Self-Reported Violence Experienced by Swiss Prehospital Emergency Care Providers

Background. Workplace violence is a serious and increasing problem in health care. Nevertheless, only few studies were carried out concerning this topic and then mainly in English-speaking countries. The objectives were to describe the acts of violence experienced by prehospital emergency care providers (PECPs) in the western part of Switzerland between January and December 2016 and to assess the consequences for subsequent PECPs behaviors. Methods. An observational cross-sectional study, carried out using an online survey, has been sent to all 416 PECPs in the Canton of Vaud, in the western, French-speaking, part of Switzerland. The survey contained items of demographic data and items to assess the type and consequence of violence sustained. This was classified as five types: verbal assault, intimidation, physical assault, sexual harassment, and sexual assault. Results. 273 (65.6%) PECPs participated in the survey. During 2016, workplace violence was reported by 229 survey participants (83.9%). Most declared to be the victim of such violence between one and three times during the year. In all cases of violence described, the patient and/or a relative initiated aggressive behavior in 96% of cases. Verbal assaults were the most common (99.2% of all acts), followed by intimidation (72.8%), physical assault (69.6%), and sexual harassment (16.3%). Concerning physical assault, PECPs were predominantly victims of spitting and/or jostling (50%). After a violent event, in 50% of cases, the PECPs modified their behavior owing to the experience of workplace violence; 82% now wear protective vests, and 16% carry weapons for self-defense, such as pepper sprays. Seventy-five percent changed their intervention strategies, acting more carefully and using verbal de-escalation techniques or physical restraints for violent patients. Conclusions. Workplace violence is frequent and has significant consequences for PECPs. In order to increase their own security, they increased their protection. These results illustrate their feelings of insecurity, which may have deleterious effects on work satisfaction and motivation. Trial Registration. Our article does not report the results of a health care intervention on human participants.

Apart from the Medical Complaints, Why do Patients Use Emergency Medical Services? Results of a Patient Survey

Introduction Many countries face an increased use of emergency medical services (EMS) with a decreasing percentage of life-threatening complaints. Though there is a broad discussion among experts about the cause, patients' self-perceived, non-medical reasons for using EMS remain largely unknown. Methods The written survey included EMS patients who had≥1 case of prehospital emergency care in 2016. Four German health insurance companies sent out postal questionnaires to 1312 insured patients. The response rate was 20%; 254 questionnaires were eligible for descriptive and interferential analyses (t-tests, chi2-tests, logistic models). Results The majority of respondents indicated that their EMS use was due to an emergency or someone else’s decision (≥84%; multiple checks allowed); 56% gave need for a quick transport as a reason. Other frequently stated reasons addressed the health care system (e. g., complaints outside of physicians’ opening hours) and insecurity/anxiety about one’s state of health (>45% of the respondents). “Social factors” were similarly important (e. g., 42% affirming, “No one could give me a ride to the emergency department or doctor’s office.”). Every fifth person had contact with other emergency care providers prior to EMS use. Respondents negating an emergency as a reason were less likely to confirm wanting immediate medical care on site or quick transports compared to those affirming an emergency. Patients using EMS at night more often denied having an emergency compared to patients with access to care during the day. Conclusion The study identified a bundle of reasons leading to EMS use apart from medical complaints. Attempts for needs-oriented EMS use should essentially include optimization of the health care and social support system and measures to reduce patients’ insecurity.

Using the South African Triage Scale for prehospital triage: a qualitative study

Background Triage is a critical component of prehospital emergency care. Effective triage of patients allows them to receive appropriate care and to judiciously use personnel and hospital resources. In many low-resource settings prehospital triage serves an additional role of determining the level of destination facility. In South Africa, the Western Cape Government innovatively implemented the South African Triage Scale (SATS) in the public Emergency Medical Services (EMS) service in 2012. The prehospital provider perspectives and experiences of using SATS in the field have not been previously studied. Methods In this qualitative study, focus group discussions with cohorts of basic, intermediate and advanced life support prehospital providers were conducted and transcribed. A content analysis using an inductive approach was used to code transcripts and identify themes. Results 15 EMS providers participated in three focus group discussions. Data saturation was reached and four major themes emerged from the qualitative analysis: Implementation and use of SATS; Effectiveness of SATS; Limitations of the discriminator; and Special EMS considerations. Participants overall felt that SATS was easy to use and allowed improved communication with hospital providers during patient handover. Participants, however, described many clinical cases when their clinical gestalt triaged the patient to a different clinical acuity than generated by SATS. Additionally, they stated many clinical discriminators were too subjective to effectively apply or covered too broad a range of clinical severity (e.g., ingestions). Participants provided examples of how the prehospital environment presents additional challenges to using SATS such as changing patient clinical conditions, transport times and social needs of patients. Conclusions Overall, participants felt that SATS was an effective tool in prehospital emergency care. However, they described many clinical scenarios where SATS was in conflict with their own assessment, the clinical care needs of the patient or the available prehospital and hospital resources. Many of the identified challenges to using SATS in the prehospital environment could be improved with small changes to SATS and provider re-training.

