scholarly journals Ambulance Transport and Services in the Rural Areas of Iceland, Scotland and Sweden

2015 ◽  
Vol 5 (1) ◽  
Author(s):  
Björn Gunnarsson ◽  
Hildigunnur Svavarsdóttir ◽  
Sveinbjörn Dúason ◽  
Andrew Sim ◽  
Agnes Munro ◽  
...  
Keyword(s):  
Rural Areas ◽  
University Hospital ◽  
Current Status ◽  
Ambulance Personnel ◽  
Emergency Medical ◽  
Ambulance Transport ◽  
Ems Education ◽  
The University ◽  
Improve Patient ◽  
And Training

Introduction The University Hospital in Akureyri (Centre for Emergency Medical Service (EMS) Education) in Iceland, Emergency & Disaster Medical Centre (AKMC) in Sweden and National Health Service - Western Isles in Scotland have undertaken a project “Ambulance Transport and Services in the Rural Areas” (ATSRuAr); the object of this paper is to provide an overview of the present status of ambulance transport and services in the three participating regions. This is a project of the INTERREG III Northern Periphery Programme (NPP) who provided a grant for the work. Methods Each partner reviewed the current status of prehospital services in their country or region and presented the results at a project meeting in Iceland in March 2006. Results & Conclusion Geography and weather provide a challenge to the ambulance transport and services in sparsely populated northern rural areas. The Emergency Medical Services (EMS) systems in these three northern rural areas have many similarities. However, there are differences in the number and distribution of ambulances, the running of the service, education and training of ambulance personnel and first responder schemes. This collaboration will debate on the provision of ambulance transport. Research is needed to indicate how improvements in ambulance transport can improve patient outcome in rural areas.

scholarly journals Implementation of Anatomic Pathology Services in Mirebalais, Haiti

2018 ◽  
Vol 4 (Supplement 1) ◽  
pp. 31s-31s
Author(s):  
Fabienne Anglade ◽  
Myrlene Mompremier ◽  
Kayleigh Bhangdia ◽  
Lauren Greenberg ◽  
Juan Daniel Orozco ◽  
...  
Keyword(s):  
United States ◽  
Rural Areas ◽  
Conflicts Of Interest ◽  
The United States ◽  
Turnaround Time ◽  
University Hospital ◽  
Phase Iii ◽  
Middle Income ◽  
Resource Limited ◽  
And Training

Abstract 97 Purpose Despite great barriers, implementing pathology services in resource-limited rural settings is achievable. Challenges include the lack of infrastructure, trained personnel, supply chain, and decentralized services, and have hindered the appropriate provision of cancer care to those who live in resource-limited settings. In Haiti, we began treating cancer at University Hospital Mirebalais (HUM) before pathology services existed, sending samples to the United States for diagnoses. This model allowed patients to receive treatment, but turnaround time was often delayed. Our goal is to implement pathology services at HUM that can provide high-quality diagnostics to patients who are enrolled in the cancer program. We demonstrate that, by rolling out a phased implementation of local pathology services with appropriate commitment from local and international partners, accurate pathologic diagnoses can exist in low- and middle-income countries. Methods Phase I—infrastructure and personnel—occurred fall 2016 with the construction of the laboratory and the hiring of a pathologist and laboratory technicians, which allowed samples to be grossed into paraffin blocks before being sent to Boston. Phase II—technology transfer and training—occurred fall 2017 with the procurement of additional equipment and hands-on histology training, which allowed samples to be cut, stained, and diagnosed on-site. In this phase, only complex samples that needed additional immunohistochemistry or a second opinion were sent to Boston. Phase III—testing capacity expansion—will occur summer 2018 and involves procuring immunohistochemistry and training, which will further limit the need to send cases to the United States. Phase IV—routine testing and quality assurance—will occur in tandem with phase III and involves implementing a telepathology system on-site in the HUM laboratory. Results Outcomes of this phased implementation will result in decentralized pathology services in the public sector and ultimately decreased turnaround times, producing better clinical outcomes. Our model demonstrates that it is possible to build local pathology capacity in rural areas. Since the opening of our laboratory, more than 1,000 cases have been processed into paraffin blocks before being sent to Boston. In September 2017, the first cases were diagnosed in country, and more than 100 cases have been processed and reported in Haiti. Conclusion Building on the foundational phases, the next phases of implementation involve long-term diagnostic support that will correlate directly with a substantial decrease in turnaround time. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.

