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1.
BMJ Open ; 14(3): e078787, 2024 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-38508612

RESUMO

OBJECTIVES: The ambulance service plays a pivotal role in the provision of care in out-of-hospital maternity emergencies. Telephone triage of this patient group is complex and must be sensitive to an emergency situation to prevent unnecessary delays in treatment. This study aimed to explore emergency medical dispatchers' (EMDs) perceptions of the structured protocol they use. DESIGN: Voluntary participation in semistructured phenomenological focus groups. The participants were asked to discuss their experiences of using Medical Priority Dispatch System Protocol 24 (pregnancy, childbirth and miscarriage). Thematic analysis was applied to code and group topics. Discussion between the EMDs is presented for each theme and their experiences, including quotes, are presented to offer an overview of the maternity protocol and its use. SETTING: A large urban UK ambulance service. PARTICIPANTS: 23 control room staff. RESULTS: Perceptions of maternity emergencies, challenges with key questions, the need for sensitivity surrounding miscarriage, using prearrival instructions and postdispatch instructions to help patients and ideas for additional ProQA functionality emerged as the five overarching themes. Protocol 24 was considered to reflect many of the clinical factors EMDs associate with maternity emergencies although further factors, including some non-clinical, were suggested for inclusion. Miscarriage and termination-related calls were thought to be challenging as the language of the protocol is designed for pregnancy. However, instructions were generally considered well written and user-friendly, although some were thought to be unnecessary. EMDs were largely positive regarding the ProQA software, but felt backward navigation was difficult if a situation changed. CONCLUSIONS: Maternity calls were considered rewarding but complex by EMDs. We suggest changes including the use of more sensitive language in response to miscarriage and termination and make recommendations for the omission and inclusion of specific instructions, as well as enhancements to key questions and functionality. Further research is needed to ensure focus group findings are generalisable to other services, particularly in other countries.


Assuntos
Aborto Espontâneo , Operador de Emergência Médica , Serviços Médicos de Emergência , Gravidez , Humanos , Feminino , Triagem/métodos , Sistemas de Comunicação entre Serviços de Emergência , Grupos Focais , Emergências , Telefone , Serviços Médicos de Emergência/métodos
2.
Scand J Trauma Resusc Emerg Med ; 31(1): 8, 2023 Feb 16.
Artigo em Inglês | MEDLINE | ID: mdl-36797760

RESUMO

BACKGROUND: Responsive and efficient emergency medical services (EMS) require accurate telephone triage. In Finland, such services are provided by Emergency Response Centre Agency (ERC Agency). In 2018, a new Finnish computer-assisted emergency dispatch system was introduced: the Emergency Response Integrated Common Authorities (ERICA). After the introduction of ERICA, the appropriateness of EMS dispatch has not been investigated yet. The study´s objective is to determine the consistency between the priority triage of the emergency medical dispatcher (EMD) and the on-scene priority assessment of the EMS, and whether the priority assessment consistency varied among the dispatch categories. METHODS: This was a prospective register-based study. All EMS dispatches registered in the Tampere University Hospital area from 1 August 2021 to 31 August 2021 were analysed. The EMD's mission priority triaged during the emergency call was compared with the on-scene EMS's assessment of the priority, derived from the pre-set criteria. The test performance levels were measured from the crosstabulation of true or false positive and negative values of the priority assessment. Statistical significance was analysed using the chi-square test and the Kruskal-Wallis H test, and p-values < 0.05 were considered significant. RESULTS: Of the 6416 EMS dispatches analysed in this study, 36% (2341) were urgent according to the EMD's dispatch priority, and of these, only 29% (688) were urgent according to the EMS criteria. On the other hand, 64% (4075) of the dispatches were non-urgent according to the EMD's dispatch priority, of which 97% (3949) were non-urgent according to the EMS criteria. Moreover, there were differences between the EMD and EMS priority assessments among the dispatch categories (p < 0.001). The overall efficiency was 72%, sensitivity 85%, specificity 71%, positive predictive value 29%, and negative predictive value 97%. CONCLUSION: While the EMD recognised the non-urgent dispatches with high consistency with the EMS criteria, most of the EMD's urgent dispatches were not urgent according to the same criteria. This may diminish the availability of the EMS for more urgent missions. Thus, measures are needed to ensure more accurate and therefore, more efficient use of EMS resources in the future.


Assuntos
Despacho de Emergência Médica , Operador de Emergência Médica , Serviços Médicos de Emergência , Parada Cardíaca , Humanos , Finlândia , Estudos Retrospectivos , Triagem , Sistemas de Comunicação entre Serviços de Emergência
3.
Am J Emerg Med ; 58: 275-280, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35752085

