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At least 127 records · Page 7Linked to original sources
PubMed2004

Development and pilot evaluation of user acceptance of advanced mass-gathering emergency medical services PDA support systems.

The support systems for the Emergency Medical Services (EMS) in the mass gatherings, such as the local marathon or the large international baseball games, had been underdeveloped. The purposes for this study were to develop triage-based EMS Personal Digital Assistant (PDA) support systems for the mass-gatherings and to evaluate users' perceived ease of use and usefulness of the systems in terms of Davis' Technology Acceptance Model (TAM). The systems were developed based on an established intelligent triage PDA support system and two other forms-the general EMS form from the Taipei EMT and the customer-made Mass Gathering Medical form used by a medical center. 23 nurses and 6 physicians in the medical center, who had ever served in the mass gatherings, were invited to examine the new systems and answered the TAM questionnaire. The results showed that the PDA systems included as many 450 information items inside 42 screens under 6 categories and the great potential of using triage-based PDA systems in the mass gatherings. Overall, most of the subjects agreed with that the systems were easy to use and useful for the mass gatherings, and they were willing to accept the systems.

Adult↗
PubMed2006

Retrieval medicine: a review and guide for UK practitioners. Part 2: safety in patient retrieval systems.

Retrieval and transfer of critically ill and injured patients is a high risk activity. Risk can be minimised with robust safety and clinical governance systems in place. This article describes the various governance systems that can be employed to optimise safety and efficiency in retrieval services. These include operating procedure development, equipment management, communications procedures, crew resource management, significant event analysis, audit and training.

Clinical Competence↗
PubMed2003

Trauma care systems in Belgium.

Belgium, the heart of Europe, has a high number of traffic related deaths. Although a well organised system of pre-hospital care composed of a centralised alarming system, trained EMT's and a MUG-system exists, no rules for the intra-hospital care exist. The Belgian government tries to reduce traffic related deaths by sensitisation and repression. Of course, this is necessary especially as one regards the high number of speedings, drunk driving and safety belt infractions related to the accidents with deaths. Besides sensitisation, repression and direct car safety measures, the organisation of a trauma system might further decrease trauma related mortality, morbidity and permanent incapacities.

Accidents, Traffic↗
PubMedDate not supplied

Comparison of interventions in prehospital care by standing orders versus interventions ordered by direct [on-line] medical command.

OBJECTIVE: The aim of this study was to compare the patient care measures provided by paramedics according to standing orders versus measures ordered by direct [on-line] medical command in order to determine the types and frequency of medical command orders. DESIGN: Prospective identification of patient care measures done as part of a prehospital quality assurance program. SETTING: An urban paramedic service in the northeast United States with direct medical command from three local hospitals. PARTICIPANTS: One thousand eight paramedic reports from October 1992 through March 1993. INTERVENTIONS: All patient care interventions recorded as done by standing orders or by direct medical command orders. Errors in patient care were determined by the same criteria as in the prior two studies of the same system. RESULTS: Direct medical command gave orders in 143/1,008 (14.2%) cases. Paramedics performed 2,453/2,624 (93.5%) of the total patient care interventions using standing orders. In 61 cases (6.1%), medical command ordered a potentially beneficial intervention not specified by standing orders or not done by the paramedic. 21/171 (12.3%) command orders were for additional doses of epinephrine or atropine in cardiac arrest cases (where the initial doses had been given under standing orders), and 59/171 (34.5%) were for interventions already mandated or permitted by standing orders. The paramedic error rate was 0.6%, and the medical command error rate was 1.8% (unchanged form the prior study of the same standing-orders system). CONCLUSION: Direct medical command gave orders in 14% of cases in this standing-orders system, but 35% of command orders only reiterated the standing orders. More selective and reduced uses of on-line command could be done in this system with no change in the types or numbers of patient care interventions performed.

Clinical Protocols↗
PubMedDate not supplied

On-line medical direction: a prospective study.

