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1.
Rev Saude Publica ; 53: 99, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31800916

RESUMO

OBJECTIVE: To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS: The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS: The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: -0.0816 - -0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: -4.3293 - -1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of -0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: -0.1060 - -0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS: Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.


Assuntos
Ambulâncias/estatística & dados numéricos , Mortalidade Hospitalar/tendências , Unidades Móveis de Saúde/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Adulto , Ambulâncias/normas , Brasil , Serviços Médicos de Emergência , Estudos de Viabilidade , Feminino , Humanos , Análise de Séries Temporais Interrompida , Masculino , Unidades Móveis de Saúde/normas , Qualidade da Assistência à Saúde , Valores de Referência , Análise de Regressão , Estações do Ano , Fatores Socioeconômicos , Fatores de Tempo
2.
Artigo em Japonês | MEDLINE | ID: mdl-31875633

RESUMO

OBJECTIVES: In this multicity study, we aimed to elucidate the city-specific factors affecting the association of high ambient temperature with ambulance dispatches due to acute illnesses. METHODS: We used the data of ambulance dispatches in 27 cities in Japan with more than 500,000 population excluding Tokyo, from May to September from 2012 to 2015. We included patients 20 years and older (≥20 years) and stratified them into three age groups (20-59, 60-79, and ≥80 years). We explored the city-specific pattern of the daily relative temperature (in temperature percentiles) and the risk of ambulance dispatches for each age group using a distributed lag nonlinear model and estimated the city-specific relative risks of ambulance dispatches at the 95/99 percentile temperature compared with the 77.6 percentile temperature defined as the reference temperature (Tref). Then, the estimates were combined by performing meta-analyses for each age group. We also applied meta-regression models to explore whether the city-specific characteristics modified the association of temperature with ambulance dispatches. RESULTS: The relative risks of the 95th percentile with respect to Tref were 1.14 (95% confidence interval (CI): 1.12, 1.16), 1.16 (95% CI: 1.13, 1.20), 1.13 (95% CI: 1.10, 1.16), and 1.13 (95% CI: 1.00, 1.16), for all-age (≥20) and age-stratified groups (20-59, 60-79, and ≥80 years), respectively. We observed a higher relative risk for the ≥20 years age group in the cities with higher proportions of single-elderly, single-mother, and single-father households. We also found that the relative risk for the 20-59 years age group was higher in the cities with a higher proportion of blue-collar workers. CONCLUSIONS: The present study provides insights into city-specific characteristics modifying heat-related health effects.


Assuntos
Ambulâncias/estatística & dados numéricos , Saúde da População Urbana , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Mudança Climática , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Risco , Adulto Jovem
3.
BMC Neurol ; 19(1): 283, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718577

RESUMO

BACKGROUND: As health behavior varies with increasing age, we aimed to examine the potential barriers in calling emergency medical services (EMS) after recognizing a stroke among 40-74- and 75-99-year-old adults. METHODS: Data were obtained from a cross-sectional community-based study (FAST-RIGHT) that was conducted from January 2017 to May 2017 and involved adults (age ≥ 40 years) across 69 administrative areas in China. A subgroup of residents (153675) who recognized stroke symptoms was analyzed. Multivariable logistic regression models were performed in the 40-74 and 75-99 age groups, separately, to determine the factors associated with wait-and-see behaviors at the onset of a stroke. RESULTS: In the 40-74 and 75-99 age groups, the rates of participants who chose "Self-observation at home" were 3.0% (3912) and 3.5% (738), respectively; the rates of "Wait for family, then go to hospital" were 31.7% (42071) and 33.1% (6957), respectively. Rural residence, living with one's spouse, low income (< 731 US $ per annum), having a single avenue to learn about stroke, and having friends with stroke were factors associated with waiting for one's family in both groups. However, unlike in the 40-74 age group, sex, number of children, family history, and stroke history did not influence the behaviors at stroke onset in the 75-99 age group. CONCLUSIONS: Different barriers from recognizing stroke and calling an ambulance exist in the 40-74 and 75-99 age groups in this specific population. Different strategies that mainly focus on changing the "Wait for family" behavior and emphasize on immediately calling EMS are recommended for both age groups.


