Reducing the time to activation of the emergency call system in operating theatres: effect of installing vertical red line indicators.

BACKGROUND: The 7th National Audit Project of the Royal College of Anaesthetists (NAP7) recommended that an emergency call system be immediately accessible in all anaesthesia locations. It is essential that all theatre team members can rapidly call for help to reduce the risk of patient harm. However, the ability of staff to activate this system in a timely manner can be affected by cluttered or unfamiliar environments and cognitive overload. One proposed strategy to enable rapid identification and activation of emergency call systems is to install a red vertical painted stripe on the wall from the ceiling to the activation button. We investigated the effect of introducing this vertical red line on activation times in operating theatres in the UK and Australia. METHODS: Operating theatre team members, including anaesthetists, surgeons, anaesthetic nurses, surgical and theatre nurses, operating theatre practitioners, and technicians, were approached without prior warning and asked to simulate activation of an emergency call. Vertical red lines were installed, and data collection repeated in the same operating theatres 4-12 months later. RESULTS: After installation of vertical red lines, the proportion of activations taking >10 s decreased from 31.9% (30/94) to 13.6% (17/125, P=0.001), and >20 s decreased from 19.1% (18/94) to 4.8% (6/125, P<0.001). The longest duration pre-installation was 120 s, and post-installation 35 s. CONCLUSIONS: This simple, safe, and inexpensive design intervention should be considered as a design standard in all operating theatres to minimise delays in calling for help.

Emergency calls from migrants to an emergency call centre: A retrospective epidemiological study.

OBJECTIVE: The study aims to evaluate migrants' inclination to call emergency call centres. Records of calls made to an emergency call centre by migrants of different age groups and nationalities were reviewed retrospectively. MATERIALS AND METHODS: A total of 4481 emergency call records from migrants of 33 different nationalities was evaluated between 2017 and 2021. RESULTS: Migrants called the emergency call centres mostly for medical reasons, and most of their calls resulted in referrals to hospitals. Pain, fever, nausea, and vomiting were among the most common medical reasons for emergency calls. The majority of the calls were in the green triage category, and the calls spread over the week. CONCLUSION: The results showed that migrants use emergency call services in non-emergency situations. The study recommended enhancing migrants' knowledge of when and how to utilise emergency call centres and making health planning to meet their specific needs.

Comparison of two infant cardiopulmonary resuscitation techniques explained by phone in a non-health professionals' population: Two-thumbs encircling hand technique vs. two-fingers technique, a randomised crossover study in a simulation environment.

BACKGROUND: Paediatric out-of-hospital cardiac arrest (OHCA) is the reason for an emergency call in approximately 8/100,000 person-years. Improvement of OHCA resuscitation needs a quality chain of survival and a rapid start of resuscitation. The aim of this study was to compare the efficacy of two resuscitation techniques provided on a mannequin, the two-fingers technique (TFT) and the two-thumbs encircling hand technique (TTHT), explained by a trained emergency call responder on the phone in a population of non-health professionals. METHODS: We conducted a randomised crossover study in the simulation lab of a University Hospital. The participants included in the study were non-health professional volunteers of legal age. The participants were assigned (1:1 ratio) to two groups: group A: TFT then TTHT, group B: TTHT then TFT. Scenario and techniques were discovered during the evaluation. RESULTS: Thirty-five volunteers were randomised before the sessions and 33 ultimately came to the simulation lab. We found a better median QCPR global score during TTHT sessions than during TFT sessions (74 vs. 59, P = 0.046). Linear mixed models showed that the TTHT method was the only variable associated with a better QCPR global score [model 1: ß = 14.3; 95% confidence interval (CI), 2.4-26.2; model 2: ß = 14.5; 95% CI, 2.5-26.6]. CONCLUSION: Our study showed the superiority of TTHT for infant CPR performed by non-health professionals when an emergency call responder advised them over the phone. It seemed to be the best technique for a solo rescuer regardless of previous training.

