Relationship between cancer status and medical response by an emergency dispatch center: From a French SAMU database.

OBJECTIVE: In many countries, the first line response to an emergency call is decided by the emergency dispatch center EMS clinician. Our main objective was to compare the pre-hospital response to calls received from cancer and non-cancer patients. We also compared the reasons for calling, for each group. METHODS: We conducted a retrospective cohort study of data collected between January 1, 2016 and December 31, 2020, from emergency dispatch center records of the Isère county, France. Statistical tests were conducted after matching one cancer patient with two non-cancer patients, resulting in a cohort of 44,022 patients. We used multivariate logistic regression to determine the impact of patient cancer status on the medical decision taken in response to the emergency call. RESULTS: Overall, data on 849,110 patients were extracted, including 16,451 patients with a diagnosis of cancer and 29,348 non-cancer patients. In the matched cohort, cancer was associated with a higher odd of having a mobile intensive care unit (MICU) [odds ratio (OR)=2.02 (1.81-2.26), p<0.001] or an ambulance being dispatched to the patient's home or other location [OR=2.36 (2.24-2.48), p<0.001]. The two most frequent medical responses were to send an ambulance (58.6%) and giving advice only (36.8%). The five main reasons for the emergency call for the cancer group were cardiovascular disease symptoms (13.5%), respiratory problems (10.6%), digestive disorders (10.4%), infections (8.9%) and neurological disorders (6.0%). CONCLUSION: An MICU or an ambulance was more often dispatched for cancer patients than for others. Considering that cancer is a very frequent comorbidity in Western countries, knowledge of the patient's cancer status should be sought and taken into consideration when a patient seeks emergency help.

Near-miss incidents owing to fatigue and irregular lifestyles in ambulance personnel.

We aimed to investigate the association between fatigue and near-miss incidents and between irregular lifestyles and fatigue in ambulance personnel. In this cross-sectional study, we used a self-administered questionnaire and ambulance dispatch records during November 2017. We performed multiple logistic regression; in total, 254 ambulance staff were eligible for inclusion in the analysis. The adjusted odds of near-miss incidents were 3.19 times higher for participants with higher fatigue than for those with normal fatigue, with statistical significance. Fatigue was significantly associated with the monthly number of ambulance dispatches, office working hours, mealtimes, daytime napping hours, and napping hours during a night shift. In this study, we demonstrated a positive association between fatigue and near-miss incidents among ambulance personnel. Additionally, our results suggest that irregular lifestyles are a root cause of fatigue in ambulance personnel.

Impact of crowding in local ambulance demand on call-to-ambulance scene arrival in out-of-hospital cardiac arrest.

BACKGROUND: Rapid emergency medical service (EMS) response is an important prognostic factor in out-of-hospital cardiac arrest (OHCA). This study aims to evaluate the association between local hourly EMS demand and ambulance response in OHCA. METHODS: OHCA occurring in 24 districts of Seoul from 2013 to 2018 was analyzed. Hourly ambulance demand per ambulance in each local district of patient location at the hour of cardiac arrest was calculated as the crowding index. The crowding index was categorized according to quartiles (1Q: ≤0.43, 2Q: 0.44-0.67, 3Q: 0.68-0.99, 4Q: ≥1.0 calls/h\r/ambulance). The primary outcome was ambulance dispatched within 1 km of the OHCA scene. Multivariable logistic regression analysis was performed to test the association between the local hourly ambulance demand and outcomes. RESULTS: A total of 26,479 patients were analyzed. The rate of ambulance dispatched within 1 km decreased according to the crowding quartile (1Q: 31.3%, 2Q: 30.0%, 3Q: 28.8%, and 4Q: 26.6%). Compared to 1Q, adjusted odds ratios (95% CIs) of dispatch distance within 1 km in 2Q, 3Q, and 4Q were 0.92 (0.86-0.99), 0.86 (0.80-0.94), and 0.77 (0.71-0.84), respectively. CONCLUSION: Crowding in local ambulance demand was associated with less ambulance dispatched within 1 km and delayed response to the scene in OHCA. Strategies to mitigate and adjust to ambulance demand crowding may be considered for better EMS response performance.

