scholarly journals Validity and risk factor analysis for helicopter emergency medical services (HEMS): The emergency call dispatch of Japanese air ambulances (Doctor-HeliTM️)

2021 ◽  
Author(s):  
Noriaki YAMADA ◽  
Yuichiro KITAGAWA ◽  
Takahiro YOSHIDA ◽  
Sho NACHI ◽  
Hideshi OKADA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Admission ◽  
Prehospital Care ◽  
University Hospital ◽  
Air Ambulances ◽  
Emergency Intervention ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Disturbance Of Consciousness ◽  
Medical Emergencies

Abstract Background:Some emergency departments use triage scales, such as the Canadian Triage and Acuity Scale and the JUST, to detect the status of life-threatening situations. However, these triage systems have not been used for aeromedical services in Japan. Therefore, we investigated these profiles and conducted a pilot study.Method:We retrospectively evaluated the helicopter emergency medical service cases from 1 April 2015 to 31 March 2020 at Gifu University Hospital using our mission record. In this study, we only evaluated cases that dealt with internal medicine. We excluded cases that were influenced by external factors such as trauma or cases that included hospital-to-hospital transportation, focusing only on prehospital care. We evaluated the validity of medical emergencies such as emergency interventions and the necessity of hospital admission. In addition, we evaluated the validity of the suggested diagnoses and the associated risk factors.Result:A total of 451 cases were suitable for inclusion in the study. In the analysis for all emergency calls, 235 (52.11%) needed emergency intervention and 300 (64.4%) required hospital admission. The suggested diagnosis was valid for 261 (57.87%) cases. After the first assessment by emergency medical technicians (EMTs), 75 cases were removed from the analysis.Therefore, the results of the analysis for all emergency calls requiring emergency intervention were: 52.31%, need admission: 70.26%, and the suggested diagnosis was valid for 69.41% of cases. Results of a multivariate analysis of some key variables identified risk factors for emergency intervention, namely, age, under sports, and gasping. Hospital admission risk factors are being years old only. The suggested diagnosis was only valid in under sports situations.In the first analysis, the risk factors for emergency intervention are years old, being male, under sports, and gasping, and for hospital admission they are years old, being male, detecting stroke symptoms, and disturbance of consciousness. The suggested diagnosis was only valid in under sports situations.Conclusion:There are some “second” keywords/phrases that predict medical emergencies. Therefore, the dispatch commander should gather these keyword/phrases to assess.

scholarly journals Validity and risk factor analysis for helicopter emergency medical services in Japan: a pilot study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Noriaki Yamada ◽  
Yuichiro Kitagawa ◽  
Takahiro Yoshida ◽  
Sho Nachi ◽  
Hideshi Okada ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pilot Study ◽  
Hospital Admission ◽  
Prehospital Care ◽  
Emergency Medical Technician ◽  
Emergency Intervention ◽  
Emergency Calls ◽  
Emergency Medical ◽  
Life Threatening ◽  
Medical Emergencies

Abstract Background Some emergency departments use triage scales, such as the Canadian Triage and Acuity Scale and Japan Urgent Stroke Triage Score, to detect life-threatening situations. However, these protocols have not been used for aeromedical services. Therefore, we investigated the factors predicting these life-threatening situations in aeromedical services as a pilot study for establishing the protocol. Method We retrospectively evaluated helicopter emergency medical service cases from 1 April 2015 to 31 March 2020 at Gifu University Hospital using the mission records. We only evaluated cases dealing with suggested internal medicine issues. We excluded cases influenced by external factors such as trauma or cases that included hospital-to-hospital transportation, focusing only on prehospital care. We evaluated the validity of the medical emergencies based on the needs for emergency interventions and hospital admission and of the suggested diagnoses and associated risk factors. Result A total of 451 cases were suitable for inclusion in the study. In the analysis for all emergency calls, 235 (52.11%) cases needed emergency intervention and 300 (64.4%) required hospital admission. The suggested diagnosis was valid for 261 (57.87%) cases. After the first assessment by emergency medical technicians, 75 cases were removed. Analysis after this first assessment found that 52.31% cases required emergency intervention, 70.26% needed admission, and the suggested diagnosis was valid for 69.41% of cases. In the analysis of emergency calls, the multivariate analysis of some key variables identified age, playing sports, and gasping as risk factors for emergency intervention. Hospital admission risk factors included being age only. The suggested diagnosis was valid only for sports situations. In the analysis after the first assessment by an emergency medical technician, risk factors for emergency intervention included being age being male, playing sports, and gasping, and those for hospital admission was being age, being male, and experiencing stroke symptoms and/or disturbance of consciousness. The suggested diagnosis was valid only for sports situations. Conclusion Some ‘second’ keywords/phrases predict medical emergencies. Therefore, the dispatch commander should gather these keyword/phrases to assess.