Barriers to and facilitators for making emergency calls - a qualitative interview study of stroke patients and witnesses.

BACKGROUND AND OBJECTIVES: Early access to hospital for diagnosis and treatment is strongly recommended for patients with acute stroke. Unfortunately, prehospital delay frequently occurs. The aim of the current study was to gain in-depth insight into patient experience and behavior in the prehospital phase of a stroke. METHODS: We conducted qualitative interviews with a purposive sample of 11 patients and six witnesses within four weeks post stroke. The interviews were audio recorded, transcribed, and analyzed utilizing Systematic Text Condensation. RESULTS: The material was classified according to two main categories each containing three subgroups. The first category contained the diversity of sudden changes that all participants noticed. The subgroups were confusing functional changes, distinct bodily changes and witnesses' observations of abnormal behavior or signs. The second category was delaying and facilitating factors. To trivialize or deny stroke symptoms, or having a high threshold for contacting emergency services, led to time delay. Factors facilitating early contact were severe stroke symptoms, awareness of the consequences of stroke or a witness standing by when the stroke occurred. CONCLUSIONS: Prehospital delays involved interrelated elements: (1) Difficulties in recognition of a stroke when symptoms were mild, odd and/or puzzling; (2) Recognition of a stroke or need for medical assistance were facilitated by interaction/communication; (3) High threshold for calling emergency medical services, except when symptoms were severe. The findings may be helpful in planning future public stroke campaigns and in education and training programs for health personnel.

[Security and user acceptance of an intelligent home emergency call system for older people living at home with limited daily living skills and receiving home care]. / Sicherheit und Nutzerakzeptanz eines intelligenten Hausnotrufsystems im Einsatz bei älteren pflegebedürftigen zu Hause lebenden Menschen mit eingeschränkter Alltagskompetenz.

BACKGROUND: Technically based support measures are becoming increasingly more important in an aging society. Such support measures can provide a self-determined life in familiar surroundings despite the need for care. An example for such a support measure is an intelligent home emergency call system (iHNR system), which automatically detects critical situations (e.g. falling down), transmits this information to an emergency call center and therefore initiates assistance faster. OBJECTIVE: The aim of this uncontrolled, two center observational study was to evaluate the security and acceptance of an iHNR system used by older people receiving home care. MATERIAL AND METHODS: The study was carried out based on 51 subjects with at least a 6-month observation period using the iHNR system. The iHNR system was installed in all homes of the participants. Interviews about acceptance, perceived and objective security, impact on independence and usability of the new iHNR system were conducted. Analysis was performed with particular respect to depression, quality of life, frailty and self-estimated need for assistance. RESULTS: A total of 39 complete records were collected and evaluated. The participants represented a vulnerable group of people with rather depressive moods, negative quality of life and a high level of frailty without significant changes over the observation period. Positive results were found regarding subjective and objective security and acceptance as well as ease of operation of the iHNR system. The fear of falling was only marginally influenced. CONCLUSION: Acceptance regarding the new iHNR system was high. The system provoked a stronger sense of security while at the same time leading to a reduced sense of control. The system seems to be able to detect critical events and can automatically and quickly alert the necessary help services. Therefore, people in need of care can remain longer in their own homes.

Are rural patients aware of myocardial infarction's risk factors, symptoms, and management? A survey study in the COVID-19 pandemic era.

