scholarly journals Dispatch accuracy of physician-staffed emergency medical services in trauma care in south-east Norway: a retrospective observational study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Martin Samdal ◽  
Kjetil Thorsen ◽  
Ola Græsli ◽  
Mårten Sandberg ◽  
Marius Rehn
Keyword(s):  
Emergency Medical Services ◽  
Trauma Care ◽  
Injury Severity ◽  
Road Traffic ◽  
Medical Services ◽  
Data Systems ◽  
Hospital Data ◽  
Accurate Identification ◽  
Emergency Medical ◽  
Patient Pathways

Abstract Background Selection of incidents and accurate identification of patients that require assistance from physician-staffed emergency medical services (P-EMS) remain essential. We aimed to evaluate P-EMS availability, the underlying criteria for dispatch, and the corresponding dispatch accuracy of trauma care in south-east Norway in 2015, to identify areas for improvement. Methods Pre-hospital data from emergency medical coordination centres and P-EMS medical databases were linked with data from the Norwegian Trauma Registry (NTR). Based on a set of conditions (injury severity, interventions performed, level of consciousness, incident category), trauma incidents were defined as complex, warranting P-EMS assistance, or non-complex. Incident complexity and P-EMS involvement were the main determinants when assessing the triage accuracy. Undertriage was adjusted for P-EMS availability and response and transport times. Results Among 19,028 trauma incidents, P-EMS were involved in 2506 (13.2%). The range of overtriage was 74–80% and the range of undertriage was 20–32%. P-EMS readiness in the event of complex incidents ranged from 58 to 70%. The most frequent dispatch criterion was “Police/fire brigade request immediate response” recorded in 4321 (22.7%) of the incidents. Criteria from the groups “Accidents” and “Road traffic accidents” were recorded in 10,875 (57.2%) incidents, and criteria from the groups “Transport reservations” and “Unidentified problem” in 6025 (31,7%) incidents. Among 4916 patient pathways in the NTR, 681 (13.9%) could not be matched with pre-hospital data records. Conclusions Both P-EMS availability and dispatch accuracy remain suboptimal in trauma care in south-east Norway. Dispatch criteria are too vague to facilitate accurate P-EMS dispatch, and pre-hospital data is inconsistent and insufficient to provide basic data for scientific research. Future dispatch criteria should focus on the care aspect of P-EMS. Better tools for both dispatch and incident handling for the emergency medical coordination centres are essential. In general, coordination, standardisation, and integration of existing data systems should enhance the quality of trauma care and increase patient safety.

scholarly journals Where There is No EMS: Lay Providers in Emergency Medical Services Care - EMS as a Public Health Priority

2017 ◽  
Vol 32 (6) ◽  
pp. 593-595 ◽  
Author(s):  
Sierra Debenham ◽  
Matthew Fuller ◽  
Matthew Stewart ◽  
Raymond R. Price
Keyword(s):  
Public Health ◽  
Emergency Medical Services ◽  
Trauma Care ◽  
Road Traffic ◽  
Medical Services ◽  
Medical Systems ◽  
Publication Type ◽  
Public Health Priority ◽  
Health Priority ◽  
Emergency Medical

AbstractBy 2030, road traffic accidents are projected to be the fifth leading cause of death worldwide, with 90% of these deaths occurring in low- and middle-income countries (LMICs). While high-quality, prehospital trauma care is crucial to reduce the number of trauma-related deaths, effective Emergency Medical Systems (EMS) are limited or absent in many LMICs. Although lay providers have long been recognized as the front lines of informal trauma care in countries without formal EMS, few efforts have been made to capitalize on these networks. We suggest that lay providers can become a strong foundation for nascent EMS through a four-fold approach: strengthening and expanding existing lay provider training programs; incentivizing lay providers; strengthening locally available first aid supply chains; and using technology to link lay provider networks.DebenhamS, FullerM, StewartM, PriceRR. Where there is no EMS: lay providers in Emergency Medical Services care - EMS as a public health priority. Prehosp Disaster Med. 2017;32(6):593–595.

A Descriptive Analysis of Traction Splint Utilization and IV Analgesia by Emergency Medical Services

2017 ◽  
Vol 32 (6) ◽  
pp. 631-635 ◽  
Author(s):  
Joshua Nackenson ◽  
Amado A. Baez ◽  
Jonathan P. Meizoso
Keyword(s):  
Emergency Medical Services ◽  
Blunt Trauma ◽  
Injury Severity ◽  
Femur Fracture ◽  
Descriptive Analysis ◽  
Penetrating Trauma ◽  
Physical Exam ◽  
Medical Services ◽  
Prehospital Treatment ◽  
Emergency Medical