scholarly journals Analysis of intracranial aneurysms treated at a University Hospital in Curitiba

2012 ◽  
Vol 31 (02) ◽  
pp. 55-60
Author(s):  
Johnni Oswaldo Zamponi Junior ◽  
Paulo Eduardo Carneiro da Silva ◽  
Guilherme Zandavalli Ramos ◽  
Guilherme Mailio Buchaim ◽  
Lucas Cunha de Andrade ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Treatment Outcome ◽  
Subarachnoid Hemorrhage ◽  
Hospital Admission ◽  
Intracranial Aneurysms ◽  
Smoking Habit ◽  
University Hospital ◽  
Anterior Circulation ◽  
History Of

Abstract Objective: The aim of this paper is analyze the population and the types of intracranial aneurysms treated in the neurosurgery service of the Hospital Universitário Evangélico of Curitiba (HUEC), checking possible relations of this pathology with some risk factors and analyzing also the result of the treatment of this patients. Method: We reviewed the hospital files, surgical and out-patient notes of all patients operated on for the treatment of intracranial aneurysms from January 2006 to December 2010, composing a sample of 93 patients. The variables analyzed were gender, age, history of hypertension, smoking habit, diabetes mellitus, site of aneurysm, score scales Hunt-Hess and Fisher at hospital admission and treatment outcome of aneurysms using the Glasgow Outcome Scale (GOS). Results: The patients studied were predominantly women (73%), ranging in age from 51 to 60 years (38%), with a history of hypertension (61%). At admission, the grade 1 in a Hunt-Hess scale was most frequent (31%), while grade 4 on a scale of Fisher was more prevalent (26%). Aneurysms were more frequent in the anterior circulation, mainly affecting the middle cerebral artery. The most frequent score in GOS was 5 (40%). Conclusion: Subarachnoid hemorrhage is an event that may worsen the outcome of treatment of patients with intracranial aneurysms, so there is a correlation between the amount of bleeding identified on CT and prognostic evolution.

scholarly journals The development of emergency medical services benefit score: a European Delphi study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Anssi Heino ◽  
Lasse Raatiniemi ◽  
Timo Iirola ◽  
Merja Meriläinen ◽  
Janne Liisanantti ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Delphi Study ◽  
Scoring System ◽  
Prehospital Care ◽  
University Hospital ◽  
Medical Services ◽  
Original Form ◽  
Clinical Use ◽  
Emergency Medical ◽  
Delphi Round

Abstract Background The helicopter emergency services (HEMS) Benefit Score (HBS) is a nine-level scoring system developed to evaluate the benefits of HEMS missions. The HBS has been in clinical use for two decades in its original form. Advances in prehospital care, however, have produced demand for a revision of the HBS. Therefore, we developed the emergency medical services (EMS) Benefit Score (EBS) based on the former HBS. As reflected by its name, the aim of the EBS is to measure the benefits produced by the whole EMS systems to patients. Methods This is a four-round, web-based, international Delphi consensus study with a consensus definition made by experts from seven countries. Participants reviewed items of the revised HBS on a 5-point Likert scale. A content validity index (CVI) was calculated, and agreement was defined as a 70% CVI. Study included experts from seven European countries. Of these, 18 were prehospital expert panellists and 11 were in-hospital commentary board members. Results The first Delphi round resulted in 1248 intervention examples divided into ten diagnostic categories. After removing overlapping examples, 413 interventions were included in the second Delphi round, which resulted in 38 examples divided into HBS categories 3–8. In the third Delphi round, these resulted in 37 prehospital interventions, examples of which were given revised version of the score. In the fourth and final Delphi round, the expert panel was given an opportunity to accept or comment on the revised scoring system. Conclusions The former HBS was revised by a Delphi methodology and EBS developed to represent its structural purpose better. The EBS includes 37 exemplar prehospital interventions to guide its clinical use. Trial registration The study permission was requested and granted by Turku University Hospital (decision number TP2/010/18).