Acute effect of the COVID-19 pandemic on emergency transportation due to acute alcoholic intoxication: a retrospective observational study.

BACKGROUND: The COVID-19 pandemic has caused changes in people's drinking habits and the emergency management system for various diseases. However, no studies have investigated the pandemic's impact on emergency transportation for acute alcoholic intoxication. This study examines the effect of the pandemic on emergency transportation due to acute alcoholic intoxication in Kochi Prefecture, Japan, a region with high alcohol consumption. METHODS: A retrospective observational study was conducted using data of 180,747 patients from the Kochi-Iryo-Net database, Kochi Prefecture's emergency medical and wide-area disaster information system. Chi-squared tests and multiple logistic regression analyses were performed. The association between emergency transportation and alcoholic intoxication was examined. The differences between the number of transportations during the voluntary isolation period in Japan (March and April 2020) and the same period for 2016-2019 were measured. RESULTS: In 2020, emergency transportations due to acute alcoholic intoxication declined by 0.2%, compared with previous years. Emergency transportation due to acute alcoholic intoxication decreased significantly between March and April 2020, compared with the same period in 2016-2019, even after adjusting for confounding factors (adjusted odds ratio 0.67; 95% confidence interval 0.47-0.96). CONCLUSIONS: This study showed that lifestyle changes due to the COVID-19 pandemic affected the number of emergency transportations; in particular, those due to acute alcoholic intoxication decreased significantly.

Educational Program Improved Senior Preparedness to Call 911 as a Response to Stroke.

OBJECTIVES: Stroke predominantly affects the elderly. Universities of the Third Age (U3A) are presented with an opportunity to target them. The goal of our study was to improve older adults' preparedness to call 911 as a response to symptoms of stroke. MATERIALS AND METHODS: Participants were recruited from U3A in Brno, Czech Republic in year 2018. The program included an educational movie about stroke and testing with pretest posttest design. Stroke awareness was measured by Stroke Action Test and video-clips portraying stroke and stroke mimicking symptoms. Respondents had to answer close-ended questions. Composite scores were compared using paired t-test. RESULTS: Data were obtained from 206 attendees of the program, that is 2% of all students, from 4 of 5 U3A in Brno. The mean test score improved from 80% to 87% (paired p < 0.001). Participants with a lower baseline knowledge improved by 12% (95% CI 9% to 16%) and with a higher baseline knowledge by 0% (95% CI 3% to 4%). The score for calling 911 for stroke mimicking symptoms improved from 29% to 20% (paired p < 0.001). CONCLUSIONS: Video-based educational program improved senior preparedness to call 911 as a response to stroke. The improvement was mild, which is at least partly due to a high baseline level of preparedness of seniors active in U3A. A lower baseline knowledge was however associated with a bigger improvement, which might be important for use in a less active/educated population. Educational intervention also decreased intention to call 911 for stroke mimicking symptoms, which could have important implications for decreasing unnecessary activation of pre-hospital services.

Sex differences in emergency medical services management of patients with myocardial infarction: analysis of routinely collected data for over 110,000 patients.

Emergency medical services (EMS) activation is an integral component in managing individuals with myocardial infarction (MI). EMS play a crucial role in early MI symptom recognition, prompt transport to percutaneous coronary intervention centres and timely administration of management. The objective of this study was to examine sex differences in prehospital EMS care of patients hospitalized with Ml using data from a retrospective population-based cohort study of linked health administrative data for people with a hospital diagnosis of MI in Australia (2001-18).

Emergency Dispatches for Suicide Attempts During the COVID-19 Outbreak in Okayama, Japan: A Descriptive Epidemiological Study.

