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Kang, Kyunghee. "Analyzing the Frequency of Emergency Room Visits and the Use of 119 Ambulance Services." Fire Science and Engineering 34, no. 5 (October 31, 2020): 104–11. http://dx.doi.org/10.7731/kifse.2c0009d5.
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This study aimed to the socioeconomic and clinical characteristics associated with the use of 119 ambulance/private cars and the number of emergency room visits based on the 2017 data from the Korea Health Panel. The analysis revealed that during emergencies, the use of private cars (59.02%) was more common than 119 ambulance services (18.89%). Moreover, 119 ambulance users were significantly older, had a lower annual total household income, and had relatively more accidents than diseases when compared to private car users. On comparing the number of emergency room visits between single and multiple visits, there were statistically significant differences in age, total annual household income, season of use, and reasons for use for private car usage than 119 ambulances. The 119 ambulance service is an essential public safety net. Therefore, it is increasingly important to solve the frequent use of 119 ambulances by non-emergency patients, and efficiently utilize limited ambulance resources.
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Sari, Nita. "Pendayagunaan Dana ZIS Untuk Operasional Ambulance Gratis Di BAZNAS Rembang." ZISWAF : Jurnal Zakat dan Wakaf 5, no. 1 (May 17, 2018): 63. http://dx.doi.org/10.21043/ziswaf.v5i1.3509.
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<p><em><span>The purpose of this study is to find out how the utilization of zakat, infaq and alms in BAZNAS Rembang for free ambulance operation and to know the obstacles and solutions in the implementation of free ambulance operational program in BAZNAS Rembang. </span><span style="font-family: Calibri;"><span style="font-size: medium;"><span title="Penelitian ini menggunakan metode kualitatif dijabarkan secara deskriptif dengan pendekatan penelitian lapangan (field research).">This research uses qualitative method described descriptively with field research approach (field research). </span><span title="Hasil penelitian menunjukkan bahwa dana ZIS di BAZNAS Rembang diberdayakan melalui program santunan anak yatim dan fakir miskin, perkembangan Islam, beasiswa pendidikan, rehap rumah tidak layak huni, modal bergulir dan ambulance beserta operasionalnya secara gratis.">The results show that ZIS funds in BAZNAS Rembang are empowered through the program of orphan and poor benefit, the development of Islam, educational scholarship, rehap house unfit for habitation, revolving capital and ambulance and its operation for free. </span><span title="Adapun pendayagunaan dana ZIS untuk operasional ambulance gratis di BAZNAS Rembang meliputi sopir, bahan bakar, oli, biaya jalan tol, cuci mobil, penggantian suku cadang, perpanjang STNK, service, dan biaya perbaikan bila terjadi kecelakaan.">The utilization of ZIS fund for free ambulance operation in BAZNAS Rembang includes driver, fuel, oil, toll road cost, car wash, replacement of spare parts, renewal STNK, service, and repair cost in case of accident. </span><span title="Kendala dan solusi dalam pelaksanaan program operasional ambulance gratis di BAZNAS Rembang adalah pendistribusian mobil ambulance yang belum merata, solusi yang harus dilakukan yaitu meningkatkan fundraising dana ZIS untuk menambah jumlah ambulance.">Constraints and solutions in the implementation of the free ambulance operational program in BAZNAS Rembang is the uneven distribution of ambulance cars, the solution that must be done is to increase fundraising of ZIS funds to increase the number of ambulances.</span></span></span></em></p>
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Singh, Uttkarsh Kumar, Sahil Yadav, Sonali Joshi, Stuti Singh, and Kayalivizhi Jayavel. "RescueAlert-an accident detection and rescue mechanism." International Journal of Electrical and Computer Engineering (IJECE) 11, no. 4 (August 1, 2021): 3356. http://dx.doi.org/10.11591/ijece.v11i4.pp3356-3364.
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With the increase of vehicles and cars of different kind and the large movement that occurs every day on the roads it was natural to observe an increase in traffic accidents, but the real dilemma lies in how to make the rescue process efficient. The problem that we want to solve is the response of ambulances towards accidents and the lengthy registration process of patients in hospitals. In the above two scenarios, the manual process of calling the ambulance leads to delay in rescue of patients from an accident and the delay in registration of patient leads to delay in medication or treatment of the patient. We want to make the process more efficient by automating accident detection for increasing the efficiency of the ambulance rescue process and by sending the details of the patient before the patient reaches the hospitals for faster treatment of patients. Along with this, alert messages will be sent to the family or friends of the patients to notify them as soon as an accident is detected.
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Marozas, Raimondas, Rytis Rimdeika, Nedas Jasinskas, Eglė Vaitkaitienė, and Dinas Vaitkaitis. "The ability of Lithuanian ambulance services to provide first medical aid in trauma cases." Medicina 43, no. 6 (June 11, 2007): 463. http://dx.doi.org/10.3390/medicina43060057.
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Objective. To evaluate the ability of country ambulance services to provide first medical aid in trauma cases. Material and methods. A survey of chiefs of emergency medicine service was performed in October–November 2005, in which 34 of the 59 institutions (58%) were participating. The questionnaire presented questions concerning physical and human resources, performance values, and system configuration. The study has shown that emergency medicine service operates in radius of 23 km, each team providing service for about 40 000 inhabitants. Taking into consideration distance and average on-scene time values, emergency medicine service is capable to render the first medical aid within so-called “golden hour” in case the accident is reported immediately. The physical resources are not quite complete. Not all the cars are equipped with essential first aid measures. Among more rarely found resources are vacuum pumps, intubation sets, defibrillators, vacuum splints, back immobilization devices, and hammock immobilization devices. There are less mentioned resources than working teams and even more than two times less than emergency cars at all. Two-thirds of the operating emergency medicine services do not provide advanced life support procedures. The evaluation of theoretical/practical ability to provide some important medical procedures used in emergency medical care showed that medical staff quite often fails to perform defibrillation, intubation, and pleural cavity drainage. Conclusions. Country ambulance service network configuration according to area under service, number of people served, and response frequency comply with the requirement set. The ambulance vehicles lack complete set up as well as some important supplies. Only rarely the staff is skilled enough to perform such advanced life support procedures as intubation, defibrillation, and pleural drainage.
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Puspita, Kumara, Samriananda Septiyani, and I. Gde Sandy Satria. "EFEKTIVITAS TIM ESCORT SEBAGAI PEMBUKA JALAN AMBULANS DI INDONESIA." Jurnal Hukum Bisnis Bonum Commune 3, no. 2 (July 22, 2020): 189–200. http://dx.doi.org/10.30996/jhbbc.v3i2.3576.
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AbstractThis study aims to identify the formation of the escort team community and the important role of the ambulance escort. Research methods used by researchers are empirical studies by obtaining live data from interviews via social media with escort teams and communities in Indonesia. Research on the role of escort team helps the ambulance travel quickly to the assigned hospital. Early in the development of the escort team in Indonesia, due to people's indifference to the presence of ambulances when the ambulance sirens went off, this caused patients to bet their lives on the streets. Several communities and police departments disagreed on the escort team's presence, as it was in the interest of security and order in police traffic that had the authority to escort ambulances. In this case the host team helps the ambulance, since the ambulance asks escort teams to escort ambulances, for a definite decision or discrete of the police force to provide a specific clearance for the escort team's communities.Keywords: ambulance escort; escort team community; roleAbstrakPenelitian ini bertujuan untuk mengetahui awal terbentuknya komunitas tim escort dan peranan penting dalam melakukan pengawalan ambulans. Metode penelitian yang digunakan peneliti adalah penelitian empiris dengan cara memperoleh data langsung dari hasil wawancara melalui media sosial dengan pihak tim escort dan masyarakat di Indonesia. Melalui penelitian ini peneliti peranan tim escort dapat membantu perjalanan ambulans agar cepat sampai ke rumah sakit yang dituju. Pada awal terbentuknya komunitas tim escort di Indonesia, disebabkan karena ketidakpedulian masyarakat akan keberadaan ambulans ketika sirine ambulans berbunyi, hal ini yang menyebabkan pasien bertaruh nyawa di jalan. Beberapa masyarakat dan pihak kepolisan tidak setuju akan keberadaan komunitas tim escort, karena demi keamanan dan ketertiban dalam berlalu lintas pihak kepolisian yang memiliki wewenang untuk melakukan pengawalan ambulans. Dalam hal ini keberadaan komunitas tim escort sangat membantu pihak ambulans, karena pihak ambulans yang meminta tim escort untuk mengawal ambulans, supaya adanya kepastian diperlukan keputusan atau diskresi kepolisian agar memberikan ketegasan berupa izin khusus untuk komunitas tim escort dalam melakukan pengawalan ambulans.Kata kunci: komunitas tim escort; pengawalan ambulans; peranan
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Davini, Ottavio, Giovanni Digiacomo, Matteo Perusia, Valeria Romano, Chiara Rivoiro, Rosario Servetto, Marika Giacometti, et al. "PP170 Health Impact Assessment Of Teleradiology Programs In Disadvantaged Areas." International Journal of Technology Assessment in Health Care 33, S1 (2017): 144–45. http://dx.doi.org/10.1017/s0266462317002987.
