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Journal articles on the topic 'Ambulance transport'
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Meites, Elissa, and John F. Brown. "Ambulance Need at Mass Gatherings." Prehospital and Disaster Medicine 25, no. 6 (December 2010): 511–14. http://dx.doi.org/10.1017/s1049023x00008682.
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AbstractIntroduction:Scant evidence exists to guide policy-making around public health needs during mass gatherings. In 2006, the City and County of San Francisco began requiring standby ambulances at all mass gatherings with attendance of >15,500 people. The objectives were to evaluate needs for ambulances at mass gatherings, and to make evidence-based recommendations for public health policy-makers. The hypothesis was that the needs for ambulances at mass gatherings can be estimated using community baseline data.Methods:Emergency medical services plans were reviewed for all public events with an anticipated attendance of >1,000 people in San Francisco County during the 12-month period 01 August 2006 through 31 July 2007. Ambulance transport data were confirmed by event coordinators and ambulance company records, and the rate was calculated by dividing ambulance transports by event attendance. Baseline ambulance transport rate was calculated by dividing the annual ambulance transports in the county's computer-aided dispatch system by the census population estimate. The risk ratio was calculated using the risk of transport from a mass gathering compared with the baseline risk of ambulance transport for the local community. Significance testing and confidence intervals were calculated.Results:Descriptive information was available for 100% of events and ambulance transport data available for 97% of events. The majority of the mass gatherings (47 unique events; 59 event days) were outdoor, weekend festivals, parades, or concerts, though a large proportion were athletic events. The ambulance transport rate from mass gatherings was 1 per 59,000 people every six hours. Baseline ambulance transport rate in San Francisco was 1 per 20,000 people every six hours. The transport rate from mass gatherings was significantly lower than the community baseline (risk ratio [RR] = 0.15, 95% CI = 0.10–0.22, p <0.001). At events reserving a standby ambulance, 46% of ambulances were unused.Discussion:San Francisco mass gatherings appear to present a lower risk of ambulance transports compared to the community baseline, suggesting that the community baseline sets an appropriate standard for requiring standby ambulances at mass gatherings. The initial ambulance requirement policy in San Francisco may have been overly conservative.Conclusions:Local baseline data is a recommended starting point when setting policy for public health needs at mass gatherings.
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Brismar, Bo. "The Alarm Center in Stockholm County Council." Prehospital and Disaster Medicine 1, S1 (1985): 131–32. http://dx.doi.org/10.1017/s1049023x00044125.
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During the last ten years, both in Western Europe and in the USA, the attitude towards medical transport activities has radically changed. From being a purely transportation vehicle the ambulance is now increasingly regarded as an extended arm of medical care. At the same time as ambulance crews have received more qualified medical training, the equipment of the ambulances themselves has been improved. In several countries such as the USA, France and West Germany, a differentiated ambulance organization has been built up, with specially equipped emergency ambulances manned by paramedics, and standard ambulances with emergency technicians for planned transports. During this time helicopters have been put into increasing use as a supplement to ambulances for emergency long distance transport to units such as trauma and burn centers.
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Sookram, Sunil, Kent Riddle, Eddie Chang, and Terry Sosnowski. "Description of Ambulance Diversions in the Edmonton Region." Prehospital and Disaster Medicine 17, no. 2 (June 2002): 91–95. http://dx.doi.org/10.1017/s1049023x00000236.
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AbstractBackground:Diversion of ambulances by hospital emergency departments has become a day-to-day occurrence in many jurisdictions within Canada. Yet, despite the increasing prevalence of this phenomenon, its impact on transported patients, on the EMS system, and on the health care system overall has not, to date, been well quantified. Despite the increasing sophistication and capabilities of North American EMS systems, it is difficult to argue with the principle that unstable or potentially unstable patients are best served by expeditious transport for definitive care to acute care facilities. T o this end, this study represents an effort to assess the systemic and patient care impacts of ambulance diversions.Methods:Patient-care and corresponding ambulance trip records for all patients transported by this EMS system for a five week period were abstracted to identify those patients in which an ambulance was diverted from its initial destination. Adverse events include hypotensive episodes, airway compromise, changes in level of consciousness, and the onset of violent behavior. Response and transport times also were abstracted, comparisons utilized student's t-test and 95% Confidence Intervals. Results: Ambulance diversions increased EMS response times and prehospital transport times. Adverse medical events occurred during 4.3% of diverted ambulance runs. Patients, when faced with the prospect of transport to other than their hospital of choice, not infrequently cancelled EMS transport and sought other means of transport. Subsequent interfacility transport was required for 4.3% of the diverted patients.Conclusions:Diversion of ambulances impacts the EMS system by increasing response and transport times; the region, by generating subsequent interfacility transports; and patients, as adverse medical events can occur during the diverted transport.
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Pniewski, Roman, Daniel Pietruszczak, and Michał Ciupak. "Logistics in collective transport of emergency medical services." AUTOBUSY – Technika, Eksploatacja, Systemy Transportowe 19, no. 12 (December 31, 2018): 955–58. http://dx.doi.org/10.24136/atest.2018.531.
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The paper discusses the subject of logistics in ambulance transport based on the example of an ambulance service. When discussing this subject, it is worth noting that an interesting issue related to its functioning is that relating to its relationship with transport logistics regarding travel time to the patient. Discussing this topic will be the subject of this paper. A logistics process will be presented on the example of logistics in the transport of ambulances.
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Sy, Eric, and Terrance Ross. "Air ambulance transport." Canadian Medical Association Journal 193, no. 37 (September 19, 2021): E1462. http://dx.doi.org/10.1503/cmaj.210354.
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Pniewski, Roman, Daniel Pietruszczak, and Michał Ciupak. "Medical transport of ambulances. Analysis of travel time." AUTOBUSY – Technika, Eksploatacja, Systemy Transportowe 19, no. 6 (June 30, 2018): 1092–96. http://dx.doi.org/10.24136/atest.2018.235.
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The paper discusses medical transport in Poland. An ambulance was defined and the way in which emergency medical services in Poland were operated. In the further part of the paper an analysis of the research related to the registration of travel times of specialized vehicles such as ambulances was shown.
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Wijngaarden, Van, R. Lafreniere, R. Cunningham, E. Joughin, R. Yim, Donna York, and J. Kortbeek. "Air Ambulance Trauma Transport." Journal of Trauma Nursing 5, no. 2 (April 1998): 46. http://dx.doi.org/10.1097/00043860-199804000-00007.
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van Wijngaarden, Mary, John Kortbeek, Rene Lafreniere, Randy Cunningham, Elaine Joughin, and Rita Yim. "Air Ambulance Trauma Transport." Journal of Trauma: Injury, Infection, and Critical Care 41, no. 1 (July 1996): 26–31. http://dx.doi.org/10.1097/00005373-199607000-00006.
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Yazaki, Hiroshi, and Hiroshi Nishiura. "Ambulance Transport of Patients with Mild Conditions in Hokkaido, Japan." International Journal of Environmental Research and Public Health 17, no. 3 (February 2, 2020): 919. http://dx.doi.org/10.3390/ijerph17030919.
