Time Is Life: Golden Ten Minutes on Scene-EuReCa_Serbia 2014-2023.

Background and Objectives: This study analyzed the frequency of factors influencing the course and outcomes of out-of-hospital cardiac arrest (OHCA) in Serbia and the prediction of pre-hospital outcomes and survival. Materials and Methods: Data were collected during the period from 1 October 2014, to 31 September 2023, according to the protocol of the EuReCa_One study (clinical trial ID number NCT02236819). Results: Overall 9303 OHCA events were registered with a median age of 71 (IQR 61-81) years and 59.7% of them being males. The annual OHCA incidence was 85.60 ± 20.73/100,000. Within all bystander-witnessed cases, bystander-initiated cardiopulmonary resuscitation in 15.3%. Within the resuscitation-initiated group, return-of-spontaneous circulation (ROSC) on scene (any ROSC) was present in 1037/4053 cases (25.6%) and ROSC on admission to the nearest hospital in 792/4053 cases (19.5%), while 201/4053 patients survived to hospital discharge (5.0%). Predictive potential on pre-hospital outcomes was shown by several factors. Also, of all patients having any ROSC, 89.2% were admitted to the hospital alive. The probability of any ROSC dropped below 50% after 17 min passed after the emergency call and 10 min after the EMS scene arrival. These time intervals were significantly associated with survival to hospital discharge (p < 0.001). Five-minute time intervals between both emergency calls and any ROSC and EMS scene arrival and any ROSC also had a significant predictive potential for survival to hospital discharge (p < 0.001, HR 1.573, 95% CI 1.303-1.899 and p = 0.017, HR 1.184, 95% CI 1.030-1.361, respectively). Conclusions: A 10-min time on scene to any ROSC is a crucial time-related factor for achieving any ROSC, and indirectly admission ROSC and survival to hospital discharge, and represents a golden time interval spent on scene in the management of OHCA patients. A similar effect has a time interval of 17 min from an emergency call. Further investigations should be focused on factors influencing these time intervals, especially time spent on scene.

On-scene time delays for epileptic seizures in emergencies during a social pandemic: A population-based study.

OBJECTIVES: The on-scene time of Emergency Medical Services (EMS), including time for hospital selection, is critical for people in an emergency. However, the outbreak of the novel coronavirus disease 2019 (COVID-19) led to longer delays in providing immediate care for individuals with non-COVID-19-related emergencies, such as epileptic seizures. This study aimed to examine factors associated with on-scene time delays for people with epilepsy (PWE) with seizures needing immediate amelioration. MATERIALS & METHODS: We conducted a population-based retrospective cohort study for PWE transported by EMS between 2016 and 2021. We used data from the Hiroshima City Fire Service Bureau database, divided into three study periods: "Pre period", the period before the COVID pandemic (2016-2019); "Early period", the early period of the COVID pandemic (2020); and "Middle period", the middle period of the COVID pandemic (2021). We performed linear regression modeling to identify factors associated with changes in EMS on-scene time for PWE during each period. In addition, we estimated the rate of total EMS call volume required to maintain the same on-scene time for PWE transported by EMS during the pandemic expansion. RESULTS: Among 2,205 PWE transported by EMS, significant differences in mean age and prevalence of impaired consciousness were found between pandemic periods. Total EMS call volume per month for all causes during the same month <5,000 (-0.55 min, 95% confidence interval [CI] -1.02 - -0.08, p = 0.022) and transport during the Early period (-1.88 min, 95%CI -2.75 - -1.00, p < 0.001) decreased on-scene time, whereas transport during the Middle period (1.58 min, 95%CI 0.70 - 2.46, p < 0.001) increased on-scene time for PWE transported by EMS. The rate of total EMS call volume was estimated as 0.81 (95%CI -0.04 - 1.07) during the expansion phase of the pandemic to maintain the same degree of on-scene time for PWE transported by EMS before the pandemic. CONCLUSIONS: On-scene time delays on PWE in critical care settings were observed during the Middle period. When the pandemic expanded, the EMS system required resource allocation to maintain EMS for time-sensitive illnesses such as epileptic seizures. Timely system changes are critical to meet dramatic social changes.