The Demographics and Education of Emergency Medical Services (EMS) Professionals: A National Longitudinal Investigation

2016 ◽  
Vol 31 (S1) ◽  
pp. S18-S29 ◽  
Author(s):  
Melissa A. Bentley ◽  
Abigail Shoben ◽  
Roger Levine
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Emergency Medical Technician ◽  
Medical Services ◽  
Continuous Variables ◽  
Longitudinal Investigation ◽  
Emergency Medical ◽  
Ems Education ◽  
Changes Over Time ◽  
Over Time

AbstractObjectivesThe objectives of this study were to assess longitudinal and cross-sectional changes in Emergency Medical Technician (EMT)-Basics and Paramedics: (1) demographics, (2) employment characteristics, and (3) initial Emergency Medical Services (EMS) education.MethodsThese data were collected between 1999 and 2008 employing survey techniques aimed at collecting valid data. A random, stratified sample was utilized to allow results to be generalizable to the nationally certified EMS population. Survey weights that were adjusted for each stratum’s response were estimated. Weighted percentages, averages for continuous variables, and 95% confidence intervals (CIs) were calculated. Significant changes over time were noted when the CIs did not overlap.ResultsIn all 10 years of data collection, the proportion of EMT-Paramedics who were male was greater than the proportion of EMT-Basics who were male. A substantial proportion of respondents performed EMS services for more than one agency: between 39.8% and 43.5% of EMT-Paramedics and 18.4% and 22.4% of EMT-Basic respondents reported this. The most common type of employer for both EMT-Basics and EMT-Paramedics was fire-based organizations. About one-third of EMT-Basics (32.3%-40.1%) and almost one-half of EMT-Paramedics (43.1%-45.3%) reported that these organizations were their main EMS employer. Rural areas (<25,000 residents) were the most common practice settings for EMT-Basics (52.1%-63.7%), while more EMT-Paramedics worked in urban settings (65.2%-77.7%).ConclusionsThis analysis serves as a useful baseline to measure future changes in the EMS profession. This study described the demographic and work-life characteristics of a cohort of nationally certified EMT-Basics and Paramedics over a 10-year period. This analysis also summarized initial EMS education changes over time.BentleyMA, ShobenA, LevineR. The demographics and education of Emergency Medical Services (EMS) professionals: a national longitudinal investigation. Prehosp Disaster Med. 2016;31(Suppl. 1):s18–s29.

Results of the reform of the emergency medical service in the Pavlodar Region

2020 ◽  
pp. 67-71
Author(s):  
Kanadan Kanashevich Akhmetzhanov
Keyword(s):  
Medical Care ◽  
Emergency Medical Service ◽  
Rural Areas ◽  
Medical Equipment ◽  
Medical Service ◽  
Medical Personnel ◽  
Emergency Medical ◽  
Medical Teams ◽  
Service Introduction ◽  
And Training

Improving the organization of medical care allows providing standardized and timely medical care of higher quality not only to residents of cities, but also to the population living in rural areas. This is achieved by the gradual reorganization of the emergency medical service, introduction of innovative technologies, 100 % provision of ambulances with medical equipment, and training of medical personnel of emergency medical teams.

scholarly journals Treatment Under Dental General Anesthesia Among Children Younger than 6 Years in Lithuania

Medicina ◽  
2013 ◽  
Vol 49 (9) ◽  
pp. 63 ◽  
Author(s):  
Birutė Jankauskienė ◽  
Jorma Virtanen ◽  
Ričardas Kubilius ◽  
Julija Narbutaitė
Keyword(s):  
Young Children ◽  
General Anesthesia ◽  
Rural Areas ◽  
Dental Fear ◽  
University Hospital ◽  
Caries Experience ◽  
Efficient Treatment ◽  
Dental Patients ◽  
Study Population ◽  
The University

Background and Objective. Dental general anesthesia (DGA) is an efficient treatment modality for young pediatric dental patients. The aim of this study was to identify the reasons for DGA, characteristics of patients receiving treatment under DGA, and treatment performed under DGA for children under school age in Kaunas, Lithuania. Material and Methods. The study population comprised all patients younger than 6 years treated under GA for dental reasons (n=144) at the University Hospital during a 3-year period from 2010 to 2012. The data were collected by means of clinical dental examinations, a survey of the parents, and the patients’ dental records and included personal background, reasons for DGA, dental status, and treatment provided. Results. More than half (54%) of the children were younger than 4 years; 40% of them resided in cities. The dental caries experience was high: the mean dmft and d were 12.9 (SD, 3.5) and 12.1 (SD 3.9), respectively. The majority (81%) of the children had multiple reasons for DGA, with the need for excessive treatment (93%), followed by dental fear and uncooperativeness (66%), being the most common. The extent of treatment increased with age and was greater among patients from rural areas. Of the 1975 primary teeth treated under GA, 50% were restored, 32% extracted, and 18% targeted with preventive procedures. Conclusions. Young children with very high levels of untreated tooth decay are treated under DGA at the Lithuanian University of Health Sciences Hospital. The need for complex treatment as well as dental fear and uncooperativeness are the major reasons for DGA. Multiple caries treatments and extractions are performed for these patients. This study highlights a great need to develop the healthcare system with regard to the appropriate management of caries among young children and postoperative DGA care.