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Understanding the epidemiological distributions of ambulance transport for patients with mild conditions according to age, disease, and geographic region could help in achieving optimal use of ambulance services. In the present study, we explored the descriptive epidemiology of ambulance transports in Hokkaido, the northernmost prefecture of Japan, identifying potential factors that determine the frequency of transports for mild diseases. Of the total 153,667 ambulance transports in Hokkaido during 2016, we found that two-thirds were for older people, of which about 60% resulted in hospital admission. There were 74,485 transports for mild cases, which were most commonly for psychiatric disorders among working-age adults (n = 4805), heart diseases among older people (n = 4246), and sensory organ diseases among older people (n = 3589). Examining the ecological correlations over 58 geographic units of ambulance services, the total unemployment rate and distance to the nearest tertiary care hospital were, respectively, positively and negatively correlated with the standardized transport ratio for multiple mild diseases. The proportion of working-age adults was uniquely identified as a possible positive predictor in mild cases of psychiatric disorders. As the identified potential predictors could be helpful in considering countermeasures, the causal links should be examined in future studies.
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Lehman, Eric J. "ETs Dislodged During Ambulance Transport." Emergency Medicine News 24, no. 3 (March 2002): 49. http://dx.doi.org/10.1097/00132981-200203000-00031.
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O’Neil, Joseph, Gregory K. Steele, Elizabeth Weinstein, Robert Collins, Judith Talty, and Marilyn J. Bull. "Ambulance Transport of Noncritical Children." Clinical Pediatrics 53, no. 3 (January 9, 2014): 250–55. http://dx.doi.org/10.1177/0009922813517168.
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Little, Jim W. "Ambulance transport for the newborn." Seminars in Neonatology 4, no. 4 (November 1999): 247–51. http://dx.doi.org/10.1053/siny.1999.0110.
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Sherwood, H. Beth, Ann Donze, and Jeanne Giebe. "Mechanical Vibration in Ambulance Transport." Journal of Obstetric, Gynecologic & Neonatal Nursing 23, no. 6 (July 1994): 457–63. http://dx.doi.org/10.1111/j.1552-6909.1994.tb01905.x.
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Zehra, Fatima Tuz, Diya Nisar, Abeeha Zehra, Mahnoor Javed, Mahnoor Usman, and Syed Uzair Mahmood. "Pervasiveness of ambulance etiquette and knowledge in general population: a perspective from Pakistan." International Journal Of Community Medicine And Public Health 7, no. 4 (March 26, 2020): 1244. http://dx.doi.org/10.18203/2394-6040.ijcmph20201427.
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Background: Ambulance ethics refers to the principles of moral conduct that make the journey of an ambulance safe, convenient whereby ensuring provision of effective pre-hospital care to the patient. It concerns three sets of population: the paramedical staff, the patient and family and also the general population.Methods: Cross-sectional comparative study, conducted from February to May 2018. A questionnaire consisting of 25 questions was filled by 412 participants who were older than 15 years of age and their responses were collected via a 5-point likert scale. Chi-square analysis was done to compare the responses of medical and non-medical participants.Results: Vast majority of individuals agreed that they should give way to ambulances by switching their lanes or by breaking the signal. Half of the individuals were of the idea that ambulances should maintain their speed limit while some favored disregarding the speed limit if it meant saving someone’s life, while others remained neutral. A large percentage of participants agreed that a vehicle must meet certain standards in order for it to act as an ambulance. A number of participants agreed that an ambulance should have basic life support (BLS), the ambulance staff should be skilled enough to give cardiopulmonary resuscitation (CPR) en route to the hospital.Conclusions: The general population supports the idea that ambulances should have a hassle-free route to transport the patient to the hospital and to hasten the treatment even if that means breaking signals, switching lanes and exceeding speed limit.
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Waseem, H., S. Shahbaz, and J. Razzak. "(A154) Overcrowding of Ambulances at the Scene of a Disaster: Pitfalls and Implications." Prehospital and Disaster Medicine 26, S1 (May 2011): s53. http://dx.doi.org/10.1017/s1049023x11001713.
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IntroductionPakistan is a developing country with a basic prehospital system in some cities. The prehospital services are a mixture of government and private ambulances.There is no central regulatory body for them and no central command to control the influx and out flux of ambulances from the scene.ObjectiveIn this paper, five episodes of terrorist incidents in the country and will try to estimate the number of ambulances on the scene.MethodsRetrospective data was collected and triangulation was done by three sources: (1) ambulance records; (2) visual estimation; and (3) print media. An estimate of total ambulances was reached along with dead and injured. Furthermore medical transport capacity was calculated where possible.ResultsIn majority of the incidents, it was found that there was a huge influx of ambulances beyond the need. This further adds to the chaos and confusion already present on the scene of disaster.ConclusionsA Command and Control Center should be established to direct all ambulance control and movements.
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Casey, Megan L., Duong T. Nguyen, Barrie Idriss, Sarah Bennett, Angela Dunn, and Stephen Martin. "Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone." Prehospital and Disaster Medicine 30, no. 6 (October 28, 2015): 625–27. http://dx.doi.org/10.1017/s1049023x15005294.
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AbstractIntroductionPrehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control.ProblemAn ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance.MethodsA convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed.ResultsMany vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant.ConclusionWaterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.CaseyML, NguyenDT, IdrissB, BennettS, DunnA, MartinS. Potential exposure to Ebola virus from body fluids due to ambulance compartment permeability in Sierra Leone. Prehosp Disaster Med. 2015;30(6):625–627.
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Murray, Brett, and Ricky Kue. "The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature." Prehospital and Disaster Medicine 32, no. 2 (January 30, 2017): 209–16. http://dx.doi.org/10.1017/s1049023x16001503.
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AbstractThe benefits of emergency lights and sirens (L&S) use as warning devices by ambulances continue to be a debated topic in Emergency Medical Services (EMS). While the most widely studied aspect of L&S use has been related to their effect on ambulance response and transport times, the literature suggests minimal time savings with more questionable impact on actual patient outcomes. As L&S use has been shown to increase the risk for vehicle crashes, the secondary concern of ambulance design and safety also becomes an important aspect on potential design recommendations that could mitigate the effects of a crash on patients, EMS providers, and the general public. The least studied aspect of L&S use (and probably the most important) is their effect on patient outcomes and quality of medical care during transport. The current evidence suggests no significant improvement on patient outcomes and potential worsening to certain aspects of patient care during transport. The purpose of this review was to examine the current literature regarding ambulance L&S use and the risks they pose to EMS providers, patients, and the general public. In doing so, it will provide sound background for EMS leaders to better develop policies governing the use of L&S by ambulances and promote better research in the patient outcomes effect associated with their use. This review offers some strategies in mitigating the risks associated with L&S use, such as ways to reduce their overall use and modifying other related factors to emergency medical vehicle collisions (EMVCs). MurrayB, KueR. The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: a comprehensive review of the literature. Prehosp Disaster Med. 2017;32(2):209–216.