I n t r o d u c t i o n: Mortality from myocardial infarction (MI) is determined by patients' ability to prevent it and, in case of its occurrence, to recognise its symptoms and call an ambulance immediately. There is scarce data on rural populations' knowledge of MI, even though they are disadvantaged in access to medical emergency services. Objective: The aim of the study was to investigate the rural patients' awareness of MI risk factors, symptoms, necessity of calling an ambulance in response to MI symptoms, and its determinants. Materials and Methods: An anonymous and voluntary survey was conducted among 194 patients and their caregivers with median age 68 years at a rural non-public healthcare facility in Poland. R e s u l t s: 60.3% perceive their knowledge of MI as insufficient. Only 26.3% were able to recognise all suggested MI risk factors. 44.8% did not know whether they are at risk of MI. Furthermore, 78% of respondents who had at least three MI risk factors were unaware of being at risk. 45.4% recognised at least three out of four suggested MI symptoms. 76.2% would call an ambulance in response to chest pain suggesting they have MI. Merely 80% were able to provide the emergency phone number. Moreover, among respondents who declared they would not call an ambulance, 38.7% were afraid of in-hospital COVID-19 infection or healthcare system collapse. C o n c l u s i o n s: Rural patients' knowledge of MI risk factors, symptoms, and proper response to them is insufficient. The problem is exacerbated by the COVID-19 pandemic. To improve survival in MI an education campaign is needed.

Implementation of a Self-Triage Web Application for Suspected COVID-19 and Its Impact on Emergency Call Centers: Observational Study.

BACKGROUND: We developed a self-triage web application for COVID-19 symptoms, which was launched in France in March 2020, when French health authorities recommended all patients with suspected COVID-19 call an emergency phone number. OBJECTIVE: Our objective was to determine if a self-triage tool could reduce the burden on emergency call centers and help predict increasing burden on hospitals. METHODS: Users were asked questions about their underlying conditions, sociodemographic status, postal code, and main COVID-19 symptoms. Participants were advised to call an emergency call center if they reported dyspnea or complete loss of appetite for over 24 hours. Data on COVID-19-related calls were collected from 6 emergency call centers and data on COVID-19 hospitalizations were collected from Santé Publique France and the French Ministry of Health. We examined the change in the number of emergency calls before and after the launch of the web application. RESULTS: From March 17 to April 2, 2020, 735,419 questionnaires were registered in the study area. Of these, 121,370 (16.5%) led to a recommendation to call an emergency center. The peak number of overall questionnaires and of questionnaires leading to a recommendation to call an emergency center were observed on March 22, 2020. In the 17 days preceding the launch of the web application, emergency call centers in the study area registered 66,925 COVID-19-related calls and local hospitals admitted 639 patients for COVID-19; the ratio of emergency calls to hospitalizations for COVID-19 was 104.7 to 1. In the 17 days following the launch of the web application, there were 82,347 emergency calls and 6009 new hospitalizations for COVID-19, a ratio of 13.7 calls to 1 hospitalization (chi-square test: P<.001). CONCLUSIONS: The self-triage web application launch was followed by a nearly 10-fold increase in COVID-19-related hospitalizations with only a 23% increase in emergency calls. The peak of questionnaire completions preceded the peak of COVID-19-related hospitalizations by 5 days. Although the design of this study does not allow us to conclude that the self-triage tool alone contributed to the alleviation of calls to the emergency call centers, it does suggest that it played a role, and may be used for predicting increasing burden on hospitals. TRIAL REGISTRATION: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171.

[Structured or protocol-based dispatching programs]. / Strukturierte bzw. standardisierte Notrufabfrage: Leisten die Systeme tatsächlich, was sie vorgeben zu leisten?

BACKGROUND: The increasing introduction of standardized emergency call systems in German-speaking countries follows the recommendations of the European Resuscitation Council (ERC) and German Resuscitation Council (GRC), according to which the emergency call shall be queried using specified protocols. Although there may be a need for improvement in terms of sensitivity and specificity with regard to the detection of special clinical pictures, standardized products are preferred for emergency call inquiries, which can enable constant call processing regardless of user, time and situation during the day. This increases both patient safety and the legal security of the control center staff and the company management. OBJECTIVES: Do such systems deliver what they are expected to perform? METHODS: Research of current literature. RESULTS: Emergency call interrogation systems are performing as expected. The compliance of the tele communicator has a significant impact on the quality of a call. CONCLUSION: There is a need for optimization of the establish standards for the use of the structured and protocol-based systems and in improving user training.