RESUMO

BACKGROUND: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) is an important prognostic factor in pediatric out-of-hospital cardiac arrest (OHCA). The recognition of cardiac arrest by dispatcher is a key factor for successful DA-CPR. In this study, we evaluated the association between pediatric age and dispatcher recognition. METHODS: A retrospective observational study was designed using a nationwide OHCA registry. Patients under 19 years of age were enrolled. Patients were categorized into four groups according to age (<1 year, 1-6 years, 7-13 years, and 14-18 years). The primary outcome was cardiac arrest recognition by dispatcher. A multivariable logistic regression analysis was performed. RESULTS: A total of 2754 pediatric OHCA patients were enrolled. A negative trend was observed between age and dispatcher performance (p < 0.01). The rate of cardiac arrest recognition was highest in patients under one year of age (61.5%) and lowest in patients ages 14-18 years old (47.1%). Patients in the 7-13 years and 14-18 years age groups were both associated with a decreased rate of recognition (adjusted odds ratio with 95% confidence interval: 0.55 (0.41-0.74) and 0.44 (0.34-0.57), respectively). In the interaction analysis, the association between age and outcomes was more prominent in patients with non-medical causes. CONCLUSION: Patients ages 7-18 years old were negatively associated with cardiac arrest recognition and DA-CPR instruction provision within optimal timeframes compared to those younger than one year old. Development of a tailored protocol could be considered according to age and cause of arrest for better dispatcher performance in pediatric OHCA patients.


Assuntos
Reanimação Cardiopulmonar , Operador de Emergência Médica , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Adolescente , Reanimação Cardiopulmonar/métodos , Criança , Serviços Médicos de Emergência/métodos , Humanos , Lactente , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia , Sistema de Registros , Estudos Retrospectivos
4.
BMJ Open ; 12(4): e059803, 2022 04 13.
Artigo em Inglês | MEDLINE | ID: mdl-35418440

RESUMO

OBJECTIVES: To explore the emergency medical dispatchers (EMDs) experiences of managing emergency medical calls. DESIGN: A qualitative interview study with an inductive approach. EMDs were interviewed individually using a semistructured interview guide. The verbatim transcripts were analysed using a qualitative content analysis. SETTING: EMDs, without a professional background as registered nurses, were recruited from emergency medical communication centers (EMCCs) within Sweden. PARTICIPANTS: To achieve a varied description of EMDs' experiences, participants were included from several EMCCs nationally, using a convenience sampling. Interviews were performed up until saturation of data, resulting in 13 EMDs from 7 EMCCs being interviewed. All the EMDs were women, ranging in age from 28 to 61 years (mean 42 years), and had worked in emergency medical dispatching between 1 and 13.5 years (mean 6.5 years). RESULTS: The analysis revealed the main category-to attentively manage a multifaceted, interactive task-made up of three categories: utilize creativity to gather information, continuously process and assess complex information, and engage in the professional role. The content of each category was reflected in several subcategories further described and illustrated with representative quotes. CONCLUSIONS: Managing emergency medical calls was experienced by EMDs to attentively manage a multifaceted interactive task. Core parts were described as: the ability to utilize creativity to gather information, continuously process and asses complex information, and engage in the professional role. Our results could be beneficial for emergency care managers when designing training programmes and organising EMD work and the EMD work environment, including further development of dispatch protocols and implementation of regular feedback sessions. Moreover, the results indicate that aspects such as self-awareness and emotional challenges encountered during EMD work could be important matters to discuss during staff evaluations.


Assuntos
Despacho de Emergência Médica , Operador de Emergência Médica , Serviços Médicos de Emergência , Adulto , Sistemas de Comunicação entre Serviços de Emergência , Serviços Médicos de Emergência/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
5.
Int Arch Occup Environ Health ; 95(6): 1389-1399, 2022 08.
Artigo em Inglês | MEDLINE | ID: mdl-35266041

RESUMO

OBJECTIVE: To evaluate the effectiveness of an ergonomic intervention program based on the PRECEDE-PROCEED model in terms of improving exposure risks and work-related health problems in emergency medical dispatchers. METHODS: This quasi-experimental study used an interrupted time series design. Participants were 55 employees working in an Emergency Medical Communications Center in Iran. The intervention program was based on the PRECEDE-PROCEED model and included five face-to-face training sessions and installing auxiliary equipment according to best ergonomic principles. Direct observations of the emergency medical dispatchers' working postures using the Rapid Office Strain Assessment and a survey which included a modified Nordic Questionnaire, Work Ability Score, Visual Fatigue Questionnaire, and a Behavioral Factors Questionnaire were used at three time points: baseline, 1 month post-intervention, and 3 months post-intervention. RESULTS: The modified Nordic Questionnaire showed significant reductions in pain intensity scores for neck, lower back, knee and ankle after the ergonomic intervention program. In addition, there were considerable post-training improvements in behavioral factors (knowledge and enabling factors) and working postures. No significant changes were observed in Work Ability Scores, or visual symptoms. CONCLUSIONS: An ergonomic intervention program based on a systematic framework such as the PRECEDE-PROCEED model and on-site interventions can be effective in improving and enhancing the working conditions of emergency medical dispatchers. Therefore, it is suggested that ergonomic interventions be implemented based on standard and valid behavioral change models such as PRECEDE-PROCEED model in other work environments in which musculoskeletal pain and digital eye strain are common.


