Qualitative Theme Analysis on Perception of Practice Scope among Emergency Medical Service Providers: Focused on Registered Nurses

This study aims to explore how emergency medical service (EMS) providers with registered nurses perceive their practice scope in Korea. This qualitative study analyzed the interview data of nine EMS providers with registered nurses using Braun and Clarke’s thematic analysis. Three themes and 10 subthemes were revealed. Theme 1 was “not clearly knowing the scope.” They perceived their scope as similar to that of a first-grade emergency medical technicians (EMTs), as wider than that of EMTs' scope, as focused on the controversial scope, it is determined according to the medical director. Theme 2 was “anxiety and distrust.” They were concerned whether they can be protected legally by the practice guideline, showed no confidence in the legal protection of the practice guideline, and were confused about their professional identity. Theme 3 was “different strengths in practices.” They reported that EMTs are more experienced and skillful in the prehospital field, as nurses lack education on prehospital emergency. However, they have different strengths from the beginning such as patient’s care. For ensuring stability of and consistency in the provided service, the practice scope of EMS providers with registered nurses needs to be clearly stipulated.

Factors Affecting the Retention of Thai Paramedics in Emergency Medical Service

Objective: To study the factors related to the rate of retention of Thai paramedics working in emergency medical service (EMS). Materials and Methods: Data were collected from paramedics all-over Thailand who decided to renew their 5-year license and were registered with the National Institute for Emergency Medicine (NIEMS). The present study was a cross-sectional study. Questionnaires were sent out between March 1 and March 31, 2021 via email, using Google forms. Results: Three hundred eighty-two questionnaires were sent, and 281 responses (74%) were obtained. Most were female (61.9%). The average age was 26.09±4.44 years. Median employment period was two years. At present, 89% of the cohort were still working as paramedics. The majority expect to continue the job for more than 10 years (41.6%). Factors affecting the retention rate were having an income of more than 15,000 Baht per month. The retention rate for the higher earning group was 11.27 times greater (adjusted OR 11.27, 95% CI 4.37 to 29.09, p<0.001) than those earning less than 15,000 Baht per month. In addition, as the mean professionalism score increased, the retention rate increased 3.63 times (adjusted OR 3.63, 95% CI 1.53 to 8.60, p=0.003). Conclusion: Remuneration and professionalism were the two factors related to the retention of the Thai paramedics in EMS. Perceived challenges to retention include professional council establishment and the Health Profession Act. Keywords: Emergency Medical Service; Paramedics; Retention

Helicopter emergency medical service for time critical interfacility transfers of patients with cardiovascular emergencies

Background The goal of improving quality through centralisation of specialised medical services must be balanced against potential harm caused by delayed access to emergency treatments in rural areas. This study aims to assess the duration of transfers of critically ill patients with cardiovascular emergencies from smaller hospitals to major medical centres by a helicopter emergency medical service (HEMS) in Switzerland. Methods This retrospective observational cohort study includes all consecutive emergency interfacility transfers (IFTs) conducted by Switzerland’s largest HEMS provider between July 3rd, 2019, and March 31st, 2021. All patients with acute myocardial infarction, non-traumatic strokes, ruptured aortic aneurysms, and other acute vascular emergencies were included. The duration and distance of each HEMS IFT were compared to calculated distances and duration of travel for the same missions using ground-based transportation (GEMS). The ground-based mission distance beyond which the total mission duration of HEMS is expected to be faster than GEMS was calculated. Findings A total of 645 patients were transferred for stroke (n = 364), myocardial infarction (n = 252) and other acute vascular emergencies (n = 29). The median total mission duration from emergency call to landing at the destination was 59.9 (IQR 51.5 to 70.5) minutes. The median road distance for the same missions was 60 (IQR 43 to 72) km. Regression analysis revealed that HEMS is expected to be faster if the road distance is more than 51.3 km. Interpretation Centralisation of specialised medical services should be accompanied by a comprehensive and specialised rescue chain. HEMS in Switzerland ensures time-sensitive IFT in medical emergencies, even in topographically challenging terrain. Graphical Abstract

Haemodynamic effects of a prehospital emergency anaesthesia protocol consisting of fentanyl, ketamine and rocuronium in patients with trauma: a retrospective analysis of data from a Helicopter Emergency Medical Service

ObjectivesPrehospital rapid sequence induction (RSI) of anaesthesia is an intervention with significant associated risk. In this study, we aimed to investigate the haemodynamic response over time of a prehospital RSI protocol of fentanyl, ketamine and rocuronium in a heterogeneous population of trauma patients.Design, setting and participantWe performed a retrospective study of all trauma patients who received a prehospital RSI for trauma by a physician staffed Helicopter Emergency Medical Service in the UK between 1 June 2018 and 1 February 2020.Primary outcome measurePrimary outcome was defined as the incidence of clinically relevant hypotensive (systolic blood pressure (SBP) or mean arterial pressure (MAP) >20% below baseline, with an absolute SBP <90 mm Hg or MAP <65 mm Hg) or hypertensive (SBP or MAP >20% above baseline) episodes in the first 10 minutes post-RSI.ResultsIn total, 322 patients were included. 204 patients (63%) received a full-dose induction of 3 μg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium, whereas 128 patients (37%) received a reduced-dose induction. Blood pressures decreased on average 12 mm Hg (95% CI 7 to 16) in the full-dose group and 6 mm Hg (95% CI 1 to 11) in the reduced-dose group, p=0.10). A hypotensive episode (mean SBP drop 53 mm Hg) was noted in 29 patients: 17 (8.3%) receiving a full dose and 12 (10.2%) receiving a reduced-dose induction, p=0.69. The blood pressure nadir was recorded on average 6–8 min after RSI. A hypertensive episode was present in 22 patients (6.8%). The highest blood pressures were recorded in the first 3 min after RSI.ConclusionPrehospital induction of anaesthesia for trauma with fentanyl, ketamine and rocuronium is not related to a significant change in haemodynamics in most patients. However, a (delayed) hypotensive response with a significant drop in SBP should be anticipated in a minority of patients irrespective of the dose regimen chosen.

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.