On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry.

BACKGROUND: Providing optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient's condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting. METHODS: The Swedish Trauma Registry was used to train and validate five models - Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network - in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates. RESULTS: There were 75,602 registrations between 2013-2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80-0.89 and AUCPR between 0.43-0.62. CONCLUSIONS: AI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.

Rapid and On-Scene Chemical Identification of Intact Explosives with Portable Near-Infrared Spectroscopy and Multivariate Data Analysis.

There is an ongoing forensic and security need for rapid, on-scene, easy-to-use, non-invasive chemical identification of intact energetic materials at pre-explosion crime scenes. Recent technological advances in instrument miniaturization, wireless transfer and cloud storage of digital data, and multivariate data analysis have created new and very promising options for the use of near-infrared (NIR) spectroscopy in forensic science. This study shows that in addition to drugs of abuse, portable NIR spectroscopy with multivariate data analysis also offers excellent opportunities to identify intact energetic materials and mixtures. NIR is able to characterize a broad range of chemicals of interest in forensic explosive investigations, covering both organic and inorganic compounds. NIR characterization of actual forensic casework samples convincingly shows that this technique can handle the chemical diversity encountered in forensic explosive investigations. The detailed chemical information contained in the 1350-2550 nm NIR reflectance spectrum allows for correct compound identification within a given class of energetic materials, including nitro-aromatics, nitro-amines, nitrate esters, and peroxides. In addition, the detailed characterization of mixtures of energetic materials, such as plastic formulations containing PETN (pentaerythritol tetranitrate) and RDX (trinitro triazinane), is feasible. The results presented illustrate that the NIR spectra of energetic compounds and mixtures are sufficiently selective to prevent false-positive results for a broad range of food-related products, household chemicals, raw materials used for the production of home-made explosives, drugs of abuse, and products that are sometimes used to create hoax improvised explosive devices. However, for frequently encountered pyrotechnic mixtures, such as black powder, flash powder, and smokeless powder, and some basic inorganic raw materials, the application of NIR spectroscopy remains challenging. Another challenge is presented by casework samples of contaminated, aged, and degraded energetic materials or poor-quality HMEs (home-made explosives), for which the spectral signature deviates significantly from the reference spectra, potentially leading to false-negative outcomes.

Factors associated with EMS on-scene time and its regional difference in road traffic injuries: a population-based observational study.

BACKGROUND: The outcome of road traffic injury (RTI) is determined by duration of prehospital time, patient's demographics, and the type of injury and its mechanism. During the emergency medical service (EMS) prehospital time interval, on-scene time should be minimized for early treatment. This study aimed to examine the factors influencing on-scene EMS time among RTI patients. METHODS: We evaluated 19,141 cases of traffic trauma recorded between April 2014 and March 2020 in the EMS database of the Nara Wide Area Fire Department and the prehospital database of the emergency Medical Alliance for Total Coordination of Healthcare (e-MATCH). To examine the association of the number of EMS phone calls until hospital acceptance, age ≥65 years, high-risk injury, vital signs, holiday, and nighttime (0:00-8:00) with on-scene time, a generalized linear mixed model with random effects for four study regions was conducted. RESULTS: EMS phone calls were the biggest factor, accounting for 5.69 minutes per call, and high-risk injury accounted for an additional 2.78 minutes. Holiday, nighttime, and age ≥65 years were also associated with increased on-scene time, but there were no significant vital sign variables for on-scene time, except for the level of consciousness. Regional differences were also noted based on random effects, with a maximum difference of 2 minutes among regions. CONCLUSIONS: The number of EMS phone calls until hospital acceptance was the most significant influencing factor in reducing on-scene time, and high-risk injury accounted for up to an additional 2.78 minutes. Considering these factors, including regional differences, can help improve the regional EMS policies and outcomes of RTI patients.

