scholarly journals Airway Management Difficulties in a Helicopter Emergency Medical Service (HEMS): A Retrospective Observational Study of 676 Out-of-Hospital Intubations

2021 ◽  
Author(s):  
Urs Pietsch ◽  
Raphael Müllner ◽  
Lorenz Theiler ◽  
Volker Wenzel ◽  
Lorenz Meuli ◽  
...  
Keyword(s):  
Airway Management ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Ventilatory Support ◽  
Helicopter Emergency Medical Service ◽  
Medical Services ◽  
Emergency Medical ◽  
Advanced Airway ◽  
Number Of Patients

Abstract Background: Airway management is a key skill in any helicopter emergency medical service (HEMS). Successful intubation is less often than in the hospital, and alternative forms of airway management are needed more often. Methods: Retrospective observational cohort study in an anaesthesiologist-staffed HEMS in Switzerland. Patients charts from all scene calls (n=9035) that took place between June 2016 and May 2017 (12 months) were analysed. The primary outcome parameter was intubation success rate. Secondary parameters included number of patients intubated by ground-based emergency medical services, alternative devices used, and comparison of patients with and without difficulties in airway management. Results: A total of 676 patients with invasive ventilatory support were identified. Difficulties in airway management were rare, occurring in 44 (6.5%) patients, and trauma was significantly more common (59.1% vs. 38.6%, p<0.001). In 335 (49.6%) patients, advanced airway management had already been initiated by Ground emergency medical services upon arrival of the HEMS. Paramedics had significantly more exposure to patients needing prehospital anaesthesia than the HEMS physicians; median 12 (IQR 9 to 17.5) versus 3 (IQR 2 to 6), p<0.001.Conclusion: Despite overall high success rates for endotracheal intubation in the physician-staffed service, each physician gets little real-life experience with advanced airway management in the field, highlighting the importance of a solid basic competence such as anaesthesiology and additional training. Direct laryngoscopy is still a valuable skill and an important Plan B in difficult airway situations in which factors such as fogging, blood, bright radiation on the video laryngoscopes screen, impaired the success of video laryngoscopes intubation.

scholarly journals The Emergency Department Arrival Mode and Its Relations to ED Management and 30-Day Mortality in Acute Heart Failure: An Ancillary Analysis From The EURODEM Study

2021 ◽  
Author(s):  
Pia Harjola ◽  
Tuukka TARVASMÄKI ◽  
Cinzia BARLETTA ◽  
Richard BODY ◽  
Jean CAPSEC ◽  
...  
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Acute Heart Failure ◽  
Medical Service ◽  
Ventilatory Support ◽  
Medical Services ◽  
Heart Failure Patients ◽  
Emergency Medical

Abstract Background: Acute heart failure patients are often encountered in emergency departments from 11% to 57 % using emergency medical services. Our aim was to evaluate the association of emergency department arrival mode with acute heart failure patients’ emergency department management and short-term outcomes. Methods: This was a sub-analysis of the European EURODEM study. Data on patients presenting with dyspnoea were collected prospectively from 66 European emergency departments. Patients with emergency department diagnosis of acute heart failure were categorized into two groups: those using emergency medical services and those self-presenting (non- emergency medical service patients). The independent association between emergency medical services use and 30-day mortality was evaluated with logistic regression. Results: Of the 500 acute heart failure patients, 309 (61.8 %) arrived at emergency department by emergency medical services. They were older (median age 80 vs. 75 years, p<0.001) and had more dementia (18.7 % vs. 7.2 %, p<0.001). On admission, emergency medical service patients had more often confusion (43 (14.2 %) vs. 4 (2.1 %), p<0.001) and higher respiratory rate (24/min vs. 21/min, p=0.014; respiratory rate > 30/min in 17.1 % patients vs. 7.5 %, p=0.005). The only difference in emergency department management appeared in the use of ventilatory support: 78.3 % of emergency medical services patients vs. 67.5% of non- emergency medical services patients received oxygen, p=0.007, non-invasive ventilation was administered to 12.5 % of emergency medical service patients vs. 4.2% non- emergency medical service patients, p=0.002. Emergency medical service patients were more often hospitalized (82.4 % vs. 65.9 %, p<0.001). The use of emergency medical services was an independent predictor of 30-day mortality (OR=2.96, 95% CI 1.27-6.92, p=0.012)Conclusion: Most acute heart failure patients arrive at emergency department by emergency medical services. These patients suffer from more severe respiratory distress and receive more often ventilatory support. Emergency medical service use is an independent predictor of 30-day mortality.

