scholarly journals Impact of Different Waves of COVID-19 on Emergency Medical Services and Out-of-hospital Cardiopulmonary Arrest in Madrid, Spain

2021 ◽  
Author(s):  
Jose-María Navalpotro-Pascual ◽  
Diana Monge-Martín ◽  
Manuel-José González-León ◽  
Fernando Neria ◽  
Francisco Peinado-Vallejo ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Emergency Services ◽  
Cardiopulmonary Arrest ◽  
Medical Services ◽  
Activation Time ◽  
Hospital Arrival ◽  
Arrival Times ◽  
Emergency Medical ◽  
The Impact ◽  
Response Activation

Abstract Background: COVID-19 has led to decreased survival of out-of-hospital cardiorespiratory arrest (OHCA). We analysed the impact of the first COVID-19 pandemic year on emergency medical services and OHCA care compared with the previous year.Methods: Data for this observational study were collected for OHCAs attended by the SUMMA 112 emergency service during March 2019 to March 2021. We compared data covering 15 March 2020–14 March 2021 (pandemic year) to retrospective data covering 15 March 2019–14 March 2020 (non-pandemic year). Results: During the pandemic period, 1743 OHCA patients were attended, compared to 1781 during the non-pandemic year. Median patient age during the pandemic period was lower than in the non-pandemic period (71 vs 72, p=0·037). Emergency services response activation time increased during the pandemic year, to 3 minutes, 16 seconds from 2 minutes, 48 seconds in the non-pandemic period (p=0·001). Time to arrival at the scene also increased during the pandemic (12 minutes vs 11 minutes, 25 seconds before the pandemic; p=0·001). The percentage of OHCAs in which resuscitation was attempted was lower during the pandemic (59·4% vs 62·9%, p=0·034), as were survival on hospital arrival (30·3% vs 34·6%, p=0·04). Differences in response activation time (p=0·003) and scene arrival times (p=0·003) were greater during the first pandemic wave compared with the later phases. Conclusions: The different phases of the pandemic variably affected OHCA care. The first wave led to longer resource activation, increased home events and scene arrival times, as well as lower patient survival.

scholarly journals The Administration of Prehospital Ketamine for Chemical Restraint does not Prolong On-Scene Times Compared to Haloperidol Based Sedation

2015 ◽  
Vol 12 (1) ◽  
Author(s):  
Aaron Burnett ◽  
Dolly Panchal ◽  
Bjorn Peterson ◽  
Eric Ernest ◽  
Kent Griffith ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Chart Review ◽  
Retrospective Chart Review ◽  
T Test ◽  
Medical Services ◽  
Demographic Differences ◽  
Chemical Restraint ◽  
Emergency Medical ◽  
Clinically Significant ◽  
The Impact

IntroductionAgitated patients who present a danger to themselves or emergency medical services (EMS) providers may require chemical restraints.  Haloperidol is employed for chemical restraint in many EMS services.  Recently, ketamine has been introduced as an alternate option for prehospital sedation.  On-scene time is a unique metric in prehospital medicine which has been linked to outcomes in multiple patient populations. When used for chemical restraint, the impact of ketamine relative to haloperidol on on-scene time is unknown.Objective: To evaluate whether the use of ketamine for chemical restraint was associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.MethodsPatients who received haloperidol or ketamine for chemical restraint were identified by retrospective chart review.  On-scene time was compared between groups using an unadjusted Student t-test powered to 80% to detect a ≥5 minute difference in on-scene time.Results110 cases were abstracted (Haloperidol = 55; Ketamine = 55). Of the patients receiving haloperidol, 11/55 (20%) were co-administered a benzodiazepine, 4/55 (7%) received diphenhydramine and 34/55 (62%) received the three drugs in combination. There were no demographic differences between the haloperidol and ketamine groups.  On-scene time was not statistically different for patients receiving a haloperidol based regimen compared to ketamine (18.2 minutes, [95% CI 15.7-20.8] vs. 17.6 minutes, [95% CI 15.1-20.0]; p = 0.71).ConclusionsThe use of prehospital ketamine for chemical restraint was not associated with a clinically significant (≥5 minute) increased on-scene time compared to a haloperidol based regimen.  