Factors affecting medical file documentation during telephone triage at an emergency call centre: a cross-sectional study of out-of-hours home visits by general practitioners in France.

BACKGROUND: In France, general practitioners (GPs) perform out-of-hours home visits (OOH-HVs) after physician-led telephone triage at the emergency call centre. The quality of a systematic physician-led triage has not been determined in France and may affect the efficiency of the OOH-HV process. The objectives of this study were first, to evaluate the quality of reporting in the electronic patient's file after such triage and second, to analyse the factors associated with altered reporting. METHODS: Cross-sectional study in a French urban emergency call centre (district of Paris area) from January to December 2015. For a random selection of 30 days, data were collected from electronic medical files that ended with an OOH-HV decision. Missing key quality criteria (medical interrogation, diagnostic hypothesis or ruled-out severity criteria) were analysed by univariate then multivariate logistic regression, adjusted on patient, temporal and organizational data. RESULTS: Among 10,284 OOH-HVs performed in 2015, 748 medical files were selected. Reasons for the encounter were digestive tract symptoms (22%), fever (19%), ear nose and throat symptoms, and cardiovascular and respiratory problems (6% each). Medical interrogation was not reported in 2% of files (n = 16/748) and a diagnostic hypothesis in 58% (n = 432/748); ruled-out severity criteria were not reported in 60% (n = 449/748). On multivariate analysis, altered reporting was related to the work overload of triage assistants (number of incoming calls, call duration, telephone occupation rate; p < 0.03). CONCLUSION: In the electronic files of patients requiring an OOH-HV by a GP in a French urban area, quality in medical reporting appeared to depend on organizational factors only, especially the triage assistants-related work factors. Corrective measures are needed to ensure good quality of triage and care.

Public knowledge and expectations about dispatcher assistance in out-of-hospital cardiac arrest.

AIM: To assess the factors associated with the knowledge and expectations among the general public about dispatcher assistance in out-of-hospital cardiac arrest incidents. BACKGROUND: In medical dispatch centres, emergency calls are frequently operated by specially trained nurses as dispatchers. In cardiac arrest incidents, efficient communication between the dispatcher and the caller is vital for prompt recognition and treatment of the cardiac arrest. DESIGN: A cross-sectional observational survey containing six questions and seven demographic items. METHOD: From January-June 2017 we conducted standardized interviews among 500 members of the general public in Norway. In addition to explorative statistical methods, we used multivariate logistic analysis. RESULTS: Most participants expected cardiopulmonary resuscitation instructions, while few expected "help in deciding what to do." More than half regarded the bystanders present to be responsible for the decision to initiate cardiopulmonary resuscitation. Most participants were able to give the correct emergency medical telephone number. The majority knew that the emergency call would not be terminated until the ambulance arrived at the scene. However, only one-third knew that the emergency telephone number operator was a trained nurse. CONCLUSION: The public expect cardiopulmonary resuscitation instructions from the emergency medical dispatcher. However, the majority assume it is the responsibility of the bystanders to make the decision to initiate cardiopulmonary resuscitation or not. Based on these findings, cardiopulmonary resuscitation training initiatives and public campaigns should focus more on the role of the emergency medical dispatcher as the team leader of the first resuscitation team in cardiac arrest incidents.

[PM 2.5 and Emergency Calls for Health with Respiratory Diseases in Chengdu in 2017].