Accessibility Assessment of Prehospital Emergency Medical Services considering Supply-Demand Differences

The reasonable accessibility assessment method is an important basis for the measurement of the level of prehospital emergency medical services. There is no general model for prehospital emergency care in traditional accessibility evaluation, and its supply-demand characteristics have also been ignored. Based on the three-step floating catchment area (3SFCA) model, the supply-demand three-step floating catchment area (SD3SFCA) model is proposed in this paper, which can express the difference between supply and demand of prehospital emergency medical services and accurately simulate unified dispatching of emergency centers. The unified dispatching behavior of emergency centers is simulated based on the potential service capacity of emergency stations with a supply-demand difference. The supply capacity of different emergency facilities is quantified from the perspective of infrastructure and technical quality. The needs of typical population densities are taken into account and adjusted by the weighting index. The validity of the model is verified, with the prehospital emergency medical service in the West Coast New District of Qingdao as an example. The results show that the model can effectively measure the accessibility level of prehospital emergency services and truly reflect the characteristics of supply and demand. Compared with previous models, the model has been significantly improved, which can provide an important reference for optimizing the allocation of prehospital emergency resources.

Critical Care Retrieval in the Middle East: Descriptive Analysis of a Multidisciplinary Adult Critical Care Transfer and Retrieval Service in Qatar

Introduction The regionalisation of critical care resources has led to an increase in the need to transfer patients between facilities. The advent and implementation of critical care transfer and retrieval services have been the bridge to this divide, lying at the confluence of prehospital emergency care, in-hospital emergency medicine, and intensive care. Within the State of Qatar, the concept of critical care transfer and retrieval is a relatively new. Consequently, we conducted a retrospective cross-sectional study of all transfer and retrieval activity of a dedicated multidisciplinary transfer and retrieval service to better understand the use of these services in the region. Methods Extracted patient care record data were analysed and described using univariate and multivariate descriptive statistics. A log-binomial regression model with robust variance estimator was used to calculate crude and adjusted prevalence ratios for intubation status and arteriovenous access; and intubation status and medication combination, adjusting for age and gender for each model. Results Amongst the completed cases, the majority were male (60.39%), and within the 40-59 (27.7%) age group. Amongst the cases transferred, those with a primary respiratory pathology were the most common (19.59%), followed by cardiovascular patients (18.5%). Half of all patients had a self-maintained airway (51.6%), followed by a third who had an endotracheal tube in situ (36.74%). Midazolam was the most common hypnotic administered (51.27%), as was Fentanyl (88.02%) amongst the analgesic medications, and Noradrenaline amongst the inotropes (72.77%). Intubated patients had the highest proportion of severe and critical patients; patients transported with a Doctor; patients with multiple routes of arterial and/or venous access; and patients receiving any hypnotic, analgesic or inotrope, or a combination thereof. Conclusion The transfer and retrieval of critical care patients across Qatar is a relatively common occurrence. Variations in patient type and severity and the expectations of the transfer team, are significant. Variation in airway type and ventilation modalities, types and combinations of hypnotic, analgesic and inotropes used, and the multitude of arteriovenous access points observed in this study directly contributed towards the complexity of moving these patients from one facility to another.

A smartwatch as a rhythm monitor in prehospital emergency care

Background A ubiquitous, portable rhythm monitor would be potentially useful in out of hospital emergencies. Smartwatches with ECG capability (SW-ECG) can obtain a single lead ECG similar to lead I. Purpose We propose a new method to use the SW-ECG to monitor cardiac rhythm when attending cardiac emergencies in the prehospital setting Methods The SW-ECG is used as shown in the figure. The explorer grabs the left hand of the patient and the back of the watch and touches the face of the patient with the watch crown. A record of the difference of potential between the head and the left arm is obtained. The EC lead so formed (head – left arm (HL)) is quite similar to lead I, and can be used to explore the cardiac rhythm in a patient. In 15 volunteers we recorded the I and HL leads using an SW-ECG. The records were compared for diagnostic accuracy. Results In all cases, the records were qualitatively similar (see figure). There was an excellent correlation between the heart rate measured by the two procedures (R2=0,92). All the abnormalities present in lead I (1 case AF, 1 case RBBB, 1 case LBBB, 1 case frequent premature ventricular contractions) were also evident in the HL lead. The mean time required to obtain a diagnostic record was 3.9 seconds. Conclusion We propose a quick, simple method to use the SW-ECG to assess heart rhythm in out of hospital emergencies. SW-ECG FUNDunding Acknowledgement Type of funding sources: None.

Perceived Use of Health Care Service: Barriers to Access Prehospital Care in Jimma City, Oromia Region of Ethiopia

Background: African nations experience a significant proportion of the global burden of death and disability. The provision of prehospital emergency care has been shown to partially reduce excess morbidity and mortality. However, access to prehospital care in Africa is still limited. This study sought to identify barriers to access prehospital care in the city of Jimma, Ethiopia.Methods: This is an interview-based qualitative study of key prehospital stakeholders in Jimma, conducted in February 2018. A purposive sample of individuals from the community and local ambulance organizations was selected for interviews. Interviews were conducted in local languages, translated into English, and then coded for consistent themes. Results: All respondents felt that prehospital care was difficult to access and therefore infrequently utilized. This was due to a combination of a limited number of ambulances, the lack of a toll-free emergency number, the lack of a single organized EMS system, a lack of uniform prehospital care protocols, inconsistent and limited training of ambulance crews, public mistrust of the existing system, poor road infrastructure, and limited public understanding of the role of prehospital care. Respondents suggested that establishment of a formalized prehospital care system, investment in infrastructure, establishment of a toll-free emergency number, public awareness campaigns, and more widely available emergency medical training were feasible solutions to these current barriers to access.Conclusion: Multiple barriers to accessing prehospital care were identified in Jimma. Establishing a formalized, well-resourced prehospital system in parallel with improving community capacity and knowledge building were suggested solutions to improve access. Hence, interventions to improve prehospital emergency care delivery should ideally target these identified barriers and proposed solutions.