Abstract WP261: Non-English-preferring Patients Have No Differences in Stroke Symptom Recognition or Emergency Care Time Metrics

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Shaw Natsui ◽  
Khawja A Siddiqui ◽  
Betty L Erfe ◽  
Nicte I Mejia ◽  
Lee H Schwamm ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Emergency Care ◽  
Medical Services ◽  
Similar Response ◽  
Language Preference ◽  
Emergency Department Care ◽  
Hospital Arrival ◽  
Stroke Symptom ◽  
Emergency Medical ◽  
Significant Difference

Introduction: The influence of patients’ language preference on the delivery of acute ischemic stroke (AIS) care in the pre-hospital and in-hospital emergency care settings is scarcely known. We hypothesize that stroke knowledge differences may be associated with non-English preferring (NEP) patients having slower time from symptom discovery to hospital presentation and less engagement of emergency medical services (EMS) than English preferring (EP) patients. Language barriers may also interfere with the delivery of time-sensitive emergency department care. Objectives: To identify whether language preference is associated with differences in patients’ time from stroke symptom discovery to hospital arrival, activation of emergency medical services, door-to-imaging time (DIT), and door-to-needle (DTN) time. Methods: We identified consecutive AIS patients presenting to a single urban, tertiary, academic center between 01/2003-04/2014. Data was abstracted from the institution’s Research Patient Data Registry and Get with the Guidelines-Stroke Registry. Bivariate and regression models evaluated the relationship between language preference and: 1) time from symptom onset to hospital arrival, 2) use of EMS, 3) DIT, and 4) DTN time. Results: Of 3,190 AIS patients who met inclusion/exclusion criteria, 9.4% were NEP (n=300). Time from symptom discovery to arrival, and EMS utilization were not significantly different between NEP and EP patients in unadjusted or adjusted analyses (overall median time 157 minutes, IQR 55-420; EMS utilization: 65% vs. 61.3% p=0.21). There was no significant difference between NEP and EP patients in DIT or in likelihood of DIT ≤ 25 minutes in unadjusted or adjusted analyses (overall median 59 minutes, IQR 29-127; DIT ≤ 25 minutes 24.3% vs. 21.3% p=0.29). There was also no significant different in DTN time or in likelihood of DTN ≤ 60 minutes in unadjusted or adjusted analyses (overall median 53 minutes, IQR 36-73; DTN ≤ 60 minutes 62.5% vs. 58.2% p=0.60). Conclusion: Non-English-preferring patients have similar response to stroke symptoms as reflected by EMS utilization and time from symptom discovery to hospital arrival. Similarly, NEP patients have no differences in in-hospital AIS care metrics of DIT and DTN time.

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.

scholarly journals IMPACT OF AGING POPULATIONS ON MUNICIPAL EMERGENCY MEDICAL SERVICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S956-S956
Author(s):  
Nidya Velasco Roldan ◽  
Caitlin E Coyle ◽  
Michael Ward ◽  
Jan Mutchler
Keyword(s):  
Emergency Medical Services ◽  
Assisted Living ◽  
Local Governments ◽  
Emergency Services ◽  
Medical Services ◽  
Assisted Living Facilities ◽  
Older Population ◽  
Emergency Medical ◽  
Age Related ◽  
Aging Populations

Abstract The services that residents require from their local governments vary depending on the demographics of their populations. While municipalities have long sought to consider how changes in the young population may impact their school system needs, few systematic considerations have been developed relating to how aging populations may impact municipal service provision. This study aims to address this issue by focusing on demands on emergency services at the municipal level. Using data from the Massachusetts Ambulance Trip Record Information System (MATRIS) we explore the association between emergency medical services (EMS) demand and population age-structure. The data shows an overrepresentation of older people among EMS users. People age 65 and older represent 16% of Massachusetts’ population but account for 31% of the transported emergent calls —e.g., 911 calls— and 60% of the scheduled transports. Results from the OLS regression analysis suggest that communities with larger shares of older residents have significantly higher numbers of EMS calls. The type of community and other age-related community features such as the percentage of older residents living alone and the percentage of older population dually eligible for Medicare and Medicaid are also significantly associated with the number of EMS calls. Contrary to our expectations, other resources available in the community such nursing homes or assisted living facilities were not significantly associated with number of EMS calls. Our research indicates that if growth in the older population occurs as projected, the demand placed on the EMS system by older populations will grow considerably in coming decades.

scholarly journals The Impact of Demographic Changes on the Organization of Emergency Medical Services: the Case of Slovenia

