Incidence and Mortality of Emergency Patients Transported by Emergency Medical Service Personnel during the Novel Corona Virus Pandemic in Osaka Prefecture, Japan: A Population-Based Study

Although the COVID-19 pandemic affects the emergency medical service (EMS) system, little is known about the impact of the COVID-19 pandemic on the prognosis of emergency patients. This study aimed to reveal the impact of the COVID-19 pandemic on the EMS system and patient outcomes. We included patients transported by ambulance who were registered in a population-based registry of patients transported by ambulance. The endpoints of this study were the incident number of patients transported by ambulance each month and the number of deaths among these patients admitted to hospital each month. The incidence rate ratio (IRR) and 95% confidence interval (CI) using a Poisson regression model with the year 2019 as the reference were calculated. A total of 500,194 patients were transported in 2019, whereas 443,321 patients were transported in 2020, indicating a significant decrease in the number of emergency patients transported by ambulance (IRR: 0.89, 95% CI: 0.88–0.89). The number of deaths of emergency patients admitted to hospital was 11,931 in 2019 and remained unchanged at 11,963 in 2020 (IRR: 1.00, 95% CI: 0.98–1.03). The incidence of emergency patients transported by ambulance decreased during the COVID-19 pandemic in 2020, but the mortality of emergency patients admitted to hospital did not change in this study.

Prevalence of pain, analgesic self-medication and mental health in German pre-hospital emergency medical service personnel: a nationwide survey pilot-study

Purpose The aim of this study was to estimate the prevalence of pain, the extent of analgesics intake and the mental health status of German pre-hospital emergency medical service (EMS) personnel. Methods We conducted a nationwide online survey, which consisted of sociodemographic and job-related items, questions on pain and analgesics intake and the short-version of the validated Depression–Anxiety–Stress Scale (DASS-21). Results A total of 774 EMS personnel with a mean age of 33.03 (standard error [SE] 0.37) years were included into the final analysis of which 23.77% were female. Pain was reported by 58.64% (454 of 774) of the study participants with 10.72% (95% confidence interval [CI] 8.54%; 13.29%) suffering from chronic, 1.68% (95% CI 0.89%; 2.87%) from acute and 46.25% (95% CI 41.49%; 51.30%) from recurrent pain, respectively. Most frequent location of pain was lumbar spine. Analgesics were used by 52.76% (239 of 454) of pre-hospital EMS personnel with pain (acute 76.92% / chronic 69.88% / recurrent 47.90%). Moreover, participants with chronic and recurrent pain indicated significantly higher depression (p ≤ 0.001), anxiety (p ≤ 0.001), and stress (p ≤ 0.001) levels compared to those without pain, respectively. Conclusion This study indicates a high prevalence of pain and analgesics usage in participating German pre-hospital EMS personnel and a poorer mental health in those with chronic and recurrent pain. Therefore, disease prevention and health promotion measures are needed to preserve health of pre-hospital EMS personnel.

The knowledge of triage system in disaster among emergency medical service personnel at Saudi Red Crescent Authority in Riyadh city stations

PurposeSimple Triage and Rapid Treatment (START) is a unique triage system used by prehospital providers during disasters to quickly categorize and prioritize patient care according to severity. This study aims at evaluating knowledge about the START triage system among field emergency medical service (EMS) personnel working at the Saudi Red Crescent Authority (SRCA) in the stations of the city of Riyadh.Design/methodology/approachThis is a cross-sectional study that examined data collected from August 2019 to January 2020. The statistical population is from all field EMS personnel working in the SRCA located in Riyadh, Saudi Arabia. Using simple random sampling, 239 field EMS personnel were assessed, and 235 completed the study (98.3% response rate). Data were collected electronically using demographics and 15 multiple choice emergency scenarios based on the START protocol.FindingsThe mean correct score is 8.21 ± 3.36 out of 15 questions of triage knowledge (score of 0–15 points), indicating that those respondents have moderate knowledge levels on the START triage tool. Physicians and paramedics have higher mean scores (10.13 ± 3.42 and 9.07 ± 3.22, respectively), which are significantly higher than emergency medical technicians and nurses (7.25 ± 3.15 and 5.63 ± 2.72, respectively; p < 0.05). The providers who attended the training course had higher mean scores (p < 0.05).Originality/valueBased on the results of the study, field EMS personnel did not reflect full knowledge of START triage tool. An interdisciplinary approach that adopts reinforcement education and periodical training courses is highly recommended to improve the respondents' performance and productivity. Moreover, there was a noticeable correlation between performance of respondents on the one hand and their education levels and prior training on the other hand.