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INTRODUCTION:Within the Home Radiology service of the Piedmont Region - R@dhome (1) - it was decided to employ a mobile radiological service to allow minor radiological procedures to be conducted in rural areas. Cortemilia (average age of population 51.6 years, population over 65 years 33.6 percent) is situated in Piedmont (Langhe region) and it is about 40 kilometers, with bad roads, from the nearest hospital. For this reason it's important to optimize the potential offered by telemedicine. The purpose of R@dhome is to provide simple radiological services (ambulatory) to vulnerable patients in outpatient settings. The aim of this work was to implement an assessment, based on Health Impact Analysis (HIA) (2,3) criteria, of the health intervention provided by the R@dhome service.METHODS:From January 2016 to December 2016 the following were assessed: •number of patients examined in the local radiological ambulatory service•inhabitants opinions (using questionnaires)•General Practitioner, Pharmacist, Family nurse opinions (using semi-structured interviews)•stakeholder opinions (Mayor, local politicians, using semi-structured interviews)•number of cars and ambulances used for the transport of patients to the nearest hospital•number of patients who avoided transportation to the nearest hospital•pollutants PM10 (particle size 10) related to cars and ambulance traffic.RESULTS:Forty percent of people interviewed were more than 60 years old, 76 percent needed x-rays (in 2015), 96.8 percent considered it useful to have a closer x-ray service, only 42 percent had a driver's licence but preferred not to drive; GP's said that 50 percent of local patients had trouble reaching the hospital and that 30 percent of local patients need informal or formal care. From Januay to December 2016 we examined (mainly chest and bone x-rays) in 598 patients using as an alternative to private cars and ambulances the radiological mobile station, and the pollutant emissions were shown to be reduced by 85 percent.CONCLUSIONS:This study has provided a comprehensive HIA report which shows that the R@dhome intervention improves patient's QOL, reduces social costs, reduces the number of patients in the Hospital Radiology Department, reduces rate of hospitalization and pollution.
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Herbert, R. L. "Medical Problems of the Moorgate Underground Disaster." Prehospital and Disaster Medicine 1, S1 (1985): 361–63. http://dx.doi.org/10.1017/s1049023x00045155.
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A few minutes before 9:00 a.m. on Friday 28th February 1975, a call was made to London Ambulance from Moorgate Station, stating nothing more than a train driver had been injured. Some three minutes later, a second call came which indicated that there had in fact, been a major disaster with many casualties. The extent of the casualties and difficulties to be encountered were still not realized, and only when the first of the rescue services and a medical team entered the wreckage was, what was before them was apparent. Three cars containing commuters had been compressed and “concertinaed” into a a blind ending tunnel. Three cars having a combined total length of 150 feet, with a possible total capacity of 440 persons, had been crushed in a tunnel with a maximum length of some 67 feet. Fortunately, despite the time, the cars were not full to capacity, and the total number of injured was only 113.
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Eibicht, S. J., and U. Vogel. "Meticillin-resistant Staphylococcus aureus (MRSA) contamination of ambulance cars after short term transport of MRSA-colonised patients is restricted to the stretcher." Journal of Hospital Infection 78, no. 3 (July 2011): 221–25. http://dx.doi.org/10.1016/j.jhin.2011.01.015.
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Çalışkan, Cüneyt, Aysun Algan, Hüseyin Koçak, Burcu Küçük Biçer, Meltem Şengelen, and Banu Çakir. "Preparations for Severe Winter Conditions by Emergency Health Personnel in Turkey." Disaster Medicine and Public Health Preparedness 8, no. 2 (April 2014): 170–73. http://dx.doi.org/10.1017/dmp.2014.28.
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AbstractObjectiveEmergency and core ambulance personnel work under all environmental conditions, including severe weather condtions. We evaluated emergency medical personnel in Çanakkale, Turkey, for their degree of preparedness.MethodsA descriptive study was conducted in Çanakkale, Turkey, within 112 emergency service units and their 17 district stations. Surveys were developed to measure the level of preparedness for serious winter conditions that individual workers made for themselves, their homes, and their cars.ResultsOf the 167 survey participants, the mean age was 29.8 ± 7.9 years; 52.7% were women; more than half (54.75%) were emergency medical technicians; and 53.3% were married. Only 10.4% of those who heated their homes with natural gas had carbon monoxide detectors. Scores relating to household and individual preparation for severe winter conditions increased by participants’ age (P < .003), being married (P < .000) and working in the city center (P < .021); and for men whose cars were equipped with tow ropes, extra clothing, and snow tires (P < .05). Absenteeism was higher for central-city personnel than district workers because they were less prepared for harsh winter conditions (P = .016).ConclusionMany of the surveyed emergency health personel demonstrated insufficient preparations for serious winter conditions. To increase the safety and efficiency of emergency medical personnel, educational training programs should be rountinely conducted. (Disaster Med Public Health Preparedness. 2014;0:1-4)
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Breeman, Wim, Mark G. Van Vledder, Michael H. J. Verhofstad, Albert Visser, and Esther M. M. Van Lieshout. "First attempt success of video versus direct laryngoscopy for endotracheal intubation by ambulance nurses: a prospective observational study." European Journal of Trauma and Emergency Surgery 46, no. 5 (February 19, 2020): 1039–45. http://dx.doi.org/10.1007/s00068-020-01326-z.
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Abstract Purpose The aim of this study was to compare the rate of first attempt success of endotracheal intubation performed by ambulance nurses in patients with a Glasgow Coma Scale (GCS) of 3 using video laryngoscopy versus direct laryngoscopy. Methods A prospective cohort study was conducted in a single, independent ambulance service. Twenty of a total of 65 nurse-staffed ambulances were equipped with a video laryngoscope; a classic direct laryngoscope (Macintosh) was available on all 65 ambulances. The primary outcome was first attempt success of the intubation. Secondary outcomes were overall success, time needed for intubation, adverse events, technical or environmental issues encountered, and return of spontaneous circulation (ROSC). Ambulance nurses were asked if the intubation device had affected the outcome of the intubation. Results The first attempt success rate in the video laryngoscopy group [53 of 93 attempts (57%)] did not differ from that in the direct laryngoscopy group [61 of 126 (48%); p = 0.221]. However, the second attempt success rate was higher in the video laryngoscopy group [77/93 (83%) versus 80/126 (63%), p = 0.002]. The median time needed for the intubation (53 versus 56 s) was similar in both groups. Ambulance nurses more often expected a positive effect when performing endotracheal intubation with a video laryngoscope (n = 72, 81%) compared with a direct laryngoscope (n = 49, 52%; p < 0.001). Conclusion Although no significant effect on the first attempt success was found, video laryngoscopy did increase the overall success rate. Ambulance nurses had a more positive valuation of the video laryngoscope with respect to success chances.
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Damir, Elena. "Pre-Hospital Intensive Therapy in Severe Trauma." Journal of the World Association for Emergency and Disaster Medicine 1, no. 2 (1985): 158. http://dx.doi.org/10.1017/s1049023x00065407.