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Reynolds, Lindy M., Vijitha De Silva, Shayna Clancy, Anjni Joiner, Catherine A. Staton, and Truls Østbye. "Predictors of ambulance transport to first health facility among injured patients in southern Sri Lanka." PLOS ONE 16, no. 6 (June 25, 2021): e0253410. http://dx.doi.org/10.1371/journal.pone.0253410.
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Background Injuries account for about 13% of all registered deaths in Sri Lanka and are the leading cause of admission to public hospitals. Prehospital trauma care is new to Sri Lanka, and in 2016, a free ambulance service was launched in the Western and Southern provinces. Objective The aim of this study was to identify the proportion of admitted injury patients at a tertiary hospital who used an ambulance to get to the first health facility and examine patient demographics, injury event, and injury type as predictors of ambulance transport. Methods A cross-sectional survey was administered to 405 patients who were admitted to the emergency trauma center at Teaching Hospital Karapitiya (THK) in Galle, Sri Lanka. Descriptive statistics were tabulated to summarize prehospital transportation variables. Logistic regression models were created to examine predictors of ambulance transport, and ArcGIS Pro was used to calculate the distance between injury location and first facility and THK. Results The proportion of patients with injuries who used an ambulance to get to the first health facility was 20.5%. Factors that were significantly associated with ambulance use were older age, injury mechanism, alcohol use prior to injury, location type, open wound, abrasion, and chest/abdomen injury. Distance from injury location to THK or nearest health facility were not significantly associated with ambulance transport to the first health facility. Conclusion Among lower acuity injury patients in southern Sri Lanka, 20.5% traveled in an ambulance to the first health facility, while over half used a tuk tuk. Older age and injuries at home were associated with lower odds of ambulance transport. Future studies on predictors of ambulance transport should include patients with more severe injuries, gather detailed data on care provided while in transport and examine the association between prehospital care and clinical outcomes.
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Dreifuss, Rodney, and Emil Pascarelli. "On-the-Scene Triage with a Rapid Response Vehicle." Prehospital and Disaster Medicine 1, S1 (1985): 144–45. http://dx.doi.org/10.1017/s1049023x00044198.
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Perhaps the greatest operational problem faced by the New York City Emergency Medical Service (EMS) today is the sheer volume of calls entering the system, and the fact that many of those requests for medical aid are not life-threatening emergencies requiring ambulance transport. This creates two situations that New York City is all too familiar with: (l) ambulances are not available for true emergencies; and (2) response times for ambulances to arrive at the scene of an emergency are extended.A four-month pilot “on-scene triage” program was initiated by EMS as a possible solution to these problems. The program ran from May to August of 1980. A marked EMS car was designated as the “Triage Car” and was in operation during those hours when ambulance requests were at their peak (usually two to ten PM).
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Tennyson, Joseph C., and Mark R. Quale. "Reduction in STEMI Transfer Times Utilizing a Municipal “911” Ambulance Service." Prehospital and Disaster Medicine 29, no. 1 (January 22, 2014): 50–53. http://dx.doi.org/10.1017/s1049023x14000016.
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AbstractIntroductionThe time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality.HypothesisIt is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the “911” ALS ambulance.MethodsQuality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite.ResultsDuring the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P = .001) reduction in the mean transfer time to the PCI suite for patients transported via the municipal ALS ambulance.ConclusionIn the appropriate setting, the use of the municipal “911” ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.TennysonJC, QualeMR. Reduction in STEMI transfer times utilizing a municipal “911” ambulance service. Prehosp Disaster Med. 2014;29(1):1-4.
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Prytz, Erik, Zandra Åkerstedt, Björn Lidestam, Maria Lampi, and Carl-Oscar Jonson. "A Pilot Investigation of the Effect of Transport-Related Factors on Care Quality in a Moving Ambulance." Prehospital and Disaster Medicine 34, s1 (May 2019): s158. http://dx.doi.org/10.1017/s1049023x19003571.
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Introduction:Providing patient care in a moving ambulance can be difficult due to various transport-related factors, (e.g., accelerations, lateral forces, and noise). Previous research has primarily focused on cardiopulmonary resuscitation (CPR) performance effects but has neglected to investigate other care interventions.Aim:To test a range of different care interventions during different driving scenarios.Methods:A workshop with ambulance practitioners was held to create a list of care interventions to be tested. Two ambulance practitioners were recruited to drive an ambulance on a closed test-track while performing care interventions on simulation models. Three driving scenarios of differing difficulty were used. Main outcome measures were estimates of workload using the NASA Task Load Index (TLX) and task difficulty. G-forces and video-data were also collected.Results:Estimated workload increased overall as the difficulty of the driving scenario increased, as did task difficulty estimates. However, some care scenarios and interventions were affected less. For example, placing intravenous access increased greatly in difficulty, whereas saturation and blood pressure measurements had more modest increases. TLX scores showed that the primarily estimated physical workload and effort that increased, but also mental and temporal demands for some care scenarios. The more difficult driving scenarios primarily increased the variability of measured G-forces but not necessarily the overall driving speed, indicating that force variability is an important factor to study further.Discussion:The study was intended as an initial pilot test of a wide range of care interventions. It will serve as input to future, larger studies of specific interventions and transport-related factors. Overall, this small pilot indicates that more interventions than only CPR should be studied in moving ambulances to investigate potential performance effects. This is important for traffic, patient, and work safety for ambulance workers and patients.
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Gongal, Rajesh, B. Dhungana, S. Regmi, M. Nakarmi, and B. Yadav. "Need of Improvement in Emergency Medical Service in Urban Cities." Journal of Nepal Medical Association 48, no. 174 (April 1, 2009): 139–43. http://dx.doi.org/10.31729/jnma.230.
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Introduction: An effective Emergency Medical Service system does not exist in Nepal. For an effective EMS system to be developed the scale of the problem and the existing facilities need to be studied. Methods: Prospective observational study was carried out on 1964 patients attending Emergency Department at Patan Hospital during one month period of September 2006. The patients were specifically enquired on mode of transport used, place of origin and whether they called for an ambulance or not. Patients triage category at the time of triaging was also noted. Information on ambulance service were collected by direct interview with the service providers and the total number of patients attending Emergency Departments daily were collected from the major hospitals of the urban Lalitpur and Kathmandu. MS Excel and SPSS software were used for data entry, editing and analysis.Results: Total 9.9% patients arrived in ambulance whereas 53.6% came in a Taxi, 11.4% came in private vehicle, 13.5 % came by bus, 5.4% came by bike and the rest 6.2% came by other modes of transportation. Only 13.5% of triage category I patients took the ambulance. There were 31 service providers with 49 ambulances and 720 patients per day attend Emergency Departments in the surveyed area. Conclusions: Very less number of patients use the ambulance service for emergency services. The available ambulances are not properly equipped and do not have trained staff and as such are only a means of transportation to the hospitals of urban Lalitpur and Kathmandu.Key Words: ambulance, emergency medical service, para-medics, triage Need of Improvement in Emergency Medical Service in Urban Cities Gongal R,1Dhungana B,1Regmi S,1Nakarmi M,2Yadav B11Patan Hospital, Lalitpur, Nepal, 2Health Care Foundation, Kathmandu, NepalCorrespondence:Dr. Rajesh GongalDepartment of SurgeryPatan Hospital, Patan, Nepal.Email: rajgongal@yahoo.comORIGINAL ARTICLE J Nepal Med Assoc 2009;48(174):139-43INTRODUCTIONThe sophisticated Emergency Medical Service (EMS) is limited to developed country only. Many developing countries are now slowly developing such system although most services are localized to the urban areas.1-5 Although inadquate ambulance services are available in the capital city of Nepa
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Oulasvirta, Jelena, Heli Salmi, Markku Kuisma, Eero Rahiala, Mitja Lääperi, and Heini Harve-Rytsälä. "Outcomes in children evaluated but not transported by ambulance personnel: retrospective cohort study." BMJ Paediatrics Open 3, no. 1 (October 2019): e000523. http://dx.doi.org/10.1136/bmjpo-2019-000523.