scholarly journals Outcomes in children evaluated but not transported by ambulance personnel: retrospective cohort study

2019 ◽  
Vol 3 (1) ◽  
pp. e000523 ◽  
Author(s):  
Jelena Oulasvirta ◽  
Heli Salmi ◽  
Markku Kuisma ◽  
Eero Rahiala ◽  
Mitja Lääperi ◽  
...  
Keyword(s):  
Cohort Study ◽  
Intensive Care ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Clinical Status ◽  
Medical Attention ◽  
Hospital Emergency ◽  
Ambulance Personnel ◽  
Emergency Medical ◽  
Ambulance Transport

BackgroundNot all children with an out-of-hospital emergency medical contact are transported by ambulance to the emergency department (ED). Non-transport means that after on-scene evaluation and possible treatment, ambulance personnel may advise the patient to monitor the situation at home or may refer the patient to seek medical attention by other means of transport. As selecting the right patients for ambulance transport is critical for optimising patient safety and resource use, we studied outcomes in non-transported children to identify possible risk groups that could benefit from ambulance transport.MethodsIn a population-based retrospective cohort study of all children aged 0–15 years encountered but not transported by ambulance in Helsinki, Finland, between 1 January 2014 and 31 December 2016, we evaluated (1) 12-month mortality, (2) intensive care admissions, (3) unscheduled ED contacts within the following 96 hours after the non-transport decision and (4) the clinical status of the child on presentation to ED in the case of a secondary ED visit.ResultsOf all children encountered by out-of-hospital emergency medical services, 3579/7765 (46%) were not transported to ED by ambulance. There was no mortality or intensive care admissions related to the non-transport. The risk factors for an unscheduled secondary ED visit after a non-transport decision were young age (p=0.001), non-transport decision during the early morning hours (p<0.001) and certain dispatch codes, including ‘dyspnoea’ (p<0.001), ‘vomiting/diarrhoea’ (p=0.030) and ‘mental illness’ (p=0.019). We did not detect deterioration in patients’ clinical presentation at ED traceable to non-transport decisions.ConclusionsNot transporting all children by ambulance after an out-of-hospital emergency medical contact was not associated with deaths, intensive care admissions or significant deterioration in general condition in our study population and healthcare system. Special attention and a formal non-transport protocol are warranted in certain subgroups, including infants.

scholarly journals Advanced basal cell carcinomas of the face: A Moroccan series

2021 ◽  
Vol 12 (2) ◽  
pp. 135-139
Author(s):  
Sara Elloudi ◽  
Aida Oulehri ◽  
Hanane Baybay ◽  
Zakia Douhi ◽  
Fatima Zahra Mernissi
Keyword(s):  
Basal Cell Carcinoma ◽  
Cell Carcinoma ◽  
Basal Cell ◽  
Rural Areas ◽  
University Hospital ◽  
Temporal Region ◽  
Dermatology Department ◽  
Skin Malignancy ◽  
The Face ◽  
The University

Background: Basal cell carcinoma (BCC) is the most common cutaneous skin malignancy. 85% of BCCs affect the face, a region particularly rich in noble organs. Although BCC progresses slowly, considerable local destruction and mutilation may be observed. Material and Methods: We performed a retrospective review of the database stored by our institution. All patients with histologically confirmed mutilating basal cell carcinoma of the face hospitalized at the dermatology department of the university hospital in Fez, Morocco, from 2015 through 2020 were evaluated. Results: Nine patients were included, with the tumors located in the lips, temporal region, orbital region, and cheeks, with sizes varying from 5 to 11 cm. Conclusion: In the series, we were able to highlight the high-risk character of the subpopulation living in rural areas and the role of smoking as a major risk factor.

scholarly journals Support for Interdisciplinary Approaches in Emergency Medical Services Education

2015 ◽  
Vol 1 (1) ◽  
pp. 60
Author(s):  
William J Leggio ◽  
Kenneth J D'Alessandro
Keyword(s):  
Emergency Medical Services ◽  
Patient Outcomes ◽  
Medical Services ◽  
Healthcare Education ◽  
Emergency Medical ◽  
Interdisciplinary Approaches ◽  
Ems Education ◽  
Interdisciplinary Healthcare ◽  
Training Opportunities ◽  
And Training