OBJECTIVE: To determine the association between daily particulate matter 2.5 (PM 2.5) mass and emergency calls for help with respiratory diseases. METHODS: Semi-parametric generalized additive model was established to determine the association between daily PM 2.5 and emergency calls for help with respiratory diseases in 2017 in Chengdu, after adjustments for time trend and variations in the days of the week and weather conditions. RESULTS: In 2017, a total of 9 309 emergency calls for help with respiratory diseases were recorded in Chengdu: on average 26 calls a day. Over the year, Chengdu reported a mean PM 2.5 mass concentration of 53.6 µg/m 3, an average temperature of 16.6 ℃, and an average relative humidity of 81.2%. The single pollutant model with lag time effect showed that a 10 µg/m 3 increase in PM 2.5 was associated with an increase of 1.26% (95% confidence interval ( CI) 0.56%-1.97%) emergency calls for help with respiratory diseases. The exposure-response was almost in a direct line. The dual pollutant model found that O 3 8-hour sliding average (O 3-8 h) enhanced the effect of PM 2.5 on emergency calls for help with respiratory diseases. CONCLUSION: Outdoor PM 2.5 is a significant predictor of emergency calls for help with respiratory diseases in Chengdu.

Factors facilitating or hampering nurses identification of stroke in emergency calls.

AIMS: To explore the factors that facilitate or hamper identification of stroke in emergency calls concerning patients with stroke who have fallen or been in a lying position. BACKGROUND: Early identification of stroke in emergency calls is vital but can be complicated as the patients may be unable to express themselves and the callers generally are bystanders. In a previous study, we found presentation of fall or the patient being in a lying position to be the major problem in 66% of emergency calls concerning, but not dispatched as acute stroke. DESIGN: A qualitative study using interpretive phenomenology. METHODS: Analysis of transcribed emergency calls concerning 29 patients with stroke diagnoses at hospital discharge, in 2011 and presented with fall/lying position. FINDINGS: Patients' ability to express themselves, callers' knowledge of the patient and of stroke, first call-takers' and nurses' authority, nurses' coaching and nurses' expertise skills facilitated or hindered the identification of stroke. Certain aspects are adjustable, but some are determined by the situation or on callers' and patients' abilities and thus difficult to change. Nurses' expertise skills were the only theme found to have a decisive effect of the identification of stroke on its own. CONCLUSION: To increase identification of stroke in emergency calls concerning stroke, the first call-takers' and nurses' action, competence and awareness of obstacles are crucial and if strengthened would likely increase the identification of stroke in emergency calls. In complicated cases, nurses' expertise skills seem essential for identification of stroke.

[Sources of information on suicide attempts in the Nord - Pas-de-Calais (France). Contributions and limitations]. / Les sources d'information sur les tentatives de suicide dans le Nord - Pas-de-Calais. Apports et limites.

BACKGROUND: There are very few permanent indicators of mental health in France; suicidal behavior is often only understood on the basis of deaths by suicide. METHOD: The epidemiological interest and methodological limits of four medico-administrative databases from which data on suicide attempts can be extracted have been the subject of a study in the Nord - Pas-de-Calais Region of France: telephone calls for emergency medical assistance after suicide attempt (2009 to 2011), admissions in emergency services with a diagnosis of suicide attempt (2012), medical-surgical hospital admissions as a result of suicide attempt (2009 to 2011), and psychiatric admissions with a diagnosis of suicide attempt (2011). RESULTS: Usable data were provided by one of two emergency medical assistance units, five of thirty emergency departments and all medical-surgical and psychiatric units; in data from the latter two sources, a unique anonymous identifier gave individual statistics, while the first two covered only suicide attempts. In 2011, the number of suicide attempt calls per 100,000 inhabitants was 304, whereas the number of hospitalisations with this diagnosis was 275; rates are highest in men between 20 and 49 years of age, and in women below 20 years of age and between 40 and 49. Sources are seen to be very homogeneous with regards to the average age at which suicide took place (between 37.8 and 38.5 years, depending on the source), and to the sex (55.0% to 57.6% of women). In 2011, the number of patients with a diagnosis of suicide attempt treated in psychiatry is 2.6 times lower than the number hospitalised for suicide attempt in medical-surgical units (3563 vs 9327). CONCLUSION: Permanent gathering of data, and the large volume of data recorded, should encourage the use of these databases in the definition and assessment of mental health policy: an increased contribution from emergency call centers and emergency services, and the coding of the suicidal nature of intoxications by a few clearly under-declaring units, must however be achieved in order to improve this source of information.

