Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 681-690 ◽  
Author(s):  
James S. Seidel ◽  
Deborah Parkman Henderson ◽  
Patrick Ward ◽  
Barbara Wray Wayland ◽  
Beverly Ness
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Pediatric Patients ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P < .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

Pediatrician's Role in Emergency Medical Services for Children

PEDIATRICS ◽  
1988 ◽  
Vol 81 (5) ◽  
pp. 735-735
Author(s):  
Keyword(s):  
Emergency Medical Services ◽  
Emergency Care ◽  
Life Support ◽  
Care Delivery ◽  
Prehospital Care ◽  
Pediatric Emergency ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Medical ◽  
Pediatric Emergency Care

To reduce the morbidity and mortality of critically ill and injured children, comprehensive care must be provided. This includes effective services and treatment from the onset of the illness or injury through definitive care. Pediatricians should counsel families not only about prevention of disease and injury but also about access to pediatric emergency care resources in their region. If the interval between recognition of illness and delivery of care is to be reduced to a minimum, a prehospital protocol must be established. Parents as well as prehospital care providers must be knowledgeable about their community's prehospital protocol for life-threatening illness or injury. Primary care pediatricians need to establish networks with hospital-based pediatricians, emergency physicians, pediatric surgeons, and other pediatric medical and pediatric surgical specialists so that there is clearly assigned responsibility for provision of pediatric emergency care.1 When available, a pediatric surgeon should take charge of the child with multiple traumatic injuries. Optimally, the pediatric emergency care delivery system will be comprehensive and designed to meet the unique needs of children. The specific objectives of an emergency medical services for children (EMS-C) system should remain constant even though available resources may vary from region to region. For an EMS-C system to be most effective, practitioners need to develop the knowledge, skills, attitudes, and experience necessary to provide essential life support for ill and injured children. Many regions currently have well-developed emergency medical services (EMS) systems with outstanding capability and sophistication but most have been designed to meet the needs of adults.2

Collegiate-Based Emergency Medical Services (EMS): A Survey of EMS Systems on College Campuses

2006 ◽  
Vol 21 (2) ◽  
pp. 91-96 ◽  
Author(s):  
Jonathan Fisher ◽  
Adam Ray ◽  
Scott C. Savett ◽  
Mark E. Milliron ◽  
George J. Koenig
Keyword(s):  
Emergency Medical Services ◽  
Life Support ◽  
International Schools ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Medical Services ◽  
Medical Systems ◽  
Emergency Medical ◽  
Levels Of Service ◽  
Emergency Medical Systems

AbstractIntroduction:Collegiate-based emergency medical systems (CBEMS) are a unique model for the delivery of prehospital care. The National Collegiate Emergency Medical Services Foundation (NCEMSF) was founded to serve as a resource for CBEMS groups. The purpose of this investigation is to describe the current state of CBEMS organizations.Methods:The NCEMSF maintains a Web-based, data collection system to gather data on CBEMS organizations. Collegiate-based emergency medical services are defined as emergency medical services in a university or college campus setting. The abstracted data from the NCEMSF registry were analyzed using descriptive statistics.Results:The NCEMSF registry contained data on 175 groups, and 145 groups were identified as providing CBEMS. The levels of service provided by the groups were: (1) first responder, 8.3%; (2) basic life support (BLS) 66.2%; (3) intermediate life support (ILS) 4.8%; (4) advanced life support (ALS), 9.7%; and (5) combination BLS/ALS, 8.3%. Transport capabilities were provided by 31.7% of the CBEMS. The average response time was estimated at 2.6 minutes (95% confidence interval (CI), 2.35–2.91 minutes). Early defibrillation using a automated external defibrillator (AED) or ALS was available by 75.9% (95% CI, 68.8–83.0) of CBEMS. Service to the community beyond the campus was provided by 21.3% of CBEMS groups. Forty-eight percent of the services operate 24 hours/day, seven days/week. The average call volume per year was 568 responses (95% CI, 315–820), and the groups averaged 29 (95% CI, 25–34) members. During the past five years, an average of 4.3 new CBEMS groups were formed per year. Eleven of the CBEMS are based at international schools.

