scholarly journals Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Significant Difference ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background This work was to study the prehospital time among suspected stroke patients who were transported by an emergency medical service (EMS) system using a national database. Methods National EMS database of suspected stroke patients who were treated by EMS system across 77 provinces of Thailand between January 1, 2015, and December 31, 2018, was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance, and distance to the scene) and prehospital time (i.e., dispatch, activation, response, scene, and transportation time) were extracted. Time parameters were also categorized according to the guidelines. Results Total 53,536 subjects were included in the analysis. Most of the subjects were transported during 06.00-18.00 (77.5%) and were 10 km from the ambulance parking (80.2%). Half of the subjects (50.1%) were served by advanced life support (ALS) ambulance. Median total time was 29 min (IQR 21, 39). There was a significant difference of median total time among ALS (30 min), basic (27 min), and first responder (28 min) ambulances, Holm P = 0.009. Although 91.7% and 88.3% of the subjects had dispatch time ≤ 1 min and activation time ≤ 2 min, only 48.3% had RT ≤ 8 min. However, 95% of the services were at the scene ≤ 15 min. Conclusion Prehospital time from EMS call to hospital was approximately 30 min which was mainly utilized for traveling from the ambulance parking to the scene and transporting patients from the scene to hospitals. Even though only 48% of the services had RT ≤ 8 min, 95% of them had the scene time ≤ 15 min.

scholarly journals Prehospital Time of Suspected Stroke Patients Treated by Emergency Medical Service: A Nationwide Study in Thailand

2020 ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
Advanced Life Support ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background: This study was to study the prehospital time among suspected stroke patients who were transported by emergency medical service (EMS) system using national database. Methods: National EMS database across 77 provinces of Thailand among suspected stroke patients who were treated by EMS system between January 1, 2015 to December 31, 2018 was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance and distance to scene) and prehospital time (i.e., dispatch, activation, response, scene and transportation times) were extracted. Time parameters were also categorized according to guideline. Results: In total 53,536 subjects were included in analysis. Most of the subjects were transported during 06.00-18.00 and were in 10 kilometers from ambulance parking. Half of the subjects were treated by advanced life support (ALS) ambulance. Median total time was 29 minutes (IQR: 21, 39) which was mainly occupied for transporting patient from scene to hospital. Although most of subjects had dispatch and activation times ≤ 2 minutes, but only 48.3% had RT ≤ 8 minutes. However, 95% of service were at scene ≤ 15 minutes. ALS ambulance had the longer total time, compared to first responder and basic level (30 minutes versus 28 and 27 minutes). Conclusions: Prehospital time from EMS call to hospital was approximately 30 minutes among suspected stroke patients. This was mainly utilized for travelling from ambulance parking to scene and transporting patient from scene to hospital. Although only 48% of services had RT ≤ 8 minutes, but 95% of them had scene time ≤ 15 minutes.

Abstract 151: Do the Simplified 2015 ERC Guidelines Improve Basic Life Support Performance Compared to 2010 ERC Guidelines?

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Dung T Nguyen ◽  
Kasper G Lauridsen ◽  
Josephine Johnsen ◽  
Katrine B Bomholt ◽  
Bo Løfgren
Keyword(s):  
Emergency Medical Service ◽  
Chest Compression ◽  
Medical Service ◽  
Basic Life Support ◽  
Life Support ◽  
Emergency Medical ◽  
Resuscitation Guidelines ◽  
Significant Difference ◽  
Service Call ◽  
Erc Guidelines

Background: The European Resuscitation Council (ERC) 2015 basic life support (BLS) algorithm has been simplified compared with the ERC 2010 BLS algorithm. Simplification of resuscitation guidelines may facilitate learning and improve guidelines adherence. This study aimed to study BLS performance using ERC 2015 compared with ERC 2010 guidelines. Methods: This is an observational study including video recordings of laypersons being skill tested after participation in a standardized ERC BLS/AED course using either the simplified ERC 2015 or ERC 2010 guidelines. The endpoints were 1) performing all steps of the BLS/AED algorithm correctly, 2) remembering the sequence of actions of the BLS/AED algorithm, 3) time to emergency medical service call, 4) time to first chest compression and 5) time to first shock. Results: We analyzed videos of 100 laypersons (50 trained using the simplified 2015 guidelines and 50 trained using the 2010 guidelines). Overall, 78% and 62% correctly performed all of the steps of the 2015 and 2010 guidelines respectively (p=0.08), whereas 94% and 82% remembered the correct sequence of actions of the 2015 and 2010 algorithms, respectively (p=0.06). There was no significant difference between participants following the 2015 vs 2010 algorithms with respect to time to emergency medical service call (difference: 0 sec, (95% confidence interval (CI): -3; 2) P=0.70), time to first chest compression (difference: 0 sec, (95% CI: -3;3) P=1.00), and time to first shock (difference: 0 sec, (95% CI: -6; 7) P=0.90). Conclusion: Laypersons tends to better perform resuscitation and adhere to the BLS algorithm when using the simplified ERC 2015 guidelines compared to the 2010 Guidelines. There were however no differences in time to emergency medical service call, time to first chest compression and shock delivery.

scholarly journals Efficacy of rescue blanket versus conventional blanket in terms of preventing accidental hypothermia during patient transfer by emergency medical service: a randomized clinical trial

2019 ◽  
Vol 6 (1) ◽  
pp. 38-42
Author(s):  
Peyman Saberian ◽  
Mostafa Sadeghi ◽  
Parisa Hasani-Sharamin ◽  
Maryam Modaber ◽  
Amirreza Farhoud ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Emergency Medical Service ◽  
Randomized Clinical Trial ◽  
Medical Service ◽  
Hospital Setting ◽  
Tympanic Temperature ◽  
Time Of Arrival ◽  
Emergency Medical ◽  
Significant Difference ◽  
The Mean

