Special Issue "Urgent and Acute Prehospital Care"

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Prehospital Care".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 6844

Special Issue Editor

Dr. Tim Kilner
E-Mail Website
Guest Editor
University of Worcester, UK
Interests: urgent and acute prehospital care; major incident and field triage; legal and professional aspects of prehospital practice; education of prehospital clinicians

Special Issue Information

Dear Colleagues,

For many patients in need of urgent or acute care, their journey starts before they enter primary, secondary or tertiary services. The term prehospital care has frequently been used to describe this initial phase of the patient journey but does not do justice to the complexity and diversity of the care provided to individuals at the first point of contact with healthcare services. This Special Issue seeks to illuminate the breadth and sophistication of clinical care provided to patients before their access to and in partnership with primary, secondary, and tertiary care services.

This Special Issue seeks to illuminate the breadth andsophistication of clinical care provided to patients beforetheir access to and in partnership with primary, secondary,and tertiary care services. The Special Issue will featureoriginal research, reviews, and short reports reflecting thediversity of prehospital urgent and acute care provided byhealthcare providers with a range of professionalbackgrounds. Of particular interest would be papers in, butnot limited to, the areas of assessment and managementof patients in the prehospital phase of care across the agespan from birth to older age, during pregnancy, those with mental health needs, and vulnerable individuals. Papers may consider emergency and acute care, as well as urgentcare interventions, be that trauma, surgical, medical or mental health. We would also be interested in papersconsidering nonclinical aspects of prehospital care such asmultiprofessional working, the education of prehospitalclinicians, and legal aspects of prehospital practice.

Dr. Tim Kilner
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Prehospital
  • EMS
  • Paramedic
  • Ambulance
  • Major incident triage
  • Field triage

Published Papers (7 papers)

