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Results for “Emergency Medical Service Communication Systems”

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At least 307 records · Page 17Linked to original sources
PubMed2004

Potential impact of interventions to reduce times to thrombolysis.

OBJECTIVES: To estimate the lifesaving potential of interventions to accelerate the administration of intravenous thrombolysis for myocardial infarction. METHODS: Data were analysed from a prospective, observational study of all patients transported to hospital by ambulance, who subsequently received intravenous thrombolysis at 20 hospitals and two ambulance services in Victoria, Australia (n = 1147). Regression models estimated the association between predictor variables age, sex, route of referral, symptom onset to call time, ambulance pre-notification of the receiving hospital, emergency department thrombolysis, and the outcome, time to thrombolysis. Further modelling estimated the number needed to treat to save one life by several recommended interventions to reduce time delays. RESULTS: Presentation via a rural hospital or general practitioner was associated with an approximate doubling of the onset to call time (2.08 and 2.30 respectively). Ambulance-hospital pre-notification and emergency department thrombolysis reduced door to needle times by 21% and 27% respectively. Modelling showed that each of the following interventions would be expected to save one life: 1069 hospital pre-notifications, 714 cases of emergency department thrombolysis, 184 cases of prehospital thrombolysis, 340 cases to bypass their rural hospital, or 50 cases to bypass their general practitioner. CONCLUSIONS: Hospital pre-notification and emergency department thrombolysis reduce time delays, although the mortality impact seems to be modest. Prehospital thrombolysis has the potential to save lives, although validation in real practice is required. Advising patients to call directly for an ambulance, rather than the general practitioner, has the greatest potential to save lives.

Adult↗
PubMed2006

Evaluation of a diabetes referral pathway for the management of hypoglycaemia following emergency contact with the ambulance service to a diabetes specialist nurse team.

OBJECTIVES: To evaluate the effectiveness of ambulance crew referral of patients treated for acute hypoglycaemia, to a diabetes specialist nurse (DSN) team. Patients were assessed by the ambulance service and did not attend an emergency department. METHODS: For a 3 month period patients were referred from two areas of West Yorkshire by the ambulance service to specialist diabetes teams. The DSNs contacted the patients within 7 days by telephone and arranged further review if necessary. Satisfaction questionnaires were sent to patients. RESULTS: Thirty eight patients were referred and all were reviewed by telephone; 30 (79%) also required a clinic review appointment. Warning signs of hypoglycaemia were identified by 21 (55%) patients, but 14 (37%) had none (three had incomplete data). Twelve patients had had a self-treated episode in the previous 6 months; nine patients had had three or more. Fifteen (39%) patients had called an emergency ambulance for similar reasons in the previous 6 months (27 "999" calls). Twenty patients (53%) had their drug treatment altered at a clinic appointment and 14 (37%) required ongoing review. Twenty six patients returned the satisfaction questionnaire; of these 88% agreed or strongly agreed that they had improved their understanding of hypoglycaemia and 73% felt more able to treat a hypoglycaemic episode in the future. Patient satisfaction with this care pathway was high. CONCLUSIONS: The ambulance service can coordinate successful referral of patients with episodes of acute hypoglycaemia to a DSN-led service. Patients often required treatment review. They valued this service and felt more confident managing their diabetes.

Adult↗
PubMed2006

Retrieval medicine: a review and guide for UK practitioners. Part 1: clinical guidelines and evidence base.

It has been proposed that formalisation of training to encompass prehospital and retrieval medicine should be considered in the UK, using those currently involved in immediate care as the core providers of these services.(1) Although there is an overlap in some aspects of "prehospital" and "retrieval" medicine, there are some distinct differences, both in terms of the skill base and service provision required. Retrieval medicine is the term used to indicate the use of an expert team to assess, stabilise and transport patients with severe injury or critical illness. Implicit in this process is the early provision of specialised advice to the health providers at the patient's side. In the UK, there is currently no national and often no regional strategy to coordinate the provision of secondary retrieval services for critically ill patients. International models do exist, which may be of help in this respect.