Objective: This study aimed to compare the efficacy of rescue blankets with conventional blankets in terms of preventing hypothermia in the pre-hospital setting. Methods: In this randomized clinical trial, patients older than 18 years old with Cold Discomfort Scale (CDS) > 2, and those who were transferred to the emergency department (ED) by emergency medical service entered the study. Patients were randomly divided into two groups based on the type of transfer. In this regard, one group was transferred with rescue blankets and the other group was transferred with conventional blankets. The tympanic temperature in patients and CDS were recorded before the use of blanket (primary) and at the time of arrival in the ED (secondary). Results: Finally, 161 patients with the mean age of 45.31±19.8 years were included (63.4% were male). Totally, 88 cases (54.7%) were transferred with rescue blankets and 73 cases (45.3%) with conventional blankets. The mean of the primary tympanic temperatures in the rescue and conventional blanket groups were 36.20±0.84°C and 36.34±0.65°C, respectively (P=0.23). The mean of the primary CDS in rescue and conventional blanket groups were 6.55±1.95 and 5.89±2.29, respectively (P=0.05). Also, the mean of the secondary tympanic temperatures in the rescue and conventional blanket groups were 36.59±0.47°C and 36.76±0.48 °C, respectively (P=0.03). Besides, the mean of the secondary CDS in the rescue and conventional blanket groups were 2.64±2.80 and 2.41±1.29, respectively (P=0.48). Conclusion: According to the results, there is no significant difference in the tympanic temperature and CDS of the patients transferred with the rescue blanket compared with the conventional blanket.

scholarly journals Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Hiroki Maeyama ◽  
Hiromichi Naito ◽  
Francis X. Guyette ◽  
Takashi Yorifuji ◽  
Yuki Banshotani ◽  
...  
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Helicopter Emergency Medical Service ◽  
Emergency Medical Service System ◽  
Success Rates ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Intubation Success Rate ◽  
Prehospital Time ◽  
Improve Patient

Abstract Introduction The Helicopter Emergency Medical Service (HEMS) commonly intubates patients who require advanced airway support prior to takeoff. In-flight intubation (IFI) is avoided because it is considered difficult due to limited space, difficulty communicating, and vibration in flight. However, IFI may shorten the total prehospital time. We tested whether IFI can be performed safely by the HEMS. Methods We conducted a retrospective cohort study in adult patients transported from 2010 to 2017 who received prehospital, non-emergent intubation from a single HEMS. We divided the cohort in two groups, patients intubated during flight (flight group, FG) and patients intubated before takeoff (ground group, GG). The primary outcome was the proportion of successful intubations. Secondary outcomes included total prehospital time and the incidence of complications. Results We analyzed 376 patients transported during the study period, 192 patients in the FG and 184 patients in the GG. The intubation success rate did not differ between the two groups (FG 189/192 [98.4%] vs. GG 179/184 [97.3%], p = 0.50). There were also no differences in hypoxia (FG 4/117 [3.4%] vs. GG 4/95 [4.2%], p = 1.00) or hypotension (FG 6/117 [5.1%] vs. GG 5/95 [5.3%], p = 1.00) between the two groups. Scene time and total prehospital time were shorter in the FG (scene time 7 min vs. 14 min, p <  0.001; total prehospital time 33.5 min vs. 40.0 min, p <  0.001). Conclusions IFI was safely performed with high success rates, similar to intubation on the ground, without increasing the risk of hypoxia or hypotension. IFI by experienced providers shortened transportation time, which may improve patient outcomes.

Abstract WP373: Emergency Medical Service Stroke Education in a Rural Community: Need for Improvement

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Pauline M Rankin ◽  
Dianne Marsh ◽  
James McLaughlin
Keyword(s):  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Signs And Symptoms ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Primary Stroke Center ◽  
Stroke Education ◽  
Comprehensive Stroke Center ◽  
Stroke Center

According to The Journal of Emergency Medical Services (EMS) the goal of stroke care is to minimize brain injury and maximize recovery. The stroke chain of survival links actions taken by patients, family, EMS and healthcare providers. Recent innovations in stroke treatment require accurate identification and appropriate triage to the appropriate treatment facility. Evidence in the literature demonstrates variability with EMS correct identification of stroke patients between 30% and 80%. Our 164 bed primary stroke center in rural Pennsylvania has been active in providing stroke education on an annual basis to emergency medical services within a two county radius. As part of our ongoing process improvement we wanted to evaluate the emergency medical technicians and paramedics knowledge of stroke signs and symptoms, their understanding of the evaluation, treatment and triage of stroke patients. A standard questionnaire with 14 variables was developed using the American Heart and Stroke Association prehospital guidelines. The questionnaire included 16 stroke and non stroke symptoms, identifying transport to primary verses comprehensive stroke centers and initial evaluation. A sample population of 90 emergency medical service staff were asked to complete the questionnaire with 28 (31%) responses received. All participants indicated they were confident to recognize stroke signs and symptoms but 6 of the non stroke items were chosen as stroke symptoms. All participants indicated they were confident in the initial evaluation of a stroke patient but 14 (50%) appropriately identified airway, breathing, circulation as the first evaluation. Evaluating triage knowledge, 26 (93%) stated confidence in decision to transport to a primary stroke center and 22 (79%) to a comprehensive stroke center, however, appropriate decision to transport to a primary stroke center was identified correctly by 46% a comprehensive stroke center 66%. In conclusion, results from this study suggest that in this rural setting, barriers exist in prehospital recognition and evaluation of the stroke patient for which proper education may be remediable. Our goal is to use this information to revise our current EMS stroke education program and enhance prehospital assessment and triage.

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