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Research

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Article
Post-Hypoxic Myoclonus Status following Out-of-Hospital Cardiac Arrest—Does It still Predict a Poor Outcome? A Retrospective Study
Healthcare 2022, 10(1), 41; https://doi.org/10.3390/healthcare10010041 - 27 Dec 2021
Viewed by 685
Abstract
In patients with out-of-hospital cardiac arrest (OHCA), the initial prehospital treatment and transfer of patients directly to intervention clinics—bypassing smaller hospitals—have improved outcomes in recent years. Despite the improved treatment strategies, some patients develop myoclonic status following OHCA, and this phenomenon is usually [...] Read more.
In patients with out-of-hospital cardiac arrest (OHCA), the initial prehospital treatment and transfer of patients directly to intervention clinics—bypassing smaller hospitals—have improved outcomes in recent years. Despite the improved treatment strategies, some patients develop myoclonic status following OHCA, and this phenomenon is usually considered an indicator of poor outcome. With this study, we wanted to challenge this perception. The regional prehospital database in Odense in the Region of Southern Denmark was searched for patients with OHCA from the period of 2011–2016. All 900 patients presenting with a diagnosis of OHCA were included in the study. Patients surviving to the hospital and presenting with myoclonic status were followed for up to one year. Only 2 out of 38 patients with myoclonic status and status epilepticus verified by an EEG survived more than one year. Eleven out of 36 patients with myoclonic status but without status epilepticus survived for more than one year. We found no evidence that myoclonic status is an unmistakable sign of poor outcome when not associated with EEG-verified status epilepticus. The conclusion for clinicians involved in post-resuscitation care is that myoclonic status is uncomfortable to witness but does not necessarily indicate that further treatment is futile. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Article
Methoxyflurane in Non-Life-Threatening Traumatic Pain—A Retrospective Observational Study
Healthcare 2021, 9(10), 1360; https://doi.org/10.3390/healthcare9101360 - 13 Oct 2021
Viewed by 645
Abstract
Pain management is a key issue in prehospital trauma. In Switzerland, paramedics have a large panel of analgesic options. Methoxyflurane was recently introduced into Switzerland, and the goal of this study was to describe both the effect of this medication and the satisfaction [...] Read more.
Pain management is a key issue in prehospital trauma. In Switzerland, paramedics have a large panel of analgesic options. Methoxyflurane was recently introduced into Switzerland, and the goal of this study was to describe both the effect of this medication and the satisfaction of its use. This was a retrospective cohort study, performed in one emergency ambulance service. It included adult patients with traumatic pain and a self-assessment of 3 or more on the visual analogue scale or verbal numerical rating scale. The primary outcome was the reduction in pain between the start of the care and the arrival at the hospital. Secondary outcomes included successful analgesia and staff satisfaction. From December 2018 to 4 June to October 2020, 263 patients were included in the study. Most patients had a low prehospital severity score. The median pain at arrival on site was 8 and the overall decrease in pain observed was 4.2 (95% CI 3.9–4.5). Regarding secondary outcomes, almost 60% had a successful analgesia, and over 70% of paramedics felt satisfied. This study shows a reduction in pain, following methoxyflurane, similar to outcomes in other countries, as well as the attainment of a satisfactory level of pain reduction, according to paramedics, with the advantage of including patients in their own care. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Article
Assessment of Transportation by Air for Patients with Acute ST-Elevation Myocardial Infarction from Non-PCI Centers
Healthcare 2021, 9(3), 299; https://doi.org/10.3390/healthcare9030299 - 08 Mar 2021
Cited by 1 | Viewed by 671
Abstract
The aim of this study was to assess the delays that can potentially occur in the emergency transfer of patients with ST-elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) centers. We conducted a retrospective study using the medical reports pertaining to 97 [...] Read more.
The aim of this study was to assess the delays that can potentially occur in the emergency transfer of patients with ST-elevation myocardial infarction (STEMI) to percutaneous coronary intervention (PCI) centers. We conducted a retrospective study using the medical reports pertaining to 97 patients who presented to the Emergency Department of the Emergency County Hospital of Galati during the year of 2018 with the diagnosis of STEMI and meeting eligibility criteria for PCI, thus warranting transfer to a hospital with PCI facilities. The pick-up time of patients diagnosed with acute myocardial infarction from the emergency department by the transfer crew is significantly shorter (p < 0.05) than those transferred by air, regardless of the PCI center to which the transfer was performed, Iasi or Bucharest, when compared to the time required to process the patients transferred by land to the same PCI centers. The results of the study shows that the helicopter use for transferring acute myocardial infarction patients to a PCI center must be considered, given the distance between non-PCI and PCI centers is over 200 km. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Article
Evaluation of a Prehospital Rotation by Senior Residents: A Web-Based Survey
Healthcare 2021, 9(1), 24; https://doi.org/10.3390/healthcare9010024 - 29 Dec 2020
Cited by 5 | Viewed by 895
Abstract
The added value of prehospital emergency medicine is usually assessed by measuring patient-centered outcomes. Prehospital rotations might however also help senior residents acquire specific skills and knowledge. To assess the perceived added value of the prehospital rotation in comparison with other rotations, we [...] Read more.
The added value of prehospital emergency medicine is usually assessed by measuring patient-centered outcomes. Prehospital rotations might however also help senior residents acquire specific skills and knowledge. To assess the perceived added value of the prehospital rotation in comparison with other rotations, we analyzed web-based questionnaires sent between September 2011 and August 2020 to senior residents who had just completed a prehospital rotation. The primary outcome was the perceived benefit of the prehospital rotation in comparison with other rotations regarding technical and non-technical skills. Secondary outcomes included resident satisfaction regarding the prehospital rotation and regarding supervision. A pre-specified subgroup analysis was performed to search for differences according to the participants’ service of origin (anesthesiology, emergency medicine, or internal medicine). The completion rate was of 71.5% (113/158), and 91 surveys were analyzed. Most senior residents found the prehospital rotation either more beneficial or much more beneficial than other rotations regarding the acquisition of technical and non-technical skills. Anesthesiology residents reported less benefits than other residents regarding pharmacological knowledge acquisition and confidence as to their ability to manage emergency situations. Simulation studies should now be carried out to confirm these findings. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Article
Trends and Characteristics of Emergency Medical Services in Italy: A 5-Years Population-Based Registry Analysis
Healthcare 2020, 8(4), 551; https://doi.org/10.3390/healthcare8040551 - 11 Dec 2020
Cited by 4 | Viewed by 1078
Abstract
Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data [...] Read more.
Background: Emergency Medical Services (EMS) plays a fundamental role in providing good quality healthcare services to citizens, as they are the first responders in distressing situations. Few studies have used available EMS data to investigate EMS call characteristics and subsequent responses. Methods: Data were extracted from the emergency registry for the period 2013–2017. This included call and rescue vehicle dispatch information. All relationships in analyses and differences in events proportion between 2013 and 2017 were tested against the Pearson’s Chi-Square with a 99% level of confidence. Results: Among the 2,120,838 emergency calls, operators dispatched at least one rescue vehicle for 1,494,855. There was an estimated overall incidence of 96 emergency calls and 75 rescue vehicles dispatched per 1000 inhabitants per year. Most calls were made by private citizens, during the daytime, and were made from home (63.8%); 31% of rescue vehicle dispatches were advanced emergency medical vehicles. The highest number of rescue vehicle dispatches ended at the emergency department (74.7%). Conclusions: Our data showed that, with some exception due to environmental differences, the highest proportion of incoming emergency calls is not acute or urgent and could be more effectively managed in other settings than in an Emergency Departments (ED). Better management of dispatch can reduce crowding and save hospital emergency departments time, personnel, and health system costs. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Other