Callers' Descriptions of Stroke Symptoms during Emergency Calls in Victims Who Have Fallen or Been Found Lying Down: A Qualitative Content Analysis.

Early identification of stroke symptoms is essential. The rate of stroke identification by call-takers at emergency medical communication centres (EMCCs) varies, and patients who are found in a lying down position are often not identified as having an ongoing stroke. OBJECTIVES: this study aimed to explore signs and symptoms of stroke in patients who had fallen or were found in a lying position. DESIGN: a retrospective exploratory qualitative study design was used. METHOD: a total of 29 emergency calls to EMCCs regarding patients discharged with a stroke diagnosis from a large teaching hospital in Stockholm, Sweden, in January-June 2011, were analysed using qualitative content analysis. RESULTS: during the emergency calls, the callers described a sudden change in the patient's health status including signs such as the patient's loss of bodily control, the patient's perception of a change in sensory perception, and the callers' inability to communicate with the patient. CONCLUSIONS: The callers' descriptions of stroke in a person found in a lying position are not always as described in assessment protocols describing the onset of a stroke. Instead, the symptom descriptions are much vaguer. Therefore, to increase identification of stroke during emergency calls, there is a need for an increased understanding of how callers describe stroke symptoms and communicate with the call-takers.

Analyzing emergency call volume, call durations, and unanswered calls during the first two waves of the COVID-19 pandemic compared to 2019: An observational study of routine data from seven bavarian dispatch centres.

Background: The spread of the COVID-19 pandemic and the corresponding implementation of measures such as stay-at-home orders and curfews had a major impact on health systems, including emergency medical services. This study examined the effect of the pandemic on call volumes, duration of calls and unanswered calls to the emergency number 112. Method: For this retrospective, descriptive study, 986,650 calls to seven emergency dispatch centres in Bavaria between January 01, 2019 and May 31, 2021 were analysed. The absolute number of calls and calls per 100,000 inhabitants as well as the number of unanswered calls are reported. The Mann‒Whitney U test was used to compare mean call durations between 2019 and 2020/2021 during several periods. Results: Call volume declined during the pandemic, especially during periods with strict lockdown restrictions. The largest decline (-12.9 %) occurred during the first lockdown. The largest reduction in the number of emergency calls overall (-25.3 %) occurred on weekends during the second lockdown. Emergency call duration increased, with the largest increase (+13 s) occurring during the "light" lockdown. The number of unanswered calls remained at a similar level as before the pandemic. Conclusion: This study showed that the studied Bavarian dispatch centres experienced lower call volumes and longer call durations during the first two waves of the COVID-19 pandemic (up to May 2021). Longer call durations could be the result of additional questions to identify potentially infectious patients. The fact that the number of unanswered calls hardly changed may indicate that the dispatch centres were not overwhelmed during the study period.

Having Children and Being Married Are Predictors of Burnout and Obesity Among Working Men: Effects of Latent Profile Analysis.

Emergency call-takers and dispatchers' (ECDs) work makes them vulnerable to occupational burnout and health problems. The aim of this research was to apply a Person-Oriented approach in order to examine the relationships between burnout risk factors (having children), personal resources (being married), and health consequences (overweight and obesity) among men working in these positions. The burnout syndrome was assessed among 228 Polish ECDs using The Link Burnout Questionnaire and the method of latent profile analysis (LPA). All ECDs were characterized by high levels of occupational burnout exhibited in 3 out of its 4 dimensions. The LPA allowed us to differentiate 4 patterns of burnout, taking into account socio-demographic variables, the length of employment as ECD and body weight. The need to balance the demands of professional work with having children and marital roles played an important role in predicting the level of professional burnout. There was a relationship between the dimensions of occupational burnout and age, being married, and having children. Being married was associated with a greater intensity of emotional exhaustion, and the level of exhaustion was higher if the employee had children in their care. Health consequences in the form of overweight and obesity can be associated with levels of emotional exhaustion and professional effectiveness. The application of the Person-Oriented approach presents hidden correlations between burnout predictors and health consequences.