The CPR outcomes of online medical video instruction versus on-scene medical instruction using simulated cardiac arrest stations.

BACKGROUND: Non-traumatic cardiac arrest is a fatal emergency condition. Its survival rate and outcomes may be better with quick and effective cardiopulmonary resuscitation (CPR). Telemedicine such as telephone or real time video has been shown to improve chest compression procedures. There are limited data on the effects of telemedicine in cardiac arrest situations in the literature particularly in Asian settings. METHODS: This study was conducted by using two simulated cardiac arrest stations during the 2014 annual Thai national conference in emergency medicine. These two stations, nos. 5 and 11, were a part of the conference activity called "EMS rally" which was comprised of 14 stations. Both stations were shockable and out-of-hospital cardiac arrest situations; station 5 was online instructed, while station 11 was on-scene instructed. There were 14 representative teams from each province from all over Thailand who participated in the rally. Each team had one physician, one nurse, and two emergency medicine technicians. Eight CPR outcomes were evaluated and compared between the online versus on-scene situations. RESULTS: There were 14 representative teams that participated in the study; a total of 14 physicians, 14 nurses, and 28 emergency medicine technicians. The average ages of participants in all three occupations were between the second and third decade of life. The percentages of participants with more than 3 years in ambulance experience was 7.1, 64.3, and 53.6 % in the physicians, nurses, and EMTs groups. The median times of all outcomes were significantly longer in the online group than the on-scene group including times from start to chest compression (total 102 vs 36 s), total times from the start to VT/VF detection (187 vs 99 s); times from VT/VF detection to the first defibrillation (57 vs 28 s); and times from the start of adrenaline injection (282 vs 165 s). The percentages of using amiodarone (21.43 % vs 57.14 %; p value < 0.001), establishment of a definitive airway (35.71 % vs 100 %; p value 0.003), and correct detections of pulseless electrical activity (PEA) (28.57 % vs 100 %; p value < 0.001) were significantly lower in the online group than the on-scene group. The high quality CPR outcomes between the online group and on-scene group were comparable. CONCLUSIONS: The online medical instruction may have worse CPR outcomes compared with on-scene medical instruction in shockable, simulated CPR scenarios. Further studies are needed to confirm these results.

A qualitative exploration of ambulance clinician behaviour and decision making to identify factors influencing on-scene times for suspected stroke patients in North East England.

Aims/objectives: Ambulance clinician assessment of suspected stroke patients aims to provide rapid access to specialist care, however regional and national data show increasing pre-hospital times. This study explored paramedic views about factors contributing to on-scene time (OST) for suspected stroke patients, with a view to identifying opportunities for future interventions, to reduce OST. Methods: Views of paramedics from one regional service on factors influencing OST were explored using a qualitative approach. Semi-structured interviews with volunteers were recorded, transcribed and analysed using thematic analysis. Results: Interviews were conducted with 13 paramedics between August and November 2021. Five interlinked themes were identified and described a range of factors influencing OST: 'Initial assessment and sources of information' describes how clinicians make assessments based on initial presentation, influenced by pre-arrival information from ambulance control and family members / bystanders at the scene, and how this influences OST.'Suitability for treatment and interventions' describes how paramedics consider actions such as the face, arms, speech test, cannulation, electrocardiograms and neurological assessments while recognising that pre-hospital interventions for suspected stroke are limited.'The environment' describes the influence of incident setting on OST, including the overall process needed to transport the patient to appropriate care.'Hospital interactions' describes how interactions with hospital staff influenced paramedic actions and OST.'Changing practice' describes the influence of experience and interaction with hospital staff leading to changes in paramedic practice over time. Conclusion: This study provides insight into how UK paramedics spend time on scene with stroke patients. Multiple factors influencing OST were identified which signpost opportunities for interventions designed to reduce OST. Standardising on-scene assessments for stroke patients, refining communication processes between ambulance services and hospital stroke services and increasing availability of stroke continuing professional development for paramedics were all identified as potential targets for improving OST.