Assuntos
Operador de Emergência Médica , Doenças Musculoesqueléticas , Dor Musculoesquelética , Doenças Profissionais , Ergonomia , Humanos , Doenças Musculoesqueléticas/prevenção & controle , Doenças Profissionais/prevenção & controle , Postura
6.
Patient Educ Couns ; 105(7): 2130-2136, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35304072

RESUMO

OBJECTIVE: Recognition of out-of-hospital cardiac arrest (OHCA) during 9-1-1 calls is critically important, but little is known about how laypersons and emergency medical dispatchers (EMDs) communicate. We sought to describe 9-1-1 calls for OHCA. METHODS: We performed a mixed-methods, retrospective analysis of 9-1-1 calls for OHCA victims in a large urban emergency medical services (EMS) system using a random sampling of cases containing the term "cardiopulmonary resuscitation" (CPR) in the EMS electronic report. A constant comparison qualitative approach with four independent reviewers continued until thematic saturation was achieved. Quantitative analysis employed computational linguistics. Callers' emotional states were rated using the emotional content and cooperation score (ECCS). RESULTS: Thematic saturation was achieved after 46 calls. Three "OHCA recognition" themes emerged [ 1) disparate OHCA terms used, 2) OHCA mimics create challenges, 3) EMD questions influence recognition]. Three "CPR facilitation" themes emerged [ 1) directive language may facilitate CPR, 2) specific instructions assist CPR, 3) caller's emotions affect CPR initiation]. Callers were generally "anxious but cooperative." Callers saying "pulse" was associated with OHCA recognition. CONCLUSION: Communication characteristics appear to influence OHCA recognition and CPR facilitation. PRACTICE IMPLICATIONS: Dispatch protocols that acknowledge characteristics of callers' communication may improve OHCA recognition and CPR facilitation.


Assuntos
Reanimação Cardiopulmonar , Operador de Emergência Médica , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Reanimação Cardiopulmonar/métodos , Comunicação , Sistemas de Comunicação entre Serviços de Emergência , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos
7.
Scand J Trauma Resusc Emerg Med ; 30(1): 1, 2022 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-35012595

RESUMO

BACKGROUND: The requirement concerning formal education for emergency medical dispatcher (EMD) is debated and varies, both nationally and internationally. There are few studies on the outcomes of emergency medical dispatching in relation to professional background. This study aimed to compare calls handled by an EMD with and without support by a registered nurse (RN), with respect to priority level, accuracy, and medical condition. METHODS: A retrospective observational study, performed on registry data from specific regions during 2015. The ambulance personnel's first assessment of the priority level and medical condition was used as the reference standard. Outcomes were: the proportion of calls dispatched with a priority in concordance with the ambulance personnel's assessment; over- and undertriage; the proportion of most adverse over- and undertriage; sensitivity, specificity and predictive values for each of the ambulance priorities; proportion of calls dispatched with a medical condition in concordance with the ambulance personnel's assessment. Proportions were reported with 95% confidence intervals. χ2-test was used for comparisons. P-levels < 0.05 were regarded as significant. RESULTS: A total of 25,025 calls were included (EMD n = 23,723, EMD + RN n = 1302). Analyses relating to priority and medical condition were performed on 23,503 and 21,881 calls, respectively. A dispatched priority in concordance with the ambulance personnel's assessment were: EMD n = 11,319 (50.7%) and EMD + RN n = 481 (41.5%) (p < 0.01). The proportion of overtriage was equal for both groups: EMD n = 5904, EMD + RN n = 306, (26.4%) p = 0.25). The proportion of undertriage for each group was: EMD n = 5122 (22.9%) and EMD + RN n = 371 (32.0%) (p < 0.01). Sensitivity for the most urgent priority was 54.6% for EMD, compared to 29.6% for EMD + RN (p < 0.01), and specificity was 67.3% and 84.8% (p < 0.01) respectively. A dispatched medical condition in concordance with the ambulance personnel's assessment were: EMD n = 13,785 (66.4%) and EMD + RN n = 697 (62.2%) (p = 0.01). CONCLUSIONS: A higher precision of emergency medical dispatching was not observed when the EMD was supported by an RN. How patient safety is affected by the observed divergence in dispatched priorities is an area for future research.


Assuntos
Operador de Emergência Médica , Serviços Médicos de Emergência , Enfermeiras e Enfermeiros , Sistemas de Comunicação entre Serviços de Emergência , Humanos , Sistema de Registros , Estudos Retrospectivos , Triagem
8.
Eur Geriatr Med ; 13(2): 351-357, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-34652784

RESUMO

PURPOSE: In the last decades, the amount of emergency department (ED) transfers of nursing home (NH) residents has disproportionally increased in western countries. The main role of emergency medical dispatcher (EMD) among this population is to refer residents to EDs in the most appropriate way. The aim of this study was to assess risk factors of inappropriate transfers from NH to ED after EMD request. METHODS: This research was a secondary analysis of a prospective observational multicenter study carried out in 17 EDs entitled FINE aimed to assess potentially inappropriate transfer prevalence among this population. Inappropriate transfers were determined in the FINE study threw a standardized approach by a unique expert team. RESULTS: Overall, 572/1037 (55.2%) of residents were transferred to the ED after an EMD's decision. Among them, 92/572 (16.1%) transfers was defined as inappropriate. The average age was 87.3 years old (SD = 0.3). The main reason for ED transfer were falls (217/572, 37.9%). In multivariate analysis, the presence of a Special Care Unit in NH was significantly associated with a high rate of inappropriate transfer (OR 1.78; 95 CI [1.07-2.93]; p = 0.02) whereas a medical examination by a general practitioner before the transfer (OR 0.55; 95 CI [0.33-0.83]; p = 0.02) and a prompt access to psychiatric advice (OR 0.54; 95 CI [0.33-0.84]; p = 0.007) were associated with a low rate of potentially inappropriate transfer. CONCLUSION: Promoting onsite medical assessment and partnership thanks to available geriatrician's advice may help the emergency medical dispatcher to improve the appropriateness of residents' transfer from Nursing Home to the emergency department.