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Case Report
Use of Technology to Aid Clinical Audit in an Asian Emergency Medical Services Department
Healthcare 2021, 9(5), 491; https://doi.org/10.3390/healthcare9050491 - 22 Apr 2021
Cited by 1 | Viewed by 726
Abstract
Although clinical audit is generally accepted to be an essential part of quality review and continuous quality improvement, there are limited reports on and several barriers to the implementation of effective clinical audit in an emergency medicine services (EMS) organization. The barriers include [...] Read more.
Although clinical audit is generally accepted to be an essential part of quality review and continuous quality improvement, there are limited reports on and several barriers to the implementation of effective clinical audit in an emergency medicine services (EMS) organization. The barriers include the significant amount of time, resources, and effort often required to conduct the audit. In this paper, we present a technology-enabled clinical audit tool, termed Medical Service Transformation and Innovation Compass (MYSTIC), which has transformed the way the clinical audit is performed in our EMS department. MYSTIC is a Python program we developed in-house, that extracts data from data fields found in routine ambulance case records maintained by our paramedics, and automatically assigns “pass” or “fail” flags based on pre-defined audit criteria. Compared to previous manual auditing, implementation of the MYSTIC computerized audit system increased the coverage of cases undergoing audit from 10% to 100% of all EMS-attended cases, and we were able to promptly identify and address some deficits in training and knowledge amongst our paramedics. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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Study Protocol
Effect on Chest Compression Fraction of Continuous Manual Compressions with Asynchronous Ventilations Using an i-gel® versus 30:2 Approach during Simulated Out-of-Hospital Cardiac Arrest: Protocol for a Manikin Multicenter Randomized Controlled Trial
Healthcare 2021, 9(3), 354; https://doi.org/10.3390/healthcare9030354 - 20 Mar 2021
Cited by 3 | Viewed by 1533
Abstract
The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous [...] Read more.
The optimal airway management strategy during cardiopulmonary resuscitation is uncertain. In the case of out-of-hospital cardiac arrest, a high chest compression fraction is paramount to obtain the return of spontaneous circulation and improve survival and neurological outcomes. To improve this fraction, providing continuous chest compressions should be more effective than using the conventional 30:2 ratio. Airway management should, however, be adapted, since face-mask ventilation can hardly be carried out while continuous compressions are administered. The early insertion of a supraglottic device could therefore improve the chest compression fraction by allowing ventilation while maintaining compressions. This is a protocol for a multicenter, parallel, randomized simulation study. Depending on randomization, each team made up of paramedics and emergency medical technicians will manage the 10-min scenario according either to the standard approach (30 compressions with two face-mask ventilations) or to the experimental approach (continuous manual compressions with early insertion of an i-gel® supraglottic device to deliver asynchronous ventilations). The primary outcome will be the chest compression fraction during the first two minutes of cardiopulmonary resuscitation. Secondary outcomes will be chest compression fraction (per cycle and overall), compressions and ventilations quality, time to first shock and to first ventilation, user satisfaction, and providers’ self-assessed cognitive load. Full article
(This article belongs to the Special Issue Urgent and Acute Prehospital Care)
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