International Journal of Environmental Research and Public Health

Research

8 pages, 616 KiB

Open AccessArticle

Medical Utilization of Emergency Departments among Patients with Prostate Cancer: A Nationwide Population-Based Study in Taiwan

by Jui-Ming Liu, Ren-Jun Hsu, Yu-Tang Chen and Yueh-Ping Liu

Int. J. Environ. Res. Public Health 2021, 18(24), 13233; https://doi.org/10.3390/ijerph182413233 - 15 Dec 2021

Cited by 1 | Viewed by 2314

Abstract

(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional [...] Read more.

(1) Background: In Taiwan, prostate cancer is a major malignancy with an increasing incidence among men. This study explores the medical utilization of emergency departments among patients with prostate cancer in Taiwan. (2) Methods: This nationwide, population-based study was conducted via a cross-sectional method based on the Registry for Catastrophic Illness Patient Database from Taiwan’s National Health Insurance Research Database. Patients with newly diagnosed prostate cancer between 1997 and 2013 were enrolled in the study and divided into four treatment-related groups. The rate of emergency department presentation, disease categorization of emergency department visits, emergency department-related medical expenditures, and temporal trends were investigated. (3) Results: A total of 18,728 patients with prostate cancer were identified between 1997 and 2013, for whom 13,098 emergency department visits were recorded. The number of emergency department visits increased during the study period. The incidence rate for the medical utilization of emergency department visits was 822 per 1000 people during the study period. The incidence rates for patients with prostate cancer in the radical prostatectomy, radiotherapy, androgen deprivation therapy, and chemotherapy groups were 549, 1611, 1101, and 372, respectively. The average medical expenditure per emergency department visit was TWD 3779.8 ± 5116.2, and the expenditure was recorded for the chemotherapy group at TWD 4690.8 ± 7043.3. The most common disease diagnoses among patients with prostate cancer who presented to the emergency department were injury/poisoning (16.79%), genitourinary disorders (10.66%), and digestive disorders (10.48%). (4) Conclusions: This nationwide population-based study examined the emergency department visits of patients with prostate cancer in Taiwan, providing useful information for improving the quality of medical care. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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14 pages, 2623 KiB

Open AccessArticle

Effect of Temporal Difference on Clinical Outcomes of Patients with Out-of-Hospital Cardiac Arrest: A Retrospective Study from an Urban City of Taiwan

by Han-Chun Huang, Tsung-Yu Lee, Cheng-Han Tsai, Yao-Sing Su, Yi-Rong Chen, Ya-Ni Yeh, Chi-Feng Hsu and Ming-Jen Tsai

Int. J. Environ. Res. Public Health 2021, 18(21), 11020; https://doi.org/10.3390/ijerph182111020 - 20 Oct 2021

Viewed by 2358

Abstract

Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 [...] Read more.

Circadian pattern influence on the incidence of out-of-hospital cardiac arrest (OHCA) has been demonstrated. However, the effect of temporal difference on the clinical outcomes of OHCA remains inconclusive. Therefore, we conducted a retrospective study in an urban city of Taiwan between January 2018 and December 2020 in order to investigate the relationship between temporal differences and the return of spontaneous circulation (ROSC), sustained (≥24 h) ROSC, and survival to discharge in patients with OHCA. Of the 842 patients with OHCA, 371 occurred in the daytime, 250 in the evening, and 221 at night. During nighttime, there was a decreased incidence of OHCA, but the outcomes of OHCA were significant poor compared to the incidents during the daytime and evening. After multivariate adjustment for influencing factors, OHCAs occurring at night were independently associated with lower probabilities of achieving sustained ROSC (aOR = 0.489, 95% CI: 0.285–0.840, p = 0.009) and survival to discharge (aOR = 0.147, 95% CI: 0.03–0.714, p = 0.017). Subgroup analyses revealed significant temporal differences in male patients, older adult patients, those with longer response times (≥5 min), and witnessed OHCA. The effects of temporal difference on the outcome of OHCA may be a result of physiological factors, underlying etiology of arrest, resuscitative efforts in prehospital and in-hospital stages, or a combination of factors. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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13 pages, 621 KiB

Open AccessArticle

Non-Conveyance Due to Patient-Initiated Refusal in Emergency Medical Services: A Retrospective Population-Based Registry Analysis Study in Riyadh Province, Saudi Arabia

by Hassan N. Moafa, Sander M. J. van Kuijk, Mohammed E. Moukhyer, Dhafer M. Alqahtani and Harm R. Haak

Int. J. Environ. Res. Public Health 2021, 18(17), 9252; https://doi.org/10.3390/ijerph18179252 - 2 Sep 2021

Cited by 6 | Viewed by 3246

Abstract

This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the [...] Read more.