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The organization of medical facilities in the USSR is able to provide adequate and rapid care, including intensive therapy in prehospital conditions for the whole population of a very big country. The principles of organization are very simple: the country is divided into regions and these into districts. Each district has to have a fixed number of hospital beds, stations for first aid and urgent care, and a determined number of physicians, and medical assistants (feldshers, nurses and others). The only difference between the emergency care in Moscow and Northern Siberia or Pamir is the distance to be travelled and the means of transport, i.e., modern first-aid cars, helicopters, planes or boats; or reindeer or dog teams when the weather makes aviation impossible. As a rule, all medical teams working in emergency medicine include physicians and medical assistants. Only in places where the population is very sparse are some emergencies still managed by only medical assistants at the pre-hospital stage.In cases of severe trauma we prefer, when possible, to have teams especially trained in shock treatment. These are already available in the emergency ambulance systems of the bigger towns. These so-called “shock-teams” are experienced and well equipped for intensive therapy at the accident site and with problems occurring during transport. When necessary, we are now able to transport critically ill or traumatized patients not only inside the hospital, but also from one hospital to another, when better intensive therapy can be obtained.
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Alfith, Alfith, and Kartiria Kartiria. "Development and Designing Smart Traffic Light with Xbee Pro." MATEC Web of Conferences 215 (2018): 01009. http://dx.doi.org/10.1051/matecconf/201821501009.
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The main function of the highway are used as a means to facilitate transportation, but today is often challenging due to all road users wanting more quickly reach its destination and precede each other. On the other hand, there is also a special car or entourage effect on traffic density, which in turn impact on congestion. To cope with this is actually the duty of the Traffic Police is not every day got in the way to manage traffic and will not be able to count the number of passing vehicles. To direct the traffic at any place such as a T-junction, an intersection, or intersection five solid pace of the traffic, the necessary traffic arrangements multifunctional tool called Smart Traffic Light. Called smart because the traffic light is deemed able to overcome three problems, such detect traffic density which affects the green light sensor uses the object infrared, able to detect the presence of specific signal from cars special like ambulance or fire engine or police or the like are automatically will change traffic lights red to green light using the XBee wireless module Pro and GPS, and seeks the traffic lights stay lit even though the supply of PLN extinguished using a spare battery. The system is capable of regulating the rate of traffic by arranging alternately road vehicle that passes a certain spot every day for nearly 24 hours a day and on these tools need to pair every day.
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Kresal, Friderika, Tine Bertoncel, and Maja Meško. "Psychosocial Factors in the Development of Low Back Pain Among Professional Drivers." Organizacija 50, no. 2 (May 1, 2017): 151–62. http://dx.doi.org/10.1515/orga-2017-0010.
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Abstract Background and purpose: Professional drivers as a group are exposed to high risk of developing low back pain due to ergonomic factors and work conditions. The purpose of the study was to examine to what extent the low back pain occurs among Slovene professional drivers as a result of the development of various psychosocial factors. Methodology: The study involved 275 respondents (professional bus drivers, car/van drivers, international truck/lorry drivers, and ambulance car drivers). Hypotheses were tested using multivariate statistical method (regression analysis) and analysis of variance. Data were collected by structured questionnaire comprised of three parts: socio-demographic data, basic psychosocial factors causing low back pain, and incidence, duration and severity of low back pain as a result of psychosocial risk factors, was implemented. Results: The results of quantitative survey suggest that low back pain is mostly caused by lifting and carrying heavy loads, inadequate working conditions, poor physical fitness, regular nights out, shift work, and stress. Only the impact of gender on low back pain distress among professional drivers was confirmed, predominantly among bus drivers and lorry drivers on international routes. Low back pain occurrence was less common, albeit not statistically significant, among professional drivers of vans and passenger cars. Conclusion: Our study suggests that psychosocial factors are also important cause for the development of low back pain among professional drivers and can limit the quality of their social and professional lives.
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Dawson, A. D. G., and P. C. B. Babington. "An Intensive Care Trolley — An Economical and Versatile Alternative to the Mobile Intensive Care Unit." Anaesthesia and Intensive Care 15, no. 2 (May 1987): 229–33. http://dx.doi.org/10.1177/0310057x8701500218.
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The concept of a mobile intensive care unit is not new. However, most of those described require modification of the ambulance which is to carry the equipment. We describe a lightweight, self-contained intensive care trolley which will fit into any of the front-line ambulances at present in service in our district.
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Larmann, Jan, Frank Vescia, and Bernhard Zwißler. "Ambulante Anästhesie - Risikomanagement in der ambulanten Anästhesie." AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 48, no. 03 (April 15, 2013): 180–91. http://dx.doi.org/10.1055/s-0033-1342904.
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Scheuber, Karin, and Karin Becke. "Ambulante Anästhesie - Kinder in der ambulanten Anästhesie." AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 48, no. 03 (April 16, 2013): 192–99. http://dx.doi.org/10.1055/s-0033-1342905.
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Lindridge, Jaqualine, Kevin Reynard, Rob Kemp, Richard Brownhill, and Jerry Penn-Ashman. "PP31 Ambulance handover: a thematic review of delays in 2018/19." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e14.2-e14. http://dx.doi.org/10.1136/emermed-2020-999abs.31.
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BackgroundAmbulance handover delays are an important indicator of an emergency care system under pressure. Delayed handovers compromise patient safety in the Emergency Department (ED). As a direct consequence patients wait longer for an emergency ambulance response, and as a result patient safety in the community is also compromised. We explored factors perceived to contribute to ambulance handover delays at EDs in an urban area of England, in order to inform delay reduction strategies.MethodsFifteen EDs were visited as part of a regional improvement programme. Ambulance handover processes were observed, and staff involved in the process were informally interviewed. A data corpus of twenty-nine written reports was generated. These reports were anonymised and thematic analysis was used inductively to explore the phenomenon of ambulance handover delay. Pattern coding was used to identify and cluster common themes, with magnitude coding added to identify the most prevalent themes.ResultsPerceived reasons for ambulance handover delay arose from a number of factors. A mismatch was frequently seen between handover capacity and demand. This occurred alongside, but was also frequently observed to be independent of, ED exit block. Approaches to escalation were often sub-optimal. This was observed both before and after an ambulance queue developed. Processes were often uneconomical by design, and pathways were frequently inefficient. Inter-professional culture was identified as an important, cross-cutting theme, with a lack of urgency to release ambulances frequently observed.ConclusionsOur results suggest several factors influence ambulance handover delays. Programmes which aim to improve overall hospital flow, streamline pathways and processes, and improve escalation are needed. Programmes should also seek to improve the inter-professional culture relating to ambulance handover. Limitations to this enquiry include an opportunistic, retrospective approach and use of a convenience sample. There are few empirical studies which address the causes of ambulance handover delay. More research is needed on this important patient safety issue.
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McClelland, Graham, Karl Charlton, Jacqueline Mains, Karen Millican, and Caroline Cullerton. "OP5 A two armed, randomised, controlled exploratory study of adding the ambugard cleaning system to normal deep cleaning procedures in a regional ambulance service." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e4.1-e4. http://dx.doi.org/10.1136/emermed-2020-999abs.5.
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BackgroundAmbulance services transport patients with infections and diseases and could pose a cross transmission risk to patients and staff through environmental contamination. The literature suggests that environmental pathogens are present on ambulances, cleaning is inconsistent and patient/staff impact is difficult to quantify. Eco-Mist developed a dry misting decontamination system for ambulance use called AmbuGard which works in <30 minutes and is 99.9999% effective against common pathogens. The research question is ‘What pathogens are present on North East Ambulance Service ambulances and what impact does adding the AmbuGard to the deep cleaning process make?’MethodsA two armed, randomised controlled trial enrolled fourteen ambulances during their regular 24 week deep clean which were 1:1 randomised to deep cleaning (control arm) or deep cleaning plus AmbuGard (intervention arm). Polywipe swabs were taken before and after cleaning from five locations selected for high rates of contact (steering wheel, shelf, side door grab rail, patient seat armrest, rear door handle/grab rail). Microbiology culture methods identified the presence and amount of bacterial organisms present including the selected pathogens: Enterococcus spp.; Enterobacter spp.; Klebsiella spp.; Staphylococcus aureus; Acinetobacter spp.; Pseudomonas spp.; Clostridium difficile; coagulase-negative staphylococci (CoNS)). The researcher taking the swabs and the laboratory were blinded to the trial arm.ResultsPathogens of interest were found on 10 (71%) vehicles. CoNS were found on all vehicles. Pathogens were found on all locations swabbed. Normal deep cleaning was effective at eliminating pathogens and the addition of AmbuGard showed no obvious improvement in effectiveness.ConclusionPathogens associated with healthcare acquired infections were found throughout all ambulances. Normal deep cleaning was effective and adding AmbuGard showed no obvious improvement. This was a small study at a single point in time. Further research is needed into temporal trends, how to reduce pathogens during normal clinical duties and patient/staff impact.