OBJECTIVES: To determine the frequency with which physician, on-line medical direction (OLMD) [direct medical control] of prehospital care results in orders, to describe the nature of these orders, and to measure OLMD time intervals. METHODS: Blinded, prospective study. SETTING: A university hospital base-station resource center. PARTICIPANTS: Ten emergency physicians, 50 advanced life support providers. INTERVENTIONS: Prehospital treatment was directed by both standing orders and OLMD physician orders. Independent observers recorded event times and the characteristics of OLMD. RESULTS: Physician orders were given in 47 (19%) of the 245 study cases, and covered a variety of interventions, including many already authorized by standing orders. Mean OLMD radio time was four minutes (245 +/- 216 seconds [sec]), and time from beginning of OLMD to hospital arrival averaged 12 minutes (718 +/- 439 sec). Mean transport time in this system was 13 minutes. CONCLUSION: Despite detailed standing orders, OLMD results in orders for clinical interventions in 19% of cases. On-line medical direction requires about four minutes of physician time per call. This constituted about one-third of the potential field treatment time interval in this system. Thus, OLMD appears to play an important role in providing quality prehospital care.

Clinical Protocols↗
PubMedDate not supplied

Emergency medical services capacities in the developing world: preliminary evaluation and training in Addis Ababa, Ethiopia.

In December 1999, a group of emergency physicians from the United States, Israel, and Ethiopia met for the Second Annual Symposium on Emergency Medicine and to perform an initial evaluation of the prehospital care system in Addis Ababa. The symposium was structured into a workshop on prehospital care and a clinical seminar for emergency medicine providers. This article describes the current prehospital infrastructure in Addis Ababa, Ethiopia. This serves as the basis for more specific needs assessments and training interventions, which are ongoing. The authors present a list of priorities for the development of an emergency medical services (EMS) system for Addis Ababa that was generated in partnership with local government and the World Health Organization. The article contrasts these initial recommendations with those found in the literature on the development of EMS systems in developing nations.

Ambulances↗
PubMed1993

A review of the present emergency medical care system in Japan.

EMT's in the United States initiate emergency treatment including patient resuscitation at accident locations. Such treatment has only recently become available in Japan. In 1992, Emergency Life Support Technicians (ELT's) became available in Japan. ELT's can now implement emergency treatment similar in scope to that of EMT's in the United States. We expect the rate of lifesaving resuscitation and subsequent rehabilitation will improve dramatically. The triage decision making process is designed to aid in choosing appropriate health care facilities. The highest available level of medical expertise should be brought into the triage decision making process. Throughout Japan, improvements in the emergency medical care system are being made in an ongoing process. The Tokyo Fire Department in particular has made great progress in updating and improving its system. It continues to investigate possible innovations which could lead to further improvements.

Data Collection↗
PubMed1995

Staffing and equipping emergency medical services systems: rapid identification and treatment of acute myocardial infarction. National Heart Attack Alert Program Coordinating Committee Access to Care Subcommittee.

Each year, about 1,250,000 people in the United States experience an acute myocardial infarction (AMI). Emergency medical services (EMS) systems play a key part in the prehospital care and transportation of AMI patients. Rapid, state-of-the-art treatment by EMS personnel is essential for improving AMI survival and outcomes, as dramatized by the patient who is the victim of out-of-hospital cardiac arrest. In order to improve the prehospital care provided to AMI patients, this article by the Access to Care Subcommittee of the National Heart Attack Alert Program Coordinating Committee makes a number of recommendations regarding the staffing and equipping of EMS systems. The recommendations cover the "chain of survival" concept, universal and enhanced 9-1-1, emergency medical dispatching, ground ambulance specifications, automated external defibrillators, advanced life support coverage, medical direction, 12-lead electrocardiograms, and prehospital thrombolysis.

Ambulances↗
PubMed1983

ESMIS--a computer-based emergency medical services management information system. Part 1: Design procedure.

This paper investigates the problem of how an emergency case is taken care of from its location until the time the case reaches an emergency medical center or a hospital. The result of this investigation is an on-line Emergency Medical Services Management Information System (ESMIS). ESMIS is implemented using the TOTAL database management system. Part 1 outlines, in general, the steps of the ESMIS design procedure and concentrates on one step, namely the specification of ESMIS outputs.

Computers↗
PubMed1984

Emergency medical care in France.