BACKGROUND: Hardships associated with the ongoing coronavirus disease 2019 (COVID-19) pandemic can affect mental health, potentially leading to increased risk of suicide. We examined the relationship between the COVID-19 outbreak and suicide attempts in Okayama, Japan using information from emergency dispatches. METHODS: This was a descriptive epidemiological study. We collected information on emergency dispatches in Okayama City and Kibichuo from March to August in 2018, 2019, and 2020 (n = 47,770 cases). We compared emergency dispatches and their demographic characteristics, especially focusing on suicide attempts, during these 3 years. RESULTS: The number of emergency dispatches in 2020 decreased compared with the previous 2 years, while the number and proportion of emergency dispatches related to suicide attempts increased. This increase was more pronounced among women and those aged 25-49 years. Among women aged 25-49 years, there was a cumulative total of 43 suicide attempts in 2018 and 2019 and 73 suicide attempts in 2020. CONCLUSIONS: The number and proportion of emergency dispatches related to suicide attempts increased in 2020 compared with the previous 2 years, especially among women and those aged 25-49 years. This increase may be partly explained by hardships, such as economic losses or reduced social ties, during the COVID-19 outbreak.

Comparison of Emergency Medical Dispatch Systems for Performance of Telecommunicator-Assisted Cardiopulmonary Resuscitation Among 9-1-1 Callers With Limited English Proficiency.

Importance: Increasing bystander cardiopulmonary resuscitation (CPR) among racial/ethnic minority groups and culturally underserved populations is a key strategy in improving health care disparities in out-of-hospital cardiac arrest. Objective: To ascertain whether implementation of the Los Angeles Tiered Dispatch System (LA-TDS) was associated with improved performance of telecommunicator-assisted CPR (T-CPR) among 9-1-1 callers with limited English proficiency in the City of Los Angeles. Design, Setting, and Participants: This cohort study compared emergency medical services-treated, nontraumatic out-of-hospital cardiac arrest calls using the Medical Priority Dispatch System (MPDS) from January 1 to March 31, 2014, with calls using LA-TDS from January 1 to March 31, 2015. Trained data abstractors evaluated all 9-1-1 audio recordings for the initiation of T-CPR and the elapsed time to predefined events. Data were analyzed between January and December 2017. Main Outcomes and Measures: The primary outcome was the prevalence of T-CPR among 9-1-1 callers with limited English proficiency for field-confirmed nontraumatic cardiac arrests. Additional outcomes included T-CPR among callers with English proficiency and the elapsed time until key events in the call. Results: Of the 1027 emergency medical services calls during the study periods, 597 met the inclusion criteria. A total of 289 calls (48%) were made using MPDS (263 callers with English proficiency, and 26 callers with limited English proficiency), and 308 calls (52%) were made using LA-TDS (273 callers with English proficiency, and 35 callers with limited English proficiency). No differences between MPDS and LA-TDS cohorts were found in age, sex, known comorbidities, arrest location (private vs public), or witnessed status. The prevalence of T-CPR among callers with limited English proficiency was significantly greater using LA-TDS (69%) vs MPDS (28%) (odds ratio [OR], 5.66; 95% CI, 1.79-17.85; P = .003). For callers with English proficiency, the prevalence of T-CPR improved from 55% using MPDS to 67% using LA-TDS (OR, 1.66; 95% CI, 1.15-2.41; P = .007). With LA-TDS, callers with limited English proficiency had a significant decrease in time to recognition of cardiac arrest (OR, 0.59; 95% CI, 0.41-0.84; P = .005) and dispatch of resources (OR, 0.71; 95% CI, 0.54-0.94; P = .02). Conclusions and Relevance: The LA-TDS compared with MPDS was associated with increased performance of T-CPR for out-of-hospital cardiac arrests involving 9-1-1 callers with limited English proficiency. Further studies are needed in communities with a predominance of people with limited English proficiency to characterize bystander response, promote activation of the chain of survival, and clarify the precise elements of LA-TDS that can improve T-CPR performance.

Characteristics of helicopter emergency medical services (HEMS) dispatch cancellations during a six-year period in a Dutch HEMS region.