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Englbrecht, Jan, and Esther Pogatzki–Zahn. "Ambulante Schmerztherapie – Optimierung der Schmerztherapie nach ambulanten Operationen." AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 45, no. 01 (January 2010): 44–55. http://dx.doi.org/10.1055/s-0029-1243378.
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Xia, Tianqi, Shuzhe Huang, Xuan Song, Ruochen Si, Xiaoya Song, Ryosuke Shibasaki, and Kyoung-Sook Kim. "Evaluating transport time in emergency medical service via GIS: an observational study of Tokyo." Abstracts of the ICA 1 (July 15, 2019): 1–2. http://dx.doi.org/10.5194/ica-abs-1-408-2019.
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<p><strong>Abstract.</strong> Emergency medical service (EMS) is one kind of medical services which focuses on providing first-time rescue to victims of sudden and life-threatening emergencies. Since a lot of studies have pointed out a close relation between the increase of cost time before the patient accommodated to the hospital and the increased risk of mortality, a reasonable distribution of EMS facilities can shorten the transportation time from the scene to the hospital and is critical to ensure the quality of the EMS system.</p><p>With the development of geographic information science and technology, GIS provides the visualization and analysis approaches for the distribution of the EMS cases, ambulance cars and hospitals as well as the ability of measuring road network distance, which results in the popularity of research with GIS based analysis approaches in the field of public health and EMS system. Despite of the prosperity in such kind of studies, most of them focused on evaluating EMS system by observational case analysis while paying less attention on the emergency medical resource distribution.</p><p>With the concerns we mentioned above, this research conducts spatial and temporal analysis for evaluating the transportation time via several GIS methods and take the EMS cases in Tokyo 23 wards as a case study. In addition to the observational studies with EMS case data and several spatial and temporal factors, we pay more attention on evaluating the distribution of cases and hospitals from both sides of demand and supplement. In addition, we also check several assumptions that are widely used in accessibility analysis on public health. As far as we know, our work is first research on detailed hospital distribution analysis in Tokyo area based on observations.</p><p>
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Berry, Steve. "Use Cop Cars- Ambulances-for Crime Fighting." JEMS: Journal of Emergency Medical Services 31, no. 5 (May 2006): 178. http://dx.doi.org/10.1016/s0197-2510(06)70409-0.
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Williams, Victoria, Yvette LaFlamme-Williams, Katie McNee, Heather Morgan, Zoe Morrison, Henry WW Potts, Debbie Shaw, et al. "PP18 Implementation of electronic patient clinical records in ambulances in the UK: a national survey." Emergency Medicine Journal 36, no. 1 (January 2019): e7.3-e8. http://dx.doi.org/10.1136/emermed-2019-999.18.
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BackgroundThe roll-out of electronic Patient Clinical Records (ePCR) across UK ambulance services has been an important aspect of modernisation. Electronic Records in Ambulances (ERA) is a two-year study which aims to describe the opportunities and challenges of implementing ePCR and associated technology in emergency ambulances.Our study includes a baseline survey of progress implementing ePCR in all UK ambulance services providing a snapshot of current usage.MethodsWe carried out semi-structured telephone interviews with information managers in each ambulance service in the UK. We asked them about the systems in use, the process and current stage of implementation and explored the perceived value of using ePCR. If services did not use ePCR we asked about plans for future introduction.The interviews were transcribed and thematically analysed, by three members of the research team.ResultsWe completed interviews with 22 managers from 13 services. Implementation varied across the UK. Seven services were using electronic records. Four services had adopted electronic records but, at the time of interview, had reverted to paper with the intention of implementing a new ePCR. Two services still used paper but hoped to move to ePCR in the future. Those who had fully implemented ePCR reported mixed success in terms of staff compliance, and in realising the potential benefits offered by ePCR to link with primary and secondary care.Reported benefits of ePCR were largely associated with improved data management for audit and record keeping. Potential improvements to patient care were discussed, but tended to be associated with future planned developments.ImplicationsImplementation of ePCR has proved challenging with wide variation in use between ambulance services. Progress has been erratic, rather than linear, demonstrated by difficulties that services experienced putting ePCR into practice. There is potential for ambulance services in the earlier stages of implementation to learn from the experiences of others.
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Aziz, Shadman, Aditi Nijhawan, Samantha Palfreyman-Jones, and Chris Hartley-Sharpe. "PP28 Volunteer emergency responder response to the COVID-19 pandemic surge." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A12.2—A12. http://dx.doi.org/10.1136/emermed-2021-999.28.
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BackgroundThe London Ambulance Service (LAS) runs an Emergency Responder (ER) scheme, where trained volunteers respond to 999 calls in blue-light rapid response vehicles (RRVs), alongside the statutory ambulance service response.The COVID-19 pandemic caused an unprecedented surge in call volume which, combined with reduced staffing of double-crewed ambulances (DCAs) due to illness, severely impaired the service’s ability to respond to calls.In response to this, as well as increasing volunteer RRV shifts, ERs were given additional up-skill training to work with regular ambulance service clinicians on DCAs, thus increasing the number of DCAs available to attend calls.This study aims to review the response to the COVID-19 pandemic provided by ERs.MethodA retrospective review was conducted of all ER shifts on volunteer RRVs and the service’s front-line DCAs. Data from the same time period (March 1 – April 30) was compared between 2019 (pre-pandemic period) and 2020 (pandemic period). The statistical significance of proportions was calculated using the χ2 test.ResultsThe absolute number of RRV hours volunteered by ERs increased by 34.2% (2,017 to 2,707), resulting in a 21.2% increase in RRV shifts (227 to 275) during the pandemic period. Furthermore, the proportion of C1 (life-threatening) incidents attended by ER RRVs doubled (32.4% vs 61.1%, p < 0.0001). In addition to RRV shifts, ERs volunteered 1,222 hours on DCAs during the pandemic, resulting in 125 additional DCA resources available. The combined total hours provided by ERs (RRV/DCA) increased by 94.8% (2,017 to 3,929).DiscussionVolunteer responders are a valuable resource during times of surge. In addition to volunteer RRV shifts, they have to the potential to assist ambulance service clinicians on DCAs. Future pandemic or winter-pressure plans should incorporate volunteer responders. This study predominantly looked at volunteer capacity, and further work is required to investigate patient-centred outcomes.
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Porter, Alison, Sarah Black, Jeremy Dale, Robert Harris-Mayes, Robin Lawrenson, Ronan Lyons, Suzanne Mason, et al. "PP32 Electronic records in ambulances – an observational study (ERA)." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e14-e14. http://dx.doi.org/10.1136/emermed-2019-999abs.32.
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BackgroundThe introduction of information technology (IT) in emergency ambulance services to electronically capture, interpret and store patient data can support out of hospital care. Although electronic health records (EHR) in ambulances and other digital technology are encouraged by national policy across the UK, there is considerable variation across services in terms of implementation. We aimed to understand how electronic records can be most effectively implemented in a pre-hospital context, in order to support a safe and effective shift from acute to community-based care.MethodsWe conducted a mixed-methods study with four work packages (WPs): a rapid literature review, a telephone survey of all 13 freestanding UK ambulance services, detailed case studies in four selected sites, and a knowledge sharing workshop.ResultsWe found considerable variation in hardware and software. Services were in a state of constant change, with services transitioning from one system to another, reverting to paper, or upgrading. Ambulance clinicians were dealing with partial or unclear information, which may not fit comfortably with the EHR. Clinicians continued to use indirect data input approaches such as first writing on a glove. The primary function of EHR in all services seemed to be as a store for patient data. There was, as yet, limited evidence of their full potential being realised to transfer information, support decision making or change patient care.ConclusionsRealising the full benefits of EHR requires engagement with other parts of the local health economy, dealing with the challenges of interoperability. Clinicians and data managers are likely to want very different things from a data set, and need to be presented with only the information that they need.
