Utilization of Emergency Medical Services by Patients with Acute Coronary Syndromes in the Arab Gulf States

Background

Emergency Medical Services (EMS) play a central role in caring for patients with acute coronary syndromes (ACS). To date, no data exist on utilization of EMS systems in the Arab Gulf States.

Objective

To examine EMS use by patients with ACS in the Gulf Registry of Acute Coronary Events (Gulf RACE). Methods: Gulf RACE was a prospective, multinational study conducted in 2007 of all patients hospitalized with ACS in 65 centers in six Arab countries. Data were analyzed based on mode of presentation (EMS vs. other).

Results

Of 7859 patients hospitalized with ACS through the emergency department (ED), only 1336 (17%) used EMS, with wide variation among countries (2% in Yemen to 37% in Oman). Younger age (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.03–1.15 per 10-year decrement), presence of chest pain (OR 1.73; 95% CI 1.48–2.03), prior myocardial infarction (OR 1.58; 95% CI 1.34–1.86), prior percutaneous coronary intervention (OR 1.27; 95% CI 1.02–1.59), family history of premature coronary disease (OR 1.25; 95% CI 1.09–1.51), and current smoking (OR 1.30; 95% CI 1.13–1.50) were independently associated with not utilizing EMS. Patients with ST-segment elevation myocardial infarction/left bundle branch block myocardial infarction who were transported by EMS were significantly less likely to exhibit major delay in presentation, and were significantly more likely to receive favorable processes of care, including shorter door-to-electrocardiogram time, more frequent coronary reperfusion therapy, and thrombolytic therapy within 30 min of arrival at the ED.

Conclusion

Despite current recommendations, fewer than 1 in 5 patients with ACS use EMS in the Arab Gulf States, highlighting a significant opportunity for improvement. Factors causing this underutilization deserve further investigation.     

Prehospital response to respiratory distress by the public ambulance system in a Ukrainian city

BACKGROUND: The capability of the public ambulance system in Ukraine to address urgent medical complaints in a prehospital environment is unknown. Evaluation using reliable sources of patient data is needed to provide insight into current treatments and outcomes. METHODS: We obtained access to de-identified computer records from the emergency medical services (EMS) dispatch center in Poltava, a medium-sized city in central Ukraine. Covering a five-month period, we retrieved data for urgent calls with a patient complaint of respiratory distress. We evaluated ambulance response and treatment times, field diagnoses, and patient disposition, and analyzed factors related to fatal outcomes. RESULTS: Over the five-month period of the study, 2,029 urgent calls for respiratory distress were made to the Poltava EMS dispatch center. A physician-led ambulance typically responded within 10 minutes. Seventy-seven percent of patients were treated and released, twenty percent were taken to hospital, and three percent died in the prehospital phase. On univariate analysis, age over 60 and altered mental status at the time of the call were strongly associated with a fatal outcome. CONCLUSION: The EMS dispatch center in a medium-sized city in Ukraine has adequate organizational infrastructure to ensure that a physician-led public ambulance responds rapidly to complaints of respiratory distress. That EMS system was able to manage most patients without requiring hospital admission. However, a prehospital fatality rate of three percent suggests that further research is warranted to determine training, equipment, or procedural needs of the public ambulance system to manage urgent medical conditions.     

Physician Medical Direction and Advanced Life Support in the United States

OBJECTIVE: To determine the specialty training and responsibilities of urban U.S. emergency medical service (EMS) medical directors how these factors relate to the type of service involved (fire, hospital, private, municipal). METHODS: A single mailed survey of training officers--field supervisors of 211 urban advanced life support (ALS) services in the United States. The survey also requested information about medications carried, approved procedures. and who set these standards. Respondents also rated the EMS medical director's involvement in various activities (quality assurance, administrative, executive, run reviews, and in-service/education). RESULTS: Eighty-five percent (n = 179) of the forms were returned. with 165 (78%) usable. The physician EMS medical directors were primarily trained in emergency medicine (77%) and were paiid (75%) for EMS responsibilities. The number of medications carried and the number of approved procedures were not related to either the number of hours the physicians commit weekly to the EMS service or their degree of involvement in ALS activities. The physician EMS medical directors were most often involved in quality assurance and education and were less likely to devote time to executive or other administrative functions of ALS units, with the exception of fire-based EMS physician medical directors, who contributed significantly to executive and administrative functions (p < 0.05). Overall practice standards were established by the medical director (46%), the state department of health (24%), and local/regional health authorities (23%). CONCLUSIONS: EMS training officers believe that urban ALS medical directors in the United States primarily provide quality assurance and educational support. With the exception of fire-based EMS systems. physicians appear to have limited involvement in other EMS administrative and executive functions.     