Emergency Medical Aid (AMU) has existed on an organized basis in France for ten years. Considering that every call for medical assistance requires an answer the SAMU (Emergency Medical Aid Service) acts as a switchboard. Its implantation in a hospital and its powerful centralized telecommunications make it possible to adapt responses to the type of case: serious ones require sophisticated equipment, whereas non-serious ones come under a General Practitioner. Treatment is free. Minor cases are taken care of by "omnipractitioners" who can be contacted by the SAMU via portable radio transceivers. Serious cases are dealt with by the Mobile Emergency and Intensive Care Service (SMUR); they either drive or fly to the spot within an average time-limit of ten minutes. The SMUR teams are composed of a physician, a nurse, often a student and a driver or a pilot. The physician makes the diagnosis, radios a description of the case and gives first-aid treatment. The minimal SMUR equipment fits into two cases. The SAMU also have other missions such as: teaching, prevention, disasters. The French system is aimed at reducing inequality in emergency situations and guaranteeing the whole population permanent medical care. Its cost to the public, however, is only +1 per inhabitant per year.

Emergency Medical Service Communication Systems↗
PubMed1996

Performance of a system to determine EMS dispatch priorities.

Inappropriate use of emergency medical services (EMS) for nonemergencies strains EMS resources and limits efficiency. Protocol-driven dispatch systems attempt to correct the imbalance that exists between demand and available resources by prioritizing 911 calls. This study compared dispatch priority decisions with apparent patient need, based on emergency department (ED) presentation, by matching 320 ED charts with corresponding EMS dispatch and run information. The priorities assigned by the system based on dispatch information were compared with those assigned by a three-member panel of physicians based on ED presentation. The physicians and dispatchers agreed on the need for advanced life support (ALS) versus basic life support (BLS) transport 74% of the time. There was only 43% agreement on the more detailed 4-level classification system. The system assigned the highest level of dispatch utilizing combined ALS and first responders to a significantly greater degree than did the physicians. It was concluded that protocol systems for setting dispatch priorities utilize EMS resources to a higher degree than actually required based on ED presentation.

Emergencies↗
PubMed1981

Cost-benefit analysis of an emergency alarm and response system: a case study of a long-term care program.

Cost-benefit analyses are routinely included in evaluations of acute care programs. In the case of long-term care, it is frequently alleged that cost-benefit analysis cannot be fruitfully applied. This article demonstrates the utility of applying cost-benefit analysis to evaluations of long-term care programs. A case study is presented in which cost-benefit analysis is used to evaluate an emergency alarm and response system developed to monitor the safety of vulnerable and disabled persons in their home environment.

Aged↗
PubMedDate not supplied

Computerized hospital on-line resources allocation link (CHORAL): a mechanism to monitor and establish policy for hospital ambulance diversions.

Ongoing monitoring of the availability of hospital critical care resources is necessary to assure patients in the emergency medical services (EMS) system reach appropriate care. In this densely populated area Multnomah County, Oregon, ambulances have been diverted by radio from several hospitals before finding one that would accept the patient. Dispatch centers and base-stations had no reliable method to monitor the availability of hospital resources. Data were not available for use in establishing policy. In response, this community developed an on-line, computerized system known as Computerized Hospital On-Line Resources Allocation Link (CHORAL) that visually displays the resource status of all hospitals to the 911 center, base station, and participating hospitals. A change of status requires simple keystrokes for entry into the computer which in turn transmitted automatically to all other CHORAL computers. Six patient care resources are monitored: Adult Ward (AW); Computerized Axial Tomography Scan (CT); Critical Care (CC); Labor and Delivery (LD); Pediatric (PEDS); and Psychiatric Secure Beds (PSB). Paramedics use protocol to determine if a particular patient fits one of these categories. Availability is relayed to paramedics by the 911 center and the base-station. During the first three months of system operation, there were 337 diversions representing 4,527 hours among 10 of the 12 participating hospitals. The most common resource resulting in diversion was PSB, which was unavailable for 2,195 hours (48.5%). Unavailability of CT resulted in the lowest number of diversions (1.3%, 60.3 hours).(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulances↗
PubMed1987

Medical direction in emergency medical services: the role of the physician.