Assuntos
Operador de Emergência Médica , Transferência de Pacientes , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Humanos , Casas de Saúde , Instituições de Cuidados Especializados de Enfermagem
9.
Scand J Trauma Resusc Emerg Med ; 29(1): 99, 2021 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-34289881

RESUMO

BACKGROUND: In chemical incidents, infrequent but potentially disastrous, the World Health Organization calls for inter-organizational coordination of actors involved. Multi-organizational studies of chemical response capacities are scarce. We aimed to describe chemical incident experiences and perceptions of Swedish fire and rescue services, emergency medical services, police services, and emergency dispatch services personnel. METHODS: Eight emergency service organizations in two distinct and dissimilar regions in Sweden participated in one organization-specific focus group interview each. The total number of respondents was 25 (7 females and 18 males). A qualitative inductive content analysis was performed. RESULTS: Three types of information processing were derived as emerging during acute-phase chemical incident mobilization: Unspecified (a caller communicating with an emergency medical dispatcher), specified (each emergency service obtaining organization-specific expert information), and aligned (continually updated information from the scene condensed and disseminated back to all parties at the scene). Improvable shortcomings were identified, e.g. randomness (unspecified information processing), inter-organizational reticence (specified information processing), and downprioritizing central information transmission while saving lives (aligned information processing). CONCLUSIONS: The flow of information may be improved by automation, public education, revised dispatcher education, and use of technical resources in the field. Future studies should independently assess these mechanism's degree of impact on mobilisation of emergency services in chemical incidents.


Assuntos
Vazamento de Resíduos Químicos , Operador de Emergência Médica/estatística & dados numéricos , Serviços Médicos de Emergência/organização & administração , Desastres , Feminino , Grupos Focais , Humanos , Masculino , Polícia , Suécia/epidemiologia
10.
Scand J Trauma Resusc Emerg Med ; 29(1): 97, 2021 Jul 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281596

RESUMO

BACKGROUND: In acute ischemic stroke, conjugated eye deviation (CED) is an evident sign of cortical ischemia and large vessel occlusion (LVO). We aimed to determine if an emergency dispatcher can recognise LVO stroke during an emergency call by asking the caller a binary question regarding whether the patient's head or gaze is away from the side of the hemiparesis or not. Further, we investigated if the paramedics can confirm this sign at the scene. In the group of positive CED answers to the emergency dispatcher, we investigated what diagnoses these patients received at the emergency department (ED). Among all patients brought to ED and subsequently treated with mechanical thrombectomy (MT) we tracked the proportion of patients with a positive CED answer during the emergency call. METHODS: We collected data on all stroke dispatches in the city of Tampere, Finland, from 13 February 2019 to 31 October 2020. We then reviewed all patient records from cases where the dispatcher had marked 'yes' to the question regarding patient CED in the computer-aided emergency response system. We also viewed all emergency department admissions to see how many patients in total were treated with MT during the period studied. RESULTS: Out of 1913 dispatches, we found 81 cases (4%) in which the caller had verified CED during the emergency call. Twenty-four of these patients were diagnosed with acute ischemic stroke. Paramedics confirmed CED in only 9 (11%) of these 81 patients. Two patients with positive CED answers during the emergency call and 19 other patients brought to the emergency department were treated with MT. CONCLUSION: A small minority of stroke dispatches include a positive answer to the CED question but paramedics rarely confirm the emergency medical dispatcher's suspicion of CED as a sign of LVO. Few patients in need of MT can be found this way. Stroke dispatch protocol with a CED question needs intensive implementation.


Assuntos
Operador de Emergência Médica , Acidente Vascular Cerebral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Serviços Médicos de Emergência , Feminino , Finlândia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos da Motilidade Ocular/etiologia , Estudos Retrospectivos
11.
Scand J Trauma Resusc Emerg Med ; 29(1): 70, 2021 May 24.
Artigo em Inglês | MEDLINE | ID: mdl-34030706