Assuntos
Serviços Médicos de Emergência , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Ambulâncias , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pobreza , População Rural , Acidente Vascular Cerebral/epidemiologia
4.
J Emerg Manag ; 17(5): 380-384, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31736044

RESUMO

The authors propose that, through innovative and mutually beneficial partnerships between medical schools and local Emergency Medical Services (EMS) agencies, medical students can help mitigate EMS shortages in areas across the country. These partnerships, which we have seen very early signs of in some places, would create channels by which medical students get their emergency medical technician certifications in the summer before matriculating and volunteer with the agency's ambulance service, either as an extracurricular clinical experience (which are very popular among medical students) or as a way to fulfill clinical or service requirements or earn elective credit. In the attached piece, the authors (1) establish, using data, that a key factor contributing to current and impending EMS shortages is a lack of certified personnel, and (2) propose why and how medical students could provide a novel source of additional volunteers for understaffed public ambulance services, explore some of the benefits and limitations of this proposal, and provide a road-map for how to form partnerships between medical schools and local EMS agencies.


Assuntos
Fortalecimento Institucional , Serviços Médicos de Emergência/organização & administração , Auxiliares de Emergência/provisão & distribução , Estudantes de Medicina , Recursos Humanos , Ambulâncias , Humanos
5.
J Hist Med Allied Sci ; 74(4): 440-466, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31592527

RESUMO

This manuscript explores the history of the Freedom House Enterprises Ambulance Service, a social and medical experiment that trained "unemployable" black citizens during the late 1960s and early 1970s to provide then state of the art prehospital care. Through archives, newspapers, personal correspondence, university memoranda, and the medical literature, this paper explores the comparable, yet different roles of the program's two leaders, Drs. Peter Safar and Nancy Caroline. Despite its success in demonstrating national standards for paramedic training and equipment, the program ended abruptly in 1975. And though Pittsburgh's city administration cited economic constraints for its fledgling support of Freedom House, black and majority newspapers and citizens alike understood the city's diminishing support of the program in racial terms. The paper discusses Safar and Caroline's well-intentioned efforts in developing this novel program, while confronting the racial, social, and structural constraints on the program and the limits of racial liberalism.


Assuntos
Ambulâncias/história , Grupos de Populações Continentais , Política , Saúde Pública/história , Cidades , História do Século XX , Humanos , Pennsylvania
7.
Emergencias (Sant Vicenç dels Horts) ; 31(5): 346-352, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184125

RESUMO

Aunque son muchos los indicadores de calidad (IC) definidos para establecer un sistema común, homogéneo y fiable de evaluación sobre la actividad en los servicios de urgencias, es escasa la información acerca de los IC relacionados con las emergencias atendidas en el ámbito extrahospitalario. El objetivo de este trabajo es identificar y analizar, a través de la literatura científica publicada, los IC específicos de dicha atención ante emergencias fuera del contexto hospitalario. Se realizó una revisión sistemática de la literatura según las recomendaciones PRISMA. Se exploraron 5 bases de datos y se elaboraron protocolos de búsqueda para localizar estudios que aportasen información sobre IC para evaluar la atención en emergencias extrahospitalarias, entre noviembre de 2017 y julio de 2018, tanto en inglés como en español. Se analizaron un total de 22 estudios y se identificaron un total de 333 IC en emergencias extrahospitalarias que fueron clasificados en clínicos y no clínicos, con sus subdominios correspondientes para cada grupo. El número de IC no clínicos identificados en la búsqueda fue superior, pudiendo concluir que son los más utilizados para evaluar la atención en las emergencias extrahospitalarias en la actualidad y dejando la puerta abierta para el diseño e implementación de nuevos IC capaces de evaluar la actividad fuera del contexto hospitalario