Emergency department admission and mortality of the non-transported emergency medical service patients: a cohort study from Northern Finland

2021 ◽  
pp. emermed-2020-209914
Author(s):  
Lauri Laukkanen ◽  
Sanna Lahtinen ◽  
Lasse Raatiniemi ◽  
Ari Ehrola ◽  
Timo Kaakinen ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Hospital Admission ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Clinical Presentation ◽  
Tertiary Care ◽  
University Hospital ◽  
Emergency Department Admission ◽  
Emergency Medical ◽  
Hospital Patients

ObjectivesA high number of emergency medical service (EMS) patients are not transported to hospital by ambulance. Various non-transport protocols and guidelines have been implemented by different EMS providers. The present study examines subsequent tertiary care ED and hospital admission and mortality of the patients assessed and not transported by EMS in Northern Finland and evaluates the factors predicting these outcomes.MethodsData from EMS missions with a registered non-transportation code during 1 January 2018–31 December 2018 were screened retrospectively. EMS charts were retrieved from a local EMS database and data concerning hospital admission and mortality were collected from the medical records of Oulu University Hospital, Oulu, Finland.ResultsA total of 12 530 EMS non-transport missions were included. Of those, a total of 344 (2.7%) patients were admitted to tertiary care ED in 48 hours after the EMS contact, and 229 (1.8%) of them were further admitted to the hospital. Patients with the dispatch code ‘abdominal pain’, clinical presentation with fever or hyperglycaemia, physician phone consultation and a decision not to transport during night hours were associated with a higher risk of ED admission within 48 hours after EMS contact. Overall 48-hour and 30-day mortalities of non-transported patients were 0.2% (n=25) and 1.0% (n=128), respectively.ConclusionIn this cohort, the rate of subsequent tertiary care ED admission and mortality in the non-transported EMS patients was low. Dispatch code abdominal pain, clinical presentation with fever or hyperglycaemia, physician phone consultation and night-hours increased the risk of ED admission within 48 hours after EMS contact.

scholarly journals Limitation of treatment in prehospital care – the experiences of helicopter emergency medical service physicians in a nationwide multicentre survey

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Heidi Kangasniemi ◽  
Piritta Setälä ◽  
Heini Huhtala ◽  
Antti Kämäräinen ◽  
Ilkka Virkkunen ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Prehospital Care ◽  
Helicopter Emergency Medical Service ◽  
University Hospital ◽  
Best Interests ◽  
Term Care ◽  
Healthcare Facilities ◽  
Emergency Medical

Abstract Background Making ethically sound treatment limitations in prehospital care is a complex topic. Helicopter Emergency Medical Service (HEMS) physicians were surveyed on their experiences with limitations of care orders in the prehospital setting, including situations where they are dispatched to healthcare facilities or nursing homes. Methods A nationwide multicentre study was conducted among all HEMS physicians in Finland in 2017 using a questionnaire with closed five-point Likert-scale questions and open questions. The Ethics Committee of the Tampere University Hospital approved the study protocol (R15048). Results Fifty-nine (88%) physicians responded. Their median age was 43 (IQR 38–47) and median medical working experience was 15 (IQR 10–20) years. All respondents made limitation of care orders and 39% made them often. Three fourths (75%) of the physicians were often dispatched to healthcare facilities and nursing homes and the majority (93%) regularly met patients who should have already had a valid limitation of care order. Every other physician (49%) had sometimes decided not to implement a medically justifiable limitation of care order because they wanted to avoid conflicts with the patient and/or the next of kin and/or other healthcare staff. Limitation of care order practices varied between the respondents, but neither age nor working experience explained these differences in answers. Most physicians (85%) stated that limitations of care orders are part of their work and 81% did not find them especially burdensome. The most challenging patient groups for treatment limitations were the under-aged patients, the severely disabled patients and the patients in healthcare facilities or residing in nursing homes. Conclusion Making limitation of care orders is an important but often invisible part of a HEMS physician’s work. HEMS physicians expressed that patients in long-term care were often without limitations of care orders in situations where an order would have been ethically in accordance with the patient’s best interests.