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BackgroundNot all children with an out-of-hospital emergency medical contact are transported by ambulance to the emergency department (ED). Non-transport means that after on-scene evaluation and possible treatment, ambulance personnel may advise the patient to monitor the situation at home or may refer the patient to seek medical attention by other means of transport. As selecting the right patients for ambulance transport is critical for optimising patient safety and resource use, we studied outcomes in non-transported children to identify possible risk groups that could benefit from ambulance transport.MethodsIn a population-based retrospective cohort study of all children aged 0–15 years encountered but not transported by ambulance in Helsinki, Finland, between 1 January 2014 and 31 December 2016, we evaluated (1) 12-month mortality, (2) intensive care admissions, (3) unscheduled ED contacts within the following 96 hours after the non-transport decision and (4) the clinical status of the child on presentation to ED in the case of a secondary ED visit.ResultsOf all children encountered by out-of-hospital emergency medical services, 3579/7765 (46%) were not transported to ED by ambulance. There was no mortality or intensive care admissions related to the non-transport. The risk factors for an unscheduled secondary ED visit after a non-transport decision were young age (p=0.001), non-transport decision during the early morning hours (p<0.001) and certain dispatch codes, including ‘dyspnoea’ (p<0.001), ‘vomiting/diarrhoea’ (p=0.030) and ‘mental illness’ (p=0.019). We did not detect deterioration in patients’ clinical presentation at ED traceable to non-transport decisions.ConclusionsNot transporting all children by ambulance after an out-of-hospital emergency medical contact was not associated with deaths, intensive care admissions or significant deterioration in general condition in our study population and healthcare system. Special attention and a formal non-transport protocol are warranted in certain subgroups, including infants.
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A Joint Position Statement of the N. "Air Ambulance Medical Transport Advertising and Marketing." Prehospital Emergency Care 15, no. 2 (January 12, 2011): 294. http://dx.doi.org/10.3109/10903127.2010.541984.
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Brown, Lawrence H., John E. Gough, Dolly M. Bryan-Berg, and Richard C. Hunt. "Assessment of Breath Sounds During Ambulance Transport." Annals of Emergency Medicine 29, no. 2 (February 1997): 228–31. http://dx.doi.org/10.1016/s0196-0644(97)70273-7.
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Wheble, Victor H. "Ambulance Transport: A Question of Patient Comfort." Engineering in Medicine 16, no. 1 (January 1987): 47–50. http://dx.doi.org/10.1243/emed_jour_1987_016_011_02.
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Moskovitz, Joshua, Joshua Sapadin, and Michael Guttenberg. "Interfacility ambulance transport of mental health patients." Journal of the American College of Emergency Physicians Open 1, no. 3 (February 8, 2020): 173–82. http://dx.doi.org/10.1002/emp2.12012.
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Stephens, J. Mark, Samuel Brotherton, Stephan C. Dunning, Larry C. Emerson, David T. Gilbertson, Matthew Gitlin, Ann C. McClellan, William M. McClellan, and Sanatan Shreay. "High Costs of Dialysis Transportation in the United States: Exploring Approaches to a More Cost-effective Delivery System." Journal of Health Economics and Outcomes Research 1, no. 2 (August 28, 2013): 134–50. http://dx.doi.org/10.36469/9861.
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Background: The costs of transporting end-stage renal disease (ESRD) patients to dialysis centers are high and growing rapidly. Research has suggested that substantial cost savings could be achieved if medically appropriate transport was made available and covered by Medicare. Objectives: To estimate US dialysis transportation costs from a purchaser’s perspective, and to estimate cost savings that could be achieved if less expensive means of transport were utilized. Methods: Costs were estimated using an actuarial model. Travel distance estimates were calculated using GIS software from patient ZIP codes and dialysis facility addresses. Cost and utilization estimates were derived from fee schedules, government reports, transportation websites and peer-reviewed literature. Results: The estimated annual cost of dialysis transportation in the United States is $3.0 billion, half of which is for ambulances. Most other costs are due to transport via ambulettes, wheelchair vans and taxis. Approximately 5% of costs incurred are for private vehicle or public transportation use. If ambulance use dropped to 1% of trips from the current 5%, costs could be reduced by one-third. Conclusions: Decision-makers should consider policies to reduce ambulance use, while providing appropriate levels of care.
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Kanter, Robert K. "Regional Variation in Critical Care Evacuation Needs for Children After a Mass Casualty Incident." Disaster Medicine and Public Health Preparedness 6, no. 2 (June 2012): 146–49. http://dx.doi.org/10.1001/dmp.2012.30.
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ABSTRACTObjectives: To determine the ability of five New York statewide regions to accommodate 30 children needing critical care after a hypothetical mass casualty incident (MCI) and the duration to complete an evacuation to facilities in other regions if the surge exceeded local capacity.Methods: A quantitative model evaluated pediatric intensive care unit (PICU) vacancies for MCI patients, based on data on existing resources, historical average occupancy, and evidence on early discharges and transfers in a public health emergency. Evacuation of patients exceeding local capacity to the nearest PICU center with vacancies was modeled in discrete event chronological simulations for three scenarios in each region: pediatric critical care transport teams were considered to originate from other PICU hospitals statewide, using (1) ground ambulances or (2) helicopters, and (3) noncritical care teams were considered to originate from the local MCI region using ground ambulances. Chronology of key events was modeled.Results: Across five regions, the number of children needing evacuation would vary from 0 to 23. The New York City (NYC) metropolitan area could accommodate all patients. The region closest to NYC could evacuate all excess patients to PICU hospitals in NYC within 12 hours using statewide critical care teams traveling by ground ambulance. Helicopters and local noncritical care teams would not shorten the evacuation. For other statewide regions, evacuation of excess patients by statewide critical care teams traveling by ground ambulance would require up to nearly 26 hours. Helicopter transport would reduce evacuation time by 40%-44%, while local noncritical care teams traveling by ground would reduce evacuation time by 16%-34%.Conclusions: The present study provides a quantitative, evidence-based approach to estimate regional pediatric critical care evacuation needs after an MCI. Large metropolitan areas with many PICU beds would be better able to accommodate patients in a local MCI, and would serve as a crucial resource if an MCI occurred in a smaller community. Regions near a metropolitan area could be rapidly served by critical care transport teams traveling by ground ambulance. Regions distant from a metropolitan area might benefit from helicopter transport. Using local noncritical care transport teams would involve shorter delays and less expert care during evacuation.(Disaster Med Public Health Preparedness. 2012;6:146–149)
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Jezek, B., J. Vaněk, K. Antos, and M. Prochazka. "(P2-27) Simulation of Transport During a Major Incident." Prehospital and Disaster Medicine 26, S1 (May 2011): s144. http://dx.doi.org/10.1017/s1049023x11004717.