Ambulances↗
PubMed1990

Flying Squad response to medical emergencies.

The Flying Squad of the Accident and Emergency Department, of the Derbyshire Royal Infirmary, was established in 1955 by Collins. The initial function was to provide emergency care to victims of industrial accidents. However, the spectrum of emergencies they now respond to has expanded and includes predominantly road traffic accidents and medical emergencies. Despite the proliferation of Flying Squads their benefit has been difficult to quantify even in a trauma setting (Robertson & Steedman, 1985; Gorman & Coals, 1983). The outcome in medical emergencies is reported as dismal (Robertson & Steedman, 1985; Rowley & Collins, 1979) yet the number of calls for the flying squad to attend medical emergencies are many. Previous reports have recorded 20-30% of Squad calls responding to medical emergencies (Gorman & Coals, 1983; Rowley & Collins, 1979; Steedman & Robertson, 1986; Harrop & Bodiwala, 1983).

Cardiopulmonary Resuscitation↗
PubMed1989

Dispatcher-assisted cardiopulmonary resuscitation. Validation of efficacy.

Dispatcher-delivered telephone instruction in cardiopulmonary resuscitation (CPR) has been proposed to increase rates of bystander CPR in cases of out-of-hospital cardiac arrest. We tested the efficacy of a previously developed CPR message using a recording mannikin in a high stress, simulated cardiac arrest scenario. Community volunteers were unaware they would perform CPR until immediately before each trial. Performance of volunteers without prior CPR training (group A, n = 65) who received telephone instruction was compared with that of previously trained volunteers (group B, n = 43) who received the same message. Performances of both groups were also compared with a third group (group C, n = 43) composed of previously trained volunteers who did not receive the message. Quality of CPR was graded by three CPR instructors using explicit criteria. Printout strips from the recording mannikins were also analyzed. Evaluators were unaware of the training status of volunteers. The three groups were of comparable sex, race, and educational level, but group C was significantly younger than groups A and B (31.7 vs. 37.7 years, p less than 0.001). Because of the time required for telephone instruction, groups A and B started chest compressions a mean of 4.0 minutes after collapse compared with 1.2 minutes for group C (p less than 0.0001). We found that the previously untrained volunteers of group A performed CPR of an overall quality comparable to that performed by previously trained members of group C. Group A performed chest compressions significantly better than group C (p less than 0.02) but had greater problems performing effective ventilations.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗
PubMed2007

Stroke symptoms and the decision to call for an ambulance.

BACKGROUND AND PURPOSE: Few acute stroke patients are treated with alteplase, partly because of significant prehospital delays after symptom onset. The aim of this study was to determine among ambulance-transported stroke patients factors associated with stroke recognition and factors associated with a call for ambulance assistance within 1 hour from symptom onset. METHODS: For 6 months in 2004, all ambulance-transported stroke or transient ischemic attack patients arriving from a geographically defined region in Melbourne (Australia) to 1 of 3 hospital emergency departments were assessed. Tapes of the call for ambulance assistance were analyzed and the patient and the caller were interviewed. RESULTS: One hundred ninety-eight patients were included in the study. Stroke was reported as the problem in 44% of ambulance calls. Unprompted stroke recognition was independently associated with facial droop (P=0.015) and a history of stroke or transient ischemic attack (P<0.001). More than half of the calls for ambulance assistance were made within 1 hour from symptom onset and only 43% of these callers spontaneously identified the problem as "stroke." Factors independently associated with a call within 1 hour were: speech problems (P=0.009), caller family history of stroke (P=0.017), and the patient was not alone at symptom onset (P=0.018). CONCLUSIONS: Stroke was reported as the problem (unprompted) by <50% of callers. Fewer than half the calls were made within 1 hour from symptom onset. Interventions are needed to more strongly link stroke recognition to immediate action and increase the number of stroke patients eligible for acute treatment.

Aged↗
PubMed2001

The World Trade Center attack. Observations from New York's Bellevue Hospital.