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Amalia, Nur Virda, Ratna Puji Priyanti, and Pepin Nahariyani. "EFEKTIVITAS PENGGUNAAN AMBULANCE SIAGA DESA DALAM TRANSPORTASI PRE HOSPITAL." Jurnal Ilmiah Keperawatan (Scientific Journal of Nursing) 4, no. 1 (March 10, 2018): 52–63. http://dx.doi.org/10.33023/jikep.v4i1.135.
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Keterbatasan kebutuhan transportasi pre hospital, baik pada masyarakat perkotaan atau pedesaan. Antara lain masyarakat di pedesaan masih sering menggunakan transportasi yang tidak layak di gunakan untuk prehospital ( sepeda motor, becak montor dll). Dengan demikian resiko untuk cidera lebih besar. Jombang sudah ada ambulance siaga desa untuk membantu masyarakat perjalanan dalam transportasi pre hospital. Tujuan penelitian ini adalah ini untuk mengetahui bagaimana efektivitas pengunaan Ambulance siaga desa terkait dengan transpotasi pre hospital.
Desain penelitian menggunakan kualitatif dengan pendekatan fenomenologi, dengan informan kepala desa, petugas kesehatan, dan saudara pengguna ambulance siaga desa dan masyarakat yang tidak menggunakan ambulance siaga desa. Metode pengambilan sample menggunakan purposive sampling. Instrumen penelitian yang utama adalah peneliti sendiri, cara pengambilan data dengan observasi, interview dan dokumentasi. Cara pengolahan data Reduction, data display, conclusion drawing / verification. Keabsahan data menggunakan triangulasi dan membercheck.
Dari hasil penelitian didapatkan tema penggunaan ambulance siaga desa dalam prehospital care di masyarakat dengan sub tema transportasi,waktu kunjungan ke rumah sakit; tema penanganan keluarga saat membawa pasien ke rumah sakit dengan sub tema pendamping,tindakan dan penanganan dan tema penggunaan ambulance dengan sub tema pengoprasian, alur penggunaan, administrasi ambulance siaga desa.
Dapat di simpulkan sesuai dengan tema dan sub tema bahwa ambulance siaga desa sudah mencakup kebutuhan masyarakat akan transportasi prehospital, namun untuk perawatan atau penanganan pre hospital dan penggunaan ambulance siaga desa belum mampu terwujud dengan baik, selain itu di karenakan administrasi yang belum jelas dan alur penggunaan ambulance siaga desa.hal lain di sebabkan kurang pelatihan dan administrasi belum baik.
Kata Kunci : Penggunaan, Ambulance Siaga Desa, Pre Hospital.
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Rao T, Sudheendra. "Use of Point of Care Testing in Ambulance on Hypoglycemic Patients during an Ambulance Call in Relation to Diagnostic Efficiency: An Observational Study." Indian Journal of Emergency Medicine 6, no. 2 (June 1, 2020): 91–94. http://dx.doi.org/10.21088/ijem.2395.311x.6220.7.
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Sticher, J., and C. Hempelmann. "Anästhesiologisches Management bei ambulanten Operationen - Patientenauswahl, Prämedikationsvisite, Anästhesieverfahren, postoperative Phase und Entlassung, Arbeitsplatz „Ambulante Anästhesie”." AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 32, no. 11 (November 1997): 687–98. http://dx.doi.org/10.1055/s-2007-995137.
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Vopelius-Feldt, Johannes von, Gavin Perkins, and Jonathan Benger. "PP15 Association between admission to a cardiac centre and survival to hospital discharge for adults following out-of-hospital cardiac arrest." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A7.2—A7. http://dx.doi.org/10.1136/emermed-2021-999.15.
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BackgroundSurvival following out-of-hospital cardiac arrest (OHCA) depends on the Chain of Survival, which spans from bystander cardio-pulmonary resuscitation to in-hospital treatment. There is an increased interest in regionalisation of post-OHCA care, which includes ambulances bypassing the nearest hospital in favour of OHCA centres. This study examined the association between admission to OHCA centres and survival to hospital discharge for adults following OHCA of presumed cardiac aetiology.MethodsWe undertook a multicentre retrospective observational study of patients transferred to hospital after OHCA of presumed cardiac aetiology in three ambulance services in England. We used propensity score matching to compare rates of survival to hospital discharge in patients admitted to OHCA centres (defined as either 24/7 PPCI availability or >100 OHCA admissions per year) to rates of survival of patients admitted to non-centres.ResultsBetween January 2017 and December 2018, 10,650 patients with OHCA were included in the analysis. After propensity score matching, admission to a hospital with 24/7 PPCI availability or a high-volume centre was associated with an absolute improvement in survival to hospital discharge of 2.5% and 2.8%, respectively. The corresponding odds ratios and 95% confidence intervals were 1.69 (1.28 to 2.23) and 1.41 (1.14 to 1.75), respectively. The results were similar when missing values were imputed. In subgroup analyses, the association between admission to an OHCA centre and improved rates of survival was mainly seen in patients with OHCA due to shockable rhythms, with no or minimal potential benefit for patients with asystole as first presenting rhythm.ConclusionsFollowing OHCA, admission to an OHCA centre is associated with a moderate improvement in survival to hospital discharge. A corresponding bypass policy would need to consider the resulting increased workload for OHCA centres and longer ambulance transfer times.
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Warren-James, Matthew, Julie Hanson, Belinda Flanagan, Mary Katsikitis, and Bill Lord. "OP08 Levels and sources of stress reported by first year paramedic students associated with their first ambulance placement." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A4.2—A4. http://dx.doi.org/10.1136/emermed-2021-999.8.
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BackgroundWhilst there is evidence to suggest paramedics experience significant stress when working in the ambulance setting little is known about the experiences of first year paramedic students. This research aimed to: (i) identify whether levels of stress, anxiety and depression experienced by first year paramedic students changed after ambulance placement compared to a control group, and (ii) identify the main perceived and actual sources of stress around ambulance placement.MethodsA before-and-after quasi-experimental design was used to compare whether the experience of ambulance placement altered the levels of stress, anxiety and depression in an experimental group that attended an ambulance placement (n = 20) and the control group who did not (n = 10). Online surveys encompassing the Depression, Anxiety and Stress Scale (DASS-21) and qualitative questions about sources of stress were concurrently deployed to both the experimental and control groups before and after the ambulance placement. Participants were first year paramedic students working in Queensland Ambulance Service, Australia.ResultsThere was a significant reduction in levels of stress in participants after undertaking their first ambulance placement (Mdn = -4.00) when compared to a control group (Mdn = 0.00), U = 52.5, p = .035, n2 = 0.15. Responses to survey questions suggest anticipation about experiencing death and dying of patients was the most frequently reported stressor of student paramedics before undertaking ambulance placements, however insecurity about knowledge, competence and fear of failure was the most frequently experienced stressor reported after completing ambulance placements.ConclusionsThe findings from this study suggest that the fear of the unknown may be worse than the reality. Anticipatory stress is the foremost problem for first year paramedic students attending their first ambulance placement. Placement pre-briefing should focus on educational interventions to build knowledge and skills competency to reduce stress levels and fear of failure.
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Paykov, V. L., E. I. Zamaleeva, D. A. Zhukov, and O. L. Chernova. "Alcohol intoxication: evaluation of the population appealability and emergency medical care in Kazan." Kazan medical journal 98, no. 2 (April 15, 2017): 243–47. http://dx.doi.org/10.17750/kmj2017-243.
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Aim. To study population appealability for emergency medical care with alcohol intoxication as well as the features of medical care service for them in Kazan at modern stage.
Methods. The data from emergency call cards from 2015 with the diagnosis «alcohol intoxication» (form No.11/u) were studied. A survey of 271 responders (medical personnel of mobile teams of emergency care and admission departments of the hospitals) of medical care service for people with alcohol intoxication in the streets was performed.