BACKGROUND: For decades, Helicopter Emergency Medical Services (HEMS) contribute greatly to prehospital patient care by performing advanced medical interventions on-scene. Unnecessary dispatches, resulting in cancellations, cause these vital resources to be temporarily unavailable and generate additional costs. A previous study showed a cancellation rate of 43.5% in our trauma region. However, little recent data about cancellation rates and reasons exist, despite revision of dispatch protocols. This study examines the current cancellation rate in our trauma region over a six-year period. Additionally, cancellation reasons are evaluated per type of dispatch and initial incident report, upon which HEMS is dispatched. METHODS: This retrospective study analyzed the data of the Dutch HEMS Lifeliner 1 (North-West region of the Netherlands, covering a population of 5 million inhabitants), analyzing all subsequent cases between April 1st 2013 and April 1st 2019. Patient characteristics, type of dispatch (primary; based on dispatcher criteria versus secondary, as judged by the first ambulance team on site), initial incident report received by the EMS dispatch center, and information regarding day- or nighttime dispatches were collected. In case of cancellation, cancel rate and reason per type of dispatch and initial incident report were assessed. RESULTS: In total, 18,638 dispatches were included. HEMS was canceled in 54.5% (95% CI 53.8-55.3%) of cases. The majority of canceled dispatches (76.1%) were canceled because respiratory, hemodynamic, and neurologic parameters were stable. Dispatches simultaneously activated with EMS (primary dispatch) were canceled in 58.3%, compared to 15.1% when HEMS assistance was requested by EMS based on their findings on-scene (secondary dispatch). A cancellation rate of 54.6% was found in trauma related dispatches (n = 12,148), compared to 52.2% in non-trauma related dispatches (n = 5378). Higher cancellation rates exceeding 60% were observed in the less common dispatch categories, e.g., anaphylaxis (66.3%), unknown incident report (66.0%), assault with a blunt object (64.1%), obstetrics (62.8%), and submersion (61.9%). CONCLUSION: HEMS cancellations are increased, compared to previous research in our region. Yet, the cancellations are acceptable as the effect on HEMS' unavailbility remains minimized. Focus should be on identifying the patient in need of HEMS care while maintaining overtriage rates low. Continuous evaluation of HEMS triage is important, and dispatch criteria should be adjusted if necessary.

Incidence of emergency calls and out-of-hospital cardiac arrest deaths during the COVID-19 pandemic: findings from a cross-sectional study in a UK ambulance service.

BACKGROUND: In response to the COVID-19 pandemic, a national lockdown was introduced on 23 March 2020. In the following weeks, emergency departments in the UK reported a reduction in attendances. We aimed to explore the incidence of emergency calls across North East England, as well as the number of out-of-hospital cardiac arrest (OHCA) deaths. METHODS: Data were collected for all patients who contacted North East Ambulance Service between 4 March 2019-2 June 2019 and 2 March 2020-31 May 2020 suffering stroke, ST elevation myocardial infarction, allergy, asthma, chronic obstructive pulmonary disease, falls, intoxication, seizure, sepsis, acute coronary syndrome and OHCA. RESULTS: There were a reduction in incidence of calls, excluding OHCA, resulting in ambulance activation during the pandemic compared with same period in 2019, 16 743 versus 19 639, respectively (-14.74%). The decline in calls was partially reversed by the end of May 2020. Incidence of OHCA at the time of the national lockdown had increased by 13.79% with a peak increase of 73.56% in the second week in April 2020. OHCA deaths peaked in the first 2 weeks in April 2020, 95.65% and 90.07%, respectively, but by the end May 2020, incidence of OHCA and OHCA deaths had returned to prelockdown levels. CONCLUSION: Incidence of emergency calls were reduced during the pandemic compared with 2019. There was a rise in incidence of OHCA and OHCA deaths during the same period; however, these changes appear transient. Further research is required to understand patient behaviour towards seeking help during the pandemic and the long-term consequences of not doing so.

Analysis of Monitoring, Early Warning and Emergency Response System for New Major Infectious Diseases in China and Overseas.

In recent years, the impact of new major infectious diseases on people's normal life is becoming more and more frequent, which has brought great impact on people's life safety and social economy, especially the corona virus disease 2019, which has been sweeping the globe. Public health and disease prevention and control systems in different countries have different performances in response to the pandemic, but they all have exposed many shortcomings. Countries around the world urgently need to improve the monitoring, early warning and emergency response systems for new major infectious diseases. As the outpost and main part of medical rescue, the hospital urgently needs to establish a set of scientifically advanced emergency response mechanism that is suitable for the business process of the medical system and unified standards in order to improve the response efficiency and quality of emergency treatment.