AbstractStudy ObjectivesTraction splinting has been the prehospital treatment of midshaft femur fracture as early as the battlefield of the First World War (1914-1918). This study is the assessment of these injuries and the utilization of a traction splint (TS) in blunt and penetrating trauma, as well as intravenous (IV) analgesia utilization by Emergency Medical Services (EMS) in Miami, Florida (USA).MethodsThis is a retrospective study of patients who sustained a midshaft femur fracture in the absence of multiple other severe injuries or severe physiologic derangement, as defined by an injury severity score (ISS) <20 and a triage revised trauma score (T-RTS)≥10, who presented to an urban, Level 1 trauma center between September 2008 and September 2013. The EMS patient care reports were assessed for physical exam findings and treatment modality. Data were analyzed descriptively and statistical differences were assessed using odds ratios and Z-score with significance set at P≤.05.ResultsThere were 170 patients studied in the cohort. The most common physical exam finding was a deformity +/- shortening and rotation in 136 patients (80.0%), followed by gunshot wound (GSW) in 22 patients (13.0%), pain or tenderness in four patients (2.4%), and no findings consistent with femur fracture in three patients (1.7%). The population was dichotomized between trauma type: blunt versus penetrating. Of 134 blunt trauma patients, 50 (37.0%) were immobilized in traction, and of the 36 penetrating trauma victims, one (2.7%) was immobilized in traction. Statistically significant differences were found in the application of a TS in blunt trauma when compared to penetrating trauma (OR=20.83; 95% CI, 2.77-156.8; P <.001). Intravenous analgesia was administered to treat pain in only 35 (22.0%) of the patients who had obtainable IV access. Of these patients, victims of blunt trauma were more likely to receive IV analgesia (OR=6.23; 95% CI, 1.42-27.41; P=.0067).ConclusionAlthough signs of femur fracture are recognized in the majority of cases of midshaft femur fracture, only 30% of patients were immobilized using a TS. Statistically significant differences were found in the utilization of a TS and IV analgesia administration in the setting of blunt trauma when compared to penetrating trauma.NackensonJ, BaezAA, MeizosoJP. A descriptive analysis of traction splint utilization and IV analgesia by Emergency Medical Services.Prehosp Disaster Med. 2017;32(6):631–635.

scholarly journals Strengthening the Capacity of Emergency Medical Services in Low and Middle Income Countries using Dispatcher-Coordinated Taxis

2020 ◽  
Vol 2674 (9) ◽  
pp. 338-345
Author(s):  
Vipul Mishra ◽  
Richa Ahuja ◽  
N. Nezamuddin ◽  
Geetam Tiwari ◽  
Kavi Bhalla
Keyword(s):  
Response Time ◽  
Emergency Medical Services ◽  
Road Traffic ◽  
International Standards ◽  
Medical Services ◽  
Road Traffic Crash ◽  
Middle Income ◽  
Middle Income Countries ◽  
Emergency Medical ◽  
Low And Middle Income

International standards recommend provision of one ambulance for every 50,000 people to fulfill demand for transporting patients to definitive care facilities in low and middle income countries (LMICs). Governments’ consistent attempt to build capacity of emergency medical services (EMS) in LMICs has been financially demanding. This study is an attempt to assess the feasibility of capacity building of existing EMS in Delhi, India by using taxis as an alternative mode of transport for emergency transportation of road traffic crash victims to enable improvement in response time for road traffic crashes where time criticality is deemed important. Performance of the proposed system is evaluated based on response time, coverage and distance. The system models the performance and quantifies the taxi–ambulance configuration for achieving EMS performance within international standards.

scholarly journals Impact of the Four-Hour Rule policy on emergency medical services delays in Australian EDs: a longitudinal cohort study

2020 ◽  
pp. emermed-2019-208958 ◽  
Author(s):  
Nicola Wing Young Man ◽  
Roberto Forero ◽  
Hanh Ngo ◽  
David Mountain ◽  
Gerard FitzGerald ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
New South ◽  
New South Wales ◽  
Interrupted Time Series ◽  
Medical Services ◽  
Hospital Data ◽  
Emergency Medical ◽  
South Wales ◽  
Meta Regression Analysis ◽  
The Impact

IntroductionDelayed handover of emergency medical services (EMS) patients to EDs is a major issue with hospital crowding considered a primary cause. We explore the impact of the 4-hour rule (the Policy) in Australia, focusing on ambulance and ED delays.MethodsEMS (ambulance), ED and hospital data of adult patients presenting to 14 EDs from 2002 to 2013 in three jurisdictions were linked. Interrupted time series ‘Before-and-After’ trend analysis was used for assessing the Policy’s impact. Random effects meta-regression analysis was examined for associations between ambulance delays and Policy-associated ED intake, throughput and output changes.ResultsBefore the Policy, the proportion of ED ambulances delayed increased between 1.1% and 1.7% per quarter across jurisdictions. After Policy introduction, Western Australia’s increasing trend continued but Queensland decreased by 5.1% per quarter. In New South Wales, ambulance delay decreased 7.1% in the first quarter after Policy introduction. ED intake (triage delay) improved only in New South Wales and Queensland. Each 1% ambulance delay reduction was significantly associated with a 0.91% reduction in triage delay (p=0.014) but not ED length of stay ≤4 hours (p=0.307) or access-block/boarding (p=0.605) suggesting only partial improvement in ambulance delay overall.ConclusionThe Policy was associated with reduced ambulance delays over time in Queensland and only the immediate period in New South Wales. Associations may be due to local jurisdictional initiatives to improve ambulance performance. Strategies to alleviate ambulance delay may need to focus on the ED intake component. These should be re-examined with longer periods of post-Policy data.

