Hospital-based air ambulance service extends emergency care

St. Louis University Hospitals lease a helicopter ambulance service to reach emergency patients in inaccessible areas quickly, to carry specialized medical personnel and equipment to outlying hospitals, and to transfer patients at risk to appropriate facilities.     

Inappropriate use of emergency ambulance services and the implications for primary health care in Japan

The number and per-capita emergency transports by public ambulancesand the percentage of transports of patients with non-emergencyconditions has been increasing in Japan, especially in urbanareas. Public ambulance services are, of course, essential fortransporting patients with crucial health problems. However,inappropriate ambulance use by patients who do not need emergencytreatment, but who need primary health care, means that thesepatients cannot get suitable health care, and diminishes theeffectiveness and efficiency of emergency medical-care servicesystems. The purposes of this study were to identify the factorsrelating to usage of public ambulance services in urban areas,to determine how to make these services more effective and moreefficient, and to discuss how to provide primary health-careservices so as to reduce the inappropriate use of public ambulanceservices. We investigated the accessibility of primary health-careservices, the characteristics of public ambulance service utilization,and the potential needs of the elderly for emergency-care servicesin two Tokyo wards: Edogawa andSetagaya. There were less healthresources, such as clinics, hospital beds and physicians, percapita in Edogawa than in Setagaya. Both the percentage of ambulancetransports of patients suffering from mild problems and thepercentage of ambulance transports on Sundays were higher inEdogawa than in Setagaya. Our survey showed that the percentagesof the elderly who would call for ambulances for each of threespecific health problems (fever, chest pain and ankle sprain)were all higher in Edogawa than in Setagaya. In both wards,elderly people living with their children and/or grandchildrenwere more likely to choose different health resources accordingto the specific problem being experienced than were elderlypeople living with other aged persons but without young people.The insufficient development of primary healthcare resourcesand systems increased the inappropriate use of high-cost emergencyambulance services by the elderly living in urban areas, wherefamily support is weakening. Health systems therefore need tobe reoriented so as to enhance accessibility to primary healthcareservices.     

A hybrid FLEET model for emergency medical service system design

Covering models have been used to locate emergency services such as ambulance and fire protection systems. As an example, in the late seventies, an analysis of the Baltimore, Maryland fire protection system was conducted with the development and use of a covering model called the Facility Location and Equipment Emplacement Technique (FLEET). The FLEET model combined the location of fire stations with the allocation of primary and special service equipment to the stations. Further, in a recent study of Austin, Texas the ambulance system was restructured based on the use of a covering model. Covering models have also been extended to handle some of the special circumstances involved in emergency service systems. One example is the maximal expected coverage problem (MEXCLP). This paper presents a new covering model which utilizes both the special coverage structure of the MEXCLP and the simultaneous station location and equipment allocation of the FLEET model. Optimal solutions are found using linear and integer programming. Results of the model applied to several planning data sets (including a form of the Austin, Texas planning problem) demonstrate that more concentrated ambulance allocation patterns exist which may lead to easier dispatching, reduced facility costs, and better crew load balancing with little or no loss of service coverage. Tradeoff curves are presented which show that significant reductions in the number of dispatching sites (keeping the number of ambulances constant) can be made without any major changes in service level.     

Quantitative analysis of the demand for emergency medicine in Yokohama City, Japan

PURPOSE: We analyzed regional characteristics that potentially might affect regional demand for emergency medicine in Yokohama city and projected the number of future ambulance users. METHODS: The number of patients transported by ambulance was regarded as an index of the demand for emergency medicine. Various factors that may affect regional demand for emergency medicine were used as dependent variables in multiple regression analysis. The future population was estimated by the cohort change rate method based on the 1995 and 2000 censuses. Data pertaining to ambulance use were obtained from the Annual Fire Fighting Bulletin, Yokohama. Data pertaining to regional factors were obtained from the Annual Health Statistics Report, Yokohama; the Annual Health Statistics Report, Kanagawa; and the Statistics Report, Yokohama. RESULTS: Statistically significant relations were observed between ambulance use per 1000 population and particular regional characteristics, i.e. the proportion of persons undergoing health examinations conducted by public health centers, the number of educational health promotion programs managed by the public sector, the proportion of persons in receipt of livelihood protection, the proportions of roads and commercial areas in each district in relation to the total area, the mean land price, the age-adjusted mortality rate, and the proportion of persons aged 65 years or over. The demand for emergency medicine in Yokohama city was predicted to increase dramatically as the population ages. The number of patients transported by ambulance, which was 121,606 in 2000, was projected to exceed 250,000 in 2030 and to approximate 300,000 in 2050. CONCLUSION: The demand for emergency medicine will increase dramatically in Yokohama city as the society ages, Regional emergency medical systems should be improved accordingly.     