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Transportation capacities belong to the key factors of the response to a major incident. Available resources, both in terms of personnel and equipment, must be transported, usually by ambulances, to the incident location. In the other direction, casualties must be transported to hospitals and other health care facilities for further treatment. For this reason, the efficiency of the response is greatly determined by ambulance travel times and the ability of health care facilities to absorb large numbers of patients. We propose methods to compute the travel times to and from the incident location based on a classified road network. The methods take into account different attributes that depend on ambulance type and capacity, road quality, time of day, weather or actual traffic density. Correctly computed travel times are crucial not only for optimal deployment of all resources within the analyzed region, but also for the evaluation of the readiness of the emergency health care system for a major incident. We have included the methods in an agent-based simulation of transport during the response. From the simulation outputs and with the help of geographical information systems and information visualization methods we have synthesized maps that represent the capability of a region to absorb a major incident defined by a scenario. When combined with risk maps and maps of population density the synthesized maps allow emergency management authorities to find critical points and gaps in the emergency health care service.
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Giri, Sonai Chaudhuri, G. Malla, R. Bhandari, M. Poudel, and S. Giri. "Transport and Pre-hospital Care Prior to Arrival in Tertiary Care Emergency Department of Eastern Nepal: a Cross sectional Study." Journal of BP Koirala Institute of Health Sciences 2, no. 1 (July 24, 2019): 60–67. http://dx.doi.org/10.3126/jbpkihs.v2i1.24971.
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Introduction: Nepal has diverse terrain and the length of time taken by the patients to get medical help is often too long. Road linkage transport may not exist, inadequate or are unreliable and irregular.
Materials and Methods: After ethical clearance, this prospective observational study was done by convenient sampling, among 2211 patients arriving in the emergency ward of B. P. Koirala Institute of health science over a period of one month. A pre-tested validated questionnaire consisting of questions related to study objectives (i.e. demography, preferred mode of transport, reasons for choosing the transport, facilities available in ambulance, cost and time taken through ambulance service and any pre-hospital care received) was handed over to the patient or their relatives and their responses were collected. Descriptive analysis was done in SPSS software version 11.2.
Result: Out of the 2211 patients presented in emergency ward, 43.2% (955) came in an ambulance. Patients with ATS 2 (very sick) arriving in ambulance were 27.6%. The median time taken by ambulance is 2 hours (IQR 1-3hrs). The median distance covered is 55km ((IQR 38km- 80km). The median cost paid was USD 31.25 or NRs. 3500 (IQR NRs 2000- NRs 6000, USD 17.86- 53.57).Their main reason expressed for not choosing ambulance service was high cost, i.e. expensive (26%).About one third subjects (29.4%) had used some sort of pre-hospital care.
Conclusion: Patients preferred private vehicles to arrive in emergency ward of this hospital with high acuity triage score (ATS 2). Awareness needs to be raised among Nepalese population to enhance the practice of using ambulance service for patient transport.
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Stone, C. Keith, and Stephen H. Thomas. "Can Correct Closed-Chest Compressions Be Performed During Prehospital Transport?" Prehospital and Disaster Medicine 10, no. 2 (June 1995): 121–23. http://dx.doi.org/10.1017/s1049023x00041856.
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AbstractIntroduction:The resuscitation rate from out-of-hospital cardiac arrest is low. There are many factors to be considered as contributing to this phenomenon. One factor not previously considered is the impact of a moving ambulance environment on the ability to perform closed-chest compressions.Hypothesis:Proper closed-chest compressions can be performed in a moving ambulance.Methods:A cardiopulmonary resuscitation (CPR) training mannequin with an attached skill meter (Skillmeter ResusciAnnie®, Laerdal, Armonk, N. Y., USA) that measures each chest compression for proper depth and hand placement was used. Ten emergency medical technician-basic (EMT-B) certified prehospital providers were assigned into one of five teams. Each team performed a total of four sessions of five minutes of continuous closed-chest compressions on the mannequin. Two sessions were done by each team: one in the control environment with the mannequin placed on the floor, and the other in the experimental environment with the mannequin placed in the back of a moving ambulance. The ambulance was operated without warning lights and siren, and all traffic rules were obeyed. The percentage of correct closed-chest compressions was recorded for each session, and the mean values were compared using Student's t-test with alpha set at 0.01 for statistical significance.Results:Ten sessions of compressions were done in both environments. The mean percentage of correct compressions was 77.6 ±15.6 for the control group and 45.6 ±18.3 for the ambulance group (p = 0.0005).Conclusion:A moving ambulance environment appears to impair the ability to perform closed-chest compressions.
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Elbashir, K., R. Gore, C. Bloem, P. Roblin, G. Ostrovskiy, T. Abuaaraki, M. Yousif, and B. Arquilla. "(A316) Pre-Hospital Emergency Care in Sudan - Current Practices in Disaster Management (DM)." Prehospital and Disaster Medicine 26, S1 (May 2011): s89. http://dx.doi.org/10.1017/s1049023x11003001.
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IntroductionThe problems of pre-hospital care and training in the developing world are very similar – resource limitations and training deficiencies. Humanitarian conditions in the Sudan have been among the worst in the world including both man-made and natural disasters. Effectively responding to emergencies is of paramount importance.MethodsThe information was collected by a group of Sudanese physicians working in the emergency department at a large urban public hospital in Khartoum, Sudan and in the U.S. for the purpose of establishing structured training programs for pre-hospital responders.ResultsThere are currently 37 registered state operated mini-van ambulances serving ∼8 million people in the capital city of Khartoum. There is 1 central dispatching command center operated by the state Ministry of Health (MOH) that serves 29 hospitals. Services are available by calling a central “999” emergency response number. There are no private ambulances in Khartoum; however, most patients are transported by private or public transportation. Ambulance transport teams consist of ∼2 ambulance emergency assistants with limited medical training. Ambulance transport costs are covered either by insurance for the insured; however, the majority of patients are self paid. Emergencies are also managed by the Department of Civil Defense, which is a branch of the Sudanese MOH that responds to natural and man-made disasters. There are 2 layers of this team; 420 physician with masters degrees in DM and emergency rescue workers. These emergency rescue workers do not have formalized training. Other important findings are: lack of training centers for first emergency responders, no standardized practice guide lines among pre-hospital care personnel.ConclusionEmergency response in the Sudan is a relatively new practice but has shown a promising trend for the continued development of a highly advanced and functional pre-hospital/emergency response system. More structured training through collaborative efforts and substantial resources are needed.
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Weerheijm, D. V., M. H. Wieringa, J. Biert, and N. Hoogerwerf. "Optimizing Transport Time from Accident to Hospital: When to Drive and When to Fly?" ISRN Emergency Medicine 2012 (October 23, 2012): 1–5. http://dx.doi.org/10.5402/2012/508579.