This report describes selected aspects of the response by Bellevue Hospital Center to the World Trade Center attack of 11 September 2001. The hospital is 2.5 miles (4 km) from the site of the attack. These first-hand observations and this analysis may aid in future preparations. Key issues described relate to communication, organization, injuries treated, staffing, and logistics.

Aircraft↗
PubMed2005

Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: a systematic review.

OBJECTIVES: Prehospital 12-lead electrocardiogram (PHECG) interpretation and advance emergency department (ED) notification may improve time-to-treatment intervals for a variety of treatment strategies to improve outcome in acute myocardial infarction. Despite consensus guidelines recommending this intervention, few emergency medical services (EMS) employ this. The authors systematically reviewed the literature to report whether mortality or treatment time intervals improved when compared with standard care. METHODS: The authors used the Cochrane strategy to search MEDLINE, EMBASE, Current Contents, Dissertation Abstracts, Cochrane Library, and Index of Scientific and Technical Proceedings. Bibliographies and grant-agency Websites were reviewed, and primary investigators and industry were contacted for published and unpublished studies. Inclusion criteria included PHECG and advance ED notification versus standard EMS care; controlled trials; English only; and evaluation of treatment time intervals, all-cause mortality, or both. Study selection was hierarchical, blinded, and independent. Agreement at each level of review was evaluated by using a kappa statistic. Study quality was measured with a validated scale and was interpreted by two independent reviewers. RESULTS: A total of 1,283 citations were identified, and five studies met the inclusion criteria. The weighted kappa for selection was 0.61 (standard error [SE], 0.045) for titles, 0.63 (SE, 0.051) for abstracts, and 0.79 (SE, 0.146) for full articles. Mean study quality measures by two independent reviewers were 6.0/15 and 5.5/15 (correlation coefficient, 0.85; p = 0.06). PHECG and advance ED notification increased the weighted mean on-scene time by 1.2 minutes (95% confidence interval [95% CI] = -0.84 to 3.2). The weighted mean door-to-needle interval was shortened by 36.1 minutes (95% CI = 9.3 to 63.0: range of means, 22-48 minutes vs. 50-97 minutes). One study reported all-cause mortality, with a statistically nonsignificant reduction from 15.6% to 8.4%. CONCLUSIONS: For patients with AMI, the literature would suggest that PHECG and advanced ED notification reduces in hospital time to fibrinolysis. One controlled trial found no difference in mortality with this out-of-hospital intervention.

Electrocardiography↗
PubMed2006

A community intervention by firefighters to increase 911 calls and aspirin use for chest pain.

OBJECTIVES: To test the effectiveness of an intervention, delivered face-to-face by local firefighters, designed to increase utilization of 911 and self-administration of aspirin for seniors experiencing chest pain. METHODS: King County, Washington was divided into 126 geographically distinct areas that were randomized to intervention and control areas. A mailing list identified households of seniors within these areas. More than 20,000 homes in the intervention areas were contacted by local firefighters. Data on all 911 calls for chest pain and self-administration of aspirin were collected from the medical incident report form (MIRF). The unit of analysis was the area. Firefighters delivered a heart attack survival kit (that included an aspirin) and counseled participants on the importance of aspirin and 911 use for chest pain. Main outcome measures were 911 calls for chest pain and aspirin ingestion for a chest pain event, obtained from the MIRFs that are collected by emergency medical services personnel for 2 years after the intervention. RESULTS: There were significantly more calls (16%) among seniors on the mailing list in the intervention than control areas in the first year after the intervention. Among the seniors who were not on the mailing list, there was little difference in the intervention and control areas. The results were somewhat sensitive to the analytical model used and to an outlier in the treatment group. CONCLUSIONS: A community-based firefighter intervention can be effective in increasing appropriate response to symptoms of a heart attack among elders.

Aged↗
PubMed2002

Planning for large events.