Results. In the structure of performed calls for adult popultion the ratio of patients who called an ambulance because of alcohol intoxication was 2.1% and because of the need for urgent care - 5.7%. Males were more prevalent than females: 82.1 and 17.9% respectively. Predominantly people younger than 60 years appealed: among males 82.7%, among females - 79%. Maximum appealability was registered in July (7.4 calls per 10 000 adults); during the week - on Saturday (11.9 per 10 000 adults), and during the day - during the period from 5 to 6 pm. The survey of the teams of ambulances and admission departments demonstrated the need for re-establishment of medical sobering-up stations (83.5 and 80% respectively) and more rarely the responders suggested development of specialized medical departments and active delivery of people with alcohol intoxication to specialized institutions involving law enforcement officials and personnel of specialized sobering-up stations (13 and 14.3% respectively).
Conclusion. In the structure of the calls performed by emergency care stations the ratio of patients who called an ambulance because of alcohol intoxication among adults was 2.1% and because of the need for urgent care - 5.7%; the appealability was affected by sex, age and calendar time; analysis of the survey results demonstrated the need for re-establishment of recently closed medical sobering-up stations and for development of specialized medical departments.
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Coster, Joanne, Alicia O’Cathain, and Jon Nicoll. "PP36 Using linked health data to explore compliance with and appropriateness of ambulance telephone advice." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e17-e17. http://dx.doi.org/10.1136/emermed-2020-999abs.36.
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BackgroundIn England, approximately 10% of patients who contact the ambulance service receive clinical telephone advice rather than a face-to-face ambulance response. This analysis identifies whether patients who receive ambulance telephone advice to attend ED comply with this advice and explores the appropriateness of subsequent ED attendances.MethodsAmbulance CAD, HES (A&E/inpatient) was linked for 2521 hear and treat callers as part of the PhOEBE study. For data linking reasons, the sample includes only patients who had other experiences of contacting the ambulance service. Additional information from the ambulance telephone advice call was linked to the PhOEBE data using the CAD ID and date/time of call. Appropriateness of ED attendances was determined using a method that assesses whether patients receive investigations/treatments in the ED and that appropriateness denotes care that is proportionate to need.ResultsThis analysis is based on 1892/2521 (75%) cases which have both ambulance telephone advice and ED attendance data, as some ambulance advice information was unavailable. 522 patients (28%) attended ED within 3 days of the ambulance call. Of these, 235 were advised by the ambulance service to attend ED. The remaining 287 patients were advised to seek other care, with most advised to seek GP care (n=180). 81.6% of ED attendances were assessed as appropriate. 129 patients were advised to attend ED and did not attend within 3 days.ConclusionsAmbulance telephone advice information was successfully linked to other health-service information. Patients included in this analysis are older and more likely to be sicker than the general hear and treat population, as all had other experiences of using the ambulance service. Most ED attendances were appropriate. Some patients did not comply with advice to attend ED. More research is required to investigate the factors around compliance with advice to attend ED and to find out what happens to these patients.
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Knowles, Emma, Nisar Ahmed, Lindsey Bishop-Edwards, and Alicia O’Cathain. "OP07 Might ambulance service organisational culture affect ambulance non conveyance rates?" Emergency Medicine Journal 34, no. 10 (September 28, 2017): e2.2-e2. http://dx.doi.org/10.1136/emermed-2017-207114.7.
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Knowles, Emma, Neil Shephard, Tony Stone, Lindsey Bishop-Edwards, Enid Hirst, Linda Abouzeid, Suzanne Mason, and Jon Nicholl. "OP5 Closing emergency departments in england (CLOSED): the impact on ambulance services." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e4.1-e4. http://dx.doi.org/10.1136/emermed-2019-999abs.5.
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BackgroundIn recent years a number of Emergency Departments (EDs) in England have closed, or been replaced by a lower acuity facility such as an Urgent Care Centre. With further re-organisation of EDs expected, the ‘closED’ study aimed to provide research evidence to inform the public, NHS, and policymakers when considering future closures. Our aim was to understand the impact of ED closure on populations and emergency care providers, the first study to do so in England. In this session I will focus on the impact on the ambulance service.MethodsWe undertook a controlled interrupted time series analysis assessing changes in ambulance service activity, following the closure of Type 1 EDs in England. Data was sourced data from Ambulance service computer-assisted dispatch (CAD) records. The resident catchment populations of five EDs, closed between 2009 and 2011, were selected for analysis. Five control areas were also selected. The primary ambulance outcome measures were: ambulance service incident volumes and mean ‘call to destination’ time.ResultsThere was some evidence of a large increase of 13.9% [95% confidence interval (CI) 3.5% to 24.4%] in the total number of emergency ambulance incidents compared with the control areas. There was an increase of 3.9 minutes (95% CI 2.2 to 5.6 minutes) in the meantime taken from a 999 ‘red’ call being answered to a patient arriving at hospital.ConclusionsGiven such major reorganisation of emergency and urgent care we might expect some changes in emergency and urgency care activity. Our study found some changes in the ambulance service measures. The increase in emergency ambulance incidents, over and above the increase in the control area, suggests that the closure of the EDs in our study may have contributed to an additional increase in workload within the ambulance services in these areas.
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Hughes, G. "Transforming NHS ambulance services." Emergency Medicine Journal 28, no. 9 (July 5, 2011): 734. http://dx.doi.org/10.1136/emj.2011.114926.
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Williams, L., and T. Stephenson. "Prioritisation of ambulance response." Emergency Medicine Journal 13, no. 3 (May 1, 1996): 231. http://dx.doi.org/10.1136/emj.13.3.231-a.
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Gray, A. J., D. Cartlidge, and M. C. Gavalas. "Can ambulance personnel intubate?" Emergency Medicine Journal 9, no. 4 (December 1, 1992): 347–51. http://dx.doi.org/10.1136/emj.9.4.347.
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Miller, Joshua. "‘We wear too many caps’: role conflict among ambulance service managers." British Paramedic Journal 3, no. 4 (January 1, 2019): 44. http://dx.doi.org/10.29045/14784726.2019.03.3.4.44.
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Park, Jeong Ho, Kyoung Jun Song, Sang Do Shin, Young Sun Ro, Ki Jeong Hong, and So Yeon Kong. "Location of arrest and effect of prehospital advanced airway management after emergency medical service-witnessed out-of-hospital cardiac arrest: nationwide observational study." Emergency Medicine Journal 36, no. 9 (July 20, 2019): 541–47. http://dx.doi.org/10.1136/emermed-2018-207871.
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ObjectivesTo investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest.MethodsWe evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest (‘at scene’ or ‘in the ambulance’). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest.ResultsAmong 6620 cases, 1425 (21.5%) cases of arrest occurred ‘at the scene’, and 5195 (78.5%) cases of arrest occurred ‘in an ambulance’. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring ‘at the scene’ and 645 (12.4%) OHCAs occurring ‘in an ambulance’. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery.ConclusionOur data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.
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Mochrie, Tessa, Theresa Foster, Larissa Prothero, and Nigel South. "PP34 The experiences and attitudes of ambulance staff towards the counter-terrorism ‘PREVENT’ training: a survey-based service evaluation." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A14.2—A14. http://dx.doi.org/10.1136/emermed-2021-999.34.
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BackgroundUnderstanding the views and opinions of ambulance clinicians about counter-terrorism is limited, as are the roles they have in identifying individuals vulnerable to radicalisation. The aim of this survey was to investigate ambulance clinician views and preparedness to identify individuals at risk of radicalisation and whether the current national PREVENT training offered is suitable for this clinical setting.MethodsA purpose-designed, 18-question survey, was developed to understand staff attitudes and content knowledge of the national PREVENT training module. The survey was opened to all emergency ambulance clinicians in one UK ambulance service during August 2020, resulting in a sample of 123 responses which were analysed using descriptive and thematic approaches.ResultsMost respondents (87%; n=107) were aware of the PREVENT strategy, with almost three-quarters (73%; n=90) receiving training within the previous three years. Respondents were asked to score training received: the majority (89%; n=110) reported 5/10 or less. Whilst most (79%; n=97) identified the correct way to refer an individual, few had completed a PREVENT referral (9%; n=11). ‘Gut instinct’ was utilised by respondents to support their knowledge obtained via PREVENT training (70%, n=86). Respondents felt the national PREVENT training lacked relevance to their role and recommended ambulance-specific training packages be made available. They recognised their responsibility of identifying radicalisation and the opportunities their unique position offered to do so. Having a ‘duty of care’ and ‘moral responsibilities’ to make PREVENT referrals, and the importance of treating individuals as patients (not criminals), was also highlighted.ConclusionsAmbulance staff have highlighted the importance of a clear and robust referral pathway for individuals vulnerable to radicalisation. Current training lacks specificity and effectiveness for the ambulance service setting. As this survey was limited to one ambulance service, future research is warranted to ensure PREVENT training is appropriate for all ambulance staff.