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Objective. In prehospital emergency medicine, rapid transport to a hospital is often required. Transport can be done by ambulance or HEMS (Helicopter Emergency Medical Service). Factors influencing transport time are mostly unknown. This study aims to identify these factors and optimize prehospital transport times. Methods. This is a retrospective study with HEMS data from 2010-2011. Trauma mechanism, patient characteristics, and weather conditions were collected from each transport. Distance to the hospital, predicted transport time, and the actual transport time were calculated. Each factor was analysed to determine influence on transport time. Results. We analysed 732 cases (612 by ambulance and 120 by helicopter) and found no association between mechanism of trauma, age, time of day, or weather conditions on transport time. However, transport by HEMS helicopter was nearly always faster, even at short distances. The average transport time of ambulance transport was 79% (95% CI 77.1–80.3) of target time, while in helicopter transport this was 39% (95% CI 37.4–42.9). Conclusion. This study shows the advantage of the HEMS helicopter in rapid transport from the scene to the hospital. Transport by helicopter was twice as fast as ground transport, independent of trauma mechanism, distance to hospital, or weather conditions.
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Scherer, Tara M., Stephan Russ, Cathy A. Jenkins, Ian D. Jones, Corey M. Slovis, Brittany L. Cunningham, and Tyler W. Barrett. "Predictors of Ambulance Transport in Patients with ST-Elevation Myocardial Infarction." Prehospital and Disaster Medicine 27, no. 3 (June 2012): 226–30. http://dx.doi.org/10.1017/s1049023x12000696.
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AbstractIntroductionDespite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated.HypothesisIt was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization.MethodsA retrospective, observational cohort study was performed for all STEMI patients treated from April 1, 2007 through June 30, 2010 at an urban, academic ED with 24-hour cardiac catheterization available. Multivariable analyses with predetermined predictors (age, sex, prior cardiac intervention, weekend/evening arrival) were performed to investigate associations with mode of transport. Door-to-balloon (D2B) times were calculated.ResultsOf the 209 STEMI patients, 11 were excluded, leaving 198 for analysis. Median age was 60 years (IQR: 53-70), 138 (70%) arrived by private vehicle, and 60 (30%) by EMS. The primary analysis did not identify significant predictors for EMS, but a post-hoc model found that private insurance (OR 0.18; 95% CI, 0.07-0.45) was associated with fewer EMS transports. Although not statistically significant due to the great variability in time of arrival for STEMI patients transported by private vehicle, EMS transports had shorter D2B times. During business hours and weekend/evenings, EMS had D2B times of 50 (IQR: 42-61) and 58 minutes (IQR: 47-63), respectively, while private vehicle transports had median D2B times of 62 (IQR: 50-74) and 78 minutes (IQR: 66-106).ConclusionNo associations between mode of transport and patient age, sex, weekend/evening presentation and history of a prior cardiac intervention were identified. Privately insured patients were less likely to use EMS when experiencing a STEMI. More effective ways are needed to educate the public on the importance of EMS activation when one is concerned for acute coronary syndrome.Scherer TM, Russ S, Jenkins CA, Jones ID, Slovis CM, Cunningham BL, Barrett TW. Predictors of ambulance transport in patients with ST-elevation myocardial infarction. Prehosp Disaster Med. 2012;27(3):1-5.
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Strum, Ryan P., Walter Tavares, Andrew Worster, Lauren E. Griffith, Ahmad Rahim, and Andrew P. Costa. "Development of the PriCARE classification for potentially preventable emergency department visits by ambulance: a RAND/UCLA modified Delphi study protocol." BMJ Open 11, no. 1 (January 2021): e045351. http://dx.doi.org/10.1136/bmjopen-2020-045351.
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IntroductionOntario ambulances are restricted from patient transportation to sub-acute levels of care when these facilities may be more suitable than emergency departments for non-emergent conditions. There is no known patient classification specifically constructed to inform ED diversion protocols and guidance for sub-acute centre transportation for primary care–like patient conditions.ObjectiveTo construct a novel patient classification of potentially preventable emergency department visits following transport by ambulance, and analyse patient-level characteristic associations with this classification based in Ontario secondary data.Methods and analysisThe Primary Care–like Ambulance transports following Response for 911-Emergencies (PriCARE) patient classification will be constructed using a two-phase RAND/UCLA modified Delphi design. All experts included are physicians with relevant experience in emergency and/or primary care in Ontario. The first phase of the study will determine consensus of the expert committee on which ED interventions performed on patients with non-emergent acuities could be conducted in sub-acute healthcare centres. The second phase will assess consensus of which patient, hospital and acuity factors are most appropriate to be incorporated into a PriCARE classification. We will also investigate secondary outcomes on consensus of which ED interventions could be transferred to a paramedic context given an expanded scope of practice and patient-level characteristics of PriCARE classified individuals.Ethics and disseminationThis study received a research ethics board exemption waiver from the Hamilton Integrated Research Ethics Board; review reference 2020-11451-GRA. Results will be submitted for publication in a peer-reviewed journal and presented at relevant conferences. The results will be shared with Ontario paramedic services and governing institutions. This study will be used to inform patient classification protocols and clinical decision tools for ambulances to transport to sub-acute healthcare centres.Trial registration numberISRCTN22901977.
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Howard, M. R. "In Larrey's Shadow: Transport of British Sick and Wounded in the Napoleonic Wars." Scottish Medical Journal 39, no. 1 (February 1994): 27–29. http://dx.doi.org/10.1177/003693309403900109.
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Dominique Jean Larrey's introduction of a ‘flying ambulance’ into Napoleons army was a great advance in military surgery. British arrangements for the transport of wounded and sick during the Napoleonic wars fell far short of Larrey's humanitarian vision. The efforts of eminent doctors such as Sir James McGrigor to create a formal ambulance service were frustrated by the army establishment. As a result the sick were often abandoned or carried in local bullock carts. Only sixty years after Waterloo did Britain finally follow Larrey's example and form afield organisation including a trained ambulance corps.
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McClelland, Graham, Karl Charlton, Jacqueline Mains, Karen Millican, and Caroline Cullerton. "A two-armed, randomised, controlled exploratory study of adding the AmbuGard cleaning system to normal deep-cleaning procedures in a regional ambulance service." British Paramedic Journal 5, no. 2 (September 1, 2020): 10–17. http://dx.doi.org/10.29045/14784726.2020.09.5.2.10.
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Background: Ambulance 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 in 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 in North East Ambulance Service ambulances and what impact does adding AmbuGard to the deep-cleaning process make?’.Methods: A two-armed, randomised controlled trial enrolled 14 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.Results: Pathogens of interest were found in 10 (71%) vehicles. CoNS were found in 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.Conclusion: Pathogens 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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Hart, Henry N. "Coronary Care by Nurses in the PreHospital Phase." Prehospital and Disaster Medicine 1, S1 (1985): 147–48. http://dx.doi.org/10.1017/s1049023x00044216.