Perceptions of Basic,Advanced, and Pediatric Life Support Training In a United States Medical School

Background

Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS) are integral parts of emergency resuscitative care. Although this training is usually reserved for residents, introducing the training in the medical student curriculum may enhance acquisition and retention of these skills.

Objectives

We developed a survey to characterize the perceptions and needs of graduating medical students regarding BLS, ACLS, and PALS training.

Methods

This was a study of graduating 4^th-year medical students at a U.S. medical school. The students were surveyed prior to participating in an ACLS course in March of their final year.

Results

Of 152 students, 109 (71.7%) completed the survey; 48.6% of students entered medical school without any prior training and 47.7% started clinics without training; 83.4% of students reported witnessing an average of 3.0 in-hospital cardiac arrests during training (range of 0–20). Overall, students rated their preparedness 2.0 (SD 1.0) for adult resuscitations and 1.7 (SD 0.9) for pediatric resuscitations on a 1–5 Likert scale, with 1 being unprepared. A total of 36.8% of students avoided participating in resuscitations due to lack of training; 98.2%, 91.7%, and 64.2% of students believe that BLS, ACLS, and PALS, respectively, should be included in the medical student curriculum.

Conclusions

As per previous studies that have examined this topic, students feel unprepared to respond to cardiac arrests and resuscitations. They feel that training is needed in their curriculum and would possibly enhance perceived comfort levels and willingness to participate in resuscitations.     

消防部队现场医疗救助应成为我国现行院前急救模式的拓展和延伸

分析我国现有院前急救管理办法、院前急救现实中存在的不足以及消防部队现场医疗救助的优势,以观察消防现场医疗救助对于院前急救的弥合作用,并提出未来我国院前急救发展前景。应充分利用消防部队的各种优势,把消防的现场医疗急救有机融合到院前急救体系中,并赋予相应的法律权限和职责,能够显著提高我国院前急救水平,缓解急救矛盾,以提高城市应急能力,增加城市安全感。在我国现有院前急救体制下,应充分利用医疗系统以外的社会急救力量,消防部队作为我国现役的一支社会综合救援力量,二者有机结合才能够突破现有急救瓶颈,适应现实社会发展需要,使我国院前急救逐渐与国际接轨。     

Opioid Abuse in the United States and Department of Health and Human Services Actions to Address Opioid-Drug-Related Overdoses and Deaths

On March 26, 2015, the Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services (HSS) published an online Issue Brief that addresses opioid abuse in the United States and (HHS) actions to address opioid-drug-related overdoses and deaths. This report, which contains the full content of the Issue Brief, is adapted from that document.     

African American Disproportionality Within CPS and Disparate Access to Support Services: Review and Critical Analysis of the Literature

This critical analysis of the literature examines the racial disproportionality of African American children in the U.S. child welfare and foster care systems, and disparate access to Child Protective Services (CPS) referred support services. At each critical decision point within child welfare and foster care services, African American children are disproportionately represented and Black children and families subject to disparate access to employment, housing, mental health assessment and treatment. Competing data regarding non-findings of racial disproportionality in CPS and foster care and disparate treatment among African American families is presented and examined.     

Indian and United States paramedic students: comparison of examination performance for the American Heart Association Advanced Cardiovascular Life Support (ACLS) training

Background

The American Heart Association (AHA) Advanced Cardiovascular Life Support (ACLS) course is taught worldwide. The ACLS course is designed for consistency, regardless of location; to our knowledge, no previous study has compared the cognitive performance of international ACLS students to those in the United States (US).

Study Objectives

As international health educational initiatives continue to expand, an assessment of their efficacy is essential. This study assesses the AHA ACLS curriculum in an international setting by comparing performance of a cohort of US and Indian paramedic students.

Methods

First-year paramedic students at the Emergency Management and Research Institute, Hyderabad, India, and a cohort of first-year paramedic students from the United States comprised the study population. All study participants had successfully completed the standard 2-day ACLS course, taught in English. Each student was given a 40-question standardized AHA multiple-choice examination. Examination performance was calculated and compared for statistical significance.

Results

There were 117 Indian paramedic students and 43 US paramedic students enrolled in the study. The average score was 86% (± 11%) for the Indian students and 87% (± 6%) for the US students. The difference between the average examination scores was not statistically significant in an independent means t-test (p = 0.508) and a Wilcoxon test (p = 0.242).

Conclusion

Indian paramedic students demonstrated excellent ACLS cognitive comprehension and performed at a level equivalent to their US counterparts on an AHA ACLS written examination. Based on the study results, the AHA ACLS course proved effective in an international setting despite being taught in a non-native language.