RESUMO

BACKGROUND: Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) increases neurologically intact survival in out-of-hospital cardiac arrest (OHCA) according to several studies. This systematic review summarizes neurologically intact survival outcomes of DA-CPR in comparison with bystander-initiated CPR and no bystander CPR in OHCA. METHODS: The systematic review was conducted according to the PRISMA guidelines. All studies including adult and/or pediatric OHCAs that compared DA-CPR with bystander-initiated CPR or no bystander CPR were included. Primary outcome was neurologically intact survival at discharge, one-month or longer. Studies were searched for in PubMed (MEDLINE), EMBASE, and the Cochrane Library databases. The risk of bias was evaluated using the Newcastle-Ottawa Scale. RESULTS: The search string generated 4742 citations of which 33 studies were eligible for inclusion. Due to overlapping study populations, the review included 14 studies. All studies were observational. The study populations were heterogeneous and included adult, pediatric and mixed populations. Some studies reported only witnessed cardiac arrests, arrests of cardiac ethiology, and/or shockable rhythm. The individual studies scored between six and nine on the Newcastle-Ottawa Scale of risk of bias. The median neurologically intact survival at hospital discharge with DA-CPR was 7.0% (interquartile range (IQR): 5.1-10.8%), with bystander-initiated CPR 7.5% (IQR: 6.6-10.2%), and with no bystander CPR 4.4% (IQR: 2.0-9.0%) (four studies). At one-month neurologically intact survival with DA-CPR was 3.1% (IQR: 1.6-3.4%), with bystander-initiated CPR 5.7% (IQR: 5.0-6.0%), and with no bystander CPR 2.5% (IQR: 2.1-2.6%) (three studies). CONCLUSION: Both DA-CPR and bystander-initiated CPR increase neurologically intact survival compared with no bystander CPR. However, DA-CPR demonstrates inferior outcomes compared with bystander-initiated CPR. Early CPR is crucial, thus in cases where bystanders have not initiated CPR, DA-CPR provides an opportunity to improve neurologically intact survival following OHCA. Variability in OHCA outcomes across studies and multiple confounding factors were identified.


Assuntos
Reanimação Cardiopulmonar/métodos , Operador de Emergência Médica , Parada Cardíaca Extra-Hospitalar/mortalidade , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Criança , Cognição , Serviços Médicos de Emergência , Humanos , Estudos Observacionais como Assunto , Alta do Paciente
12.
Scand J Trauma Resusc Emerg Med ; 29(1): 45, 2021 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-33750425

RESUMO

BACKGROUND: Medical dispatching is a highly complex procedure and has an impact upon patient outcome. It includes call-taking and triage, prioritization of resources and the provision of guidance and instructions to callers. Whilst emergency medical dispatchers play a key role in the process, their perception of the process is rarely reported. We explored medical dispatchers' perception of the interaction with the caller during emergency calls. Secondly, we aimed to develop a model for emergency call handling based on these findings. METHODS: To provide an in-depth understanding of the dispatching process, an explorative qualitative interview study was designed. A grounded theory design and thematic analysis were applied. RESULTS: A total of 5 paramedics and 6 registered nurses were interviewed. The emerging themes derived from dispatchers' perception of the emergency call process were related to both the callers and the medical dispatchers themselves, from which four and three themes were identified, respectively. Dispatchers reported that for callers, the motive for calling, the situation, the perception and presentation of the problem was influencing factors. For the dispatchers the expertise, teamwork and organization influenced the process. Based on the medical dispatchers´ perception, a model of the workflow and interaction between the caller and the dispatcher was developed based on themes related to the caller and the dispatcher. CONCLUSIONS: According to medical dispatchers, the callers seem to lack knowledge about best utilization of the emergency number and the medical dispatching process, which can be improved by public awareness campaigns and incorporating information into first aid courses. For medical dispatchers the most potent modifiable factors were based upon the continuous professional development of the medical dispatchers and the system that supports them. The model of call handling underlines the complexity of medical dispatching that embraces the context of the call beyond clinical presentation of the problem.


Assuntos
Emergências , Operador de Emergência Médica/estatística & dados numéricos , Sistemas de Comunicação entre Serviços de Emergência/organização & administração , Serviços Médicos de Emergência/métodos , Percepção/fisiologia , Pesquisa Qualitativa , Triagem/métodos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Eur J Trauma Emerg Surg ; 47(3): 703-711, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33438040

RESUMO

PURPOSE: The SARS-CoV-2 virus has disrupted global and local medical supply chains. To combat the spread of the virus and prevent an uncontrolled outbreak with limited resources, national lockdown protocols have taken effect in the Netherlands since March 13th, 2020. The aim of this study was to describe the incidence, type and characteristics of HEMS and HEMS-ambulance 'Lifeliner 1' dispatches during the initial phase of the COVID-19 pandemic compared to the same period one year prior. METHODS: A retrospective review of all HEMS and HEMS-ambulance 'Lifeliner 1' dispatches was performed from the start of Dutch nationwide lockdown orders from March 13th until May 13th, 2020 and the corresponding period one year prior. Dispatch-, operational-, patient-, injury-, and on-site treatment characteristics were extracted for analysis. In addition, the rate of COVID-19 positively tested HEMS personnel and the time physicians were unable to take call was described. RESULTS: During the initial phase of the COVID-19 pandemic, the HEMS and HEMS-ambulance was requested in 528 cases. One year prior, a total of 620 requests were received. The HEMS (helicopter and ambulance) was cancelled after deployment in 56.4% of the COVID-19 cohort and 50.7% of the historical cohort (P = 0.05). Incident location type did not differ between the two cohorts, specifically, there was no significant difference in the number of injuries that occurred at home in pandemic versus non-pandemic circumstances. Besides a decrease in the number of falls, the distribution of mechanisms of injury remained similar during the COVID-19 study period. There was no difference in self-inflicted injuries observed. Prehospital interventions remained similar during the COVID-19 pandemic compared to one year prior. Specifically, prehospital intubation did not differ between the two cohorts. The rate of COVID-19 positively tested HEMS personnel was 23.1%. Physicians who tested positive were unable to take call for a mean of 25 days (range 8-53). CONCLUSION: A decrease in the number of deployments and increase in the number of cancelled missions was observed during the COVID-19 study period. No major differences in operational- and injury characteristics were found for HEMS and HEMS-ambulance dispatches between the initial phase of the COVID-19 pandemic in the Netherlands and the same period one year prior. These findings highlight the importance of continued operability of the HEMS, even during pandemic circumstances. LEVEL OF EVIDENCE: III, retrospective comparative study.


