

2017 ◽

Vol 24 (5) ◽

pp. 384-389 ◽

Cited By ~ 4

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.

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

Injury Prevention ◽

10.1136/injuryprev-2019-043408 ◽

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.

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Injury incidence and characteristics for elite, male, artistic USA gymnastics competitions from 2008 to 2018

British Journal of Sports Medicine ◽

10.1136/bjsports-2019-101297 ◽

2020 ◽

pp. bjsports-2019-101297

Author(s):

David William Kruse ◽

Andrew Seiji Nobe ◽

John Billimek

Keyword(s):

Athletic Trainers ◽

Common Type ◽

Injury Incidence ◽

Muscle Strain ◽

Time Loss ◽

Certified Athletic Trainers ◽

Injury Site ◽

The Usa ◽

Location Type ◽

Type Of Injury

ObjectivesTo determine the injury incidence and characteristics for elite, male, artistic USA gymnasts during gymnastics competitions, held in the USA, from 2008 to 2018.MethodsInjury documentation performed by lead physician and certified athletic trainers at elite junior and senior USA Gymnastics competitions from 2008 to 2018 were reviewed and compiled into an excel database. Injury incidence was computed per 1000 registered gymnasts by competition setting as well as injury location, type, cause, severity, and setting.ResultsFrom 2008 to 2018, 180 injuries were reported in a total of 2102 gymnasts with injury incidence of 85.6 per 1000 gymnasts (95% CI 73.4 to 97.8). The most common injury site was at the ankle (16.7 per 1000 gymnasts, 95% CI 10.9 to 22.4), and muscle strain/rupture/tear was the most common type of injury (28.5 per 1000 gymnasts, 95% CI 21.2 to 35.9). The most common cause was contact with surface (56.1 per 1000 gymnasts, 95% CI 46.1 to 66.2), and the event where most injuries were sustained was the vault (21.9 per 1000 gymnasts, 95% CI 15.4 to 28.4). Incidence of time loss injuries was 38.5 per 1000 gymnasts (95% CI 30.1 to 47.0). Injury incidence was higher during competition (58.5 per 1000 gymnasts, 95% CI 48.2 to 68.8) than during training (27.1 per 1000 RG, 95% CI 19.9 to 34.3; RR 2.16, 95% CI 1.59 to 2.94, p<0.001); injury incidence was greater at Olympic Trials (RR 3.23, 95% CI 1.24 to 8.47, p=0.017) than at National Qualifier meets. We report concussion incidence in gymnastics (5.7 per 1000 gymnasts, 95% CI 2.3 to 9.2).ConclusionsThis is the largest injury study to date for male artistic gymnasts (180 injuries, 2102 gymnasts, 11 years).

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Education and skills training for care partners of hospitalised older adults: A scoping review

Health Education Journal ◽

10.1177/00178969211034192 ◽

2021 ◽

pp. 001789692110341

Author(s):

Madeline Carbery ◽

Samantha Schwartz ◽

Nicole Werner ◽

Beth Fields

Keyword(s):

Older Adults ◽

Hospital Admission ◽

Health Outcomes ◽

Older Adult ◽

Scoping Review ◽

Hospital Care ◽

Skills Training ◽

Individual Care ◽

Care Partners ◽

The Usa

Background: The care partners of hospitalised older adults often feel dissatisfied with the education and skills training provided to them, resulting in unpreparedness and poor health outcomes. Objective: This review aimed to characterise and identify gaps in the education and skills training used with the care partners of older adults in the hospital. Methods: We conducted a scoping review on the education and skills training practices used with the care partners of hospitalised older adults in the USA via sources identified in the PubMed, PsychINFO and CINAHL databases. Results: Twelve studies were included in this review. Results illustrate that nurses utilise multiple modes of delivery and frequently provide education and skills training tailored to the needs of care partners at the latter end of hospital care. The provision of education and skills training varies greatly, however, including who provides education, in what way information is conveyed, and how care partner outcomes are measured. Conclusion: This is the first scoping review to describe and synthesise the education and skills training practices used with care partners of hospitalised older adults. Findings highlight the need for education and skills training to be interprofessional, tailored to individual care partners’ needs and begin at, or even before, the hospital admission of older adult patients.

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Timing and Reasons Behind Single-Sport Specialization in Soccer: A Survey of 64 Major League Soccer Athletes

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738120911373 ◽

2020 ◽

Vol 12 (4) ◽

pp. 355-360

Author(s):

Derrick M. Knapik ◽

Katherine H. Rizzone ◽

James E. Voos

Keyword(s):

