scholarly journals Hangings attended by emergency medical services: a scoping review

2021 ◽  
Vol 5 (4) ◽  
pp. 40-48
Author(s):  
Gary Shaw ◽  
Lee Thompson ◽  
Graham McClelland
Keyword(s):  
Emergency Medical Services ◽  
Scoping Review ◽  
Grey Literature ◽  
Psychological Impact ◽  
Patient Characteristics ◽  
Medical Services ◽  
North East ◽  
Emergency Medical ◽  
Advanced Airway ◽  
The Uk

<sec id="s1"> Background: In the United Kingdom (UK) there were 6507 deaths by suicide in 2018, with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted. Trauma audits conducted by North East Ambulance Service NHS Foundation Trust have identified an increased trend in hanging cases, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice. </sec> <sec id="s2"> Methods: A five-stage scoping review method was used. Relevant studies were identified by searching MEDLINE, CINAHL, EMBASE and EMCARE with the help of the Library and Knowledge Service for NHS Ambulance Services in England. Grey literature and reference lists were also searched. Studies were included based on relevance to hangings attended by EMS. Data were tabulated and narratively synthesised. </sec> <sec id="s3"> Results: Sixteen papers were included in the review. Australia was the most frequent source of studies (n = 5, 31%). Most studies (n = 11, 69%) were published in the past 10 years. The median sample size was 53 (IQR 41‐988, range 10‐3981). All papers included varying levels of patient characteristics, EMS input and patient outcomes. </sec> <sec id="s4"> Conclusion: Hanging is a highly lethal method of suicide that is increasingly used in the UK. This scoping review found that there is scarce literature focused on hangings attended by EMS. Treatment of the hanging patient in cardiac arrest is described in many of the papers included. Hanging patients may benefit from the presence of specialist resources who can deliver interventions such as sedation and advanced airway management. The psychological impact of attending, or witnessing, hanging patients is an area that needs further consideration. Further research is needed to describe and improve EMS treatment of hangings. </sec>

PP21 Hangings attended by emergency medical services: a scoping review

2021 ◽  
Vol 38 (9) ◽  
pp. A9.3-A10
Author(s):  
Gary Shaw ◽  
Lee Thompson ◽  
Graham McClelland
Keyword(s):  
Emergency Medical Services ◽  
Scoping Review ◽  
Grey Literature ◽  
Psychological Impact ◽  
Patient Characteristics ◽  
Medical Services ◽  
Lead Author ◽  
Emergency Medical ◽  
Advanced Airway ◽  
The Uk

BackgroundIn the United Kingdom (UK) there were 6,507 deaths by suicide in 2018 with hanging being the most common method. Hanging will normally result in emergency medical services (EMS) being called and may result in resuscitation being attempted.The lead author identified an increasing trend in hanging cases in the NHS Ambulance service trauma audit, which were also reported in national data. The aim of this scoping review was to explore the literature around EMS attendance at hangings to inform further research and clinical practice.MethodsA five-stage scoping review method was used. Relevant studies were identified by searching MEDLINE, CINAHL, EMBASE and EMCARE with the help of the Library and Knowledge Service for NHS Ambulance Services in England (LKS). Grey literature and reference lists were also searched. Studies were included based on relevance to hangings attended by EMS. Data were tabulated and narratively synthesised.ResultsSixteen papers were included in the review. Australia was the most frequent source of studies (n=5, 31%). Most studies (n=11, 69%) were published in the past ten years. The median sample size was 53 (IQR 41-988, range 10-3981). All papers included varying levels of patient characteristics, EMS input and patient outcomes.ConclusionHanging is a highly lethal method of suicide that is increasingly used in the UK. This scoping review found that there is scarce literature focussed on hangings attended by EMS. Treatment of the hanging patient in cardiac arrest is described in many of the papers included. Hanging patients may benefit from the presence of specialist resources who can deliver interventions such as sedation and advanced airway management. The psychological impact of attending, or witnessing, hanging patients is an area that needs further consideration. Further research is needed to describe and improve EMS treatment of hangings.

Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

1999 ◽  
Vol 14 (3) ◽  
pp. 67-72 ◽  
Author(s):  
John R. Richards ◽  
Stephen J. Ferrall
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Patient Characteristics ◽  
University Hospital ◽  
Medical Services ◽  
Shortness Of Breath ◽  
Study Objective ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

scholarly journals Emergency Medical Services Core Competencies: A Scoping Review

2018 ◽  
Vol 4 (4) ◽  
pp. 245-258 ◽  
Author(s):  
Talal AlShammari ◽  
Paul A. Jennings ◽  
Brett Williams
Keyword(s):  
Emergency Medical Services ◽  
Scoping Review ◽  
Core Competencies ◽  
Medical Services ◽  
Emergency Medical

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.