Assuntos
Resgate Aéreo , COVID-19 , Serviços Médicos de Emergência , Ferimentos e Lesões , Adulto , Resgate Aéreo/organização & administração , Resgate Aéreo/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Criança , Controle de Doenças Transmissíveis/métodos , Emergências/epidemiologia , Operador de Emergência Médica/estatística & dados numéricos , Serviços Médicos de Emergência/métodos , Serviços Médicos de Emergência/estatística & dados numéricos , Serviços Médicos de Emergência/provisão & distribuição , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Saúde Ocupacional/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , SARS-CoV-2 , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/terapia
14.
Prehosp Emerg Care ; 25(1): 76-81, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-32091293

RESUMO

BACKGROUND: Telephone-assisted cardiopulmonary resuscitation (CPR) is an effective and proven tool to improve patient survival and outcome after cardiac arrest, and is therefore recommended in international resuscitation guidelines. A new technology that provides the emergency medical services (EMS) dispatcher with a video livestream from a smartphone during telephone-assisted CPR was investigated to assess whether a correct judgment of CPR quality is feasible. MATERIAL AND METHODS: After Ethics Committee approval, we conducted this study from August to September 2018 in the University Hospital of Cologne and its metropolitan area. Our study team set up a full-scale resuscitation mannequin on 54 study sites. Video telephony between caller and EMS dispatcher was established, and CPR was initiated with randomized common quality issues concerning compression frequency, compression depth, and compression point. It was evaluated whether the dispatcher recognized correct and incorrect resuscitation performance. RESULTS: Forty-six video calls were established successfully. EMS dispatching staff identified correct compression frequency (100-120/min) in 87.5% of the cases, too low frequency (<80/min) was correctly identified in 92%, and too high frequency (>140/min) in 58.5%, respectively. Correct compression depth (5-6 cm) was identified in 70.6%, shallow compressions (<3cm) in 92.9% and a continuous decrease of depth in 100% of all cases. Correct compression point was identified in 87.5%, incorrect epigastric compression in 92.3%, incomplete release in 58.8%. CONCLUSION: A video livestream from a smartphone can support an EMS dispatcher's assistance in resuscitation. Typical resuscitation mistakes, like incorrect compression frequency or depth, and incorrect compression points could be recognized and corrected efficiently via video livestream.


Assuntos
Reanimação Cardiopulmonar , Operador de Emergência Médica , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Humanos , Parada Cardíaca Extra-Hospitalar/terapia , Smartphone
15.
Emerg Med J ; 38(4): 252-257, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32998954

RESUMO

BACKGROUND: Several Chinese cities have implemented dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), although out-of-hospital cardiac arrest (OHCA) survival rates remain low. We aimed to assess the process compliance, barriers and outcomes of OHCA in one of the earliest implemented (DA-CPR) programmes in China. METHODS: We retrospectively reviewed OHCA emergency dispatch records of Suzhou emergency medical service from 2014 to 2015 and included adult OHCA victims (>18 years) with a bystander-witnessed atraumatic OHCA that was subsequently confirmed by on-site emergency physician. The circumstances and DA-CPR process related to the OHCA event were analysed. Dispatch audio records were reviewed to identify potential barriers to implementation during the DA-CPR process. RESULTS: Of the 151 OHCA victims, none survived. The median time from patient collapse to call for emergency services and that from call to provision of cardiopulmonary resuscitation instructions was 30 (IQR 20-60) min and 115 (IQR 90-153) s, respectively. Only 110 (80.3%) bystanders/rescuers followed the dispatcher instructions; of these, 51 (46.3%) undertook persistent chest compressions. Major barriers to following the DA-CPR instructions were present in 104 (68.9%) cases, including caller disconnection of the call, distraught mood or refusal to carry out either compressions or ventilations. CONCLUSIONS: The OHCA survival rate and the DA-CPR process were far from optimal. The zero survival rate is disproportionally low compared with survival statistics in high-income countries. The prolonged delay in calling the emergency services negated and rendered futile any DA-CPR efforts. Thus, efforts targeted at developing public awareness of OHCA, calling for help and competency in DA-CPR should be increased.