Trauma System Development and Future Directions

1993 ◽  
Vol 8 (2) ◽  
pp. 111-114 ◽  
Author(s):  
Judith B. Braslow ◽  
Joan A. Snyder
Keyword(s):  
Public Health ◽  
Emergency Medical Services ◽  
Trauma Care ◽  
System Development ◽  
Trauma System ◽  
The United States ◽  
Advisory Council ◽  
Medical Services ◽  
Emergency Medical ◽  
Care Systems

AbstractTraumatic injury, both unintentional and intentional, is a serious public health problem. Trauma care systems play a significant role in reducing mortality, morbidity, and disability due to injuries. However, barriers to the provision of prompt and appropriate emergency medical services still exist in many areas of the United States. Title XII of the Public Health Service Act provides for programs in support of trauma care planning and system development by states and localities. This legislation includes provisions for: 1) grants to state agencies to modify the trauma care component of the state Emergency Medical Services (EMS) plan; 2) grants to improve the quality and availability of trauma care in rural areas; 3) development of a Model Trauma Care System Plan for states to use as a guide in trauma system development; and 4) the establishment of a National Advisory Council on Trauma Care Systems.

scholarly journals Helicopter and ground emergency medical services transportation to hospital after major trauma in England: a comparative cohort study

2020 ◽  
Vol 5 (1) ◽  
pp. e000508 ◽  
Author(s):  
Oliver Beaumont ◽  
Fiona Lecky ◽  
Omar Bouamra ◽  
Dhushy Surendra Kumar ◽  
Tim Coats ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Emergency Medical Services ◽  
Major Trauma ◽  
Road Traffic ◽  
Cohort Analysis ◽  
Primary Outcome Measure ◽  
Research Network ◽  
Medical Services ◽  
Emergency Medical ◽  
The Uk

BackgroundThe utilization of helicopter emergency medical services (HEMS) in modern trauma systems has been a source of debate for many years. This study set to establish the true impact of HEMS in England on survival for patients with major trauma.MethodsA comparative cohort design using prospectively recorded data from the UK Trauma Audit and Research Network registry. 279 107 patients were identified between January 2012 and March 2017. The primary outcome measure was risk adjusted in-hospital mortality within propensity score matched cohorts using logistic regression analysis. Subset analyses were performed for subjects with prehospital Glasgow Coma Scale <8, respiratory rate <10 or >29 and systolic blood pressure <90.ResultsThe analysis was based on 61 733 adult patients directly admitted to major trauma centers: 54 185 ground emergency medical services (GEMS) and 7548 HEMS. HEMS patients were more likely male, younger, more severely injured, more likely to be victims of road traffic collisions and intubated at scene. Crude mortality was higher for HEMS patients. Logistic regression demonstrated a 15% reduction in the risk adjusted odds of death (OR=0.846; 95% CI 0.684 to 1.046) in favor of HEMS. When analyzed for patients previously noted to benefit most from HEMS, the odds of death were reduced further but remained statistically consistent with no effect. Sensitivity analysis on 5685 patients attended by a doctor on scene but transported by GEMS demonstrated a protective effect on mortality versus the standard GEMS response (OR 0.77; 95% CI 0.62 to 0.95).DiscussionThis prospective, level 3 cohort analysis demonstrates a non-significant survival advantage for patients transported by HEMS versus GEMS. Despite the large size of the cohort, the intrinsic mismatch in patient demographics limits the ability to statistically assess HEMS true benefit. It does, however, demonstrate an improved survival for patients attended by doctors on scene in addition to the GEMS response. Improvements in prehospital data and increased trauma unit reporting are required to accurately assess HEMS clinical and cost-effectiveness.

Impact of Improved Emergency Medical Services and Emergency Trauma Care on the Reduction in Mortality from Trauma

1985 ◽  
Vol 25 (7) ◽  
pp. 575-579 ◽  
Author(s):  
JOSEPH P. ORNATO ◽  
EDWARD J. CRAREN ◽  
NORMAN M. NELSON ◽  
KENNETH F. KIMBALL
Keyword(s):  
Emergency Medical Services ◽  
Trauma Care ◽  
Medical Services ◽  
Emergency Medical
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