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The Netherlands, due to its density of population (415 residents per square kilometer) has ambulance services organized under municipal and district health departments (emergency services) or private services (routine transportation). The law requires that each patient be reached by an ambulance within 15 minutes everywhere in the country.Emergency services are generally performed by the health departments, whereas more routine patient transport is carried out by private firms. In the Netherlands, it is usual that emergency complaints are first directed to the family physician who makes further decisions concerning the use of ambulance services. All ambulance services are coordinated from central district ambulance posts.
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Ahn, Joonghyun, Kyle Candela, Philomena Costabile, Eric Henderson, Sarabdeep Singh, oritsetimeyin moju, Theophilus Moss, and Corina Noje. "1117: STAFF SAFETY DURING INTERFACILITY PEDIATRIC AMBULANCE TRANSPORT." Critical Care Medicine 44, no. 12 (December 2016): 355. http://dx.doi.org/10.1097/01.ccm.0000509792.02475.4e.
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MAIO, RONALD F., PHILLIP TEDESCHI, ROBERT SWOR, JOHN KROHMER, RUSS FERREL, and DEBORAH L. JACQUES. "Regional variation of nonrural pediatric ambulance transport rates." Pediatric Emergency Care 12, no. 4 (August 1996): 277–82. http://dx.doi.org/10.1097/00006565-199608000-00010.
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USUL, Eren, and Semih KORKUT. "Transport of COVID-19 patients by air ambulance." Turkish Bulletin of Hygiene and Experimental Biology 78, no. 1 (2021): 47–52. http://dx.doi.org/10.5505/turkhijyen.2020.16046.
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Shinozaki, Rod M., Andreas Schwingshackl, Neeraj Srivastava, Tristan Grogan, and Robert B. Kelly. "Pediatric interfacility transport effects on mortality and length of stay." World Journal of Pediatrics 17, no. 4 (July 28, 2021): 400–408. http://dx.doi.org/10.1007/s12519-021-00445-w.
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Abstract Background We aimed to evaluate the effects of interfacility pediatric critical care transport response time, physician presence during transport, and mode of transport on mortality and length of stay (LOS) among pediatric patients. We hypothesized that a shorter response time and helicopter transports, but not physician presence, are associated with lower mortality and a shorter LOS. Methods Retrospective, single-center, cohort study of 841 patients (< 19 years) transported to a quaternary pediatric intensive care unit and cardiovascular intensive care unit between 2014 and 2018 utilizing patient charts and transport records. Multivariate linear and logistic regression analyses adjusted for age, diagnosis, mode of transport, response time, stabilization time, return duration, mortality risk (pediatric index of mortality-2 and pediatric risk of mortality-3), and inotrope, vasopressor, or mechanical ventilation presence on admission. Results Four hundred and twenty-eight (50.9%) patients were transported by helicopter, and 413 (49.1%) were transported by ambulance. Physicians accompanied 239 (28.4%) transports. The median response time was 2.0 (interquartile range 1.4–2.9) hours. Although physician presence increased the median response time by 0.26 hours (P = 0.020), neither physician presence nor response time significantly affected mortality, ICU length of stay (ILOS) or hospital length of stay (HLOS). Helicopter transports were not significantly associated with mortality or ILOS, but were associated with a longer HLOS (3.24 days, 95% confidence interval 0.59–5.90) than ambulance transports (P = 0.017). Conclusions These results suggest response time and physician presence do not significantly affect mortality or LOS. This may reflect the quality of pre-transport care and medical control communication. Helicopter transports were only associated with a longer HLOS. Our analysis provides a framework for examining transport workforce needs and associated costs.
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Partridge, Tom, Lorelei Gherman, David Morris, Roger Light, Andrew Leslie, Don Sharkey, Donal McNally, and John Crowe. "Smartphone monitoring of in-ambulance vibration and noise." Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine 235, no. 4 (January 9, 2021): 428–36. http://dx.doi.org/10.1177/0954411920985994.
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Transferring sick premature infants between hospitals increases the risk of severe brain injury, potentially linked to the excessive exposure to noise, vibration and driving-related accelerations. One method of reducing these levels may be to travel along smoother and quieter roads at an optimal speed, however this requires mass data on the effect of roads on the environment within ambulances. An app for the Android operating system has been developed for the purpose of recording vibration, noise levels, location and speed data during ambulance journeys. Smartphone accelerometers were calibrated using sinusoidal excitation and the microphones using calibrated pink noise. Four smartphones were provided to the local neonatal transport team and mounted on their neonatal transport systems to collect data. Repeatability of app recordings was assessed by comparing 37 journeys, made during the study period, along an 8.5 km single carriageway. The smartphones were found to have an accelerometer accurate to 5% up to 55 Hz and microphone accurate to 0.8 dB up to 80 dB. Use of the app was readily adopted by the neonatal transport team, recording more than 97,000 km of journeys in 1 year. To enable comparison between journeys, the 8.5 km route was split into 10 m segments. Interquartile ranges for vehicle speed, vertical acceleration and maximum noise level were consistent across all segments (within 0.99 m . s−1, 0.13 m · s−2 and 1.4 dB, respectively). Vertical accelerations registered were representative of the road surface. Noise levels correlated with vehicle speed. Android smartphones are a viable method of accurate mass data collection for this application. We now propose to utilise this approach to reduce potential harmful exposure, from vibration and noise, by routing ambulances along the most comfortable roads.
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Di Nardo, Matteo, Margherita Lonero, Elisabetta Pasotti, Federica Cancani, Daniela Perrotta, Corrado Cecchetti, Francesca Stoppa, et al. "The first five years of neonatal and pediatric transports on extracorporeal membrane oxygenation in the center and south of Italy: The pediatric branch of the Italian “Rete Respira” network." Perfusion 33, no. 1_suppl (May 2018): 24–30. http://dx.doi.org/10.1177/0267659118766829.
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Introduction: Neonatal and pediatric ECMO is a high-risk procedure that should be performed only in expert centers. Children who are eligible for ECMO and are managed in hospitals without ECMO capabilities should be referred to the closest ECMO center before the severity of illness precludes safe conventional transport. When the clinical situation precludes safe conventional transport, ECMO should be provided on site with the patient transported on ECMO. Methods: We retrospectively reviewed our institutional database of all ECMO transports for neonatal and pediatric respiratory failure from February 2013 to February 2018. Results: Over the last 5 years, we provided 24 transports covering all requests from the center and south of Italy except for the islands. Of these transports, 20 were performed on ECMO and 4 without ECMO. No patient died during transportation. Five complications were reported only during the ECMO transports, and all of these were managed without compromising the patient’s safety. The preferred modes of transport were by ambulance (70%) and ambulance transported into the fixed wing aircraft (30%) for longer national distances. The survival to hospital discharge of the patients transported with ECMO was 75% among the neonatal transports and 83.3% among the pediatric transports. The survival to hospital discharge of the four patients transported without ECMO was 100% for both neonates and children. Conclusions: Neonatal and pediatric ECMO transports can be safely performed with a dedicated team that maintains stringent adherence to well-designed management protocols.
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Eastwood, Kathryn, Amee Morgans, Karen Smith, Angela Hodgkinson, Gareth Becker, and Johannes Stoelwinder. "A novel approach for managing the growing demand for ambulance services by low-acuity patients." Australian Health Review 40, no. 4 (2016): 378. http://dx.doi.org/10.1071/ah15134.