Physicians are increasingly called upon to provide medical support for mass gatherings such as concerts, sporting events, political conventions, and other special events. Until recently, individuals planning such support have had little reliable information to assist them in determining what specific personnel and equipment are necessary to optimally support a mass gathering. Recently, the National Association of Emergency Medical Services Physicians established and published the most definitive and up-to-date document to assist a physician with planning medical care for a mass gathering: Mass Gathering Medical Care: The Medical Director's Checklist. As one of the most important developments in mass gathering medicine, this article highlights and discusses key areas of the document.

Anniversaries and Special Events↗
PubMed2000

A cost-benefit analysis of the effect of shipboard telemedicine in a selected oceanic region.

Data from a selected oceanic region, the UK search and rescue region, were used to establish the average annual of ship diversions and emergency service call-outs arising from urgent medical problems of passengers or crew. During the period 1997-8 there were 228 medical evacuations. An attempt was made to estimate the extent to which some or all of the diversions and call-outs could have been averted if telemedical facilities had been available on-board the ships. The analysis showed that telemedicine would be an expensive alternative to existing evacuation methods, but did not allow for the fact that helicopter and lifeboat evacuations cannot be carried out in bad weather or at distances over 200 nautical miles (370 km) from land. Taking into consideration the cost of ship diversions in such circumstances produces completely different results. Telemedicine could clearly provide substantial cost-savings for the shipping industry, and a separate analysis focused on the shipowner alone would make an overwhelming economic argument for investment in a telemedicine service simply on the strength of diversion avoidance.

Cost-Benefit Analysis↗
PubMed2005

Patients with acute chest pain - experiences of emergency calls and pre-hospital care.

Acute chest pain is a common reason why people call an emergency medical dispatch (EMD) centre. We examined how patients with acute chest pain experience the emergency call and their pre-hospital care. A qualitative design was used with a phenomenological-hermeneutic approach. Thirteen patients were interviewed, three women and 10 men. The patients were grateful that their lives had been saved and in general were satisfied with their pre-hospital contact. Sometimes they felt that it took too long for the emergency operators to answer and to understand the urgency. They were in a life-threatening situation and their feeling of vulnerability and dependency was great. Time seemed to stand still while they were waiting for help during their traumatic experience. The situation was fraught with pain, fear and an experience of loneliness. A sense of individualized care is important to strengthen trust and confidence between the patient and the pre-hospital personnel. Patients were aware of what number to call to reach the EMD centre, but were uncertain about when to call. More lives can be saved if people do not hesitate to call for help.

Acute Disease↗
PubMed1984

Etymologic evolution of emergency paging euphemisms.

Emergency paging euphemisms such as "code call," "blue 100," or "Dr. Ambu" have the potential to become part of the technical vocabulary of medicine through the human tendency to use words creatively; yet this process may occur with considerable diversity of intended meaning, and a loss of precision in speech or thought may result. This study demonstrates that the informal verbification and further etymologic evolution of a paging euphemism at one medical center has resulted in words which mean different things to different users and listeners.

Emergency Medical Service Communication Systems↗
PubMed1981

Impact of a regional infant dispatch center on neonatal mortality.

In 1976, a regional Infant Medical Dispatch Center (IMDC) was implemented in Southern California to improve the lives and well-being of the critically ill newborn infants by expediting location of beds in neonatal intensive care units. Comparison of birth weight-specific neonatal mortality rates among 701-2000 grams neonates before and after the program showed a six-fold improvement in hospitals served by the Center over hospitals not served by the Center during the two-year period. From 1975 to 1977, a 43.7 per cent improvement in neonatal mortality among the 701-2000 grams neonates with hyaline membrane disease was observed in the transported infants served by the Infant Medical Dispatch Center as compared to a 22.9 per cent improvement in the group of transported infants not served by IMDC. Both indicators had consistently shown a marked improvement associated with the IMDC program beyond the improvement of medical sciences over the two years. The data suggest that the improved outcome of the neonates referred by IMDC might be related to the improved efficiency of locating available neonatal intensive care beds.

California↗