Integration of telemedicine into emergency medical services

We developed an integrated model of telemedicine services in emergency medical care. The architecture was designed to support pre-hospital management. The experimental work was carried out with the collaboration of the emergency medical services (EMS) in Madrid. Two different study populations were defined: a control population using conventional EMS protocols and a population using the telemedicine system. The telemedicine system was based on a telepresence service; electrocardiograms and images were transmitted from the ambulance to the health emergency coordination centre. The cost of dealing with 100 patients using telemedicine was C6030 less than the cost of conventional care. The response times using telemedicine were significantly lower.     

An evaluation of pre-hospital communication between ambulances and an accident and emergency department

We studied pre-hospital notification and the quality of data received from ambulance crews transporting seriously ill or injured patients to an accident and emergency department. During a two-month study period, pre-hospital notification was received for 54 patients. However, the department was notified about only 25 of 62 patients (40%) who, on arrival by ambulance, were triaged as emergencies. Despite developing a data protocol for emergency pre-hospital communication and being equipped to receive emergency ambulance calls directly, many such patients still arrived either unannounced or described in insufficient detail to allow appropriate preparations to be made for them.     

A research proposition for using high definition video in emergency medical services

In emergency situations, communication between the ambulance crew and an emergency department in the hospital can be crucial in determining the best decision for a patient's health. Currently, when an ambulance crew reports at an emergency, paramedics use voice communication from scene of emergency to the hospital. In critical life threatening situations, use of high quality visual images and live video streaming can allow paramedics on the scene of an emergency to take better informed decisions by liaising with expert consultants in the hospital emergency department. This paper proposes the relay of high definition video between the ambulance crew and the hospital using public Internet infrastructure through utilising a virtual path slice controller. The paper also proposes a set of criteria for evaluating the use of video in emergency scenarios taking into account technical, user, application and process requirements together with an overview of the benefits, risks and ethical issues.     

Patients’ experiences and views of an emergency and urgent care system

Background Surveys of patients’ experiences and views of health care usually focus on single services. During an unexpected episode of ill health, patients may make contact with different services and therefore experience care within an emergency and urgent care system. We developed the Urgent Care System Questionnaire and used it to describe patients’ experiences and views of an emergency and urgent care system in England. Methods A market research company used quota sampling and random digit dialling to undertake a telephone survey of 1000 members of the general population in July 2007. Results 15% (151/1000) of the population reported using the emergency and urgent care system in the previous 3 months. Two thirds of users (68%, 98/145) contacted more than one service for their most recent event, with a mean of 2.0 services per event. Users entered the system through a range of services: the majority contacted a daytime GP in the first instance (59%, 85/145), and 12% (18/145) contacted either a 999 emergency ambulance or an emergency department. Satisfaction with all aspects of care diminished when four or more services had been contacted. Conclusions This is the first study to describe patients’ experiences and views of the emergency and urgent care system. The majority of patients experienced a system of care rather than single service care. There was an indication that longer pathways resulted in lower levels of patient satisfaction. Health care organisations can undertake similar surveys to identify problems with their system or to assess the impact of changes made to their system.     

加强急诊"三环理论"的实践体会

目的 探讨急诊"三环理论"在急危重症的抢救、突发公共卫生事件的处置及人才培养等方面的优势.方法回顾分析我院急诊科自2005以来的院前急救、急诊抢救、急诊ICU等环节的临床资料及急诊医生培养情况.结果 急诊科布局合理,急诊绿色通道通畅快捷.120出诊平均在接诊后5～10分钟内到达现场,抢救成功率87.34%,抢救后的危重患者在转运途中无死亡;院内急诊抢救成功率95.25%,急诊ICU救治成功率95.69%,无手术死亡.结论 按照急诊三环理论建设急诊医疗服务体系,可以实现院前急救体系、院内急诊体系和重症监护治疗体系无缝衔接,有利于提高危重病抢救成功率和处置公共卫生事件的能力,有利于培养急诊医学队伍.有针对性的人员排班和与其他科室的良好协调能进一步保障危重病患者的抢救.     

A rural-urban comparison of prehospital emergency medical services in Nebraska.