A prehospital diagnostic algorithm for strokes using machine learning: a prospective observational study

High precision is optimal in prehospital diagnostic algorithms for strokes and large vessel occlusions (LVOs). We hypothesized that prehospital diagnostic algorithms for strokes and their subcategories using machine learning could have high predictive value. Consecutive adult patients with suspected stroke as per emergency medical service personnel were enrolled in a prospective multicenter observational study in 12 hospitals in Japan. Five diagnostic algorithms using machine learning, including logistic regression, random forest, support vector machine, and eXtreme Gradient Boosting (XGBoost), were evaluated for stroke and subcategories including acute ischemic stroke (AIS) with/without LVO, intracranial hemorrhage (ICH), and subarachnoid hemorrhage (SAH). Of the 1446 patients in the analysis, 1156 (80%) were randomly included in the training cohort and 290 (20%) were included in the test cohort. In the diagnostic algorithms for strokes using XGBoost had the highest diagnostic value (test data, area under the receiver operating curve [AUROC] 0.980, confidence interval [CI; 0.962–0.994]). In the diagnostic algorithms for the subcategories using XGBoost had a high predictive value (test data, AUROC [CI], AIS with LVO 0.898 [0.848–0.939], AIS without LVO 0.882 [0.836–0.923], ICH 0.866 [0.817–0.911], SAH 0.926 [0.874–0.971]). Prehospital diagnostic algorithms using machine learning had high predictive value for strokes and their subcategories.

Factors associated with difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases: A nationwide population-based observational study

Although it is essential to shorten the interval to initial treatment in the care of acute ischemic stroke, some hospitals in Japan reject requests for hospital acceptance from on-scene emergency medical service personnel because of limited resources, which can cause delays in care. We aimed to assess the risk factors for difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases. We conducted a retrospective analysis of the national ambulance records of the Fire and Disaster Management Agency in Japan in 2016. Multivariable logistic regression analysis was used to assess the association between difficulty of hospital acceptance of patients suspected to have cerebrovascular diseases and prehospital factors. During the study period, a total of 222,926 patients were included, and 5283 patients (2.4%) experienced difficulties in hospital acceptance. In multivariable analysis, nights (adjusted odds ratio [AOR] 1.54, 95% confidence interval [CI] 1.45–1.64), weekends (AOR 1.32, 95% CI 1.24–1.40), <25 percentile ratio of emergency physicians and neurosurgeons to all physicians (AOR 1.13, 95% CI 1.03–1.23) (AOR 1.36, 95% CI 1.25–1.48), and mean age of physicians (AOR 1.06, 95% CI 1.05–1.07) were significantly associated with difficulties of hospital acceptance of patients suspected to have cerebrovascular disease. There was a marked regional variation in the difficulties of hospital acceptance. Among the national ambulance records of patients suspected to have cerebrovascular diseases, certain prehospital factors such as weekends were positively associated with difficulty of hospital acceptance. A comprehensive strategy for hospital acceptance of patients with cerebrovascular diseases considering regional variation is required.

Cervical Spine Immobilization in Patients With a Geriatric Facial Structure: The Influence of a Geriatric Mandible Structure on the Immobilization Quality Using a Cervical Collar

Introduction: Demographic changes have resulted in an increase in injuries among geriatric patients. For these patients, a rigid cervical collar is crucial for immobilizing the cervical spine. However, evidence suggests that patients with a geriatric facial structure require a different means of immobilization than patients with an adult facial structure. This study aimed to analyze the remaining motion of the immobilized cervical spine based on facial structure. Materials and Methods: This study was performed on 8 fresh human cadavers. Facial structure was evaluated via ascertaining the mandibular angle by computer tomography. A mandibular angle below 130°, belongs to the adult facial structure group ( n = 4) and a mandibular angle above 130°, belongs to the geriatric facial structure group ( n = 4). The flexion and lateral bending of the immobilized cervical spine were analyzed in both groups using a wireless motion tracker system. Results: A flexion of up to 19.0° was measured in the adult facial structure group. The mean flexion in the adult vs. geriatric facial structure groups were 14.5° vs. 6.5° (ranges: 9.0-19.0 vs. 5.0-7.0°), respectively. Thus, cervical spine motion was ( p = 0.0286) significantly more reduced in the adult facial structure group. No ( p = 0.0571) significant difference was oberserved in the mean lateral bending of the adult facial structure group (14.5°) compared to the geriatric facial structure group (7.5°). Conclusion: Emergency medical service personnel should therefore follow current guidelines and recommendations and perform cervical spine immobilization with a cervical collar, including in patients with a geriatric facial structure.