Hourly associations between heat and ambulance calls.

PubMed

Guo, Yuming

2017-01-01

The response speed of ambulance calls is very crucial to rescue patients suffering immediately life threatening conditions. The serious health outcomes might be caused by exposing to extreme heat only several hours before. However, limited evidence is available on this topic. This study aims to examine the hourly association between heat and ambulance calls, to improve the ambulance services and to better protect health. Hourly data on ambulance calls for non-accidental causes, temperature and air pollutants (PM 10 , NO 2 , and O 3 ) were collected from Brisbane, Australia, during 2001 and 2007. A time-stratified case-crossover design was used to examine the associations between hourly ambulance calls and temperature during warm season (Nov, Dec, Jan, Feb, and Mar), while adjusting for potential confounders. Stratified analyses were performed for sex and age groups. Ambulance calls peaked at 10am for all groups, except those aged <15 years at 19pm, while temperature was hottest at 13pm. The hourly heat-ambulance calls relationships were non-linear for all groups, with thresholds between 27 °C and 31 °C. The associations appeared immediately, and lasted for about 24 h. There were no significant modification effect by sex and age. The findings suggest that hot hourly temperatures (>27 °C) increase the demands of ambulance. This information is helpful to increase the efficiency of ambulance service then save lives, for example, preparing more ambulance before appearance of extremely hot temperature in combination with weather forecast. Also, people should better arrange their time for outdoor activities to avoid exposing to extreme hot temperatures. Copyright © 2016 Elsevier Ltd. All rights reserved.

Reducing ambulance response times using discrete event simulation.

PubMed

Wei Lam, Sean Shao; Zhang, Zhong Cheng; Oh, Hong Choon; Ng, Yih Ying; Wah, Win; Hock Ong, Marcus Eng

2014-01-01

The objectives of this study are to develop a discrete-event simulation (DES) model for the Singapore Emergency Medical Services (EMS), and to demonstrate the utility of this DES model for the evaluation of different policy alternatives to improve ambulance response times. A DES model was developed based on retrospective emergency call data over a continuous 6-month period in Singapore. The main outcome measure is the distribution of response times. The secondary outcome measure is ambulance utilization levels based on unit hour utilization (UHU) ratios. The DES model was used to evaluate different policy options in order to improve the response times, while maintaining reasonable fleet utilization. Three policy alternatives looking at the reallocation of ambulances, the addition of new ambulances, and alternative dispatch policies were evaluated. Modifications of dispatch policy combined with the reallocation of existing ambulances were able to achieve response time performance equivalent to that of adding 10 ambulances. The median (90th percentile) response time was 7.08 minutes (12.69 minutes). Overall, this combined strategy managed to narrow the gap between the ideal and existing response time distribution by 11-13%. Furthermore, the median UHU under this combined strategy was 0.324 with an interquartile range (IQR) of 0.047 versus a median utilization of 0.285 (IQR of 0.051) resulting from the introduction of additional ambulances. Response times were shown to be improved via a more effective reallocation of ambulances and dispatch policy. More importantly, the response time improvements were achieved without a reduction in the utilization levels and additional costs associated with the addition of ambulances. We demonstrated the effective use of DES as a versatile platform to model the dynamic system complexities of Singapore's national EMS systems for the evaluation of operational strategies to improve ambulance response times.

Effectiveness of media awareness campaigns on the proportion of vehicles that give space to ambulances on roads: An observational study.

PubMed

Shaikh, Shiraz; Baig, Lubna A; Polkowski, Maciej

2017-01-01

The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people's awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances. This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression. Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during (OR=2.13, 95% CI=1.22-3.71, p=0.007) and after the campaign (OR=1.73, 95% CI=1.02-2.95, p=0.042) were significantly more likely give space to ambulances. Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives.

Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

PubMed

Ssebunya, Rogers; Matovu, Joseph K B

2016-03-03

Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances were meant for and appreciated their role in taking pregnant women to health facilities. The use of motorcycle ambulances was associated with older age of the mother, male participation in birth preparedness, and consultations with TBAs. These findings suggest a need for interventions to involve men in reproductive health as well as efforts to reach women younger than 35 years of age.

Medicare program; coverage and payment of ambulance services; inflation update for CY 2004. Final rule with comment period.

PubMed

2003-12-05

This final rule provides the sunset date for the interim bonus payment for rural ambulance mileage of 18 through 50 miles as required by the Medicare, Medicaid and State Child Health Insurance Program Benefits Improvement and Protection Act of 2000 (BIPA) and provides notice of the annual Ambulance Inflation Factor (AIF) for ambulance services for calendar year (CY) 2004. The statute requires that this inflation factor be applied in determining the fee schedule amounts and payment limits for ambulance services.

Weather and age-gender effects on the projection of future emergency ambulance demand in Hong Kong.

PubMed

Lai, Poh-Chin; Wong, Ho-Ting

2015-03-01

An accurate projection for ambulance demand is essential to enable better resource planning for the future that strives to either maintain current levels of services or reconsider future standards and expectations. More than 2 million cases of emergency room attendance in 2008 were obtained from the Hong Kong Hospital Authority to project the demand for its ambulance services in 2036. The projection of ambulance demand in 2036 was computed in consideration of changes in the age-gender structure between 2008 and 2036. The quadratic relation between average daily temperature and daily ambulance demand in 2036 was further explored by including and excluding age-gender demographic changes. Without accounting for changes in the age-gender structure, the 2036 ambulance demand for age groups of 65 and above were consistently underestimated (by 38%-65%), whereas those of younger age groups were overestimated (by 6%-37%). Moreover, changes in the 2008 to 2036 age-gender structure also shift upward and emphasize relationships between average daily temperature and daily ambulance demand at both ends of the quadratic U-shaped curve. Our study reveals a potential societal implication of ageing population on the demand for ambulance services. © 2012 APJPH.