BACKGROUND: Provision of emergency medical services (EMS) in the rural United States presents a unique challenge. While rural and urban EMS outcomes have been compared, differing urban-rural population characteristics and roles for rural ambulance teams can confound such comparisons. METHODS: A year-long study of the prehospital EMS was conducted in rural Richardson County, Nebraska. Data were collected on the age, sex, and race of patients, response time, transport distance, medical problems encountered, and treatment rendered enroute. These data compared with those from an urban Lancaster County comparison group and statistical data from the Nebraska State Health Department. RESULTS: In the rural county, 70 percent of calls involved the elderly, whereas 38 percent of the urban calls and 36 percent of the Nebraska State calls involved the elderly. The rural ambulance service was more likely to provide for routine transfers, to involve patients with fractures and cardiorespiratory and neurologic problems, and twice as likely to result in hospital admission than was the urban ambulance service. The frequency with which advanced life support measures were applied in the rural area was similar to that in the urban area. The rural area response times were equivalent to the urban area response times after the rural area long-distance transfers were excluded. The location of service in the rural area was more likely to be the hospital or nursing home, whereas the urban location was more likely to be a home, on a highway, or in a public setting. CONCLUSIONS: Prehospital EMS in this rural location involved a predominantly elderly population with a large number of routine transfers linking the nursing home and community hospital. Further comparisons of rural and urban EMS outcomes should account for possible differences in type and severity of illness and type and location of service.     

Guideline 'Pain management for trauma patients in the chain of emergency care'

Pain management for trauma patients is a neglected aspect in the chain of emergency care in general practices, ambulance services, mobile trauma teams and in hospital emergency departments. The aim of the guideline 'Pain management for trauma patients in the chain of emergency care' is to provide pain management recommendations for trauma patients in the chain of emergency care and thereby improve the assistance that patients receive. Paracetamol is the treatment of choice, if necessary with additional use of NSAIDs or opioids; NSAIDs can be administered in the absence of contra-indications, but should be avoided in cases where the patient history is unknown; fentanyl and morphine can be given for severe pain during emergency care, esketamine can be considered in patients with severe pain and hypovolemia. The guideline contains 3 algorithms for measuring pain and for its pharmacological treatment in the chain of emergency care. Implementation of the algorithms requires an alternative working procedure; pain scores must be documented, and general practitioners and nursing staff may administer opioids intravenously.     

院前急救医师配置缺口的测算方法和结果——以上海为例

本文研制院前急救医师配置缺口的测算方法并对上海市的急救医师配置缺口进行测算。以减少迟缓派车现象为目标,通过分析上海市市区近两年的迟缓派车数据来获得上海市市区急救医师缺口的数量,并推广至整个上海市。课题组研制出了峰值法,该方法建立了急救医师增量与减少迟缓派车次数的数量关联。峰值法采用描述统计方法,运用SAS软件编程对原始数据进行分析,具有良好的信度和效度。课题组使用峰值法对上海市2013年、2014年的迟缓派车数据进行分析,结果发现增加40辆值班车次(381名急救医师)可将迟缓派车率从25.61%降至0.22%。建立了增加急救医师与减少迟缓派车次数的数量关联,为决策提供了科学依据。     

大城市急救医疗网络的建设

随着我国城市建设的飞速发展,城市急救医疗体系建设,尤其是网络建设,关系到人民群众的生命安全和保障,具有重要的现实意义.作者提出要在以下6个方面加强城市急救医疗网络建设,籍以提高急救反应速度,提高抢救水平和抢救效果.①加强网络建设,缩短抢救半径;②严格科学管理,提高反应速度;③普及急救知识,延伸医疗保障;④创新急救模式,前置救护车辆;⑤组建特勤队伍,应对突发事件;⑥设置专用车道,确保通行无阻.     

Prehospital and emergency department capacity for acute stroke care in Minnesota

Introduction

Stroke is the third leading cause of death in Minnesota. One strategy to reduce the burden of stroke is to implement systems-level improvements in the prehospital and acute care settings. Two surveys conducted in 2006 obtained information about current practices and capacities of emergency medical services and emergency departments in Minnesota.

Methods

In 2006, the Minnesota Department of Health and the Minnesota Stroke Partnership (the statewide stroke collaborative group) conducted two surveys. The survey for emergency medical services organizations, mailed to every licensed ambulance service in Minnesota, asked about transportation policies and training needs. The survey for hospitals, mailed to every hospital in the state, asked about capacity to treat acute stroke. Results were calculated using simple frequency analyses.

Results

Of 257 surveys mailed to ambulance services, 199 (77%) were returned. Ambulance services generally considered stroke an emergency. Training on stroke was reported most effective in person annually or semiannually. Of 133 surveys mailed to hospitals, 120 (90%) were returned. Stroke capacity differed markedly between hospitals in rural areas and hospitals in the large Minneapolis–St. Paul metropolitan area. Many hospitals, particularly small hospitals, reported lacking stroke protocols. Training for stroke is needed overall but particularly in small hospitals.

Conclusion

Transport and treatment of people with acute stroke in Minnesota vary by hospital size and location. Standardization of transport and protocols for acute treatment may increase efficiency and overall care for stroke patients. In addition, the need to train ambulance personnel and emergency departments about stroke remains high.     

Measurement for management: report of a pilot project to quantify ambulance misuse for managers of a Fife hospital.