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Objective The aim of the present study was to describe the Ambulance Victoria (AV) secondary telephone triage service, called the Referral Service (RS), for low-priority patients calling triple zero. This service provides alternatives to ambulance dispatch, such as doctor or nurse home visits. Methods A descriptive epidemiological review of all the cases managed between 2009 and 2012 was conducted, using data from AV case records, the Victorian Admitted Episodes Dataset and the Australian Bureau of Statistics. Cases were reviewed for patient demographics, condition, final disposition and RS outcome. Results In all, 107148 cases were included in the study, accounting for 10.3% of the total calls for ambulance attendance. Median patient age was 54 years and 55% were female. Geographically based socioeconomic status was associated with the rate of calls to the RS (r = –0.72; 95% confidence interval CI –0.104, –0.049; P < 0.001). Abdominal pain and back symptoms were the most common patient problems. Although 68% of patients were referred to the emergency department, only 27.6% of the total cases were by emergency ambulance; the remainder were diverted to non-emergency ambulance or the patient’s own private transport. The remaining 32% of cases were referred to alternative service providers or given home care advice. Conclusions This paper describes the use of an ongoing secondary triage service, providing an effective strategy for managing emergency ambulance demand. What is known about the topic? Some calls to emergency services telephone numbers for ambulance assistance consist of cases deemed to be low-acuity that could potentially be better managed in the primary care setting. The demand on ambulance resources is increasing each year. Secondary telephone triage systems have been trialled in ambulance services in the US and UK with minimal success in terms of overall impact on ambulance resourcing. What does this paper add? This study describes a model of secondary telephone triage in the ambulance setting that has provided an effective way to divert patients to more suitable forms of health care to meet their needs. What are the implications for practitioners? The implications for practitioners are vast. Some of the issues that currently face paramedics include: fatigue because of high workloads; skills decay because of a lack of exposure to patients requiring intervention with skills the paramedics have, as well as a lack of time for paramedics to practice these skills during their downtime; and decreasing job satisfaction linked to both these factors. Implications for patients include quicker response times because more ambulances will be available to respond and increased patient safety because of decreased fatigue and higher skill levels in paramedics.
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Romundstad, Luis, Knut Ole Sundnes, Johan Pillgram-Larsen, Geir K. Røste, and Mads Gilbert. "Challenges of Major Incident Management When Excess Resources are Allocated: Experiences from a Mass Casualty Incident after Roof Collapse of a Military Command Center." Prehospital and Disaster Medicine 19, no. 2 (June 2004): 179–84. http://dx.doi.org/10.1017/s1049023x00001710.
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AbstractDuring a military exercise in northern Norway in March 2000, the snowladen roof of a command center collapsed with 76 persons inside. Twentyfive persons were entrapped and/or buried under snow masses. There were three deaths. Seven patients had serious injuries, three had moderate injuries, and 16 had minor injuries.A military Convalescence Camp that had been set up in a Sports Hall 125 meters from the scene was reorganized as a causality clearing station. Officers from the Convalescence Camp initially organized search and rescue. In all, 417 persons took part in the rescue work with 36 ambulances, 17 helicopters, three ambulance airplanes and one transport plane available. Two ambulances, five helicopters and one transport aircraft were used. Four patients were evacuated to a civilian hospital and six to a field hospital.The stretcher and treatment teams initially could have been more effectively organized. As resources were ample, this was a mass casualty, not a disaster. Firm incident command prevented the influx of excess resources.
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Kim, Ki Young, Yun Kwon Kim, Kang Hyun Lee, and Suk Joong Yong. "Factors affecting the use of a realtime telemetry system in emergency medical services." Journal of Telemedicine and Telecare 17, no. 8 (October 28, 2011): 441–45. http://dx.doi.org/10.1258/jtt.2011.110305.
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We investigated the factors that affected the use of a realtime telemetry system (RTS) in emergency ambulances. During the study, a total of 7144 patients were transported to a hospital in the city of Wonju via ambulance. In 466 of these cases (7%), the Emergency Medical Technician (EMT) used the RTS. Based on the Elaboration Likelihood Model, we extracted variables from the run records, such as the qualifications of the EMT, level of the patient's consciousness and the transport time. The results indicated that EMTs with higher levels of expertise were more likely to use the RTS when the level of patient consciousness was low, regardless of transport time. Conversely, EMTs with low levels of expertise were more likely to use the RTS when the transport time from scene to hospital was long and were less likely to use the RTS when the transport time was short. There appear to be several ways of improving RTS usage in the pre-hospital situation.
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Apiratwarakul, Korakot, Kamonwon Lenghong, Vajarabhongsa Bhudhisawasdi, Dhanu Gaysonsiri, and Somsak Tiamkao. "Does the Use of Lights and Sirens on Ambulances Affect Pre-hospital Time?" Open Access Macedonian Journal of Medical Sciences 9, E (January 15, 2021): 26–28. http://dx.doi.org/10.3889/oamjms.2021.5526.
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BACKGROUND: The use of lights and sirens (L&S) alerts other drivers of the presence of an ambulance and that they are required yield, increasing the speed and safety of emergency medical services (EMS) operations. However, there have been no studies examining the effect of L&S on pre-hospital time conducted in Thai EMS agencies.
AIM: The aim of the study was to compare the operation times of ambulances with and without the use of L&S.
METHODS: This was a cross-sectional study consisting of patients over 18 years of age assessed and treated through the Srinagarind Hospital EMS between April 2019 and March 2020. Data were collected from the Srinagarind Hospital EMS operation database and hospital information database system.
RESULTS: A total of 1764 patients were enrolled, 1426 (80.8%) of whom were transported in an ambulance that used L&S. The mean age of patients in the L&S group was 45.2 ± 6.2 years and 742 (52.0%) were male. The average response times in the L&S and non-L&S groups were 10.2 min and 18.2 min, respectively (p < 0.001). Average L&S transport time was 11.1 min and non-L&S transport time was 17.1 min (p = 0.008).
CONCLUSIONS: The use L&S reduced the response and transport times of EMS operations but not affect on-scene time.
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Bussières, Sylvain, François Bégin, Pierre-Alexandre Leblanc, Alain Tanguay, Jean-Michel Paradis, Denise Hébert, and Richard Fleet. "Clinical adverse events in prehospital patients with ST-elevation myocardial infarction transported to a percutaneous coronary intervention centre by basic life support paramedics in a rural region." CJEM 20, no. 6 (June 5, 2018): 857–64. http://dx.doi.org/10.1017/cem.2018.383.
Full textAbstract:
CLINICIAN’S CAPSULEWhat is known about the topic?ST-elevation myocardial infarction (STEMI) patients transported by ambulance are at risk for adverse events.What did this study ask?What is the impact of transport time on the occurrence of adverse events in the presence of basic life support paramedics?What did this study find?Transport time is not associated with a higher risk of adverse events.Why does this study matter to clinicians?Largest investigation of adverse events in a Canadian cohort of STEMI patients transported by ambulance.