[The Netherlands Triage Standard applied to paediatric patients in emergency medicine: is it reliable and valid?] / Toepassing van de Nederlandse Triage Standaard bij kinderen in de spoedzorg.

OBJECTIVE: To determine the inter-rater reliability and validity of the Netherlands Triage Standard (NTS) for paediatric triage. DESIGN: A cross-sectional study using fictional cases for telephone and physical triage. METHOD: An expert panel established in advance the urgency of 40 cases concerning emergency help requests from non-referred children (the reference standard). These requests were presented in an online survey to triagists from three general practitioner (GP) out-of-hours practices, three ambulance dispatching centres and three hospital emergency departments. Triagists assessed all cases, using the NTS. We determined the agreement on degrees of urgency between different triagists and compared them with the reference standard. The outcome measure for inter-rater reliability was the intraclass correlation coefficient (ICC). The outcome measures for validity were the degree of agreement with the reference standard, under-triage and over-triage, and sensitivity and specificity in identifying high-urgency (U0-U2) versus low-urgency cases (U30U5). RESULTS: In total, 116 triagists participated in the study (response: 86%). The ICC was 0.73 among all triagists, and was highest in the out-of-hours GP cooperatives. There was 62.3% agreement with the reference standard, 17.4% under-triage and 20.2% over-triage. Of the divergent urgencies, 77% differed by only one urgency category. The sensitivity was 85.2% and the specificity 89.7%. The sensitivity and specificity of triage by the GP out-of-hours practices (82.7% and 92.7%, respectively) were almost the same as that by the hospital emergency departments (79.6% and 92.5%, respectively). Triage by the ambulance dispatching centres had relatively high sensitivity (93%), but relatively low specificity (82.4%). CONCLUSION: The results of the study contribute to the evidence that the NTS is a reliable and valid triage standard for paediatric patients. The urgency assessments by triagists in the GP out-of-hours practices, ambulance dispatching centres and hospital emergency departments were broadly in agreement. Results were limited by cases being on paper and triage only on anamnestic characteristics.

Ambulance dispatch calls attributable to influenza A and other common respiratory viruses in the Netherlands (2014-2016).

BACKGROUND: Ambulance dispatches could be useful for syndromic surveillance of severe respiratory infections. We evaluated whether ambulance dispatch calls of highest urgency reflect the circulation of influenza A virus, influenza B virus, respiratory syncytial virus (RSV), rhinovirus, adenovirus, coronavirus, parainfluenzavirus and human metapneumovirus (hMPV). METHODS: We analysed calls from four ambulance call centres serving 25% of the population in the Netherlands (2014-2016). The chief symptom and urgency level is recorded during triage; we restricted our analysis to calls with the highest urgency and identified those compatible with a respiratory syndrome. We modelled the relation between respiratory syndrome calls (RSC) and respiratory virus trends using binomial regression with identity link function. RESULTS: We included 211 739 calls, of which 15 385 (7.3%) were RSC. Proportion of RSC showed periodicity with winter peaks and smaller interseasonal increases. Overall, 15% of RSC were attributable to respiratory viruses (20% in out-of-office hour calls). There was large variation by age group: in <15 years, only RSV was associated and explained 11% of RSC; in 15-64 years, only influenza A (explained 3% of RSC); and in ≥65 years adenovirus explained 9% of RSC, distributed throughout the year, and hMPV (4%) and influenza A (1%) mainly during the winter peaks. Additionally, rhinovirus was associated with total RSC. CONCLUSION: High urgency ambulance dispatches reflect the burden of different respiratory viruses and might be useful to monitor the respiratory season overall. Influenza plays a smaller role than other viruses: RSV is important in children while adenovirus and hMPV are the biggest contributors to emergency calls in the elderly.

Using trigger tools to identify triage errors by ambulance dispatch nurses in Sweden: an observational study.