<p>This article analyzes the need for Emergency Medical Services (EMS) educational programs and academicians to develop interdisciplinary educational and training opportunities with other healthcare disciplines. A literature review was conducted on EMS education and interdisciplinary approaches in healthcare education. In general, support for both didactic and simulated interdisciplinary education in healthcare is supported by positive impacts on student learning and improved patient outcomes. Support for interdisciplinary approaches in EMS education was constructed by applying research on interdisciplinary healthcare education to the identified criticisms of EMS education. A critical analysis of the literature allowed for recommendations to be made on the implementation of and further research for interdisciplinary approaches in EMS education. This article supports EMS students to be educated in a way that is reflective of a profession that must work collaboratively to provide out-of-hospital healthcare. </p>

Medication safety in a German telemedicine centre: Implementation of a telepharmaceutical expert consultation in addition to existing tele-intensive care unit services

2018 ◽  
Vol 26 (1-2) ◽  
pp. 105-112 ◽  
Author(s):  
Julia Amkreutz ◽  
Rebekka Lenssen ◽  
Gernot Marx ◽  
Robert Deisz ◽  
Albrecht Eisert
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Medication Safety ◽  
Dosage Adjustment ◽  
University Hospital ◽  
Special Focus ◽  
Expert Consultation ◽  
The University ◽  
Improve Patient

Introduction Tele-intensive care unit (tele-ICU) services offer the possibility to provide specialized medical care in remote areas and to improve patient outcomes. The aim of this study was to implement and evaluate an additional telepharmaceutical expert consultation as part of tele-ICU services. Methods This is a prospective observational study conducted in the telemedicine centre of the University Hospital RWTH Aachen, Germany. Between March and July 2015, all tele-ICU patients of one internal and two remote ICUs received telepharmaceutical consultation. Number and type of drug related problems (DRPs) were identified in a comprehensive medication safety check. Implementation of DRPs was discussed interdisciplinarily by tele-ICU pharmacist, tele-ICU physician and remote ICU physician. Special focus was on drug–drug interactions (DDIs) and dosage adjustment in renal and liver failure. Results A total of 210 DRPs in 103 patients were identified and discussed. On average, 2.0 (range 0–17) DRPs per patient were found. At least one DRP was found in 62% of patients. Antibacterials for systemic use were most involved in DRPs. A total of 1129 DDI-alerts were generated by ID PHARMA CHECK®. Fifty-six DDIs (5%) were discussed in tele-ICU rounds. The tele-ICU team discussed 28 cases of dosage adjustment in organ failure. Discussion Telepharmaceutical consultation as part of tele-ICU services was successfully implemented and can improve medication safety. Telemedicine infrastructure provides the possibility to implement guidelines recommending pharmaceutical service in the ICU in remote hospitals not having access to clinical pharmacists. Thus, quality of care can be improved.

Symptomatic vascular complications after vascular closure device use following diagnostic and interventional catheterisation

VASA ◽  
2004 ◽  
Vol 33 (2) ◽  
pp. 78-81 ◽  
Author(s):  
Thalhammer ◽  
Aschwanden ◽  
Jeanneret ◽  
Labs ◽  
Jäger
Keyword(s):  
Current Literature ◽  
Vascular Complications ◽  
University Hospital ◽  
Closure Device ◽  
Ultrasound Guided ◽  
Vascular Closure Device ◽  
Device Use ◽  
Arterial Stenoses ◽  
The University ◽  
Stenotic Lesions

Background: Haemostatic puncture closure devices for rapid and effective hemostasis after arterial catheterisation are a comfortable alternative to manual compression. Implanting a collagen plug against the vessel wall may become responsible for other kind of vascular injuries i.e. thrombotic or stenotic lesions and peripheral embolisation. The aim of this paper is to report our clinically relevant vascular complications after Angio-Seal® and to discuss the results in the light of the current literature. Patients and methods: We report the symptomatic vascular complications in 17 of 7376 patients undergoing diagnostic or therapeutic catheterisation between May 2000 and March 2003 at the University Hospital Basel. Results: Most patients presented with ischaemic symptoms, arterial stenoses or occlusions and thrombotic lesions (n = 14), whereas pseudoaneurysms were extremely rare (n = 3). Most patients with ischaemic lesions underwent vascular surgery and all patients with a pseudoaneurysm were successfully treated by ultrasound-guided compression. Conclusions: Severe vascular complications after Angio-Seal® are rare, consistent with the current literature. There may be a shift from pseudoaneurysms to ischaemic lesions.

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