This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the scene during 2018 in the Riyadh province. First, the number and percentages of conveyances statuses were calculated. Then, using crude and adjusted linear and logistic regression analysis, we determined which characteristics were predictors of NC due to PIR. We found that 23,991 (34.4%) of missions ended in NC due to PIR, and 5969 ended in EMS-initiated refusal (8.6%). NC rates due to PIR were higher for women, adults, for missions in Riyadh city, during nighttime, for medical emergencies, and for advanced life support (ALS) crews. We also found the following additional predictors significantly associated with the odds of NC due to PIR in crude regression analyses: age category, geographical location, EMS-shift, time of call, emergency type, and response time. We conclude that the NC rate represents half of all missions for patients requesting EMS, and the rate in Riyadh city has increased compared to previous studies. Most NC cases occur for the highest urgency level of medical emergency type in Riyadh city during the nighttime with ALS crews. NC due to PIR involves younger patients more than elderly, and females more than males. This study’s findings have provided empirical evidence that indicate that conducting further studies involving EMS providers, patients, and the public to identify precise and detailed reasons is required. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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12 pages, 668 KiB

Open AccessArticle

Factors Influencing Physician Decision Making to Attempt Advanced Resuscitation in Asystolic Out-of-Hospital Cardiac Arrest

by Charles Payot, Christophe A. Fehlmann, Laurent Suppan, Marc Niquille, Christelle Lardi, François P. Sarasin and Robert Larribau

Int. J. Environ. Res. Public Health 2021, 18(16), 8323; https://doi.org/10.3390/ijerph18168323 - 6 Aug 2021

Cited by 8 | Viewed by 2624

Abstract

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all [...] Read more.

The objective of this study was to identify the key elements used by prehospital emergency physicians (EP) to decide whether or not to attempt advanced life support (ALS) in asystolic out-of-hospital cardiac arrest (OHCA). From 1 January 2009 to 1 January 2017, all adult victims of asystolic OHCA in Geneva, Switzerland, were retrospectively included. Patients with signs of “obvious death” or with a Do-Not-Attempt-Resuscitation order were excluded. Patients were categorized as having received ALS if this was mentioned in the medical record, or, failing that, if at least one dose of adrenaline had been administered during cardiopulmonary resuscitation (CPR). Prognostic factors known at the time of EP’s decision were included in a multivariable logistic regression model. Included were 784 patients. Factors favourably influencing the decision to provide ALS were witnessed OHCA (OR = 2.14, 95% CI: 1.43–3.20) and bystander CPR (OR = 4.10, 95% CI: 2.28–7.39). Traumatic aetiology (OR = 0.04, 95% CI: 0.02–0.08), age > 80 years (OR = 0.14, 95% CI: 0.09–0.24) and a Charlson comorbidity index greater than 5 (OR = 0.12, 95% CI: 0.06–0.27) were the factors most strongly associated with the decision not to attempt ALS. Factors influencing the EP’s decision to attempt ALS in asystolic OHCA are the relatively young age of the patients, few comorbidities, presumed medical aetiology, witnessed OHCA and bystander CPR. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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11 pages, 978 KiB

Open AccessArticle

A Weakly-Supervised Named Entity Recognition Machine Learning Approach for Emergency Medical Services Clinical Audit

by Han Wang, Wesley Lok Kin Yeung, Qin Xiang Ng, Angeline Tung, Joey Ai Meng Tay, Davin Ryanputra, Marcus Eng Hock Ong, Mengling Feng and Shalini Arulanandam

Int. J. Environ. Res. Public Health 2021, 18(15), 7776; https://doi.org/10.3390/ijerph18157776 - 22 Jul 2021

Cited by 7 | Viewed by 3028

Abstract

Clinical performance audits are routinely performed in Emergency Medical Services (EMS) to ensure adherence to treatment protocols, to identify individual areas of weakness for remediation, and to discover systemic deficiencies to guide the development of the training syllabus. At present, these audits are [...] Read more.