Although many health care quality indicators have been defined for establishing a common, homogeneous, and reliable system for assessing emergency department care, less information is available on the use of indicators of quality in attending emergencies outside the hospital. We aimed to identify and analyze quality indicators that have appeared in the literature on out-of-hospital emergencies. This systematic review of the literature followed the ations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). We developed protocols for searching 5 databases to locate studies using quality indicators to evaluate care in out-of-hospital emergencies. Studies were published between July 2017 and July 2018 in either English or Spanish. We identified 22 studies naming 333 quality indicators in out-of-hospital emergencies. The indicators were classified as clinical or nonclinical; within each of these 2 sets, we also identified domains, or subcategories. As nonclinical quality identifiers were more numerous in the literature, it seems that they are the ones most often used to assess out-of-hospital emergency care at this time. This finding leaves the door open to designing and implementing new indicators able to measure quality of care in this clinical setting


Assuntos
Humanos , Indicadores de Qualidade em Assistência à Saúde , Serviços Médicos de Emergência/métodos , Segurança do Paciente , Gestão da Qualidade Total/métodos , Gestão da Qualidade Total/normas , Ambulâncias/organização & administração
11.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 31(8): 928-929, 2019 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-31537212

RESUMO

OBJECTIVE: The transfer of critically ill patients is related to the treatment and prognosis of patients. It is not only the work of saving lives and injuries in the medical and health system, but also a measure of the ability and level of public health services in a region. "Non-emergency medical transshipment service" is a new form of business which is emerging at present. The phenomenon of "illegal ambulance" derived from it has attracted the attention of relevant government departments and has become the focus of media. The solution of this problem involves many aspects. The perspectives of defining the orientation of transfer work, constructing transfer service system, formulating transfer process norms and improving the quality of transfer efficiency are discussed in this paper, and it clearly puts forward that the development of "non-emergency medical transfer service" should adhere to the development path of marketization, diversification, standardization and specialization.


Assuntos
Estado Terminal , Serviços Médicos de Emergência , Ambulâncias , Humanos , Encaminhamento e Consulta
12.
Emerg Med J ; 36(9): 535-540, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31427472

RESUMO

OBJECTIVES: We set out to investigate paramedics' views of ethics and research, drawing on experiences from Paramedic-2, a randomised controlled trial comparing epinephrine and placebo in out-of-hospital cardiac arrest (OHCA). METHODS: An interpretative phenomenological approach was adopted. A purposive sample of paramedics (n=6) from North East Ambulance Service NHS Foundation Trust were invited to a semi-structured, in-depth interview. RESULTS: Three superordinate themes emerged: (1) morality, (2) emotion and (3) equipoise. Some viewed Paramedic-2 as an opportunity to improve OHCA outcomes for the many, viewing participation as a moral obligation; others viewed the study as unethical, equating participation with immoral behaviour. Morality was a motivator to drive individual action. Positive and negative emotions were exhibited by the paramedics involved reflecting the wider view each paramedic held about trial participation. Those morally driven to participate in Paramedic-2 discussed their pride in being associated with the trial, while those who found participation unethical, discussed feelings of guilt and regret. Individual experience and perceptions of epinephrine guided each paramedic's willingness to accept or reject equipoise. Some questioned the role of epinephrine in OHCA; others believed withholding epinephrine was synonymous to denying patient care. CONCLUSION: A paucity of evidence exists to support any beneficial role of epinephrine in OHCA. Despite this, some paramedics were reluctant to participate in Paramedic-2 and relied on their personal perceptions and experiences of epinephrine to guide their decision regarding participation. Failure to acknowledge the importance of individual perspectives may jeopardise the success of future out-of-hospital trials.