Assuntos
Operador de Emergência Médica/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/mortalidade , Avaliação de Processos em Cuidados de Saúde/métodos , China/epidemiologia , Humanos , Parada Cardíaca Extra-Hospitalar/epidemiologia , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Ressuscitação/métodos , Ressuscitação/normas , Estudos Retrospectivos , Análise de Sobrevida
16.
Am J Emerg Med ; 44: 333-338, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32336582

RESUMO

INTRODUCTION: Out of hospital cardiac arrest (OHCA) is a leading cause of mortality. Bystander CPR is associated with increased OHCA survival rates. Dispatcher assisted CPR (DA-CPR) increases rates of bystander CPR, shockable rhythm prevalence, and improves ROSC rates. The aim of this article was to quantify and qualify DA-CPR (acceptance/rejection), ROSC, shockable rhythms, and associations between factors as seen in MDA, Israel, during 2018. METHODS: All 2018 OHCA incidents in Israel's national EMS database were studied retrospectively. We identified rates and reasons for DA-CPR acceptance or rejection. Reasons DA-CPR was rejected/non-feasible by caller were categorized into 5 groups. ROSC was the primary outcome. We created two study groups: 1) No DA-CPR (n = 542). 2) DA-CPR & team CPR (n = 1768). RESULTS: DA-CPR was accepted by caller 76.5% of incidents. In group 1, ROSC rates were significantly lower compared to patients in group 2 (12.4% vs. 21.3% p < .001). Group 1 had 12.4% shockable rhythms vs. 17.1% in group 2 (DA-CPR and team CPR). Of the total 369 shockable cases, 42.3% (156) achieved ROSC, in the non-shockable rhythms only 14.8% achieved ROSC. CONCLUSIONS: OHCA victims receiving dispatcher assisted bystander CPR have higher rates of ROSC and more prevalence of shockable rhythms. MDA dispatchers offer DA-CPR and it is accepted 76.5% of the time. MDA patients receiving DA-CPR had higher ROSC rates and more shockable rhythms. MDA's age demographic is high, possibly affecting ROSC and shockable rhythm rates.


Assuntos
Reanimação Cardiopulmonar/normas , Operador de Emergência Médica , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Israel , Masculino , Estudos Retrospectivos
17.
Resuscitation ; 159: 85-96, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33253767

RESUMO

INTRODUCTION: Cardiac arrest is a time-sensitive condition requiring urgent intervention. Prompt and accurate recognition of cardiac arrest by emergency medical dispatchers at the time of the emergency call is a critical early step in cardiac arrest management allowing for initiation of dispatcher-assisted bystander CPR and appropriate and timely emergency response. The overall accuracy of dispatchers in recognizing cardiac arrest is not known. It is also not known if there are specific call characteristics that impact the ability to recognize cardiac arrest. METHODS: We performed a systematic review to examine dispatcher recognition of cardiac arrest as well as to identify call characteristics that may affect their ability to recognize cardiac arrest at the time of emergency call. We searched electronic databases for terms related to "emergency medical dispatcher", "cardiac arrest", and "diagnosis", among others, with a focus on studies that allowed for calculating diagnostic test characteristics (e.g. sensitivity and specificity). The review was consistent with Grading of Recommendations, Assessment, Development and Evaluation (GRADE) method for evidence evaluation. RESULTS: We screened 2520 article titles, resulting in 47 studies included in this review. There was significant heterogeneity between studies with a high risk of bias in 18 of the 47 which precluded performing meta-analyses. The reported sensitivities for cardiac arrest recognition ranged from 0.46 to 0.98 whereas specificities ranged from 0.32 to 1.00. There were no obvious differences in diagnostic accuracy between different dispatching criteria/algorithms or with the level of education of dispatchers. CONCLUSION: The sensitivity and specificity of cardiac arrest recognition at the time of emergency call varied across dispatch centres and did not appear to differ by dispatch algorithm/criteria used or education of the dispatcher, although comparisons were hampered by heterogeneity across studies. Future efforts should focus on ways to improve sensitivity of cardiac arrest recognition to optimize patient care and ensure appropriate and timely resource utilization.


Assuntos
Reanimação Cardiopulmonar , Despacho de Emergência Médica , Operador de Emergência Médica , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar , Sistemas de Comunicação entre Serviços de Emergência , Humanos , Parada Cardíaca Extra-Hospitalar/diagnóstico , Parada Cardíaca Extra-Hospitalar/terapia
18.
Medicine (Baltimore) ; 99(42): e22728, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33080730

RESUMO

BACKGROUND: Implementation of dispatcher-assisted cardiopulmonary resuscitation (DACPR) has increased the likelihood of bystander CPR upon cardiac arrest. However, the quality of CPR has been found to be very low. In this study, we aimed to compare CPR quality between the current DACPR practices and the interventional instruction of adding verbal encouragement from the dispatcher. METHODS: In this randomized controlled trial, we recruited adult (age ≥18) laypersons who were non-health care providers and had never received any previous verified CPR training. They were randomly selected to perform DACPR using metronome sounds (mDACPR) as per the standard protocol, or DACPR with metronome sounds along with human encouragement (mheDACPR). The ratio of accurate compression rate, depth, and complete release for each CPR phase was examined. RESULTS: Sixty nine records (34, mDACPR; 35, mheDACPR) were taken. The median proportion of accurate chest compression rate was initially 29.5% with mDACPR, and significantly increased to 71% after 2 minutes of CPR administration (P = .046). However, the median ratio of accurate chest compression depth was 61.5% in the first phase, and significantly decreased to 0% in the last phase (P < .001). In contrast, for the mheDACPR group, a high accurate compression rate was maintained throughout the 2 minutes of CPR administration (91%, 100%, 100%, 100%). CONCLUSION: To maintain the quality of CPR administered by bystanders, continuous feedback and repeated human encouragement should be provided during DACPR. Active dispatcher intervention reduces the time required to reach an appropriate CPR rate and allows for the maintenance of accurate compression rates.