Optimal duration and timing of basic-life-support-only intervention for patients with out-of-hospital cardiac arrest.

To elucidate the relationship between the interval from cardiopulmonary resuscitation initiation to return of spontaneous circulation (ROSC) and neurologically favourable 1-month survival in order to determine the appropriate duration of basic life support (BLS) without advanced interventions. This population-based cohort study included patients aged ≥ 18 years with 9132 out-of-hospital cardiac arrest of presumed cardiac origin who were bystander-witnessed and had achieved ROSC between 2018 and 2020. Patients were classified into two groups based on the resuscitation methods as the "BLS-only" and the "BLS with administered epinephrine (BLS-AE)" groups. Receiver operating characteristic (ROC) curve analysis indicated that administering BLS for 9 min yielded the best neurologically outcome for patients with a shockable rhythm [sensitivity, 0.42; specificity, 0.27; area under the ROC curve (AUC), 0.60] in the BLS-only group. Contrastingly, for patients with a non-shockable rhythm, performing BLS for 6 min yielded the best neurologically outcome (sensitivity, 0.65; specificity, 0.43; AUC, 0.63). After propensity score matching, multivariate analysis revealed that BLS-only resuscitation [6.44 (5.34-7.77)] was associated with neurologically favourable 1-month survival. This retrospective study revealed that BLS-only intervention had a significant impact in the initial minutes following CPR initiation. Nevertheless, its effectiveness markedly declined thereafter. The optimal duration for effective BLS-only intervention varied depending on the patient's initial rhythm. Consequently, advanced interventions should be administered within the first few minutes to counteract the diminishing effectiveness of BLS-only intervention.

Multifaceted implementation and sustainability of a protocol for prehospital anaesthesia: a retrospective analysis of 2115 patients from helicopter emergency medical services.

BACKGROUND: Prehospital emergency anaesthesia (PHEA) is a high-risk procedure. We developed a prehospital anaesthesia protocol for helicopter emergency medical services (HEMS) that standardises the process and involves ambulance crews as active team members to increase efficiency and patient safety. The aim of the current study was to evaluate this change and its sustainability in (i) on-scene time, (ii) intubation first-pass success rate, and (iii) protocol compliance after a multifaceted implementation process. METHODS: The protocol was implemented in 2015 in a HEMS unit and collaborating emergency medical service systems. The implementation comprised dissemination of information, lectures, simulations, skill stations, academic detailing, and cognitive aids. The methods were tailored based on implementation science frameworks. Data from missions were gathered from mission databases and patient records. RESULTS: During the study period (2012-2020), 2381 adults underwent PHEA. The implementation year was excluded; 656 patients were analysed before and 1459 patients after implementation of the protocol. Baseline characteristics and patient categories were similar. On-scene time was significantly redused after the implementation (median 32 [IQR 25-42] vs. 29 [IQR 21-39] minutes, p < 0.001). First pass success rate increased constantly during the follow-up period from 74.4% (95% CI 70.7-77.8%) to 97.6% (95% CI 96.7-98.3%), p = 0.0001. Use of mechanical ventilation increased from 70.6% (95% CI 67.0-73.9%) to 93.4% (95% CI 92.3-94.8%), p = 0.0001, and use of rocuronium increased from 86.4% (95% CI 83.6-88.9%) to 98.5% (95% CI 97.7-99.0%), respectively. Deterioration in compliance indicators was not observed. CONCLUSIONS: We concluded that clinical performance in PHEA can be significantly improved through multifaceted implementation strategies.

Impact of the first response unit on prehospital on-scene time among paramedic-suspected stroke patients: a retrospective before-after cohort study in Finland.