Assuntos
Atitude do Pessoal de Saúde , Ensaios Clínicos como Assunto/ética , Auxiliares de Emergência/psicologia , Parada Cardíaca Extra-Hospitalar/tratamento farmacológico , Adulto , Ambulâncias/ética , Emoções , Epinefrina/administração & dosagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Princípios Morais , Seleção de Pacientes/ética , Placebos/administração & dosagem , Pesquisa Qualitativa , Recusa de Participação/ética , Recusa de Participação/psicologia , Ressuscitação/ética , Ressuscitação/métodos , Reino Unido
13.
Environ Pollut ; 254(Pt A): 112769, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31419665

RESUMO

A number of systematic reviews have investigated the association between air pollutants and health impacts, these mostly focus on morbidity and mortality from hospital data. Previously, no reviews focused solely on ambulance dispatch data. These data sets have excellent potential for environmental health research. For this review, publications up to April 2019 were identified using three main search categories covering: ambulance services including dispatches; air pollutants; and health outcomes. From 308 studies initially identified, 275 were excluded as they did not relate to ambulance service dispatches, did not report the air pollutant association, and/or did not study ambient air pollution. The main health outcomes in the remaining 33 studies were cardiac arrest (n = 14), cardiovascular (n = 11) and respiratory (n = 10) dispatches. Meta-analyses were performed to summarise pooled relative risk (RR) of pollutants: particulate matter less than 2.5 and 10 µm (PM2.5, PM10), the fraction between PM10 and PM2.5 (coarse) and suspended particulate matter (SPM) per 10 µg/m3 increase, carbon monoxide (CO) per 1 ppm increase and of sulphur dioxide (SO2), nitrogen dioxide (NO2), and ozone (O3) per 10 ppb increment and ambulance dispatches. Statistically significant associations were found for ambulance dispatch data for all-respiratory and PM2.5 at 1.03 (95% CI:1.02-1.04) and at 1.10 (95% CI:1.00-1.21) for asthma and NO2 associations. For dispatches with subsequent paramedic assessment for cardiac arrest with PM2.5, CO and coarse dispatches at 1.05 (95% CI:1.03-1.08), 1.10 (95% CI:1.02-1.18) and 1.04 (95% CI:1.01-1.06) respectively. For dispatches with subsequent physician diagnosis for all-respiratory and PM2.5 at 1.02 (95% CI:1.01-1.03). In conclusion, air pollution was significantly associated with an increase in ambulance dispatch data, including those for cardiac arrest, all-respiratory, and asthma dispatches. Ambulance services should plan accordingly during pollution events. Furthermore, efforts to improve air quality should lead to decreases in ambulance dispatches.


Assuntos
Poluentes Atmosféricos/análise , Ambulâncias/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Material Particulado/análise , Poluição do Ar , Asma , Monóxido de Carbono , Exposição Ambiental/análise , Saúde Ambiental , Humanos , Masculino , Dióxido de Nitrogênio , Ozônio , Risco , Dióxido de Enxofre
14.
Sci Total Environ ; 696: 133956, 2019 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-31450053

RESUMO

BACKGROUND: Most studies on the short-term health effects of air pollution have been conducted on a daily time scale, while hourly associations remain unclear. METHODS: We collected the hourly data of emergency ambulance calls (EACs), ambient air pollution, and meteorological variables from 2014 to 2016 in Luoyang, a central Chinese city in Henan Province. We used a generalized additive model to estimate the hourly effects of ambient air pollutants (PM2.5, PM10, SO2, and NO2) on EACs for all natural causes and cardiovascular and respiratory morbidity, with adjustment for potential confounding factors. We further examined the effect modification by temperature, relative humidity, wind speed, and atmospheric pressure using stratified analyses. RESULTS: In the single-pollutant models, PM2.5, PM10, SO2, and NO2 were associated with an immediate increase in all-cause morbidity at 0, 0, 12, 10 h, separately, after exposure to these pollutants (excess risks: 0.19% (95% confidence interval (CI): 0.03%, 0.35%), 0.13% (95% CI: 0.02%, 0.24%), 0.28% (95% CI: 0.01%, 0.54%) and 0.52% (95% CI: 0.06%, 0.99%), respectively). These effects remained generally stable in two-pollutant models. SO2 and NO2 were significantly associated with an immediate increase in risk of cardiovascular morbidity, but the effects on respiratory morbidity were relatively more delayed. The stratified analyses suggested that temperature could modify the association between PM2.5 and EACs, humidity and atmospheric pressure could modify the association between SO2 and EACs. CONCLUSIONS: Our study provides new evidence that higher concentrations of PM2.5, PM10, SO2, and NO2 may have transiently acute effects on all-cause morbidity and subacute effects on respiratory morbidity. SO2 and NO2 may also have immediate effects on cardiovascular morbidity. Findings of this study have important implications for the formation of hourly air quality standards.