Organizacija ◽  
2015 ◽  
Vol 48 (4) ◽  
pp. 247-258 ◽  
Author(s):  
Tatjana Kitić Jaklič ◽  
Jure Kovač
Keyword(s):  
Emergency Medical Services ◽  
Planning Process ◽  
National Level ◽  
Social Factor ◽  
Software Tool ◽  
Medical Services ◽  
Emergency Medical ◽  
Rate Of Increase ◽  
Starting Point ◽  
The Impact

Abstract Background and Purpose: The modern environment requires that organizations (profit and non-profit) continually harmonize their organizational models with changes in their respective environments and with their own visions and strategies for further development. The organizational structure of Emergency Medical Services (hereinafter EMS) is currently a very topical issue in Slovenia, given that a project to establish a new organization of EMS is currently underway at the national level. By examining the case of one region in Slovenia, this article presents an analysis of factors that impact on the number and types of EMS activities and depicts a forecast of future trends for the requirement of EMS. The analysis presents the initial phase of a strategic planning process for the mentioned activity and consequently, a starting point for the formation of an organizational EMS model. Methodology: This article presents an analysis of factors that impact on the formulation of an EMS model on the basis of research carried out for one geographical region of Slovenia. For the previous period, data was collected from 2002 to 2014. The software tool used for the analysis was STATA 13.0. For the purpose of forecasting a five-year period trend we used statistical package RStudio and Hyndman’s Forecast package given that this package contains algorithms for forecasting univariate time series including exponential smoothing using automated spatial models and ARIMA modelling. Results: The research has confirmed a correlation between social/environmental factors and the rate of increase in the demand for EMS. A population’s age structure has been identified as the key social factor that increases the need for EMS. On the basis of this finding, this article presents a model for forecasting growth trends in the scope of EMS activities. Conclusion: The research study has identified some important elements that are imperative to take into consideration when formulating an EMS network at the prehospital level. Population ageing has emerged as a key social factor. In the accordance with forecasted trends, an increase in the burden placed on EMS activities may also be anticipated in the future.

Prehospital Emergency Medical Services Departure Interval: Does Patient Age Matter?

2016 ◽  
Vol 31 (6) ◽  
pp. 608-613 ◽  
Author(s):  
Bruno Schnegg ◽  
Mathieu Pasquier ◽  
Pierre-Nicolas Carron ◽  
Bertrand Yersin ◽  
Fabrice Dami
Keyword(s):  
Response Time ◽  
Emergency Medical Services ◽  
Time Of Day ◽  
Medical Services ◽  
Time Interval ◽  
Patient Age ◽  
Emergency Medical ◽  
Patient Âgé ◽  
Prehospital Emergency ◽  
The Impact

AbstractIntroductionThe concept of response time with minimal interval is intimately related to the practice of emergency medicine. The factors influencing this time interval are poorly understood.ProblemIn a process of improvement of response time, the impact of the patient’s age on ambulance departure intervals was investigated.MethodThis was a 3-year observational study. Departure intervals of ambulances, according to age of patients, were analyzed and a multivariate analysis, according to time of day and suspected medical problem, was performed.ResultsA total of 44,113 missions were included, 2,417 (5.5%) in the pediatric group. Mean departure delay for the adult group was 152.9 seconds, whereas it was 149.3 seconds for the pediatric group (P =.018).ConclusionA statistically significant departure interval difference between missions for children and adults was found. The difference, however, probably was not significant from a clinical point of view (four seconds).SchneggB, PasquierM, CarronPN, YersinB, DamiF. Prehospital Emergency Medical Services departure interval: does patient age matter?Prehosp Disaster Med. 2016;31(6):608–613.

scholarly journals Measuring the impact of emergency medical services (EMS) on out-of-hospital cardiac arrest survival in a developing country

Medicine ◽  
2017 ◽  
Vol 96 (29) ◽  
pp. e7570 ◽  
Author(s):  
Mazen El Sayed ◽  
Reem Al Assad ◽  
Yasmin Abi Aad ◽  
Nour Gharios ◽  
Marwan M. Refaat ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Emergency Medical Services ◽  
Developing Country ◽  
Medical Services ◽  
Emergency Medical ◽  
The Impact ◽  
Cardiac Arrest Survival ◽  
Hospital Cardiac Arrest
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