OBJECTIVES: This study aimed to assess whether trigger tools were useful identifying triage errors among patients referred to non-emergency care by emergency medical dispatch nurses, and to describe the characteristics of these patients. DESIGN: An observational study of patients referred by dispatch nurses to non-emergency care. SETTING: Dispatch centres in two Swedish regions. PARTICIPANTS: A total of 1089 adult patients directed to non-emergency care by dispatch nurses between October 2016 and February 2017. 53% were female and the median age was 61 years. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was a visit to an emergency department within 7 days of contact with the dispatch centre. Secondary outcomes were (1) visits related to the primary contact with the dispatch centre, (2) provision of care above the primary level (ie, interventions not available at a typical local primary care centre) and (3) admission to hospital in-patient care. RESULTS: Of 1089 included patients, 260 (24%) visited an emergency department within 7 days. Of these, 209 (80%) were related to the dispatch centre contact, 143 (55%) received interventions above the primary care level and 99 (38%) were admitted to in-patient care. Elderly (65+) patients (OR 1.45, 95% CI 1.05 to 1.98) and patients referred onwards to other healthcare providers (OR 1.58, 95% CI 1.15 to 2.19) had higher likelihoods of visiting an emergency department. Six avoidable patient harms were identified, none of which were captured by existing incident reporting systems, and all of which would have received an ambulance if the decision support system had been strictly adhered to. CONCLUSION: The use of these patient outcomes in the framework of a Global Trigger Tool-based review can identify patient harms missed by incident reporting systems in the context of emergency medical dispatching. Increased compliance with the decision support system has the potential to improve patient safety.

Dispatcher-assisted cardiopulmonary resuscitation: Differential effects of landline, Mobile, and transferred calls.

BACKGROUND: Dispatcher-assisted cardiopulmonary resuscitation (DACPR) could improve the survival rate of out-of-hospital cardiac arrest (OHCA). However, the efficiency of DACPR varies. Our study compared the effectiveness of DACPR instructed via landline calls, mobile calls, and landline calls transferred to mobiles. METHOD: This prospective cohort study enrolled patients with OHCA between 1 July 2017 and 30 November 2018 in Taichung. Patients were divided into a mobile group and a landline group according to device used to call emergency medical services (EMS). The landline group was subdivided according to whether the call was transferred to a mobile. We compared the DACPR rate and call to chest compression time between groups. RESULTS: The study comprised 2404 cases after exclusion: 934 cases of DACPR via mobile and 1470 via landline. In the mobile group, DACPR rate (54% vs. 47.5%, P <  0.001) was higher and call to chest compression time (median: 156 s vs. 174 s P < 0.001) was shorter than in the landline group. In the transferred group, DACPR rate (72.7% vs. 28.8%, P <  0.001) was higher than in the non-transferred group, but no difference was observed in call to chest compression time (median: 173 s vs. 177 s, P = 0.69). CONCLUSION: According to this city-based prospective clinical study, communication over mobiles resulted in higher DACPR rate and shorter call to chest compression time than that over landlines. Transferring calls from a landline to a mobile could increase the DACPR rate without delaying the initiation of chest compression.

Use of Ambulance Dispatch Calls for Surveillance of Severe Acute Respiratory Infections.

Ambulance dispatches for respiratory syndromes reflect incidence of influenza-like illness in primary care. Associations are highest in children (15%-34% of respiratory calls attributable to influenza), out-of-office hours (9%), and highest urgency-level calls (9%-11%). Ambulance dispatches might be an additional source of data for severe influenza surveillance.

Effectiveness of the Dual Dispatch to Cardiac Arrest Policy in Houston, Texas.