Clinical performance audits are routinely performed in Emergency Medical Services (EMS) to ensure adherence to treatment protocols, to identify individual areas of weakness for remediation, and to discover systemic deficiencies to guide the development of the training syllabus. At present, these audits are performed by manual chart review, which is time-consuming and laborious. In this paper, we report a weakly-supervised machine learning approach to train a named entity recognition model that can be used for automatic EMS clinical audits. The dataset used in this study contained 58,898 unlabeled ambulance incidents encountered by the Singapore Civil Defence Force from 1st April 2019 to 30th June 2019. With only 5% labeled data, we successfully trained three different models to perform the NER task, achieving F1 scores of around 0.981 under entity type matching evaluation and around 0.976 under strict evaluation. The BiLSTM-CRF model was 1~2 orders of magnitude lighter and faster than our BERT-based models. Our proposed proof-of-concept approach may improve the efficiency of clinical audits and can also help with EMS database research. Further external validation of this approach is needed. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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11 pages, 2001 KiB

Open AccessArticle

Impact of COVID-19 on Out-of-Hospital Cardiac Arrest in Singapore

by Shir Lynn Lim, Nur Shahidah, Seyed Ehsan Saffari, Qin Xiang Ng, Andrew Fu Wah Ho, Benjamin Sieu-Hon Leong, Shalini Arulanandam, Fahad Javaid Siddiqui and Marcus Eng Hock Ong

Int. J. Environ. Res. Public Health 2021, 18(7), 3646; https://doi.org/10.3390/ijerph18073646 - 31 Mar 2021

Cited by 38 | Viewed by 6029

Abstract

This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) in Singapore. We used data from the Singapore Civil Defence Force to compare the incidence, characteristics and outcomes of all Emergency Medical Services (EMS)-attended [...] Read more.

This study aimed to evaluate the impact of the Coronavirus Disease 2019 (COVID-19) pandemic on out-of-hospital cardiac arrest (OHCA) in Singapore. We used data from the Singapore Civil Defence Force to compare the incidence, characteristics and outcomes of all Emergency Medical Services (EMS)-attended adult OHCA during the pandemic (January–May 2020) and pre-pandemic (January–May 2018 and 2019) periods. Pre-hospital return of spontaneous circulation (ROSC) was the primary outcome. Binary logistic regression was used to calculate the adjusted odds ratios (aOR) for the characteristics of OHCA. Of the 3893 OHCA patients (median age 72 years, 63.7% males), 1400 occurred during the pandemic period and 2493 during the pre-pandemic period. Compared with the pre-pandemic period, OHCAs during the pandemic period more likely occurred at home (aOR: 1.48; 95% CI: 1.24–1.75) and were witnessed (aOR: 1.71; 95% CI: 1.49–1.97). They received less bystander CPR (aOR: 0.70; 95% CI: 0.61–0.81) despite 65% of witnessed arrests by a family member, and waited longer for EMS (OR ≥ 10 min: 1.71, 95% CI 1.46–2.00). Pre-hospital ROSC was less likely during the pandemic period (aOR: 0.67; 95% CI: 0.53–0.84). The pandemic saw increased OHCA incidence and worse outcomes in Singapore, likely indirect effects of COVID-19. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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9 pages, 1027 KiB

Open AccessArticle

Understanding the Effect of Electronic Prehospital Medical Records in Ambulances: A Qualitative Observational Study in a Prehospital Setting

by Frederikke Bøgh Jensen, Kathrine Tornbjerg Ladefoged, Tim Alex Lindskou, Morten Breinholt Søvsø, Erika Frischknecht Christensen and Maurizio Teli

Int. J. Environ. Res. Public Health 2021, 18(5), 2330; https://doi.org/10.3390/ijerph18052330 - 27 Feb 2021

Cited by 7 | Viewed by 4036

Abstract

Little is known of ambulance professionals’ work practices regarding the use of medical records, their communication with patients, before and during hand over to Emergency Departments (ED). An electronic Prehospital Medical Record (ePMR) has been implemented in all Danish ambulances since 2015. Our [...] Read more.