High School ◽

The United States ◽

Injury Incidence ◽

Level Of Evidence ◽

Cross Sectional ◽

Advanced Level ◽

School Location ◽

Major League Soccer ◽

Major League ◽

The Impact

Background: Single-sport specialization at the exclusion of other sports has become increasingly popular in youth sporting culture. The purpose of this study was to survey Major League Soccer (MLS) athletes to examine factors influencing the timing of single-sport specialization in soccer. Hypothesis: The majority of surveyed athletes will have participated in multiple sports prior to specialization and specialized primarily as a result of a coach’s recommendation, with no significant impact on specialization timing stemming from birth or high school location, obtaining a collegiate scholarship, MLS experience, or position. Study Design: Cross-sectional study. Level of Evidence: Level 4. Methods: Anonymous surveys were distributed to 3 MLS organizations and completed by MLS athletes during preseason physicals. Surveys evaluated the age and reason(s) behind an athlete’s decision to specialize in soccer, birth location, geographic high school location for US-born athletes, participation in a developmental league, college scholarship, years in the MLS, and position played. Results: Approximately 74% (64/86) of athletes returned completed surveys. Athletes reported beginning soccer at a mean age of 5.1 ± 2.1 years and specializing at age 12.6 ± 4.3 years. Athletes who participated in no other sports prior to specialization ( P < 0.001), athletes reporting soccer to be their first sport played at an advanced level ( P < 0.001), and athletes receiving a college scholarship ( P = 0.02) specialized at a significantly younger age. Internationally born athletes specialized at significantly younger ages when compared with US-born athletes ( P < 0.001). Conclusion: The majority of athletes participated in multiple sports prior to specialization and eventually specialized to focus exclusively on soccer. The timing of sport specialization in professional MLS athletes was not associated with multisport participation prior to specialization, playing soccer at an advanced level prior to other sports, receiving a college scholarship, or being born outside the United States. Clinical Relevance: Timing of sport specialization is associated with multiple factors prior to athlete promotion to the MLS that warrant further investigation to better understand the impact of specialization on injury incidence, performance, and career length.

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EP07.13: Experience of advanced level II ultrasonography for evaluation of fetal anomaly in a tertiary level hospital of Bangladesh

Ultrasound in Obstetrics and Gynecology ◽

10.1002/uog.21239 ◽

2019 ◽

Vol 54 (S1) ◽

pp. 272-272

Author(s):

N. Sultana ◽

A. Sarker ◽

N. Dorji ◽

T. Parveen ◽

R. Parveen ◽

...

Keyword(s):

Fetal Anomaly ◽

Tertiary Level ◽

Advanced Level ◽

Level Ii ◽

Level Hospital

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DESIGNING RESILIENT ROOF SYSTEMS

Proceedings of International Structural Engineering and Construction ◽

10.14455/isec.res.2018.17 ◽

2018 ◽

Vol 5 (1) ◽

Author(s):

Thomas W. Hutchinson

Keyword(s):

Natural Disasters ◽

Building Industry ◽

First Line ◽

Industrial Construction ◽

Severe Storms ◽

Climate Conditions ◽

Performance Objective ◽

Roof System ◽

The Usa ◽

The Government

Recent powerful climate storms in the USA have the government discussing the need for resilient buildings: Buildings that can withstand severe storms, provide life safety and be quickly repaired. A building’s roof is often the first line of defense in the changing climate conditions with its catastrophic natural disasters. The roof, if designed properly, can mitigate the impacts of these emergencies and allow a building to withstand and recover from the disruption caused. Resilience is increasingly being viewed as an important performance objective for governmental, educational, commercial and industrial construction. Interest in resiliency is high and is being actively discussed at all levels of the building industry: Governmental, Codes and Standards and Trade Organizations (ASTM, Resilient). This paper will review key resilient roof system elements that need to be considered by roof system designers: Best design and detail practices for roofing to achieve resiliency. The needed level of design and detailing will be reviewed. Recommendations to achieve resilient roof systems will be provided.

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Helicopter EMS: Research Endpoints and Potential Benefits

Emergency Medicine International ◽

10.1155/2012/698562 ◽

2012 ◽

Vol 2012 ◽

pp. 1-14 ◽

Cited By ~ 18

Author(s):

Stephen H. Thomas ◽

Annette O. Arthur

Keyword(s):

Case Reports ◽

Rural Setting ◽

Level Of Care ◽

Advanced Level ◽

Level Ii ◽

Timely Access ◽

Hospital Systems ◽

Potential Benefits ◽

Level I ◽

Interfacility Transport

Patients, EMS systems, and healthcare regions benefit from Helicopter EMS (HEMS) utilization. This article discusses these benefits in terms of specific endpoints utilized in research projects. The endpoint of interest, be it primary, secondary, or surrogate, is important to understand in the deployment of HEMS resources or in planning further HEMS outcomes research. The most important outcomes are those which show potential benefits to the patients, such as functional survival, pain relief, and earlier ALS care. Case reports are also important “outcomes” publications. The benefits of HEMS in the rural setting is the ability to provide timely access to Level I or Level II trauma centers and in nontrauma, interfacility transport of cardiac, stroke, and even sepsis patients. Many HEMS crews have pharmacologic and procedural capabilities that bring a different level of care to a trauma scene or small referring hospital, especially in the rural setting. Regional healthcare and EMS system's benefit from HEMS by their capability to extend the advanced level of care throughout a region, provide a “backup” for areas with limited ALS coverage, minimize transport times, make available direct transport to specialized centers, and offer flexibility of transport in overloaded hospital systems.

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