CONTEXT: Houston policy is to dual dispatch medically trained firefighters, in addition to emergency medical services (EMS) units to out-of-hospital cardiac arrest (OHCA) cases. While believed to improve public health outcomes, no research exists supporting the policy that when firefighters respond before a better-equipped EMS unit, they increase the probability of survival. OBJECTIVE: To inform EMS policy decisions regarding the effectiveness of dual dispatch by determining the impact of medically trained firefighter dispatch on return of spontaneous circulation (ROSC), a measure of survivability, in OHCA 911 calls while controlling for the subsequent arrival of an EMS unit. DESIGN: This retrospective study uses logistic regression to determine the association between ROSC and response time for fire apparatus first responders controlling for arrival of the EMS unit. SETTING: Out-of-hospital cardiac arrest cases in Houston between May 2008 and April 2013 when dual dispatch was used. PARTICIPANTS: A total of 6961 OHCA cases with the complete data needed for the analysis. MAIN OUTCOME MEASURES: Logistic regression of the dependence of OHCA survival using the indicator ROSC, as related to the fire first responder response times controlling for subsequent arrival of the EMS. RESULTS: Fire apparatus arrived first in 46.7% of cases, a median value of 1.5 minutes before an EMS unit. Controlling for subsequent arrival time of EMS has no effect on ROSC achieved by the fire first responder. If the firefighters had not responded, the resulting 1.5-minute increase in response time equates to a decrease in probability of attaining ROSC of 20.1% for cases regardless of presenting heart rhythm and a 47.7% decrease for ventricular fibrillation cases in which bystander cardiopulmonary resuscitation was initiated. CONCLUSIONS: The firefighter first responder not only improved response time but also greatly increased survivability independent of the arrival time of the better-equipped EMS unit, validating the public health benefit of the dual dispatch policy in Houston.

Association between gaseous pollutants and emergency ambulance dispatches for asthma in Chengdu, China: a time-stratified case-crossover study.

OBJECTIVES: The association between concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and emergency ambulance dispatches (EADs) for asthma was explored in the central Sichuan Basin of southwestern China for the first time. METHODS: EADs for asthma were collected from the Chengdu First-Aid Command Center. Pollutant concentrations were collected from 24 municipal environmental monitoring centers and including SO2, NO2, CO, daily 8-h mean concentrations of O3 (O3-8 h), and particulate matter less than 2.5 µm in aerodynamic diameter (PM2.5). The climatic data were collected from the Chengdu Municipal Meteorological Bureau. All data were collected from years spanning 2013-2017. A time-stratified case-crossover design was used to analyze the data. RESULTS: After controlling for temperature, relative humidity, and atmospheric pressure, IQR increases in SO2 (13 µg/m3), NO2 (17 µg/m3), and CO (498 µg/m3) were associated with 18.8%, 11.5%, and 3.1% increases in EADs for asthma, respectively. The associations were strongest for EADs and SO2, NO2, and CO levels with 3-, 5-, and 1-day lags, respectively. CONCLUSIONS: This study provides additional data to the limited body of literature for potential health risks arising from ambient gaseous pollutants. The results of the study suggest that increased concentrations of SO2, NO2, and CO were positively associated with emergency ambulance dispatches for asthma in Chengdu, China. Further studies are needed to investigate the effects of individual air pollutants on asthma.

A descriptive study of solitary death in Yokohama City.

BACKGROUND: The solitary death rate in Japan is expected to continue increasing because of its growing super-aged society and the rapid growth of home care in the country. To accurately determine the actual status of solitary deaths, we used a novel analysis method of combining vital statistics and ambulatory care information in Yokohama City. METHODS: Data of persons who died at home in 2013 were obtained from death certificate notifications. We also obtained the emergency transportation records that matched the cases of these death certificate notifications. Then, we gathered information regarding age, gender, marital status, and cause of death for the matched cases. RESULTS: There were 1890 "suspected unnatural deaths," in which most solitary deaths could be included, among all citizens who died at home (n = 4847). We were able to match 1503 of these cases with emergency transportation records. These 1503 cases were divided into two groups, "solitary death" (n = 349) and "un-solitary death" (n = 1154) according to the postmortem interval until finding (PMI-f). Pearson's χ2 tests conducted for the two groups revealed that there were significant differences regarding the proportion of persons who were elderly, unmarried, male, and had a hepatic disease and senility. A logistic regression analysis also showed that an increased likelihood of a prolonged PMI-f was associated with males and an unmarried status with hepatic diseases. CONCLUSIONS: Unmarried, male sex, and liver diseases are independent risks for solitary death in Yokohama City.