Policy, Practice, and Research Agenda for Emergency Medical Services Oversight: A Systematic Review and Environmental Scan

2018 ◽  
Vol 33 (1) ◽  
pp. 89-97 ◽  
Author(s):  
Rekar K. Taymour ◽  
Mahshid Abir ◽  
Margaret Chamberlin ◽  
Robert B. Dunne ◽  
Mark Lowell ◽  
...  
Keyword(s):  
New York ◽  
Emergency Medical Services ◽  
Research Agenda ◽  
Grey Literature ◽  
Quality Measurement ◽  
Medical Services ◽  
Washington Dc ◽  
Environmental Scan ◽  
Policy Practice ◽  
Emergency Medical

AbstractIntroductionIn a 2015 report, the Institute of Medicine (IOM; Washington, DC USA), now the National Academy of Medicine (NAM; Washington, DC USA), stated that the field of Emergency Medical Services (EMS) exhibits signs of fragmentation; an absence of system-wide coordination and planning; and a lack of federal, state, and local accountability. The NAM recommended clarifying what roles the federal government, state governments, and local communities play in the oversight and evaluation of EMS system performance, and how they may better work together to improve care.ObjectiveThis systematic literature review and environmental scan addresses NAM’s recommendations by answering two research questions: (1) what aspects of EMS systems are most measured in the peer-reviewed and grey literatures, and (2) what do these measures and studies suggest for high-quality EMS oversight?MethodsTo answer these questions, a systematic literature review was conducted in the PubMed (National Center for Biotechnology Information, National Institutes of Health; Bethesda, Maryland USA), Web of Science (Thomson Reuters; New York, New York USA), SCOPUS (Elsevier; Amsterdam, Netherlands), and EMBASE (Elsevier; Amsterdam, Netherlands) databases for peer-reviewed literature and for grey literature; targeted web searches of 10 EMS-related government agencies and professional organizations were performed. Inclusion criteria required peer-reviewed literature to be published between 1966-2016 and grey literature to be published between 1996-2016. A total of 1,476 peer-reviewed titles were reviewed, 76 were retrieved for full-text review, and 58 were retained and coded in the qualitative software Dedoose (Manhattan Beach, California USA) using a codebook of themes. Categorizations of measure type and level of application were assigned to the extracted data. Targeted websites were systematically reviewed and 115 relevant grey literature documents were retrieved.ResultsA total of 58 peer-reviewed articles met inclusion criteria; 46 included process, 36 outcomes, and 18 structural measures. Most studies applied quality measures at the personnel level (40), followed by the agency (28) and system of care (28), and few at the oversight level (5). Numerous grey literature articles provided principles for high-quality EMS oversight.Conclusions:Limited quality measurement at the oversight level is an important gap in the peer-reviewed literature. The grey literature is ahead in this realm and can guide the policy and research agenda for EMS oversight quality measurement.TaymourRK, AbirM, ChamberlinM, DunneRB, LowellM, WahlK, ScottJ. Policy, practice, and research agenda for Emergency Medical Services oversight: a systematic review and environmental scan. Prehosp Disaster Med. 2018;33(1):89–97.

scholarly journals Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

2019 ◽  
Author(s):  
Linda Huibers ◽  
Anders H Carlsen ◽  
Grete Moth ◽  
Helle C Christensen ◽  
Ingunn S Riddervold ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Medical Services ◽  
Healthcare Service ◽  
Service Providers ◽  
Patient Characteristics ◽  
Medical Services ◽  
Cross Sectional ◽  
Out Of Hours ◽  
Emergency Medical ◽  
Acute Healthcare

Abstract Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

scholarly journals Determining Potentially Avoidable Emergency Medical Services (EMS) Transports: A Population Level Study Using Linked Administrative Data in Alberta Health Services (AHS)

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Ping Cai ◽  
Gregory Vogelaar ◽  
Kim Liss ◽  
Hude Quan
Keyword(s):  
Emergency Medical Services ◽  
Quality Care ◽  
Population Level ◽  
Patient Characteristics ◽  
Medical Services ◽  
Community Based ◽  
Rural Residents ◽  
Term Care ◽  
Emergency Medical ◽  
Alternative Settings

IntroductionTraditionally Emergency Medical Services (EMS) transports patients to Emergency Departments (EDs). However, some patients might be appropriately managed in alternative settings outside the ED. A number of non-traditional EMS programs have evolved in Alberta, in an attempt to provide quality care through a community-based care model. Objectives and ApproachThe project aimed to identify and quantify potentially avoidable EMS transports to EDs in Alberta. We identified 911 responses by ground ambulance in Alberta between September 1, 2017 and December 31, 2017. Patients 18 years and over transported to EDs were linked to Alberta Provincial Registry for more accurate demographic Information, and linked to Long Term Care (LTC) and ED data to capture patient characteristics and frequency of potentially avoidable EMS transports to EDs, defined as the Canadian Triage and Acuity Scale (CTAS) Level IV and Level V in EDs not requiring inpatient admission. ResultsWe identified 72,182 transports to EDs, of which 1 in 4 patients were rural residents. After excluding individuals<18 years and non-Alberta residents, we were able to match 58,137 of the 60,020 EMS transports to EDs (96.8%). Overall, 7,697 (13%) were triaged as less urgent with no hospital admission. Patients 65 years and over accounted for almost half (49%) of the transports in this cohort, 6% of which were for LTC clients. Percentage of potentially avoidable transports in LTC clients were similar to seniors living in the community (12%). Geographic visualization at the provincial level indicated variation across the province. In general, rural residents were more likely than urban residents to be transported to EDs with less urgent conditions (18% vs 12%). Conclusion/ImplicationsThis is the first analysis exploring potentially avoidable EMS transports to EDs in Alberta, Canada, where a comprehensive, single source of EMS system data is currently available. The project suggests opportunities for future EMS research and policies focusing on enhancing community–based care.