The past two decades has seen the development of sophisticated systems of prehospital care. The task now is to intensify the input of well-trained physicians into all aspects of EMS systems. This article tracks the history of EMS in this country and provides some suggested answers to the difficult questions facing this new specialty.

Clinical Competence↗
PubMed1990

Characteristics of midsized urban EMS systems.

Emergency medical services (EMS) systems in 25 midsized cities (population, 400,000 to 900,000) are described. Information describing EMS system configuration and performance was collected by written and telephone surveys with follow-ups. Responding cities provide either one- or two-tier systems. In a one-tier system, an advanced life support (ALS) unit responds to and transports all patients who use 911 to activate the system. Three types of two-tier systems are identified. In system A, ALS units respond to all calls. Once on scene, an ALS unit can turn a patient over to a basic life support (BLS) unit for transport. In system B, ALS units do not respond to all calls; BLS units may be sent for noncritical calls. In system C, a nontransport ALS unit is dispatched with a transporting BLS unit. For ALS calls, ALS personnel join BLS personnel for transport. Overall, cities staff an average of one ambulance per 51,223 population. One-tier systems average one ambulance per 53,291 compared with two-tier systems, which average one ambulance per 47,546. In the two-tiered system B, the average ALS unit serves 118,956 population. In the 60% of cities that use a one-tier system, one ALS unit serves 58,336 (P less than .0005). Overall, the code 3 response time for all cities is an average of 6.6 minutes. The average response time of two-tier systems is 5.9 minutes versus 7.0 minutes for one-tier systems (.05 less than P less than .1). These data suggest that the two-tiered system B allows for a given number of ALS units to serve a much larger population while maintaining a rapid code 3 response time.

Ambulances↗
PubMed1981

Community awareness of emergency phone numbers.

Knowledge of numbers to call for medical emergencies was compared among communities with three different call numbers: 1) 911; 2) regional seven-digit numbers; and 3) local seven-digit numbers. Correct responses were 85 per cent in the 911 communities; 47 per cent in areas with regional systems, and 36 per cent in areas with local systems. Persons living adjacent to a 911 area were more likely to believe 911 was the emergency number (28 per cent) than persons not adjacent to 911 areas (12 per cent).

Community Participation↗
PubMedDate not supplied

The effect of hospital resource unavailability and ambulance diversions on the EMS system.

HYPOTHESES: 1) There is no increase in transport or scene time of diverted patients and no increase in distances traveled; 2) hospital resource shortages bear no relationship to the number of patients diverted; and 3) paramedics are able to match their patient correctly with the resources available at a given hospital. METHODS: This was a five-month, prospective, observational study in an urban area with a population of 600,000 comparing all 9-1-1 ambulance diversions against a randomly selected sample of 5% of all other 9-1-1 originated patients. All patient diversions that originated from the 9-1-1 center are included in the study. RESULTS: Hospitals identify their diversion status on a community-wide computer system monitored at the 9-1-1 center and base station. Accepted categories include: 1) diversion of all patients through the 9-1-1 center from the emergency department (ED); 2) trauma system patients (T); 3) psychiatric secure beds (PSB); 4) general acute ward beds (AW); 5) critical care (CC); 6) computed tomography scan (CT); 7) labor and delivery (LD); and 8) pediatric beds (PEDS). Data were abstracted from 481 patients' records. A total of 111 were diverted from their intended destination. Transport times were longer and diverted patients traveled further (p < .002). Hospitals showing ED and LD diversion categories were more likely to have patients diverted away (r2 = .895, multilinear regression, p < .001). Of the 111 patients, 21 (19%) were diverted because of CC unavailability. Six of these (28%) were inappropriate because they did not fit the CC definition. CONCLUSIONS: In this system, hospital diversions increase transport times and distances traveled. Diversion of patients correlated strongly to unavailability of specific categories. Paramedics make errors in determining appropriate CC diversions. Systems reviewing their diversion problems need to assess the impact of longer out-of-hospital times and of certain diversion categories, and to clarify definitions.

Ambulances↗