Feedback to Emergency Medical Services Providers: The Good, the Bad, and the Ignored

1997 ◽  
Vol 12 (2) ◽  
pp. 74-77 ◽  
Author(s):  
Elisabeth F. Mock ◽  
Keith D. Wrenn ◽  
Seth W. Wright ◽  
T. Chadwick Eustis ◽  
Corey M. Slovis
Keyword(s):  
Emergency Department ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Service Providers ◽  
Medical Services ◽  
Emergency Medical Service System ◽  
Constructive Feedback ◽  
Emergency Medical ◽  
Emergency Medical Service Provider

AbstractHypothesis:To determine the type and frequency of immediate unsolicited feedback received by emergency medical service (EMS) providers from patients or their family members and emergency department (ED) personnel.Methods:Prospective, observational study of 69 emergency medical services providers in an urban emergency medical service system and 12 metropolitan emergency departments. Feedback was rated by two medical student observers using a prospectively devised original scale.Results:In 295 encounters with patients or family, feedback was rated as follows: 1) none in 224 (76%); 2) positive in 51 (17%); 3) negative in 19 (6%); and 4) mixed in one (<1%). Feedback from 254 encounters with emergency department personnel was rated as: 1) none in 185 (73%); 2) positive in 46 (18%); 3) negative in 21 (8%); and 4) mixed in 2 (1%). Patients who had consumed alcohol were more likely to give negative feedback than were patients who had not consumed alcohol. Feedback from emergency department personnel occurred more often when the emergency medical service provider considered the patient to be critically ill.Conclusion:The two groups provided feedback to emergency medical service providers in approximately one quarter of the calls. When feedback was provided, it was positive more than twice as often as it was negative. Emergency physicians should give regular and constructive feedback to emergency medical services providers more often than currently is the case.

The emergency medical system

2021 ◽  
pp. 65-75
Author(s):  
Olivier Hoogmartens ◽  
Michiel Stiers ◽  
Koen Bronselaer ◽  
Marc Sabbe
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Tertiary Care ◽  
Medical Services ◽  
High Quality ◽  
Emergency Medical ◽  
High Quality Medical Care ◽  
The Moment

The mission of the emergency medical services is to promote and support a system that provides timely, professional and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time and any location. A medical emergency has five different phases, namely: population awareness and behaviour, occurrence of the problem and its detection, alarming of trained responders and help rendered by bystanders and trained pre-hospital providers, transport to the nearest or most appropriate hospital, and, if necessary, admission or transfer to a tertiary care centre which provides a high degree of subspecialty expertise. In order to meet these goals, emergency medical services must work aligned with local, state officials; with fire and rescue departments; with other ambulance providers, hospitals, and other agencies to foster a high performance network. The term emergency medical service evolved to reflect a change from a straightforward system of ambulances providing nothing but transportation, to a complex network in which high-quality medical care is given from the moment the call is received, on-scene with the patient and during transportation. Medical supervision and/or participation of emergency medicine physicians (EP) in the emergency medical service systems contributes to the quality of medical care. This emergency medical services network must be capable to respond instantly and to maintain efficacy around the clock, with well-trained, well-equipped personnel linked through a strong communication system. Research plays a pivotal role in defining necessary resources and in continuously improving the delivery of high-quality care. This chapter gives an overview of the different aspects of emergency medical services and calls for high quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

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.

scholarly journals Structured evaluation of stress triggers in prehospital emergency medical care

2021 ◽  
Author(s):  
Hendrik Eismann ◽  
Lion Sieg ◽  
Thomas Palmaers ◽  
Vera Hagemann ◽  
Markus Flentje
Keyword(s):  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Organizational Factors ◽  
Professional Group ◽  
Stress Factors ◽  
Medical Services ◽  
Professional Groups ◽  
Emergency Medical ◽  
Advanced Paramedics