scholarly journals Management and outcomes of pediatric patients transported by emergency medical services in a Canadian prehospital system

CJEM ◽  
2006 ◽  
Vol 8 (01) ◽  
pp. 6-12 ◽  
Author(s):  
Julie Richard ◽  
Martin H. Osmond ◽  
Lisa Nesbitt ◽  
Ian G. Stiell
Keyword(s):  
Emergency Medical Services ◽  
Life Support ◽  
Hospital Admissions ◽  
Advanced Life Support ◽  
Patient Characteristics ◽  
High Rate ◽  
Blood Glucose Monitoring ◽  
Cardiac Monitoring ◽  
Medical Services ◽  
Emergency Medical

ABSTRACTObjectives:There is uncertainty around the types of interventions that are provided by emergency medical services (EMS) to children during prehospital transport. We describe the patient characteristics, events, interventions provided and outcomes of a cohort of children transported by EMS.Methods:This prospective cohort study was conducted in a city of 750 000 people with a 2-tiered EMS system. All children &lt;16 years of age who were attended by EMS during a 6-month period were enrolled. Data were extracted from ambulance call reports and hospital charts, and analyzed using descriptive statistics.Results:During the study period there were 1377 pediatric EMS calls. Mean age was 8.2 years (standard deviation 5.4), and the most common diagnoses were trauma (44.9%), seizure (11.8%) and respiratory distress (8.8%). The ambulance return code wasUrgentin 7%,Promptin 57%,Deferrablein 8% andNot Transportedin 28%. Fifty-six percent received either an Advanced Life Support or Basic Life Support prehospital intervention. Common procedures included cardiac monitoring (20.0%), oxygen administration (19.8%), blood glucose monitoring (16.3%), spine board (12.2%), limb immobilization (11.1%) and cervical collar (10.0%). Uncommon procedures included administering medications intravenously (IV) (1.4%), bag-valve-mask ventilation (0.3%) and endotracheal intubation (0.1%). Seventy-eight percent of attempted IV lines were successful. Only 9.0% of EMS-transported children were admitted to hospital, and 2.2% were admitted to the intensive care unit.Conclusions:This first study of Canadian pediatric prehospital interventions shows a high rate of non-transport, and a low rate ofUrgenttransports and hospital admissions for children. Very few children receive prehospital airway management, ventilation or IV medications; consequently EMS personnel have little opportunity to maintain these pediatric skills in the field.

scholarly journals How Does the Response and Management of Terrorist Attacks by Emergency Medical Services in the UK Compare to Europe and the USA?

2019 ◽  
Vol 1 (1) ◽  
Author(s):  
Alex Grant ◽  
Simon Dady
Keyword(s):  
Emergency Medical Services ◽  
Research Question ◽  
The United States ◽  
Lessons Learned ◽  
Terrorist Attacks ◽  
Medical Services ◽  
Recent Experience ◽  
Emergency Medical ◽  
The Usa ◽  
The Uk

Research question How does the response and management of terrorist attacks by emergency medical services (EMS) in the United Kingdom (UK) compare to Europe and the United States of America (USA)?  Introduction Terrorist attacks and active shooter events account for a growing number of mass casualty and major incidents in the UK, Europe and the USA. In order to better prepare for future incidents, analysis of prior events is essential.   Methods Systematic literature searches of papers published between 1/1/2004 and 5/31/2018 were conducted using two key databases: CINAHL Plus and PubMed (indexed from MEDLINE). Key contents of identified papers were abstracted, including EMS response and patient management, with emphasis placed upon identified recommendations and lessons learned.  Results Four hundred and forty-two records were identified in the preliminary search, with 176 records further screened using the title and abstract. Ten papers were included in the final review, reflecting 13 events from five countries across two continents. Three major themes identified throughout the papers were emergency preparedness, resilience and response (EPRR), casualty triage, and tactical emergency medical services (TEMS). These themes were present in 90%, 70% and 40% of the papers respectively.  Conclusion New and innovative EMS response strategies occurred over the study period, in part due to the dissemination of lessons learned. Despite advances in response to mass violence events, significant gaps remain, in part due to lack of adoption of recommendations. Recent experience with advanced TEMS providers capable of operating within the inner perimeter suggests that this approach should be further evaluated as part of the response plan for future events.

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