Ambulance services appear to be under increasing pressure to provide a full range of services to the Community. It is important, therefore, that the service is appropriately utilised by patients. Health Service Managers, however, have little readily available information which identifies 'appropriate' utilisation. A simple technique is suggested to measure 'appropriateness' of utilisation of ambulances and a pilot survey of ambulance use by patients attending Dunfermline and West Fife Hospital Out-Patient clinics is described. In each case of ambulance use a panel of health professionals evaluated the 'appropriateness' of the patient having utilised this service. In the clinics surveyed, 91% of the sample of 328 patients did not use an ambulance to travel to clinics; in only two cases was use of the ambulance considered to be 'probably inappropriate'. Misuse of the ambulance service was minimal during this study. Health Service Managers have been provided with some evidence to refute suggestions of substantial, inappropriate use of the ambulance service.     

Study to examine the timeliness of care received by patients with open fractures of the lower limb.

The aim of this study was to identify deficiencies in the timeliness of emergency care received by patients with open fracture of the lower limb treated in the Accident and Emergency department at the City Hospital Truro, to help decide whether further investments in emergency ambulance services are warranted and, if so, where specific investments should be made. The ambulance service 'response time', 'on-scene times' and 'mission times', and the 'time to operation after attendance in casualty' were considered. The major deficiency in care identified was the long in-hospital delay before operation, probably resulting from unavailability of operating theatre staff. A lesser deficiency was that ambulance crew seemed to be spending too long on-scene. Suggestions are made on how to identify weaknesses in emergency service, and thus prevent costly and inappropriate investments.     

Barriers to accessing ambulance services in rural Victoria for acute asthma: patients' and medical professionals' perspectives

OBJECTIVE: To study the attitudes and perceptions of rural asthma patients and medical health professionals towards accessing ambulance services for acute asthma. DESIGN: Health professional and patient based focus groups, audit of ambulance patient care records and self administered survey. SETTING: Asthma patients and medical professionals from rural south-western Victoria. RESULTS: The audit of patient care records included 69 asthma case records, and identified short response times (mean, 7 min; SD, 5 min), and documented patient improvement in clinical status in response to ambulance treatment. The focus group analysis identified patient perceptions which act as barriers to accessing ambulance services in acute asthma. These included the perception of response time delays, '000' call centre delays and misunderstanding of the role of paramedics, and when it is appropriate to call an ambulance for acute asthma. These perceptions were expressed by both patients and medical professionals, and both groups had poor knowledge of how and when to access ambulance services for acute asthma. CONCLUSIONS: The misperceptions expressed are of particular concern in a rural population where distance can cause prolonged response times to treatment, and patients who are acutely ill need to contact emergency services promptly and appropriately to improve patient health outcomes.     

No Friday afternoon peak in the number of patients referred to the emergency room at De Weezenlanden Hospital of Zwolle, May/June 1997

OBJECTIVE: To determine how the influx of patients in an emergency room (ER) is spread over the week and what factors play a part. DESIGN: Prospective. METHOD: The ER contacts in the De Weezenlanden Hospital of Zwolle, the Netherlands, were recorded on standardized forms during the period 1 May-14 June 1997 (6 weeks). RESULTS: 1995 ER contacts were recorded: 47% were referred by the GP and 8% by the municipal ambulance service, while 45% came at their own initiative. Injuries to the locomotor apparatus and wounds accounted for at least 50% of all contacts and were more frequent among patients attending at their own initiative (73%) or delivered by the ambulance service (49%) than among those referred by the GP (31%). Patients with various diseases, on the other hand, were mostly referred by the GPs (62%). 76% of all contacts occurred between 8 a.m. and 8 p.m. There was no Friday afternoon peak. The differences between the number of contacts during the week and in the weekend were not significant. Of the patients referred by the GP or delivered by the ambulance service more than half were admitted to the hospital, as against 18% of the patients attending at their own initiative. CONCLUSION: In the ER examined there were not more new patients on the Friday afternoon than during the rest of the week.     

Accident and emergency: patients don't--staff do

Who is responsible for the misuse of the ambulance service and what can be done about it? This question is raised by Terry Ball, planning officer for West Yorkshire Metropolitan Ambulance Service, who believes that the guilty parties are the ambulance service itself, doctors, nurses administrators and support service staff. Here he explores ways in which the misuse can be rectified.     

救护艇医疗队海上应急救援演练体会

医疗救护艇是救治海上伤病员的快速船舶,应急救治能力的高低直接关系到部队的战斗力。通过对医疗救护艇首次参加多兵种海上应急救援演练的总结体会,探讨医疗救护艇的训练方法,建立应急救援的联合保障体系,进一步提高医疗救护艇海上应急保障能力。