BACKGROUND: Revascularization of an occluded artery by either thrombolysis or mechanical thrombectomy is a time-critical intervention in ischaemic stroke. Each link in the stroke chain of survival should minimize the delay to definitive treatment in every possible way. In this study, we investigated the effect of routine dispatch of a first response unit (FRU) on prehospital on-scene time (OST) on stroke missions. METHODS: Medical dispatch of FRU together with an emergency medical service (EMS) ambulance was a routine strategy in the Tampere University Hospital area before 3 October 2018, after which the FRU has only been dispatched to medical emergencies on the decision of an EMS field commander. This study presents a retrospective before-after analysis of 2,228 paramedic-suspected strokes transported by EMSs to Tampere University Hospital. We collected data from EMS medical records from April 2016 to March 2021, and used statistical tests and binary logistic regression to detect the associations between the variables and the shorter and longer half of OSTs. RESULTS: The median OST of stroke missions was 19 min, IQR [14-25] min. The OST decreased when the routine use of the FRU was discontinued (19 [14-26] min vs. 18 [13-24] min, p < 0.001). The median OST with the FRU being the first at the scene (n = 256, 11%) was shorter than in cases where the FRU arrived after the ambulance (16 [12-22] min vs. 19 [15-25] min, p < 0.001). The OST with a stroke dispatch code was shorter than with non-stroke dispatches (18 [13-23] min vs. 22 [15-30] min, p < 0.001). The OST for thrombectomy candidates was shorter than that for thrombolysis candidates (18 [13-23] min vs. 19 [14-25], p = 0.01). The shorter half of OSTs were associated with the FRU arriving first at the scene, stroke dispatch code, thrombectomy transportation and urban location. CONCLUSION: The routine dispatch of the FRU to stroke missions did not decrease the OST unless the FRU was first to arrive at the scene. In addition, a correct stroke identification in the dispatch centre and thrombectomy candidate status decreased the OST.

Factors influencing on-scene time in a physician-staffed helicopter emergency medical service (HEMS): a retrospective observational study.

BACKGROUND: For helicopter emergency service systems (HEMS), the prehospital time consists of response time, on-scene time and transport time. Little is known about the factors that influence on-scene time or about differences between adult and paediatric missions in a physician-staffed HEMS. METHODS: We analysed the HEMS electronic database of Swiss Air-Rescue from 01-01-2011 to 31-12-2021 (N = 110,331). We included primary missions and excluded missions with National Advisory Committee for Aeronautics score (NACA) score 0 or 7, resulting in 68,333 missions for analysis. The primary endpoint 'on-scene time' was defined as first physical contact with the patient until take-off to the hospital. A multivariable linear regression model was computed to examine the association of diagnosis, type and number of interventions and monitoring, and patient's characteristics with the primary endpoint. RESULTS: The prehospital time and on-scene time of the missions studied were, respectively, 50.6 [IQR: 41.0-62.0] minutes and 21.0 [IQR: 15.0-28.6] minutes. Helicopter hoist operations, resuscitation, airway management, critical interventions, remote location, night-time, and paediatric patients were associated with longer on-scene times. CONCLUSIONS: Compared to adult patients, the adjusted on-scene time for paediatric patients was longer. Besides the strong impact of a helicopter hoist operation on on-scene time, the dominant factors contributing to on-scene time are the type and number of interventions and monitoring: improving individual interventions or performing them in parallel may offer great potential for reducing on-scene time. However, multiple clinical interventions and monitoring interact and are not single interventions. Compared to the impact of interventions, non-modifiable factors, such as NACA score, type of diagnosis and age, make only a minor contribution to overall on-scene time.

Emergency medical services clinicians in the United States are increasingly exposed to death.

