PREHOSPITAL EMERGENCY MEDICAL SERVICES UTILIZATION FOR CRITICAL PATIENTS AND ITS DETERMINANTS IN THAILAND

This research aimed to determine the situations and factors associated with prehospital emergency medical services (EMS) utilization for critical patients in Thailand. This cross-sectional study used the data of a survey conducted by the Information Technology for Emergency Medical System (ITEMS) of the National Institute of Emergency Medicine, Thailand. The survey collected the data among 1,145 participants using a structured questionnaire. The generalized linear mixed model (GLMM) was used to identify the factors associated with prehospital EMS utilization among critical patients when controlling the effects of covariates presenting adjusted OR and 95% confidence interval. Among 1,145 critical patients, 33.71 % reported using the prehospital EMS of the emergency medical system. Factors that were associated with prehospital EMS use had a high level of knowledge on prehospital EMS (adj. OR = 6.49; 95%CI: 3.78-11.12), high level of trust in quality and safety of prehospital EMS (adj. OR = 4.72; 95%CI: 3.50-6.36), low-moderate severity of perceived illness (adj. OR= 3.71; 95%CI: 2.54-5.42), critical condition occurred at workplace/building (adj. OR=3.57; 95%CI: 2.33-5.47), at home/residential building (adj. OR = 2.21; 95%CI: 1.37-3.58), had adequate services in the area (adj. OR= 1.94; 95%CI: 1.45-2.60), finished at least secondary school (adj. OR= 1.62; 95%CI: 1.11-2.37), less than 15km distance between scene and EMS service site (adj. OR= 1.47; 95%CI: 1.10-1.98), and were very satisfied with services (adj. OR = 1.15; 95%CI: 1.08-1.22) from the reasons mentioned.

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Introduction and characteristics of helicopter emergency medical services

Journal of Korean Medical Association ◽

10.5124/jkma.2020.63.4.188 ◽

2020 ◽

Vol 63 (4) ◽

pp. 188-192

Author(s):

Han Joo Choi ◽

Hyung Il Kim

Keyword(s):

Emergency Medical Services ◽

Optimal Strategies ◽

Medical Personnel ◽

Medical System ◽

Emergency Medical System ◽

Medical Services ◽

Core Element ◽

Helicopter Emergency Medical Services ◽

Emergency Medical ◽

The Government

Helicopter emergency medical services (HEMS) are a part of air medical services. The transportation of patients using helicopters or airplanes is a core element of the air medical services. HEMS have developed from militarybased transportation, which used helicopters on the battlefield. HEMS have played an important role in properly transporting critical patients before the golden time elapses. The optimal strategies for the operation of HEMS at any emergency medical system are dependent on the characteristics of the regional emergency medical system, diversitiy of HEMS organizations, and the legal background of each country. Therefore, every participant, including the government, medical personnel, and HEMS organizations, should concentrate their efforts toward the establishment of HEMS. Other than the factors related to patients, the key element in facilitating the establishment of HEMS is the safety of the flight and crew members.

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Resuscitation Potentials in Mass Disasters

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00030314 ◽

1986 ◽

Vol 2 (1-4) ◽

pp. 34-47 ◽

Cited By ~ 33

Author(s):

Peter Safar

Keyword(s):

Infectious Diseases ◽

Emergency Medical Services ◽

Medical System ◽

Medical Services ◽

Nuclear Accidents ◽

Industrial Accidents ◽

Emergency Medical ◽

Mass Disasters ◽

Political Economic ◽

National Disaster

Mass disastersare events which overwhelm, damage or destroy local Emergency Medical Services (EMS) systems, and therefore need the response of a State or National Disaster Medical System (NDMS). Natural mass disasters include major earthquakes, floods, hurricanes and fires. Manmade mass disasters include major fires, industrial accidents, wars, and nuclear accidents. Mass disasters must be distinguished from “multicasualty incidents” (MCI), such as major transportation accidents, which the local EMS system should be able to handle, if necessary, with the assistance of surrounding (regional) EMS systems. Endemic-epidemic disasters (e.g., droughts, famines, infectious diseases, and refugee problems) are catastrophes which deserve separate considerations, as they require ongoing political-economic solutions.