Job Stressors and Job Satisfaction in a Major Metropolitan Public EMS Service

1999 ◽  
Vol 14 (4) ◽  
pp. 32-35 ◽  
Author(s):  
J. Shelby Bowron ◽  
Knox H. Todd
Keyword(s):  
Job Satisfaction ◽  
Career Choice ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Emergency Medical Technicians ◽  
Medical Services ◽  
Job Stressors ◽  
Emergency Medical

AbstractIntroduction:Behavioral and social science research suggests that job satisfaction and job performance are positively correlated. It is important that Emergency Medical Services managers identify predictors of job satisfaction in order to maximize job performance among prehospital personnel.Purpose:Identify job stressors that predict the level of job satisfaction among prehospital personnel.Methods:The study was conducted with in a large, urban Emergency Medical Services (Emergency Medical Services) service performing approximately 60,000 Advanced Life Support (Advanced Life Support) responses annually. Using focus groups and informal interviews, potential predictors of global job satisfaction were identified. These factors included: interactions with hospital nurses and physicians; on-line communications; dispatching; training provided by the ambulance service; relationship with supervisors and; standing orders as presently employed by the ambulance service. These factors were incorporated into a 21 item questionnaire including one item measuring global job satisfaction, 14 items measuring potential predictors of satisfaction, and seven questions exploring demographic information such as age, gender, race, years of experience, and years with the company. The survey was administered to all paramedics and Emergency Medical Technicians (Emergency Medical Technicians s) Results of the survey were analyzed using univariate and multivariate techniques to identify predictors of global job satisfaction.Results:Ninety paramedics and Emergency Medical Technicians participated in the study, a response rate of 57.3%. Job satisfaction was cited as extremely satisfying by 11%, very satisfying by 29%, satisfying by 45%, and not satisfying by 15% of respondents. On univariate analysis, only the quality of training, quality of physician interaction, and career choice were associated with global job satisfaction. On multivariate analysis, only career choice (p = 0.005) and quality of physician interaction (p = 0.05) were predictive of global job satisfactionConclusion:Quality of career choice and interactions with physicians are predictive of global job satisfaction within this urban emergency medical service (Emergency Medical Technicians). Future studies should examine specific characteristics of the physician-paramedic interface that influence job satisfaction and attempt to generalize these results to other settings.

scholarly journals Management of EMS on-scene time during advanced life support in out-of-hospital cardiac arrest: a retrospective observational trial

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S82-S89
Author(s):  
Michael Poppe ◽  
Mario Krammel ◽  
Christian Clodi ◽  
Christoph Schriefl ◽  
Alexandra-Maria Warenits ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Life Support ◽  
Advanced Life Support ◽  
Spontaneous Circulation ◽  
Medical Services ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Emergency Medical ◽  
Hospital Cardiac Arrest

Objective Most western emergency medical services provide advanced life support in out-of-hospital cardiac arrest aiming for a return of spontaneous circulation at the scene. Little attention is given to prehospital time management in the case of out-of-hospital cardiac arrest with regard to early coronary angiography or to the start of extracorporeal cardiopulmonary resuscitation treatment within 60 minutes after out-of-hospital cardiac arrest onset. We investigated the emergency medical services on-scene time, defined as emergency medical services arrival at the scene until departure to the hospital, and its association with 30-day survival with favourable neurological outcome after out-of-hospital cardiac arrest. Methods All patients of over 18 years of age with non-traumatic, non-emergency medical services witnessed out-of-hospital cardiac arrest between July 2013 and August 2015 from the Vienna Cardiac Arrest Registry were included in this retrospective observational study. Results Out of 2149 out-of-hospital cardiac arrest patients, a total of 1687 (79%) patients were eligible for analyses. These patients were stratified into groups according to the on-scene time (<35 minutes, 35–45 minutes, 45–60 minutes, >60 minutes). Within short on-scene time groups, out-of-hospital cardiac arrest occurred more often in public and bystander cardiopulmonary resuscitation was more common (both P<0.001). Patients who did not achieve return of spontaneous circulation at the scene showed higher rates of 30-day survival with favourable neurological outcome with an on-scene time of less than 35 minutes (adjusted odds ratio 5.00, 95% confidence interval 1.39–17.96). Conclusion An emergency medical services on-scene time of less than 35 minutes was associated with higher rates of survival and favourable outcomes. It seems to be reasonable to develop time optimised advance life support protocols to minimise the on-scene time in view of further treatments such as early coronary angiography as part of post-resuscitation care or extracorporeal cardiopulmonary resuscitation in refractory out-of-hospital cardiac arrest.

scholarly journals Standard Precautions Among Emergency Medical Services in Urban and Rural Areas

2019 ◽  
Vol 68 (2) ◽  
pp. 73-80
Author(s):  
Riyadh A. Alhazmi ◽  
R. David Parker ◽  
Sijin Wen
Keyword(s):  
West Virginia ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Services ◽  
Cross Sectional Survey ◽  
Standard Precautions ◽  
Cross Sectional ◽  
Emergency Medical ◽  
Rural And Urban