Introduction: Exposure to patient death places healthcare workers at increased risk for burnout and traumatic stress, yet limited data exist exploring exposure to death among emergency medical services (EMS) clinicians. Our objective was to describe changes in EMS encounters involving on-scene death from 2018 to 2021. Methods: We retrospectively analyzed deidentified EMS records for 9-1-1 responses from the ESO Data Collaborative from 2018 to 2021. We identified cases where patient dispositions of death on scene, with or without attempted resuscitation, and without EMS transport. A non-parametric test of trend was used to assess for monotonic increase in agency-level encounters involving on-scene death and the proportion of EMS clinicians exposed to ≥1 on-scene death. Results: We analyzed records from 1109 EMS agencies. These agencies responded to 4,286,976 calls in 2018, 5,097,920 calls in 2019, 4,939,651 calls in 2020, and 5,347,340 calls in 2021.The total number of encounters with death on scene rose from 49,802 in 2018 to 60,542 in 2019 to 76,535 in 2020 and 80,388 in 2021. Agency-level annual counts of encounters involving death on scene rose from a median of 14 (interquartile range [IQR], 4-40) in 2018 to 2023 (IQR, 6-63) in 2021 (P-trend < 0.001). In 2018, 56% of EMS clinicians responded to a call with death on scene, and this number rose to 63% of EMS clinicians in 2021 (P-trend < 0.001). Conclusion: From 2018 to 2021, EMS clinicians were increasingly exposed to death. This trend may be driven by COVID-19 and its effects on the healthcare system and reinforces the need for evidence-based death notification training to support EMS clinicians.

On-site illicit-drug detection with an integrated near-infrared spectral sensor: A proof of concept.

Illicit-drug production, trafficking and seizures are on an all-time high. This consequently raises pressure on investigative authorities to provide rapid forensic results to assist law enforcement and legal processes in drug-related cases. Ideally, every police officer is equipped with a detector to reliably perform drug testing directly at the incident scene. Such a detector should preferably be small, portable, inexpensive and shock-resistant but should also provide sufficient selectivity to prevent erroneous identifications. This study explores the concept of on-site drugs-of-abuse detection using a 1.8 × 2.2 mm2 multipixel near-infrared (NIR) spectral sensor that potentially can be integrated into a smartphone. This integrated sensor, based on an InGaAs-on-silicon technology, exploits an array of resonant-cavity enhanced photodetectors without any moving parts. A 100% correct classification of 11 common illicit drugs, pharmaceuticals and adulterants was achieved by chemometric modelling of the response of 15 wavelength-specific pixels. The performance on actual forensic casework was investigated on 246 cocaine-suspected powders and 39 MDMA-suspected ecstasy tablets yielding an over 90% correct classification in both cases. These findings show that presumptive drug testing by miniaturized spectral sensors is a promising development ultimately paving the way for a fully integrated drug-sensor in mobile communication devices used by law enforcement.

Prehospital Time Interval for Urban and Rural Emergency Medical Services: A Systematic Literature Review.

The aim of this study was to discuss the differences in pre-hospital time intervals between rural and urban communities regarding emergency medical services (EMS). A systematic search was conducted through various relevant databases, together with a manual search to find relevant articles that compared rural and urban communities in terms of response time, on-scene time, and transport time. A total of 37 articles were ultimately included in this review. The sample sizes of the included studies was also remarkably variable, ranging between 137 and 239,464,121. Twenty-nine (78.4%) reported a difference in response time between rural and urban areas. Among these studies, the reported response times for patients were remarkably variable. However, most of them (number (n) = 27, 93.1%) indicate that response times are significantly longer in rural areas than in urban areas. Regarding transport time, 14 studies (37.8%) compared this outcome between rural and urban populations. All of these studies indicate the superiority of EMS in urban over rural communities. In another context, 10 studies (27%) reported on-scene time. Most of these studies (n = 8, 80%) reported that the mean on-scene time for their populations is significantly longer in rural areas than in urban areas. On the other hand, two studies (5.4%) reported that on-scene time is similar in urban and rural communities. Finally, only eight studies (21.6%) reported pre-hospital times for rural and urban populations. All studies reported a significantly shorter pre-hospital time in urban communities compared to rural communities. Conclusions: Even with the recently added data, short pre-hospital time intervals are still superior in urban over rural communities.

Perspectives from law enforcement officers who respond to overdose calls for service and administer naloxone.