Incidence and Outcomes after Out-of-Hospital Medical Emergencies in Gambia: A Case for the Integration of Prehospital Care and Emergency Medical Services in Primary Health Care

2018 ◽  
Vol 33 (6) ◽  
pp. 650-657
Author(s):  
Sunkaru Touray ◽  
Baboucarr Sanyang ◽  
Gregory Zandrow ◽  
Isatou Touray
Keyword(s):  
Health Care ◽  
Emergency Medical Services ◽  
Emergency Care ◽  
Prehospital Care ◽  
The Gambia ◽  
Medical Emergency ◽  
Medical Services ◽  
Primary Health ◽  
Emergency Medical ◽  
Medical Emergencies

AbstractBackgroundThe Gambia is going through a rapid epidemiologic transition with a dual disease burden of infections and non-communicable diseases occurring at the same time. Acute, time-sensitive, medical emergencies such as trauma, obstetric emergencies, respiratory failure, and stroke are leading causes of morbidity and mortality among adults in the country.ProblemData on medical emergency care and outcomes are lacking in The Gambia. Data on self-reported medical emergencies among adults in a selection of Gambian communities are presented in this report.MethodsA total of 320 individuals were surveyed from 34 communities in the greater Banjul area of The Gambia using a survey instrument estimating the incidence of acute medical emergencies in an adult population. Self-reported travel time to a health facility during medical emergencies and patterns of health-seeking behavior with regard to type of facility visited and barriers to accessing emergency care, including cost and medical insurance coverage, are presented in this report.ResultsOf the 320 individuals surveyed, 262 agreed to participate resulting in a response rate of 82%. Fifty-two percent of respondents reported an acute medical emergency in the preceding year that required urgent evaluation at a health facility. The most common facility visited during such emergencies was a health center. Eighty-seven percent of respondents reported a travel time of less than one hour during medical emergencies. Out-of-pocket cost of medications accounted for the highest expenditure during emergencies. There was a low awareness and willingness to subscribe to health insurance among individuals surveyed.Conclusion: There is a high incidence of acute medical emergencies among adults in The Gambia which are associated with adverse outcomes due to a combination of poor health literacy, high out-of-pocket expenditures on medications, and poor access to timely prehospital emergency care. There is an urgent need to develop prehospital acute care and Emergency Medical Services (EMS) in the primary health sector as part of a strategy to reduce mortality and morbidity in the country.TourayS, SanyangB, ZandrowG, TourayI. Incidence and outcomes after out-of-hospital medical emergencies in Gambia: a case for the integration of prehospital care and Emergency Medical Services in primary health care. Prehosp Disaster Med. 2018;33(6):650–657.

Infectious safety of patients in the provision of prehospital care for burns

2020 ◽  
pp. 71-75
Author(s):  
Marina Dmitryeva
Keyword(s):  
Medical Care ◽  
Prehospital Care ◽  
Medical Professionals ◽  
Emergency Medical Care ◽  
Emergency Medical

The article describes the measures taken by medical professionals of emergency medical care to observe infectious safety of patients in the provision of pre-medical care in case of burns.

Risk Factors and Outcome of Pretrem Labor in Pregnant Women Attending Zagazig Maternity University Hospital

2020 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Hassan Hassan Nassar ◽  
Ali Ali ◽  
Sherin Shazly ◽  
Ahmed Mansour
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
University Hospital

Prevalence of and Risk Factors for Low Free Testosterone Levels in Japanese Men with Well-controlled Human Immunodeficiency Virus Infection

2020 ◽  
Vol 18 (5) ◽  
pp. 381-386
Author(s):  
Yusuke Yoshino ◽  
Ichiro Koga ◽  
Yoshitaka Wakabayashi ◽  
Takatoshi Kitazawa ◽  
Yasuo Ota
Keyword(s):  
Risk Factors ◽  
Human Immunodeficiency Virus ◽  
Standard Deviation ◽  
Hiv Infection ◽  
Free Testosterone ◽  
Serum Levels ◽  
University Hospital ◽  
Rapid Decline ◽  
Total Testosterone ◽  
Immunodeficiency Virus