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Prothero, Larissa, Theresa Foster, Ketan Dhatariya, Andrea Lake, Adrian Boyle, Gerry Rayman, Julia Williams, and Mike Sampson. "PP37 Use of capillary blood ketone meters to improve ambulance service care of hyperglycaemic patients: protocol for a stepped-wedge, controlled feasibility study (KARMA2)." Emergency Medicine Journal 38, no. 9 (August 19, 2021): A15.3—A16. http://dx.doi.org/10.1136/emermed-2021-999.37.
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BackgroundDiabetic ketoacidosis (DKA) is a potentially life-threatening condition associated with diabetes (Type 1 and Type 2), certain medications (i.e. SGLT2 inhibitors), and other health conditions. Hospital-based guidelines advocate immediate start of intravenous fluid therapy upon DKA diagnosis, which does not reliably happen in the pre-hospital setting. Ambulance clinicians do not routinely have access to ketone meters to determine presence of ketones; they rely on non-specific clinical signs and symptoms for care strategies. The aims of this feasibility study are to determine whether ambulance clinicians can reliably and safely identify patients with DKA using capillary blood ketone meters, commence fluid therapy, and gather necessary study data.MethodsDuring an 8-month period (4-month control: 4-month intervention), 120 ambulance clinicians from one UK ambulance service will receive training to determine presence of ketones using capillary blood testing from 800 consenting patients with hyperglycaemia and unwell patients with diabetes. Subsequent patient care will depend on the ketone value obtained: high-risk DKA patients will receive fluid therapy. Twenty ambulance and hospital clinicians will be invited to an interview to share their views of DKA care and the impact of capillary blood ketone meters.ResultsInformation collated will include completion of study training, patient recruitment, intervention adherence, service call activity, and ambulance and hospital patient clinical data. Prevalence and severity of hyperglycaemia, incidence of DKA and ability of paramedics to commence fluid therapy for DKA will be explored. Quantitative findings will be analysed using descriptive statistics, whilst the qualitative study interviews will be thematically analysed.ConclusionsStudy findings will be used to inform the need and feasibility to proceed to a full stepped-wedge, controlled trial. If warranted, we will develop a research funding proposal evaluating the clinical and cost-effectiveness of ambulance ketone meters and further explore meter provision for improved ambulance patient care.
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Miller, Joshua, and Shaun McBride. "04 ‘What is the rate of general practitioner registration amongst homeless patients who present to an english ambulance service?’." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e3.2-e3. http://dx.doi.org/10.1136/emermed-2020-999abs.4.
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BackgroundMarginalised groups such as homeless people and migrants experience barriers to registration with a general practitioner (GP). While various interventions have been trialed to improve registration rates, the potential for opportunistic interventions through the ambulance service has not yet been considered. The aim of this study was to determine the scope for these interventions by researching the prevalence of GP registration amongst the homeless population that present to a regional English ambulance service that covers both rural and urban areas.MethodsA retrospective search of electronic patient records was carried out for cases where a box for the attending clinician to click to indicate homelessness had been ticked between 1st April 2016 and 30th September 2019. A search of these records for GP registration was then performed.ResultsA total of 14 707 ambulance attendances were marked as being for a homeless patient. 10 511 (71.5%) had a GP recorded, while 4 196 (28.5%) did not. On average, the ambulance service had face-to-face contact with 11.5 homeless patients per day, and 3 face-to-face contacts with patients who did not have GP registration per day.ConclusionThis indicates ambulance services could perform opportunistic interventions to improve GP registration rates amongst the homeless population. The data also suggests that the ambulance service is well-placed to perform other opportunistic interventions targeted at the homeless population.
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Anderson, Natalie Elizabeth, Merryn Gott, and Julia Slark. "Beyond prognostication: ambulance personnel’s lived experiences of cardiac arrest decision-making." Emergency Medicine Journal 35, no. 4 (January 5, 2018): 208–13. http://dx.doi.org/10.1136/emermed-2017-206743.
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IntroductionThe purpose of this study was to explore ambulance personnel’s decisions to commence, continue, withhold or terminate resuscitation efforts for patients with out-of-hospital cardiac arrest.MethodSemistructured interviews with a purposive sample of 16 demographically diverse ambulance personnel, currently employed in a variety of emergency ambulance response roles, around New Zealand.ResultsParticipants sought and integrated numerous factors, beyond established prognostic indicators, when making resuscitation decisions. Factors appeared to be integrated in four distinct phases, described under four main identified themes: prearrival impressions, immediate on-scene impressions, piecing together the big picture and transition to termination of resuscitation. Commencing or continuing resuscitation was sometimes a default action, particularly where ambulance personnel felt the context was uncertain, unfamiliar or overwhelming. Managing the impact of termination of resuscitation and resulting scene of a death required significant confidence, psychosocial skills and experience.ConclusionThis unique, exploratory study provides new insights into ambulance personnel’s experiences of prehospital resuscitation decision-making. Prognostication in out-of-hospital cardiac arrest is known to be challenging, but results from this study suggest that confidence in a poor prognosis for the cardiac arrested patient is only part of the resuscitation decision-making picture. Results suggest ambulance personnel may benefit from greater educational preparation and mentoring in managing the scene of a death to avoid inappropriate or prolonged resuscitation efforts.
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Seema B, Wasnik, Kaur Mohandeep, Dhir Vinod Bala, Mittal Rajishth, Singh Tarundeep, Sikri Himanshu, and Nisha . "A Retrospective Study of Serial Inspection of ACLS Ambulances in a Tertiary Care Facility." Indian Journal of Anesthesia and Analgesia 6, no. 1 (2019): 341–52. http://dx.doi.org/10.21088/ijaa.2349.8471.6119.47.
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Phung, Viet-Hai, Ian Trueman, Fiona Togher, Roderick Ørner, and Niroshan Siriwardena. "PP7 Perceptions and experiences of being a community first responder: interview study." Emergency Medicine Journal 36, no. 1 (January 2019): e3.2-e3. http://dx.doi.org/10.1136/emermed-2019-999.7.
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BackgroundCommunity First Responder (CFR) schemes work with ambulance services, supporting volunteers to respond to medical emergencies. The CFR’s primary role is to stabilise a patient’s condition and perform basic clinical procedures before handing over to statutory ambulance service staff. By early 2014, there were 2,431 CFR schemes, with over 12 000 volunteers in the UK. Despite expansion in numbers and role, little is known about perspectives of CFRs. We aimed to explore the perceptions and experiences of CFRs about their role.MethodsWe used a qualitative design conducting semi-structured interviews with a purposive sample of CFRs from one scheme in one English county. Interviews were transcribed verbatim and coded thematically in NVivo 10 using the Framework approach.ResultsWe interviewed four female and 12 male adult CFRs between June and July 2016. The interviews identified five overarching themes,: ‘getting started and keeping going’; ‘the reality of being a CFR’; ‘recognition and relationships’; ‘learning to be a CFR’; and ‘the way forward’ for CFRs and schemes. Participants were keen to enhance their skills and progress. CFRs felt that the public confused them with ambulance staff, although patients felt reassured by the presence of someone who could help them regardless of who they were. CFRs were keen to raise their profile within the communities they served and to establish a distinct identity. The relationship between CFRs and ambulance staff was ambivalent: sometimes they worked well together while at other times they perceived a poor relationship with ambulance staff.ConclusionThe complex relationship between CFRs, patients and the ambulance service has implications for how such schemes develop in the future. As such, further research is required on public and ambulance staff perceptions of what they do to see how these complex relationships can be harnessed effectively to benefit the communities they serve.