Backround: Emergency medical services (EMS) workers are at risk of exposure to bloodborne pathogens and frequently exposed to blood and bodily fluids through percutaneous injuries. This study aimed to assess the consistency with which standard precautions (SPs) among rural and urban EMS providers were used. Methods: This study consisted of a cross-sectional survey conducted with a sample of certified EMS providers in West Virginia in which we ascertained details about sociodemographic characteristics, and the frequency of consistent SP. An email invitation was sent to a comprehensive list of agencies obtained from the Office of West Virginia EMS. Findings: A total of 248 out of 522 (47%) EMS providers completed the survey. The majority of the EMS providers (76%) consistently complied with SPs; however, more than one third (38%) of urban EMS providers indicated inconsistent use compared with 19% of rural EMS providers ( p = .002). Most EMS providers reported low prevention practices to exposure of blood and body fluids in both areas. Conclusion/Application to Practice: The results emphasize the need to enhanced safe work practices among EMS providers in both rural and urban areas through education and increasing self-awareness. Occupational health professional in municipalities that serve these workers are instrumental in ensuring these workers are trained and evaluated for their compliance with SPs while in the field.

Fall with Syncope

2018 ◽  
pp. 52-57
Author(s):  
Christopher J. Fullagar
Keyword(s):  
Emergency Medicine ◽  
Pain Management ◽  
Patient Care ◽  
Emergency Medical Services ◽  
Basic Life Support ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical Services ◽  
Emergency Medical

Syncope has a number of worrisome potential etiologies and often prompts a basic life support (BLS) emergency medical services (EMS) crew to call for advanced life support (ALS). Pain management may be another valid reason to call for ALS. EMS, and emergency medicine in general, is tasked with evaluating and mitigating the most worrisome causes of a patient’s presentations even if those causes are not necessarily the most likely. ALS is indicated for many patients who have suffered a syncopal episode although astute BLS assessment and intervention may be all that are indicated in certain cases. The importance of BLS care is often minimized or overlooked in EMS but can have a significant effect on patient care if well implemented. The case demonstrates how well-applied BLS effectively managed this patient presenting with syncope and a painful fracture.

scholarly journals Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services

2020 ◽  
Vol 17 (21) ◽  
pp. 7944
Author(s):  
Hassan N. Moafa ◽  
Sander Martijn Job van Kuijk ◽  
Dhafer M. Alqahtani ◽  
Mohammed E. Moukhyer ◽  
Harm R. Haak
Keyword(s):  
Saudi Arabia ◽  
Emergency Medical Services ◽  
Central Region ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Services ◽  
Utilization Rate ◽  
Rural And Urban Areas ◽  
Emergency Medical ◽  
Rural And Urban

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary.

scholarly journals Out-of-hospital cardiac arrest: determinant factors for immediate survival after cardiopulmonary resuscitation

2014 ◽  
Vol 22 (4) ◽  
pp. 562-568 ◽  
Author(s):  
Daniela Aparecida Morais ◽  
Daclé Vilma Carvalho ◽  
Allana dos Reis Correa
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Basic Life Support ◽  
Life Support ◽  
Advanced Life Support ◽  
Medical Services ◽  
Determinant Factors ◽  
Emergency Medical ◽  
Advanced Support

OBJECTIVE: to analyze determinant factors for the immediate survival of persons who receive cardiopulmonary resuscitation from the advanced support units of the Mobile Emergency Medical Services (SAMU) of Belo Horizonte.METHOD: this is a retrospective, epidemiological study which analyzed 1,165 assistance forms, from the period 2008 - 2010. The collected data followed the Utstein style, being submitted to descriptive and analytical statistics with tests with levels of significance of 5%.RESULTS: the majority were male, the median age was 64 years, and the ambulance response time, nine minutes. Immediate survival was observed in 239 persons. An association was ascertained of this outcome with "cardiac arrest witnessed by persons trained in basic life support" (OR=3.49; p<0.05; CI 95%), "cardiac arrest witnessed by Mobile Emergency Medical Services teams" (OR=2.99; p<0.05; CI95%), "only the carry out of basic life support" (OR=0.142; p<0.05; CI95%), and "initial cardiac rhythm of asystole" (OR=0.33; p<0.05; CI 95%).CONCLUSION: early access to cardiopulmonary resuscitation was related to a favorable outcome, and the non-undertaking of advanced support, and asystole, were associated with worse outcomes. Basic and advanced life support techniques can alter survival in the event of cardiac arrest.

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