Background: The change in the prevalence of hypogonadism with age in men with human immunodeficiency virus (HIV) infection is subject to debate. Objective: To address this issue, we diagnosed hypogonadism based on serum levels of free testosterone (fTST) rather than total testosterone which is thought to be an inaccurate indicator. We also determined the relationship between age and fTST levels and identified risk factors for hypogonadism in men with HIV infection. Method: We retrospectively reviewed fTST levels and associated clinical factors in 71 wellcontrolled HIV-infected men who were treated at Teikyo University Hospital between April 2015 and March 2016 and who had data available on serum fTST levels, measured >6 months after starting antiretroviral therapy. fTST was measured using radioimmunoassay on blood samples collected in the morning. Risk factors for hypogonadism were identified using Welch’s t-test and multiple regression analysis. Results: The men had a mean (± standard deviation) age of 47.4 ± 13.6 years, and mean (± standard deviation) serum fTST level of 13.0 ± 6.1 pg/mL. Fifteen (21.1%) men had hypogonadism based on a fTST <8.5 pg/mL. Serum fTST levels significantly decreased with age (−0.216 pg/mL/year). Older age and low hemoglobin levels were identified as risk factors for hypogonadism. Conclusion: The men in the study experienced a more rapid decline in fTST levels with age than men in the general population (−0.161 pg/mL/year). Serum fTST levels in men with HIV infection should be monitored, especially in older men and those with low hemoglobin levels.

scholarly journals Emergency Department Visits During Outpatient Parenteral Antimicrobial Therapy: A Cohort Study

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S333-S334
Author(s):  
So Lim Kim ◽  
Angela Everett ◽  
Susan J Rehm ◽  
Steven Gordon ◽  
Nabin Shrestha
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Hospital Admission ◽  
Vascular Access ◽  
Antimicrobial Therapy ◽  
Cleveland Clinic ◽  
Emergency Department Visits ◽  
Outpatient Parenteral Antimicrobial Therapy ◽  
Ed Visits ◽  
Access Complications

Abstract Background Outpatient parenteral antimicrobial therapy (OPAT) carries risk of vascular access complications, antimicrobial adverse effects, and worsening of infection. Both OPAT-related and unrelated events may lead to emergency department (ED) visits. The purpose of this study was to describe adverse events that result in ED visits and risk factors associated with ED visits during OPAT. Methods OPAT courses between January 1, 2013 and December 31, 2016 at Cleveland Clinic were identified from the institution’s OPAT registry. ED visits within 30 days of OPAT initiation were reviewed. Reasons and potential risk factors for ED visits were sought in the medical record. Results Among 11,440 OPAT courses during the study period, 603 (5%) were associated with 1 or more ED visits within 30 days of OPAT initiation. Mean patient age was 58 years and 57% were males. 379 ED visits (49%) were OPAT-related; the most common visit reason was vascular access complication, which occurred in 211 (56%) of OPAT-related ED visits. The most common vascular access complications were occlusion and dislodgement, which occurred in 99 and 34 patients (47% and 16% of vascular access complications, respectively). In a multivariable logistic regression model, at least one prior ED visit in the preceding year (prior ED visit) was most strongly associated with one or more ED visits during an OPAT course (OR 2.96, 95% CI 2.38 – 3.71, p-value &lt; 0.001). Other significant factors were younger age (p 0.01), female sex (p 0.01), home county residence (P &lt; 0.001), and having a PICC (p 0.05). 549 ED visits (71%) resulted in discharge from the ED within 24 hours, 18 (2%) left against medical advice, 46 (6%) were observed up to 24 hours, and 150 ED visits (20%) led to hospital admission. Prior ED visit was not associated with hospital admission among patients who visited the ED during OPAT. Conclusion OPAT-related ED visits are most often due to vascular access complications, especially line occlusions. Patients with a prior ED visit in the preceding year have a 3-fold higher odds of at least one ED visit during OPAT compared with patients without a prior ED visit. A strategy of managing occlusions at home and a focus on patients with prior ED visits could potentially prevent a substantial proportion of OPAT-related ED visits. Disclosures All authors: No reported disclosures.

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