Assuntos
Poluição do Ar/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Exposição Ambiental/estatística & dados numéricos , Poluentes Atmosféricos/análise , Ambulâncias , China/epidemiologia , Humanos , Material Particulado/análise
15.
Scand J Trauma Resusc Emerg Med ; 27(1): 84, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464622

RESUMO

BACKGROUND: Chest pain is common in acute ambulance transports. This study aims to characterize and compare ambulance-transported chest pain patients to non-chest pain patients and evaluate if patient characteristics and accompanying symptoms accessible at the time of emergency call can predict cause and outcome in chest pain patients. METHODS: Retrospective, observational population-based study, including acute ambulance transports. Patient characteristics and symptoms are included in a multivariable risk model to identify characteristics, associated with being discharged without an acute cardiac diagnosis and surviving 30 days after chest pain event. RESULTS: In total, 10,033 of 61,088 (16.4%) acute ambulance transports were due to chest pain. In chest pain patients, 30-day mortality was 2.1% (95%CI 1.8-2.4) compared to 6.0% (95%CI 5.7-6.2) in non-chest pain patients. Of chest pain patients, 1054 (10.5%) were diagnosed with acute myocardial infarction, and 5068 (50.5%) were discharged without any diagnosis of disease. This no-diagnosis group had very low 30-day mortality, 0.4% (95%CI 0.2-0.9). Female gender, younger age, chronic pulmonary disease, absence of accompanying symptoms of dyspnoea, radiation, severe pain for > 5 min, clammy skin, uncomfortable, and nausea were associated with being discharged without an acute cardiac diagnosis and surviving 30 days after a chest pain event. CONCLUSION: Chest pain is a common reason for ambulance transport, but the majority of patients are discharged without a diagnosis and with a high survival rate. Early risk prediction seems to hold a potential for resource downgrading and thus cost-saving in selected chest pain patients.


Assuntos
Ambulâncias , Dor no Peito/epidemiologia , Adulto , Idoso , Dinamarca , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/mortalidade , Prevalência , Estudos Retrospectivos , Taxa de Sobrevida
16.
Ital J Pediatr ; 45(1): 97, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391074

RESUMO

OBJECTIVES: This article describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service (NETS). To date, the European Community rules specify requirements for the design, testing, performance, and equipping of road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. METHODS: The project consisted of electric and gas supply planning, interior design taking into account ergonomic and occupant protection principles, both during travel and during medical care performances. RESULTS: A detailed project is presented. Main differences between European Type C ambulance and the new proposed Type D neonatal ground ambulance are the presence on board of air compressed cylinder, iNO cylinders and delivery system, phototheraphy, shock adsorbing stretcher support, cooling device, patient's placenta (refrigeration box), and transcutaneous gas analyzer. CONCLUSION: The European Community rules specify requirements for road ambulance used for transport and care of adult injured or ill patients, completely ignoring neonatal transport. This study describes the detailed project aimed to realize a dedicated ground ambulance for neonatal emergency transport service. This study demonstrated that it is not possible simply to adapt the currently dedicated ambulance for mobile intensive care and resuscitation services (actual type C European Community) in a modern dedicated NETS ambulance; it is of paramount importance suggesting to European Community to introduce a further ambulance type, to be identified type D, strictly reserved to neonatal transport activities.