Little is known of ambulance professionals’ work practices regarding the use of medical records, their communication with patients, before and during hand over to Emergency Departments (ED). An electronic Prehospital Medical Record (ePMR) has been implemented in all Danish ambulances since 2015. Our aim was to investigate the use of ePMR and whether it affected the ambulance professionals’ clinical practice. We performed a qualitative study with observations of ePMR use in ambulance runs in the North Denmark Region. Furthermore, informal interviews with ambulance professionals was performed. Analysis was accomplished with inspiration from grounded theory. Our main findings were: (1) the ePMR is an essential work tool which aided ambulance professionals with overview of data collection and facilitated a checklist for ED hand overs, (2) mobility and flexibility of the ePMR facilitated conversations and relations with the patients, and (3) in acute severe situations, the ePMR could not stand alone in hand over or communication with the ED. The ePMR affected the ambulance professionals’ work practice in various ways and utilization of ePMR while simultaneously treating patients in ambulances does not obstruct the relation with the patient. To this end, the ePMR appears feasible in collaboration across the prehospital setting. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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11 pages, 1169 KiB

Open AccessArticle

Community Socioeconomic Status and Dispatcher-Assisted Cardiopulmonary Resuscitation for Patients with Out-of-Hospital Cardiac Arrest

by Ching-Fang Tzeng, Chien-Hsin Lu and Chih-Hao Lin

Int. J. Environ. Res. Public Health 2021, 18(3), 1207; https://doi.org/10.3390/ijerph18031207 - 29 Jan 2021

Cited by 9 | Viewed by 3229

Abstract

Few studies have investigated the association between dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance and the outcomes of out-of-hospital cardiac arrest (OHCA) among communities with different socioeconomic statuses (SES). A retrospective cohort study was conducted using an Utstein-style population OHCA database in Tainan, Taiwan, between [...] Read more.

Few studies have investigated the association between dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance and the outcomes of out-of-hospital cardiac arrest (OHCA) among communities with different socioeconomic statuses (SES). A retrospective cohort study was conducted using an Utstein-style population OHCA database in Tainan, Taiwan, between January 2014 and December 2015. SES was defined based on real estate prices. The outcome measures included the achievement of return of spontaneous circulation (ROSC) and the performance of DA-CPR. Statistical significance was set at a two-tailed p-value of less than 0.05. A total of 2928 OHCA cases were enrolled in the high SES (n = 1656, 56.6%), middle SES (n = 1025, 35.0%), and low SES (n = 247, 8.4%) groups. The high SES group had a significantly higher prehospital ROSC rate, ever ROSC rate, and sustained ROSC rate and good neurologic outcomes at discharge (all p < 0.005). The low SES group, compared to the high and middle SES groups, had a significantly longer dispatcher recognition time (p = 0.004) and lower early (≤60 s) recognition rate (p = 0.029). The high SES group, but none of the DA-CPR measures, had significant associations with sustained ROSC in the multivariate regression model. The low SES group was associated with a longer time to dispatcher recognition of cardiac arrest and worse outcomes of OHCA. Strategies to promote public awareness of cardiac arrest could be tailored to neighborhood SES. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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16 pages, 1040 KiB

Open AccessArticle

Improving Psychological Comfort of Paramedics for Field Termination of Resuscitation through Structured Training

by Chungli Bang, Desmond Ren Hao Mao, Rebacca Chew Ying Cheng, Jen Heng Pek, Mihir Gandhi, Shalini Arulanandam, Marcus Eng Hock Ong and Stella Quah

Int. J. Environ. Res. Public Health 2021, 18(3), 1050; https://doi.org/10.3390/ijerph18031050 - 25 Jan 2021

Viewed by 2547

Abstract

This study examines the impact of a newly developed structured training on Singapore paramedics’ psychological comfort before the implementation of a prehospital termination of resuscitation (TOR) protocol. Following a before and after study design, the paramedics underwent a self-administered questionnaire to assess their [...] Read more.

