The Potential of Multi-rotor Drone to Strengthen Emergency Medical Service System: a preliminary study in a Chinese county

Objective: To explore the feasibility and advantage of using multi-rotor drones in a county emergency medical service system.Methods: This study was conducted in Changxing County, Zhejiang Province from January to September 2018. We applied drones to simulate the transfer of first aid materials from health centers to the Changxing County People's Hospital. A total of 3 indicators were obtained: (1) The flight time of the drone; (2) The estimated time of ambulance dispatched from the county hospital was measured by Baidu map, Amap and Tencent map software; (3) The road transportation time measured by Amap software at 0: 00, 8: 00, 10:00, 12:00, 14:00, 16:00, 18:00, 20:00.Results: A total of 10 health centers were included in this study. Linear distance from county people's hospital to these centers was (10.97±3.59) km, and the road distance was (13.61±4.95) km. (2) The flight time of drones were (16.35±5.15) min, less than road transportation time measured by Amap, Baidu, and Tencent map software, which was (21.40±5.15) min, (22.50±6.11) min, (22.00±5.23) min, respectively (P＜0.01). The road transportation time measured using Amap software was longer than that of drones from 0:00 to 20:00 (P＜0.01), with the maximum time of (27.80±6.12) min at 18:00, and the minimum time of (21.40±5.15) min at midnight. Drones could save up to 14.07 min at most and 2.8min at least, with an average save of (7.98±1.32) min.Conclusions: Drone was faster than road transportation to transfer first aid medical supplies within a county. Further researches are needed to integrate drone into emergency medical service system.

Outcome of Stroke Fast-Track Patients Arrival by Emergency Medical Services

Objective: To compare duration of door to needle time (DTN) of stroke patients between patients delivered to hospital by a stroke fast-track emergency medical system (SEFT) and those who came to hospital by a non-stroke EMS fast-track service (SNEFT) or, by themselves. Materials and Methods: Retrospective descriptive study to compare the outcomes of stroke fast track patients. Results: The present study retrieved medical records of 177 stroke fast track patients came to Khon Kaen hospital between October, 2018 and August, 2020. Over half the patients were male (60.5%). Ninety-nine (55.90%) came to hospital by Stroke EMS Fast Track (SEFT) and 78 (44.10%) by themselves or via Stroke Non-EMS Fast Track (SNEFT). The mean age of the SEFT and SNEFT groups was 62.11+13.63 and 59.37+15.39 years, respectively. Results showed the SEFT group had mean times door to CT, door to laboratory, door to physician, and door to needle of 16.53+4.63, 30.57+9.87, 33.99+15.16 and 45.37+7.91 minutes, respectively. Duration to treatment for all of the four treatment phases was statistically significantly shorter in the SEFT group than in the SNEFT group (p<0.001). Conclusion: The SEFT group had significantly shorter door to CT, door to lab, door to physician, and door to needle time than SNEFT group. Keywords: Stroke fast track, Emergency medical service system, Duration to treatment

Spatial accessibility to emergency care in Sichuan province in China

Timely access to emergency care can substantially improve overall population’s health outcomes. However, currently existed evidence focusing on access to emergency care in China remains insufficient. A better understanding of emergency care from the perspective of spatial accessibility is therefore essential to assist in future healthcare planning. This study provided a brief introduction to the emergency medical service system of China, and assessed the spatial accessibility of emergency care as well as its associated social-economic characteristics based on Sichuan province. Based on populational and hospital administrative data in 2018, we employed the nearest-neighbor method to measure the spatial accessibility while identifying its associated social-economic factors via conventional Ordinary Least Square (OLS) model. The shortest travel time analysis reported a relatively high level of overall spatial accessibility to emergency care in Sichuan. However, substantial geographical disparity in accessibility could nevertheless be observed throughout the province, with the eastern area presenting much higher accessibility than the western area. Regression results suggested that county-level discrepancies in accessibility could be significantly attributed to the variance in local economic development, urbanization level and administrative area. These findings indicated that long-term efforts need to be made by central government on optimizing the allocation of healthcare resources, as well as on fortifying financial support and providing preferential policies for economically disadvantaged regions.

Intubation during a medevac flight: safety and effect on total prehospital time in the helicopter emergency medical service system

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.

Pattern and Outcomes of Injuries among Trauma Patients in Gedeo Zone, Dilla, South Ethiopia: A 5 Years Retrospective Analysis

BACKGROUND: Injury has become a life threatening community health problem associated with significant mortality and morbidity worldwide. The aim of this study was to assess the burden of injury in Dilla University Hospital.METHODS: Institution-based retrospective cross-sectional study was conducted from January 2015 to June 2019. Data was collected using questionnaire adapted from WHO injury surveillance guideline. Bivariate and multivariate logistic regressions were performed to determine the factors associated with hospital mortality.RESULTS: Road traffic accident was the commonest cause of injury 178(47.3%) followed by interpersonal violence 113(30.1%). Revised trauma score (RTS) < 10 (AOR=2.5; 95% CI, 1.8-25.6), Glasgow coma scale (GCS) (AOR =0.3; 95% CI, 0.13-0.5), length of hospitalization (LOS) 1-7 days (AOR=0.1; 95% CI, 0.01-0.8) and time of arrival >24hr were predictors of mortality in a patient with injury.CONCLUSION: Lower extremity injury was common and mostly associated with RTA. Pre-hospital emergency medical service system and trauma registry need to be established to decrease the burden of injury.

Out-of-Hospital Cardiac Arrest Response to a Pregnant Woman by the 119 Emergency Medical Service System: A Case Study

When a pregnant woman experiences cardiac arrest, resuscitation is of the utmost importance. Cardiac arrest in pregnant women differs from cardiac arrest in the general population since both mother and fetus need to be taken into consideration. In the event of cardiac arrest, determining whether to deliver the baby is significant. Cardiopulmonary resuscitation is not always successful, and the survival rate depends on the speed and precision of the procedure. In this study, we focus on the case of a 30-year-old pregnant woman who experienced cardiac arrest and whose family was quick to perceive her condition and call the hospital. A witness performed initial cardiopulmonary resuscitation, while rescue workers performed the advanced procedure. In this case, the patient and baby received proper treatment and left the hospital after six days. It is extremely rare for a pregnant patient to achieve return of spontaneous circulation (ROSC) or receive advanced cardiac life support before reaching the hospital. However, the woman in question in this study achieved ROSC and received both cardiopulmonary resuscitation before reaching the hospital and advanced cardiac life support at the hospital. The specifics of the case are reported in the context of a literature review.