Assuntos
Reanimação Cardiopulmonar , Comunicação , Operador de Emergência Médica , Parada Cardíaca/terapia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
19.
Prehosp Disaster Med ; 35(6): 638-644, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32840194

RESUMO

INTRODUCTION: Triage - the sorting of patients according to urgency of need for clinical care - is an essential part of delivering effective and efficient emergency care. But when frequent over- or under-triaging occurs, finite time and resources are diverted away from those in greatest need of care and the entire Emergency Medical Services (EMS) system is strained. In resource-constrained settings, such as South Africa, poor triage in EMS only serves to compound other contextual challenges. This study examined the accuracy of dispatcher triage over a one-year period in the Western Cape Government (WCG) EMS system in South Africa. METHODS: A retrospective analysis of existing dispatch and EMS data to assess the accuracy of dispatch-assigned priorities was conducted. The mismatch between dispatcher-assigned call priority and triage levels determined by EMS personnel was analyzed via over- and under-triage rates, sensitivity and specificity, and positive and negative predictive values (PPVs and NPVs, respectively). RESULTS: A total of 185,166 records from December 2016 through November 2017 were analyzed. Across all dispatch complaints, the over-triage rate was 67.6% (95% CI, 66.34-68.76) and the under-triage rate was 16.2% (95% CI, 15.44-16.90). Dispatch triage sensitivity for all included records was 49.2% (95% CI, 48.10-50.38), specificity 71.9% (95% CI, 71.00-72.92), PPV 32.5% (95% CI, 30.02-34.88), and NPV 83.8% (95% CI, 81.93-85.73). CONCLUSION: This study provides the first evaluation of dispatch triage accuracy in the WCG EMS system, identifying that the system is suffering from both under- and over-triage. Despite variance across dispatch complaints, both under- and over-triage remained higher than widely accepted norms, and all rates were significantly above acceptable target metrics described in similar studies. Results of this study will be used to motivate the development of more rigorous training programs and resources for WCG EMS dispatchers, including improved dispatch protocols for conditions suffering from high over- and under-triage.


Assuntos
Operador de Emergência Médica , Sistemas de Comunicação entre Serviços de Emergência/normas , Triagem , Sistemas de Comunicação entre Serviços de Emergência/estatística & dados numéricos , Humanos , Estudos Retrospectivos , Sensibilidade e Especificidade , África do Sul
20.
Prehosp Disaster Med ; 35(4): 372-381, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32466824

RESUMO

OBJECTIVE: This systemic review and meta-analysis was conducted to explore the impact of dispatcher-assisted bystander cardiopulmonary resuscitation (DA-BCPR) on bystander cardiopulmonary resuscitation (BCPR) probability, survival, and neurological outcomes with out-of-hospital cardiac arrest (OHCA). METHODS: Electronically searching of PubMed, Embase, and Cochrane Library, along with manual retrieval, were done for clinical trials about the impact of DA-BCPR which were published from the date of inception to December 2018. The literature was screened according to inclusion and exclusion criteria, the baseline information, and interested outcomes were extracted. Two reviewers assessed the methodological quality of the included studies. Pooled odds ratio (OR) and 95% confidence interval (CI) were calculated by STATA version 13.1. RESULTS: In 13 studies, 235,550 patients were enrolled. Compared with no dispatcher instruction, DA-BCPR tended to be effective in improving BCPR rate (I2 = 98.2%; OR = 5.84; 95% CI, 4.58-7.46; P <.01), return of spontaneous circulation (ROSC) before admission (I2 = 36.0%; OR = 1.17; 95% CI, 1.06-1.29; P <.01), discharge or 30-day survival rate (I2 = 47.7%; OR = 1.25; 95% CI, 1.06-1.46; P <.01), and good neurological outcome (I2 = 30.9%; OR = 1.24; 95% CI, 1.04-1.48; P = .01). However, no significant difference in hospital admission was found (I2 = 29.0%; OR = 1.09; 95% CI, 0.91-1.30; P = .36). CONCLUSION: This review shows DA-BPCR plays a positive role for OHCA as a critical section in the life chain. It is effective in improving the probability of BCPR, survival, ROSC before admission, and neurological outcome.


Assuntos
Reanimação Cardiopulmonar , Operador de Emergência Médica , Parada Cardíaca Extra-Hospitalar/terapia , Humanos , Parada Cardíaca Extra-Hospitalar/mortalidade
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