This study examines the impact of a newly developed structured training on Singapore paramedics’ psychological comfort before the implementation of a prehospital termination of resuscitation (TOR) protocol. Following a before and after study design, the paramedics underwent a self-administered questionnaire to assess their psychological comfort level applying the TOR protocol, 22 months before and one month after a 3-h structured training session. The questionnaire addressed five domains: sociocultural attitudes on resuscitation and TOR, multi-tasking, feelings towards resuscitation and TOR, interactions with colleagues and bystanders and informing survivors. Overall psychological comfort total (PCT) scores and domain-specific scores were compared using the paired t-test with higher scores representing greater comfort. Ninety-six of the 345 eligible paramedics responded. There was no statistically significant change in the mean PCT scores at baseline and post-training; however, the “feelings towards resuscitation and TOR” domain improved by 4.77% (95% CI 1.42 to 8.13 and p = 0.006) and the multi-tasking domain worsened by 4.11% (95% CI −7.82 to −0.41 and p = 0.030). While the structured training did not impact on the overall psychological comfort levels, it led to improvements in the feelings of paramedics towards resuscitation and TOR. Challenges remain in improving paramedics’ psychological comfort levels towards TOR. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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12 pages, 1387 KiB

Open AccessArticle

Association between Survival and Time of On-Scene Resuscitation in Refractory Out-of-Hospital Cardiac Arrest: A Cross-Sectional Retrospective Study

by Hang A Park, Ki Ok Ahn, Eui Jung Lee, Ju Ok Park and on behalf of the Korean Cardiac Arrest Research Consortium (KoCARC) Investigators

Int. J. Environ. Res. Public Health 2021, 18(2), 496; https://doi.org/10.3390/ijerph18020496 - 9 Jan 2021

Cited by 15 | Viewed by 3758

Abstract

It is estimated that over 60% of out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm are refractory to current treatment, never achieve return of spontaneous circulation, or die before they reach the hospital. Therefore, we aimed to identify whether field resuscitation time [...] Read more.

It is estimated that over 60% of out-of-hospital cardiac arrest (OHCA) patients with a shockable rhythm are refractory to current treatment, never achieve return of spontaneous circulation, or die before they reach the hospital. Therefore, we aimed to identify whether field resuscitation time is associated with survival rate in refractory OHCA (rOHCA) with a shockable initial rhythm. This cross-sectional retrospective study extracted data of emergency medical service (EMS)-treated patients aged ≥ 15 years with OHCA of suspected cardiac etiology and shockable initial rhythm confirmed by EMS providers from the OHCA registry database of Korea. A multivariable logistic regression analysis was conducted for survival to discharge and good neurological outcomes in the scene time interval groups. The median scene time interval for the non-survival and survival to discharge patients were 16 (interquartile range (IQR) 13–21) minutes and 14 (IQR 12–16) minutes, respectively. In this study, for rOHCA patients with a shockable rhythm, continuing CPR for more than 15 min on the scene was associated with a decreased chance of survival and good neurological outcome. In particular, we found that in the patients whose transport time interval was >10 min, the longer scene time interval was negatively associated with the neurological outcome. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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13 pages, 1700 KiB

Open AccessArticle

Symptom-Based Dispatching in an Emergency Medical Communication Centre: Sensitivity, Specificity, and the Area under the ROC Curve

by Robert Larribau, Victor Nathan Chappuis, Philippe Cottet, Simon Regard, Hélène Deham, Florent Guiche, François Pierre Sarasin and Marc Niquille

Int. J. Environ. Res. Public Health 2020, 17(21), 8254; https://doi.org/10.3390/ijerph17218254 - 9 Nov 2020

Cited by 4 | Viewed by 3410

Abstract

Background: Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva’s dispatch system based on symptom assessment, in particular, [...] Read more.