BACKGROUND: Many law enforcement agencies across the United States equip their officers with the life-saving drug naloxone to reverse the effects of an opioid overdose. Although officers can be effectively trained to administer naloxone, and hundreds of law enforcement agencies carry naloxone to reverse overdoses, little is known about what happens on scene during an overdose call for service from an officer's perspective, including what officers perceive their duties and responsibilities to be as the incident evolves. METHODS: The qualitative study examined officers' experiences with overdose response, their perceived roles, and what happens on scene before, during, and after an overdose incident. In-person interviews were conducted with 17 officers in four diverse law enforcement agencies in the United States between January and May 2020. RESULTS: Following an overdose, the officers described that overdose victims are required to go to a hospital or they are taken to jail. Officers also described their duties on scene during and after naloxone administration, including searching the belongings of the person who overdosed and seizing any drug paraphernalia. CONCLUSION: These findings point to a pressing need for rethinking standard operating procedures for law enforcement in these situations so that the intentions of Good Samaritan Laws are upheld and people get the assistance they need without being deterred from asking for future help.

Performance evaluation of handheld Raman spectroscopy for cocaine detection in forensic case samples.

Handheld Raman spectroscopy is an emerging technique for rapid on-site detection of drugs of abuse. Most devices are developed for on-scene operation with a user interface that only shows whether cocaine has been detected. Extensive validation studies are unavailable, and so are typically the insight in raw spectral data and the identification criteria. This work evaluates the performance of a commercial handheld Raman spectrometer for cocaine detection based on (i) its performance on 0-100 wt% binary cocaine mixtures, (ii) retrospective comparison of 3,168 case samples from 2015 to 2020 analyzed by both gas chromatography-mass spectrometry (GC-MS) and Raman, (iii) assessment of spectral selectivity, and (iv) comparison of the instrument's on-screen results with combined partial least square regression (PLS-R) and discriminant analysis (PLS-DA) models. The limit of detection was dependent on sample composition and varied between 10 wt% and 40 wt% cocaine. Because the average cocaine content in street samples is well above this limit, a 97.5% true positive rate was observed in case samples. No cocaine false positives were reported, although 12.5% of the negative samples were initially reported as inconclusive by the built-in software. The spectral assessment showed high selectivity for Raman peaks at 1,712 (cocaine base) and 1,716 cm-1 (cocaine HCl). Combined PLS-R and PLS-DA models using these features confirmed and further improved instrument performance. This study scientifically assessed the performance of a commercial Raman spectrometer, providing useful insight on its applicability for both presumptive detection and legally valid evidence of cocaine presence for law enforcement.

Grady Health System's Mobile Integrated Health Program: A Statistical Analysis of Low-Acuity 911 Calls.

Grady's Mobile Integrated Health (MIH) program works to manage outpatient health concerns that otherwise burden EDs, improve quality of care, and connect patients to the appropriate level of care and resources. This prospective study collected data from 09/01/2019-03/31/2020 to analyze Grady's MIH response to low-acuity 911 calls compared to a traditional EMS (ACLS/BLS) response. A total of 2,759 EMS calls were reviewed. These calls comprised the four most common emergency medical dispatch codes for Grady's MIH response: i) "sick person other pain," ii) "diabetic alert behaving normally," iii) "back pain," and iv) "falls." Descriptive statistics and multivariable logistic regressions (MLR) were performed to compare disposition differences between MIH and traditional EMS services in whether calls were mitigated on-scene or transported. For MIH responses (n=300), 66.1% were mitigated on-scene. Comparatively, for traditional EMS responses (n=263), 11.4% were mitigated on-scene. The MLR model found the odds that a patient was mitigated on-scene for an MIH response were 24 times that for an ACLS/BLS response (OR=24.19, p<0.001) after adjusting for patient sex, ethnicity, age, blood pressure, heart rate, pain response, glucose, time of day, and EMD code. The magnitude of the odds ratio significantly differed based on the dispatch code. The results of this study indicate that utilizing Grady's current MIH model is an effective way to mitigate low-acuity 911 concerns and decrease unnecessary ED utilization, while potentially reducing hospital readmissions and healthcare costs.

Do EMS times associate with injury severity?