Abstract Background Emergency medical services work in the environment of high responsibility teams and have to act under unpredictable working conditions. Stress occurs and has potential of negative effects on tasks, teamwork, prioritization processes and cognitive control. Stress is not exclusively dictated by the situation—the individuals rate the situation of having the necessary skills that a particular situation demands. There are different occupational groups in the emergency medical services in Germany. Training, tasks and legal framework of these groups vary. Objective The aim of this study was to identify professional group-specific stressors for emergency medical services. These stress situations can be used to design skills building tools to enable individuals to cope with these stressors. Material and methods The participants were invited to the study via posters and social media. An expert group (minimum 6 months of experience) developed a set of items via a two-step online Delphi survey. The experts were recruited from all professional groups represented in the German emergency medical service. We evaluated the resulting parameters for relevance and validity in a larger collective. Lastly, we identified stress factors that could be grouped in relevant scales. In total 1017 participants (paramedics, physicians) took part in the final validation survey. Results After validation, we identified a catalogue of stressors with 7 scales and 25 items for EMT (Emergency Medical Technician) paramedics (KMO [Kayser-Meyer-Olkin criterion] 0.81), 6 scales and 24 items for advanced paramedics (KMO 0.82) and 6 scales and 24 items for EMS (Emergency Medical Service) physicians (KMO 0.82). For the professional group of EMT basic, the quality parameters did not allow further processing of the items. Professional group-specific scales for EMT paramedics are “professional limitations”, “organizational framework”, “expectations” and “questions of meaning”. For advanced paramedics “appreciation”, “exceptional circumstances” and “legal certainty” were identified. The EMT physicians named “handling third parties”, “tolerance to ambiguity”, “task management” and “pressure to act”. A scale that is representative for all professional groups is “teamwork”. Organizational circumstances occur in all groups. The item “unnecessary missions” for EMT paramedics and “legal concerns with the application of methods” for advanced paramedics are examples. Discussion Different stressors are relevant for the individual professional groups in the German emergency medical service. The developed catalogue can be used in the future to evaluate the subjective stress load of emergency service professionals. There are stressors that are inherent in the working environment (e.g. pressure to act) and others that can be improved through training (teamwork). We recommend training of general resistance as well as training of specific items (e.g., technical, nontechnical skills). All professionals mentioned items with respect to organizational factors. The responsible persons can identify potential for improvement based on the legal and organizational items. The EMT basic requires further subdivision according to task areas due to its variable applicability.

scholarly journals The Danish prehospital emergency healthcare system and research possibilities

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Tim Alex Lindskou ◽  
Søren Mikkelsen ◽  
Erika Frischknecht Christensen ◽  
Poul Anders Hansen ◽  
Gitte Jørgensen ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Record ◽  
Healthcare System ◽  
Emergency Care ◽  
Medical Service ◽  
Medical Services ◽  
Emergency Medical Service System ◽  
Emergency Medical ◽  
Medical Healthcare

Abstract The emergency medical healthcare system outside hospital varies greatly across the globe - even within the western world. Within the last ten years, the demand for emergency medical service systems has increased, and the Danish emergency medical service system has undergone major changes. Therefore, we aimed to provide an updated description of the current Danish prehospital medical healthcare system. Since 2007, Denmark has been divided into five regions each responsible for health services, including the prehospital services. Each region may contract their own ambulance service providers. The Danish emergency medical services in general include ambulances, rapid response vehicles, mobile emergency care units and helicopter emergency medical services. All calls to the national emergency number, 1-1-2, are answered by the police, or the Copenhagen fire brigade, and since 2011 forwarded to an Emergency Medical Coordination Centre when the call relates to medical issues. At the Emergency Medical Coordination Centre, healthcare personnel assess the situation guided by the Danish Index for Emergency Care and determine the level of urgency of the situation, while technical personnel dispatch the appropriate medical emergency vehicles. In Denmark, all healthcare services, including emergency medical services are publicly funded and free of charge. In addition to emergency calls, other medical services are available for less urgent health problems around the clock. Prehospital personnel have since 2015 utilized a nationwide electronic prehospital medical record. The use of this prehospital medical record combined with Denmark’s extensive registries, linkable by the unique civil registration number, enables new and unique possibilities to do high quality prehospital research, with complete patient follow-up.

Sign in / Sign up

Export Citation Format

Share Document