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Outcomes of people with severe hypoglycaemia requiring prehospital emergency medical services management: a prospective study

Diabetologia ◽

10.1007/s00125-019-4933-y ◽

2019 ◽

Vol 62 (10) ◽

pp. 1868-1879 ◽

Cited By ~ 1

Author(s):

Melanie Villani ◽

Arul Earnest ◽

Karen Smith ◽

Dimitra Giannopoulos ◽

Georgia Soldatos ◽

...

Keyword(s):

Prospective Study ◽

Emergency Medical Services ◽

Severe Hypoglycaemia ◽

Medical Services ◽

Emergency Medical ◽

Prehospital Emergency ◽

A Prospective Study

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Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120953737 ◽

2020 ◽

pp. 147451512095373

Author(s):

Ahmad Alrawashdeh ◽

Ziad Nehme ◽

Brett Williams ◽

Karen Smith ◽

Michael Stephenson ◽

...

Keyword(s):

Myocardial Infarction ◽

Emergency Medical Services ◽

Symptom Onset ◽

St Elevation Myocardial Infarction ◽

Medical Services ◽

Factors Associated ◽

Emergency Medical ◽

History Of ◽

St Elevation ◽

At Home

Objective: The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. Methods: This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011–January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. Results: The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17–176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10–11.83; and 8.02; 3.65–17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. Conclusion: Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient’s decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.

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Temporal Trends and Risk Factors for Delayed Hospital Admission in Suspected Stroke Patients

Journal of Clinical Medicine ◽

10.3390/jcm9082376 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2376

Author(s):

Moritz Kielkopf ◽

Thomas Meinel ◽

Johannes Kaesmacher ◽

Urs Fischer ◽

Marcel Arnold ◽

...

Keyword(s):

Risk Factors ◽

General Practitioner ◽

Time Delay ◽

Emergency Medical Services ◽

Symptom Onset ◽

Temporal Trends ◽

Medical Services ◽

Factors Associated ◽

Emergency Medical ◽

Suspected Stroke

(1) Background: The benefit of acute ischemic stroke (AIS) treatment declines with any time delay until treatment. Hence, factors influencing the time from symptom onset to admission (TTA) are of utmost importance. This study aimed to assess temporal trends and risk factors for delays in TTA. (2) Methods: We included 1244 consecutive patients from 2015 to 2018 with suspected stroke presenting within 24 h after symptom onset registered in our prospective, pre-specified hospital database. Temporal trends were assessed by comparing with a cohort of a previous study in 2006. Factors associated with TTA were assessed by univariable and multivariable regression analysis. (3) Results: In 1244 patients (median [IQR] age 73 [60–82] years; 44% women), the median TTA was 96 min (IQR 66–164). The prehospital time delay reduced by 27% in the last 12 years and the rate of patients referred by Emergency medical services (EMS) increased from 17% to 51% and the TTA for admissions by General Practitioner (GP) declined from 244 to 207 min. Factors associated with a delay in TTA were stroke severity (beta−1.9; 95% CI–3.6 to −0.2 min per point NIHSS score), referral by General Practitioner (GP, beta +140 min, 95% CI 100–179), self-admission (+92 min, 95% CI 57–128) as compared to admission by emergency medical services (EMS) and symptom onset during nighttime (+57 min, 95% CI 30–85). Conclusions: Although TTA improved markedly since 2006, our data indicates that continuous efforts are mandatory to raise public awareness on the importance of fast hospital referral in patients with suspected stroke by directly informing EMS, avoiding contact of a GP, and maintaining high effort for fast transportation also in patients with milder symptoms.

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