In this study, emergency medical services times, along with other crash-related explanatory variables, have been used to investigate influential factors on injury severity. To overcome the complexity of emergency medical services times impact on crash outcome, the interaction effects of EMS times and injury location on the body were also investigated in a separate model. This study utilized the linked data of police-reported crash data and emergency medical services runs, including 2192 crash injuries that transferred to hospital. A random-effects ordered probit approach was implemented to identify effective factors on crash injury severity. Three models of (1) crash-related variables, (2) crash-related and emergency medical services times and (3) crash-related, emergency medical services times and interaction effects of EMS times and injury location on the body were developed. Although the outcome could not find the impact of faster emergency medical services times on injury severity in the second model, in the third model, faster response time and slower on-scene time were associated with decreasing the severity of entire-body injuries. We discuss why this may be the case.

Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study.

BACKGROUND: Traumatic cardiac arrest (TCA) is a severe and life-threatening situation that mandates urgent action. Outcomes after on-scene treatment of TCA in the Netherlands are currently unknown. The aim of the current study was to investigate the rate of survival to discharge in patients who suffered from traumatic cardiac arrest and who were subsequently treated on-scene by the Dutch Helicopter Emergency Medical Services (HEMS). METHODS: A retrospective cohort study was performed including patients ≥ 18 years with TCA for which the Dutch HEMS were dispatched between January 1st 2014 and December 31st 2018. Patients with TCA after hanging, submersion, conflagration or electrocution were excluded. The primary outcome measure was survival to discharge after prehospital TCA. Secondary outcome measures were return of spontaneous circulation (ROSC) on-scene and neurological status at hospital discharge. RESULTS: Nine-hundred-fifteen patients with confirmed TCA were included. ROSC was achieved on-scene in 261 patients (28.5%). Thirty-six (3.9%) patients survived to hospital discharge of which 17 (47.2%) had a good neurological outcome. Age < 70 years (0.7% vs. 5.2%; p=0.041) and a shockable rhythm on first ECG (OR 0.65 95%CI 0.02-0.28; p<0.001) were associated with increased odds of survival. CONCLUSION: Neurologic intact survival is possible after prehospital traumatic cardiac arrest. Younger patients and patients with a shockable ECG rhythm have higher survival rates after TCA. LEVEL OF EVIDENCE: prognostic study, level III.

EMS agencies with high rates of field termination of resuscitation and longer scene times also have high rates of survival.

AIM: Out-of-hospital cardiac arrest (OOHCA) management dichotomizes strategies to (1) "scoop-and-run" to a higher level of care or (2) "treat on the X" with the goal of return of spontaneous circulation (ROSC) before transport, with field termination of resuscitation (FTOR) of unsuccessful resuscitations. We hypothesized that EMS agencies with greater average time on-scene and higher rates of field termination of resuscitation would have more favorable outcomes. METHODS: The Cardiac Arrest Registry to Enhance Survival (CARES) was used to identify OOHCA cases from 2013 to 2018. Agencies in the top and bottom quartiles of on-scene time were categorized as high (HiOST) and low (LoOST); in the top and bottom quartiles of field termination rate were categorized as high (HiTOR) and low (LoTOR). Generalized estimating equation models compared top and bottom quartiles. RESULTS: We classified 95 agencies as HiOST (average > 25.1 min) or LoOST (average < 19.3 min). We classified 95 agencies as HiTOR (average > 46.5% FTOR) or LoTOR (average < 23.5% FTOR). Controlling for agency characteristics, HiOST had a higher survival to discharge for transported patients (28.1% vs 23.1%, OR = 2.8, 95 %CI 2.1-3.6, p < 0.001), ROSC on emergency department arrival, and favorable neurologic outcome than LoOST. HiTOR had a higher survival to discharge for transported patients (25.6% vs 19.3%, OR = 3.3, 95 %CI 2.5-4.4, p < 0.001), ROSC on emergency department arrival, and favorable neurologic outcome than LoTOR. CONCLUSION: EMS agencies with higher rates of FTOR and longer on-scene times for patients with OOHCA have higher overall patient survival, ROSC, and favorable neurologic function.