Background: Measuring the performance of emergency medical dispatch tools used in paramedic-staffed emergency medical communication centres (EMCCs) is rarely performed. The objectives of our study were, therefore, to measure the performance and accuracy of Geneva’s dispatch system based on symptom assessment, in particular, the performance of ambulance dispatching with lights and sirens (L&S) and to measure the effect of adding specific protocols for each symptom. Methods: We performed a prospective observational study including all emergency calls received at Geneva’s EMCC (Switzerland) from 1 January 2014 to 1 July 2019. The risk levels selected during the emergency calls were compared to a reference standard, based on the National Advisory Committee for Aeronautics (NACA) scale, dichotomized to severe patient condition (NACA ≥ 4) or stable patient condition (NACA < 4) in the field. The symptom-based dispatch performance was assessed using a receiver operating characteristic (ROC) curve. Contingency tables and a Fagan nomogram were used to measure the performance of the dispatch with or without L&S. Measurements were carried out by symptom, and a group of symptoms with specific protocols was compared to a group without specific protocols. Results: We found an acceptable area under the ROC curve of 0.7474, 95%CI (0.7448–0.7503) for the 148,979 assessments included in the study. Where the severity prevalence was 21%, 95%CI (20.8–21.2). The sensitivity of the L&S dispatch was 87.5%, 95%CI (87.1–87.8); and the specificity was 47.3%, 95%CI (47.0–47.6). When symptom-specific assessment protocols were used, the accuracy of the assessments was slightly improved. Conclusions: Performance measurement of Geneva’s symptom-based dispatch system using standard diagnostic test performance measurement tools was possible. The performance was found to be comparable to other emergency medical dispatch systems using the same reference standard. However, the implementation of specific assessment protocols for each symptom may improve the accuracy of symptom-based dispatch systems. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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12 pages, 1294 KiB

Open AccessArticle

Hands-On Times, Adherence to Recommendations and Variance in Execution among Three Different CPR Algorithms: A Prospective Randomized Single-Blind Simulator-Based Trial

by Sami Rifai, Timur Sellmann, Dietmar Wetzchewald, Heidrun Schwager, Franziska Tschan, Sebastian G. Russo and Stephan Marsch

Int. J. Environ. Res. Public Health 2020, 17(21), 7946; https://doi.org/10.3390/ijerph17217946 - 29 Oct 2020

Cited by 2 | Viewed by 2465

Abstract

Background: Alternative cardiopulmonary resuscitation (CPR) algorithms, introduced to improve outcomes after cardiac arrest, have so far not been compared in randomized trials with established CPR guidelines. Methods: 286 physician teams were confronted with simulated cardiac arrests and randomly allocated to one of three [...] Read more.

Background: Alternative cardiopulmonary resuscitation (CPR) algorithms, introduced to improve outcomes after cardiac arrest, have so far not been compared in randomized trials with established CPR guidelines. Methods: 286 physician teams were confronted with simulated cardiac arrests and randomly allocated to one of three versions of a CPR algorithm: (1) current International Liaison Committee on Resuscitation (ILCOR) guidelines (“ILCOR”), (2) the cardiocerebral resuscitation (“CCR”) protocol (3 cycles of 200 uninterrupted chest compressions with no ventilation), or (3) a local interpretation of the current guidelines (“Arnsberg“, immediate insertion of a supraglottic airway and cycles of 200 uninterrupted chest compressions). The primary endpoint was percentage of hands-on time. Results: Median percentage of hands-on time was 88 (interquartile range (IQR) 6) in “ILCOR” teams, 90 (IQR 5) in “CCR” teams (p = 0.001 vs. “ILCOR”), and 89 (IQR 4) in “Arnsberg” teams (p = 0.032 vs. “ILCOR”; p = 0.10 vs. “CCR”). “ILCOR” teams delivered fewer chest compressions and deviated more from allocated targets than “CCR” and “Arnsberg” teams. “CCR” teams demonstrated the least within-team and between-team variance. Conclusions: Compared to current ILCOR guidelines, two alternative CPR algorithms advocating cycles of uninterrupted chest compressions resulted in very similar hands-on times, fewer deviations from targets, and less within-team and between-team variance in execution. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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14 pages, 616 KiB

Open AccessArticle

Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services

by Hassan N. Moafa, Sander Martijn Job van Kuijk, Dhafer M. Alqahtani, Mohammed E. Moukhyer and Harm R. Haak

Int. J. Environ. Res. Public Health 2020, 17(21), 7944; https://doi.org/10.3390/ijerph17217944 - 29 Oct 2020

Cited by 13 | Viewed by 4222

Abstract

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time [...] Read more.