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Barley, Chloé, and Alec Tooms. "02 ‘Have you had the surgery?’: A survey of transgender and non-binary patients’ experiences of interacting with the ambulance service." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e2.2-e2. http://dx.doi.org/10.1136/emermed-2019-999abs.2.
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BackgroundPre-hospital research around the experience of transgender and non-binary (TNB) patients is scarce, with existing articles lacking input from TNB patients. This research aimed to collate TNB patients’ experiences of interacting with the ambulance service. A secondary aim was to gather TNB patients’ opinions regarding the education of ambulance clinicians on TNB health issues.MethodAn online-based, mixed-methods survey was created. A range of free text, multiple choice and Likert-scaled questions were used. Advertisement on social media was tailored to target TNB individuals who have had patient contact with the ambulance service. All respondents were anonymous and voluntary. This survey was conducted by TNB individuals in a personal capacity, without funding.Results72% of the 25 respondents rated their experience as satisfactory or above. 40% reported that identifying as TNB affected the way they were treated and 40% reported that they were asked about their gender by the ambulance crew. In free text answers, the main themes identified were the misidentification of gender, the use of incorrect pronouns, hospital handovers, intrusive/irrelevant questioning and the need for training.ConclusionsThe responses suggest that TNB patients feel that being asked about their gender is important however ambulance staff sometimes struggled to address this sensitively. Positive experiences included having gender and pronouns addressed in hospital handover which can form a recommendation for best practice. Negative experiences were associated with being misgendered, using incorrect pronouns and intrusive/irrelevant questioning. Survey responses led to practical recommendations for ambulance staff interacting with TNB patients, including the authors creating a training session which has received positive feedback from clinicians. Limitations include small sample size, potential for response bias due to survey being self-selecting and missing demographic data. Recommendations for further research are to provide a more in-depth exploration of TNB experience and of ambulance staff views.
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Groom, Nicholas, Sarah Taylor, Ed England, Helen Pocock, and Charles D. Deakin. "PP20 A retrospective service evaluation of the presentation of anaphylaxis to a UK ambulance service." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e9.2-e9. http://dx.doi.org/10.1136/emermed-2019-999abs.20.
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BackgroundThere is a lack of data relating to frequency and presentation of anaphylaxis to the ambulance service in England. Little research exists relating to the patients’ self-treatment of anaphylaxis and there is an absence of evidence to evaluate the impact of self-administered adrenaline, there is a need to describe this patient group to evaluate any potential to develop their care.MethodsRetrospective data were collected from the electronic patient records of a single NHS ambulance service serving a population of approximately four million. Records between 1stApril 2017 and 31st March 2018 were included where a diagnosis of anaphylaxis was recorded. Gender, age, incident location, allergy history, were summarised to identify any trends in presentation. The frequency of patient self-administration, as well as ambulance administration, of adrenaline was also included for analysis to determine any correlation.Results326 records were included in the analysis. The mean, median and modal patient ages were 34, 29 and 20 respectively. Patient ages ranged from six months to 95 years. Patients were 65% female, 35% male and 59% of incidents occurred at home. 76% of patients reported having a known allergy with food being the most common allergen (44%). Peak times for calling 999 were midday and 6pm. 35% of patients had self-administered adrenaline. 52% received ambulance-administered adrenaline. The doses of self-administered adrenaline ranged from 0–3 doses and ambulance administered adrenaline ranged from 0–8 doses. Patients who self-administered adrenaline were less likely to receive further adrenaline from the ambulance service. No correlation was found between the number of self-administered doses and ambulance administered doses.ConclusionPatient demographics such as age, gender and allergies were consistent with two previous small-scale studies. This study suggests that early self-administration of adrenaline is beneficial. Opportunities for improvements in data recording as well as patient education were identified.
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Irving, Andy, Davina Allen, Joanne Blake, Simon Moore, and Steve Goodacre. "PP9 Managing alcohol intoxication in the night-time economy: staff and patient perspectives." Emergency Medicine Journal 36, no. 10 (September 24, 2019): e5.2-e5. http://dx.doi.org/10.1136/emermed-2019-999abs.9.
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BackgroundAlcohol-related harms arising in the Night-Time Economy (NTE) impose a substantial burden on emergency services (ES) especially ambulance services engaged in both street level care and transportation of acutely intoxicated patients to a hospital Emergency Department (ED). Alcohol Intoxication Management Services (AIMS) are intended as an alternative care pathway for intoxicated patients who would normally use emergency services and are often run by ambulance services in partnership with other agencies. Despite growing policy interest in AIMS as an alternative pathway it is not known what their users think of them nor the experiences of frontline staff engaged in and around AIMS.MethodsAs part of a mixed-method study semi-structured interviews were followed by a survey of users recruited from six different AIMS. A parallel ethnographic component used observations and interviews with ambulance staff in two cities with AIMS and one without.ResultsSurveys and interviews found AIMs users retrospectively viewed the decision to take them to AIMS favourably and highly rated the care they received, especially the friendly, non-judgemental atmosphere created between ambulance staff and other agents involved in AIMS. A majority of AIMS survey respondents said they would not have called emergency services (85%) or gone to the ED (75.6%). Ethnographic work showed ambulance personnel considered AIMS to have a positive impact on ES, freeing capacity to attend to other emergencies. Ambulance staff without AIMS worked to avoid conveyance to ED but this could result in extended periods risk assessing individuals at street level, which meant they felt unavailable to address other emergency calls.ConclusionsAIMS are viewed very positively by their users and the ambulance staff involved. Findings from surveys, interviews and ethnography suggest that AIMS and EDs are managing different patient groups in different ways, and thus may represent complementary rather than competing alternatives care pathways.
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Phung, Viet-Hai, Zahid Asghar, Milika Matiti, and Niro Siriwardena. "PP14 Improving access to, and experience of, ambulance care for eastern european migrants: a paramedic interview study." Emergency Medicine Journal 37, no. 10 (September 25, 2020): e8.1-e8. http://dx.doi.org/10.1136/emermed-2020-999abs.14.
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BackgroundThe UK has experienced significant immigration from Eastern Europe following European Union (EU) expansion in 2004. Lincolnshire is a predominantly rural county in the East Midlands region of the UK with a large Eastern European migrant population requiring healthcare, including urgent ambulance care. The Equality Act 2010 requires public bodies such as health services to provide access to high quality healthcare, while the Equality Delivery System seeks to ensure that NHS organisations comply with the legislation. This study aimed to explore the perceptions and experiences of ambulance staff attending Eastern European migrants in Lincolnshire.MethodsQualitative semi-structured interviews were conducted with 15 ambulance staff at locations across Lincolnshire. Purposive and maximum variation sampling ensured that participants were knowledgeable about Eastern European migrants’ use of ambulance care and covered a range of demographic characteristics. The data were analysed using framework analysis.ResultsDifficulty in accessing professional interpreters meant that some patients relied instead on family members. Some Eastern European migrants brought back foreign language medication, which ambulance staff could not understand. It was common for patients to not be registered with GPs because they were temporarily resident, did not understand how the UK healthcare system worked or preferred to go to their home country for treatment. By not registering with GPs, patients were sometimes transported to the Emergency Department for primary care conditions.ConclusionsThe practical recommendations for service delivery improvements may be valuable for service providers and could be incorporated into future protocols. These include: having a glossary of key terms in Eastern European languages; simple packs explaining how and when to use the ambulance service translated into different languages where necessary; encouraging patients to register with GPs; and face-to-face meetings where the ambulance service inform the Eastern European communities about how to use their services.
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Wahlin, Ulla, Inger Wieslander, and Bengt Fridlund. "Loving care in the ambulance service." Intensive and Critical Care Nursing 11, no. 6 (December 1995): 306–13. http://dx.doi.org/10.1016/s0964-3397(95)80308-4.
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Porter, K. "Do ambulance crews triage patients." Emergency Medicine Journal 10, no. 1 (March 1, 1993): 61–62. http://dx.doi.org/10.1136/emj.10.1.61.
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