Assuntos
Ambulâncias/normas , Desenho de Equipamento/normas , Europa (Continente) , Humanos , Recém-Nascido , Itália
17.
Emerg Med J ; 36(9): 541-547, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31326952

RESUMO

OBJECTIVES: To investigate the association of prehospital advanced airway management (AAM) on outcomes of emergency medical service (EMS)-witnessed out-of-hospital cardiac arrest (OHCA) according to the location of arrest. METHODS: We evaluated a Korean national OHCA database from 2012 to 2016. Adults with EMS-witnessed, non-traumatic OHCA were included. Patients were categorised into four groups according to whether prehospital AAM was conducted (yes/no) and location of arrest ('at scene' or 'in the ambulance'). The primary outcome was discharge with good neurological recovery (cerebral performance category 1 or 2). Multivariable logistic regression analysis was conducted to evaluate the association between AAM and outcome according to the location of arrest. RESULTS: Among 6620 cases, 1425 (21.5%) cases of arrest occurred 'at the scene', and 5195 (78.5%) cases of arrest occurred 'in an ambulance'. Prehospital AAM was performed in 272 (19.1%) OHCAs occurring 'at the scene' and 645 (12.4%) OHCAs occurring 'in an ambulance'. Patients with OHCA in the ambulance who had prehospital AAM showed the lowest good neurological recovery rate (6.0%) compared with OHCAs in the ambulance with no AAM (8.9%), OHCA at scene with AAM (10.7%) and OHCA at scene with no AAM (7.7%). For OHCAs occurring in the ambulance, the use of AAM had an adjusted OR of 0.67 (95% CI 0.45 to 0.98) for good neurological recovery. CONCLUSION: Our data show no benefit of AAM in patients with EMS-witnessed OHCA. For patients with OHCA occurring in the ambulance, AAM was associated with worse clinical outcome.


Assuntos
Manuseio das Vias Aéreas/efeitos adversos , Ambulâncias , Doenças do Sistema Nervoso/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Sistema de Registros/estatística & dados numéricos , República da Coreia/epidemiologia , Análise Espaço-Temporal , Análise de Sobrevida , Fatores de Tempo , Resultado do Tratamento
18.
J Therm Biol ; 83: 150-156, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31331513

RESUMO

Climate change has a devastating effect on human societies, including their economic, cultural and health conditions. Our objective was to investigate the association between meteorological variables and ambulance attendance in the event of cardiovascular diseases using time-series analyses. We used a time series analysis to investigate the relationship between meteorological variables and ambulance attendance in the event of cardiovascular diseases from 2010 to 2015. To examine the effect of high temperatures on ambulance attendance, we investigated the relative risk of the daily volume of high temperature attendance, the 99th temperature percentile compared to the 75th temperature percentile. Upon examining the effect of cold temperatures on ambulance attendance, or the relative risk of the daily volume of attendance with low temperatures, the 1st temperature percentile compared to the 25th temperature percentile. In 1826 days, from March 21, 2010 to March 19, 2015, there were 7051 emergency calls for cardiovascular diseases. Significant variations were identified in the monthly (P < 0.001) and seasonal (P < 0.001) distributions. The highest seasonal incidence occurred in the winter and lowest was observed in the summer. With regard to association between cold temperature and calls for ambulance attendance in the event of cardiovascular diseases according to lag days, our findings showed a significant increase in lag 7 ((RR, 1.026; 95% CI, 1.003 to 1.050), lag 8 (RR, 1.023; 95% CI, 1.005to 1.041) and lag 9 (RR, 1.019; 95% CI, 1.002 to 1.036) respectively. These results suggest that the demand for an ambulance for cardiovascular diseases was higher in the cold weather and that humidity can increase this demand in the warm seasons.


Assuntos
Ambulâncias/estatística & dados numéricos , Doenças Cardiovasculares/epidemiologia , Temperatura Baixa , Estações do Ano , Utilização de Instalações e Serviços/estatística & dados numéricos , Humanos , Umidade , Irã (Geográfico)
19.
J Stroke Cerebrovasc Dis ; 28(9): 2530-2536, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31307897