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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12 pages, 797 KiB

Open AccessArticle

Association between Area-Level Socioeconomic Deprivation and Prehospital Delay in Acute Ischemic Stroke Patients: An Ecological Study

by Hang A Park, Hye Ah Lee and Ju Ok Park

Int. J. Environ. Res. Public Health 2020, 17(20), 7392; https://doi.org/10.3390/ijerph17207392 - 11 Oct 2020

Cited by 12 | Viewed by 2608

Abstract

We analyzed the associations between area-level socioeconomic status (SES) and prehospital delay in acute ischemic stroke (AIS) patients by degree of urbanization with the use of an ecological framework. The participants were 13,637 patients over 18 years of age who experienced AIS from [...] Read more.

We analyzed the associations between area-level socioeconomic status (SES) and prehospital delay in acute ischemic stroke (AIS) patients by degree of urbanization with the use of an ecological framework. The participants were 13,637 patients over 18 years of age who experienced AIS from 2007 to 2012 and were admitted to any of the 29 hospitals in South Korea. Area-level SES was determined using 11 variables from the 2010 Korean census. The primary outcome was a prehospital delay (more than three hours from AIS onset time). Multilevel logistic regression was conducted to define the associations of individual- and area-level SES with prehospital delay after adjusting for confounders, which includes the use of emergency medical services (EMS) and individual SES. After adjusting for covariates, it was found that the area-level SES and urbanization were not associated with prehospital delay and EMS use was beneficial in both urban and rural areas. However, after stratification by urbanization, low area-level SES was significantly associated with a prehospital delay in urban areas (adjusted odds ratio (aOR) 1.24, 95% confidence interval (CI) 1.04–1.47) but not in rural areas (aOR 1.04, 95% CI 0.78–1.38). Therefore, we posit that area-level SES in urban areas might be a significant barrier to improving prehospital delay in AIS patients. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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11 pages, 604 KiB

Open AccessArticle

Factors Affecting Treatment with Life-Saving Interventions, Computed Tomography Scans and Specialist Consultations

by Chu-Chieh Chen, Chin-Yi Chen, Ming-Chung Ko, Yi-Chun Chien, Emily Chia-Yu Su and Yi-Tui Chen

Int. J. Environ. Res. Public Health 2020, 17(8), 2914; https://doi.org/10.3390/ijerph17082914 - 23 Apr 2020

Viewed by 3004

Abstract

Background: Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed [...] Read more.

Background: Emergency treatments determined by emergency physicians may affect mortality and patient satisfaction. This paper attempts to examine the impact of patient characteristics, health status, the accredited level of hospitals, and triaged levels on the following emergency treatments: immediate life-saving interventions (LSIs), computed tomography (CT) scans, and specialist consultations (SCs). Methods: A multivariate logistic regression model was employed to analyze the impact of patient characteristics, including sex, age, income and the urbanization degree of the patient’s residence; patient health status, including records of hospitalization and the number of instances of ambulatory care in the previous year; the Charlson Comorbidity Index (CCI) score; the accredited level of hospitals; and the triaged level of emergency treatments. Results: All the patient characteristics were found to impact receiving LSI, CT and SC, except for income. Furthermore, a better health status was associated with a decreased probability of receiving LSI, CT and SC, but the number of instances of ambulatory care was not found to have a significant impact on receiving CT or SC. This study also found no evidence to support impact of CCI on SC. Hospitals with higher accredited levels were associated with a greater chance of patients receiving emergency treatments of LSI, CT and SC. A higher assigned severity (lower triaged level) led to an increased probability of receiving CT and SC. In terms of LSI, patients assigned to level 4 were found to have a lower chance of treatment than those assigned to level 5. Conclusions: This study found that several patient characteristics, patient health status, the accredited level of medical institutions and the triaged level, were associated with a higher likelihood of receiving emergency treatments. This study suggests that the inequality of medical resources among medical institutions with different accredited levels may yield a crowding-out effect. Full article

(This article belongs to the Special Issue Emergency Medical Services Research)

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