Identification of Anterior Large Vessel Occlusion Stroke During the Emergency Call: Protocol for a Controlled, Nonrandomized Trial.

BACKGROUND: Endovascular thrombectomy (ET), combined with intravenous thrombolysis if possible, is an effective treatment option for patients with stroke who have confirmed anterior large vessel occlusion (aLVO). However, ET is mainly limited to comprehensive stroke centers (CSCs), resulting in a lack of ET capacity in remote, sparsely populated areas. Most stroke networks use the "Drip and Ship" or "Mothership" strategy, resulting in either delayed ET or intravenous thrombolysis, respectively. OBJECTIVE: This study protocol introduces the Leitstellen-Basierte Erkennung von Schlaganfall-Patienten für eine Thrombektomie und daraufhin abgestimmte Optimierung der Rettungskette (LESTOR) strategy, developed to optimize the preclinical part of the stroke chain of survival to improve the clinical outcome of patients with suspected aLVO stroke. This involves refining the dispatch strategy for identifying patients with acute aLVO stroke using a phone-based aLVO query. This includes dispatching emergency physicians and emergency medical services (EMS) to urban emergency sites, as well as dispatching helicopter EMS to remote areas. If a highly suspected aLVO is identified after a standardized aLVO score evaluation during a structured examination at the emergency scene, prompt transport to a CSC should be prioritized. METHODS: The LESTOR study is a controlled, nonrandomized study implementing the LESTOR strategy, with a stepped-wedge, cluster trial design in 6 districts in southwest Germany. In an interprofessional, iterative approach, an aLVO query or dispatch protocol intended for use by dispatchers, followed by a coordinated aLVO examination score for use by EMS, is being developed, evaluated, and pretested in a simulation study. After the training of all participating health care professionals with the corresponding final aLVO query, the LESTOR strategy is being implemented stepwise. Patients otherwise receive usual stroke care in both the control and intervention groups. The primary outcome is the modified Rankin Scale at 90 days in patients with stroke receiving endovascular treatment. We will use a generalized linear mixed model for data analysis. This study is accompanied by a cost-effectiveness analysis and a qualitative process evaluation. RESULTS: This paper describes and discusses the protocol for this controlled, nonrandomized LESTOR study. Enrollment was completed in June 2023. Data analysis is ongoing and the first results are expected to be submitted for publication in 2024. The project started in April 2020 and will end in February 2024. CONCLUSIONS: We expect that the intervention will improve the clinical outcome of patients with aLVO stroke, especially outside the catchment areas of CSCs. The results of the accompanying process evaluation and the cost-effectiveness analysis will provide further insights into the implementation process and allow for a better interpretation of the results. TRIAL REGISTRATION: German Clinical Trials Register DRKS00022152; https://drks.de/search/de/trial/DRKS00022152. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/51683.

Ambulance deployment without transport: a retrospective difference analysis for the description of emergency interventions without patient transport in Bavaria.