RESUMO

BACKGROUND: UCHealth's Mobile Stroke Unit (MSU) at University of Colorado Hospital is an ambulance equipped with a computed tomography (CT) scanner and tele-stroke capabilities that began clinical operation in Aurora, Colorado January 2016. As one of the first MSU's in the United States, it was necessary to design unique and dynamic information technology infrastructure. This includes high-speed cellular connectivity, Health Insurance Portability and Accountability Act compliance, cloud-based and remote access to electronic medical records (EMR), and reliable and rapid image transfer. Here we describe novel technologies incorporated into the MSU. Technological data-handling aspects of the MSU were reviewed. Functions evaluated include wireless connectivity while in transit, EMR access and manipulation in the field, CT with image transfer from the MSU to the hospital's Picture Archiving Communication System (PACS), and video and audio communication for neurological assessment. METHODS/RESULTS: The MSU wireless system was designed with redundancy to avoid dropped signals during data transfer. Two separate Internet Protocol destinations with split-tunnel architecture are assigned, for videoconferencing and for EMR data transfer. Brain images acquired in the ambulance CT scanner are transferred initially to an onboard laptop, then via Citrix Receiver to the hospital-based PACS server where they can be viewed in PACS or EMR by the stroke neurologist, neuroradiologist, and other providers. PACS and Radiology Information System are 2 of the XenApps utilized by CT technologists on board the MSU. DISCUSSION/CONCLUSIONS: These technologies will serve as a blueprint for development of similar units elsewhere, and as a framework for improvement in this technology.


Assuntos
Ambulâncias/organização & administração , Diagnóstico por Computador , Registros Eletrônicos de Saúde/organização & administração , Unidades Móveis de Saúde/organização & administração , Acidente Vascular Cerebral/diagnóstico por imagem , Integração de Sistemas , Telerradiologia/organização & administração , Tomografia Computadorizada por Raios X , Tecnologia sem Fio/organização & administração , Colorado , Prestação Integrada de Cuidados de Saúde/organização & administração , Diagnóstico por Computador/instrumentação , Humanos , Valor Preditivo dos Testes , Prognóstico , Avaliação de Programas e Projetos de Saúde , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Telerradiologia/instrumentação , Fatores de Tempo , Tempo para o Tratamento , Tomografia Computadorizada por Raios X/instrumentação , Tecnologia sem Fio/instrumentação , Fluxo de Trabalho
20.
Work ; 63(4): 547-557, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31282462

RESUMO

BACKGROUND: The National Ambulance Resilience Unit (NARU) works on behalf of each National Health Service (NHS) Ambulance Trust in England to strengthen national resilience and improve patient outcome in challenging pre-hospital scenarios. OBJECTIVE: To conduct a Job Task Analysis and describe the physical demands of NARU roles. METHODS: A focus group was conducted to describe the physically demanding tasks performed by NARU personnel. Subsequently, the physical demands of the identified tasks were measured in 34 NARU personnel (29 male and 5 female). RESULTS: Eleven criterion tasks were identified; Swift Water Rescue (SWR), Re-board Inflatable Boat (RBIB), Set up Decontamination Tent (SDT), Clinical Decontamination (CD), Movement in Gas Tight Suits (MGTS), Marauding Terrorist Fire Arms (MTFA), Over Ground Rescue (OGR), Unload Incidence Response Unit Vehicle (UIRUV), Above Ground Rescue (AGR), Over Rubble Rescue (ORR) and Subterranean Rescue (SR). The greatest cardiovascular strain was measured during SWR, MGTS, and MTFA. The most thermally challenging tasks were the MTFA, CD, SR and OGR. The greatest muscular strength requirements were during MTFA and OGR. CONCLUSIONS: All five components of fitness (aerobic endurance, anaerobic endurance, muscular strength, muscular endurance and mobility) were required for successful completion of the physically demanding tasks performed by NARU personnel.


Assuntos
Ambulâncias/normas , Auxiliares de Emergência/normas , Avaliação de Desempenho Profissional/normas , Aptidão Física , Análise e Desempenho de Tarefas , Ambulâncias/organização & administração , Inglaterra , Feminino , Grupos Focais , Humanos , Masculino , Seleção de Pessoal/normas , Melhoria de Qualidade , Medicina Estatal/organização & administração , Medicina Estatal/normas
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