BACKGROUND: Not all patients who call the ambulance service are subsequently transported to hospital. In 2018, a quarter of deployments of an emergency ambulance in Bavaria were not followed by patient transport. This study describes factors that influence patient transport rates. METHOD: This is a retrospective cross-sectional study based on data from all Integrated Dispatch Centres of the Free State of Bavaria in 2018. Included were ambulance deployments without emergency physician involvement, which were subdivided into ambulance deployments without transport and ambulance deployments with transport. The proportion of transported patients were determined for the primary reasons for deployment and for the different community types. On-scene time was compared for calls with and without patient transport. Differences were tested for statistical significance using Chi2 tests and the odds ratio was calculated to determine differences between groups. RESULTS: Of 510,145 deployments, 147,621 (28.9%) could be classified as ambulance deployments without transport and 362,524 (71.1%) as ambulance deployments with transport.The lowest proportion of patients transported was found for activations where the fire brigade was involved ("fire alarm system" 0.6%, "fire with emergency medical services" 5.4%) and "personal emergency response system active alarm" (18.6%). The highest transport rates were observed for emergencies involving "childbirth/delivery" (96.9%) and "trauma" (83.2%). A lower proportion of patients is transported in large cities as compared to smaller cities or rural communities; in large cities, the odds ratio for emergencies without transport is 2.02 [95% confidence interval 1.98-2.06] referenced to rural communites. The median on-scene time for emergencies without transport was 20.8 min (n = 141,052) as compared to 16.5 min for emergencies with transport (n = 362,524). The shortest on-scene times for emergencies without transport were identified for activations related to "fire alarm system" (9.0 min) and "personal emergency response system active alarm" (10.6 min). CONCLUSION: This study indicates that the proportion of patients transported depends on the reason for deployment and whether the emergency location is urban or rural. Particularly low transport rates are found if an ambulance was dispatched in connection with a fire department operation or a personal emergency medical alert button was activated. The on-scene-time of the rescue vehicle is increased for deployments without transport. The study could not provide a rationale for this and further research is needed. Trial registration This paper is part of the study "Rettungswageneinsatz ohne Transport" ["Ambulance deployment without transport"] (RoT), which was registered in the German Register of Clinical Studies under the number DRKS00017758.

Contribution of Live Video to Physicians' Remote Assessment of Suspected COVID-19 Patients in an Emergency Medical Communication Centre: A Retrospective Study and Web-Based Survey.

The COVID-19 pandemic had a major impact on emergency medical communication centres (EMCC). A live video facility was made available to second-line physicians in an EMCC with a first-line paramedic to receive emergency calls. The objective of this study was to measure the contribution of live video to remote medical triage. The single-centre retrospective study included all telephone assessments of patients with suspected COVID-19 symptoms from 01.04.2020 to 30.04.2021 in Geneva, Switzerland. The organisation of the EMCC and the characteristics of patients who called the two emergency lines (official emergency number and COVID-19 number) with suspected COVID-19 symptoms were described. A prospective web-based survey of physicians was conducted during the same period to measure the indications, limitations and impact of live video on their decisions. A total of 8957 patients were included, and 2157 (48.0%) of the 4493 patients assessed on the official emergency number had dyspnoea, 4045 (90.6%) of 4464 patients assessed on the COVID-19 number had flu-like symptoms and 1798 (20.1%) patients were reassessed remotely by a physician, including 405 (22.5%) with live video, successfully in 315 (77.8%) attempts. The web-based survey (107 forms) showed that physicians used live video to assess mainly the breathing (81.3%) and general condition (78.5%) of patients. They felt that their decision was modified in 75.7% (n = 81) of cases and caught 7 (7.7%) patients in a life-threatening emergency. Medical triage decisions for suspected COVID-19 patients are strongly influenced by the use of live video.

Exploring the impact of the COVID-19 epidemic on the medical emergency calls and calls for cardiovascular diseases in Hangzhou, China.

AIMS: We aimed to evaluate the impact of the COVID-19 epidemic on emergency and cardiovascular disease-related calls in Hangzhou, China. METHODS: We conducted a single-center retrospective study, collecting data on emergency calls to the Hangzhou Emergency Center (HEC) during the COVID-19 epidemic (January 20, 2020, to March 15, 2020). Data were compared with the same period in 2019. RESULTS: Compared to 2019, the number of emergency calls has dropped by 21.63%, ambulance calls by 29.02%, rescue calls by 22.57%, and cardiovascular disease-related emergency calls by 32.86%. The numbers of emergency, ambulance, and rescue calls in 2020 were significantly lower than in 2019. CONCLUSIONS: During the COVID-19 epidemic in Hangzhou, the numbers of emergency and cardiovascular disease-related calls have decreased significantly. These results point to a severe social problem that requires the attention of the medical community and the government.