Emergency Medical Service

NASA Technical Reports Server (NTRS)

1980-01-01

Lewis Research Center helped design the complex EMS Communication System, originating from space operated telemetry, including the telemetry link between ambulances and hospitals for advanced life support services. In emergency medical use telemetry links ambulances and hospitals for advanced life support services and allows transmission of physiological data -- an electrocardiogram from an ambulance to a hospital emergency room where a physician reads the telemetered message and prescribes emergency procedures to ambulance attendants.

Effectiveness of media awareness campaigns on the proportion of vehicles that give space to ambulances on roads: An observational study

PubMed Central

Shaikh, Shiraz; Baig, Lubna A; Polkowski, Maciej

2017-01-01

Background and Objective: The findings of the Health Care in Danger project in Karachi suggests that there is presence of behavioral negligence among vehicle operators on roads in regards to giving way to ambulances. A mass media campaign was conducted to raise people’s awareness on the importance of giving way to ambulances. The main objective of this study was to determine the effectiveness of the campaign on increasing the proportion of vehicles that give way to ambulances. Methods: This was a quasi-experimental study that was based on before and after design. Three observation surveys were carried out in different areas of the city in Karachi, Pakistan before, during and after the campaign by trained observers who recorded their findings on a checklist. Each observation was carried out at three different times of the day for at least two days on each road. The relationship of the media campaign with regards to a vehicle giving space to an ambulance was calculated by means of odds ratios and 95% confidence intervals using multivariate logistic regression. Results: Overall, 245 observations were included in the analysis. Traffic congestion and negligence/resistance, by vehicles operators who were in front of the ambulance, were the two main reasons why ambulances were not given way. Other reasons include: sudden stops by minibuses and in the process causing obstruction, ambulances not rushing through to alert vehicle operators to give way and traffic interruption by VIP movement. After adjustment for site, time of day, type of ambulance and number of cars in front of the ambulance, vehicles during (OR=2.13, 95% CI=1.22-3.71, p=0.007) and after the campaign (OR=1.73, 95% CI=1.02-2.95, p=0.042) were significantly more likely give space to ambulances. Conclusion: Mass media campaigns can play a significant role in changing the negligent behavior of people, especially when the campaign conveys a humanitarian message such as: giving way to ambulances can save lives. PMID:28367204

Using a discrete-event simulation to balance ambulance availability and demand in static deployment systems.

PubMed

Wu, Ching-Han; Hwang, Kevin P

2009-12-01

To improve ambulance response time, matching ambulance availability with the emergency demand is crucial. To maintain the standard of 90% of response times within 9 minutes, the authors introduce a discrete-event simulation method to estimate the threshold for expanding the ambulance fleet when demand increases and to find the optimal dispatching strategies when provisional events create temporary decreases in ambulance availability. The simulation model was developed with information from the literature. Although the development was theoretical, the model was validated on the emergency medical services (EMS) system of Tainan City. The data are divided: one part is for model development, and the other for validation. For increasing demand, the effect was modeled on response time when call arrival rates increased. For temporary availability decreases, the authors simulated all possible alternatives of ambulance deployment in accordance with the number of out-of-routine-duty ambulances and the durations of three types of mass gatherings: marathon races (06:00-10:00 hr), rock concerts (18:00-22:00 hr), and New Year's Eve parties (20:00-01:00 hr). Statistical analysis confirmed that the model reasonably represented the actual Tainan EMS system. The response-time standard could not be reached when the incremental ratio of call arrivals exceeded 56%, which is the threshold for the Tainan EMS system to expand its ambulance fleet. When provisional events created temporary availability decreases, the Tainan EMS system could spare at most two ambulances from the standard configuration, except between 20:00 and 01:00, when it could spare three. The model also demonstrated that the current Tainan EMS has two excess ambulances that could be dropped. The authors suggest dispatching strategies to minimize the response times in routine daily emergencies. Strategies of capacity management based on this model improved response times. The more ambulances that are out of routine duty, the better the performance of the optimal strategies that are based on this model.

Geographic-time distribution of ambulance calls in Singapore: utility of geographic information system in ambulance deployment (CARE 3).

PubMed

Ong, Marcus E H; Ng, Faith S P; Overton, Jerry; Yap, Susan; Andresen, Derek; Yong, David K L; Lim, Swee Han; Anantharaman, V

2009-03-01

Pre-hospital ambulance calls are not random events, but occur in patterns and trends that are related to movement patterns of people, as well as the geographical epidemiology of the population. This study describes the geographic-time epidemiology of ambulance calls in a large urban city and conducts a time demand analysis. This will facilitate a Systems Status Plan for the deployment of ambulances based on the most cost effective deployment strategy. An observational prospective study looking at the geographic-time epidemiology of all ambulance calls in Singapore. Locations of ambulance calls were spot mapped using Geographic Information Systems (GIS) technology. Ambulance response times were mapped and a demand analysis conducted by postal districts. Between 1 January 2006 and 31 May 2006, 31,896 patients were enrolled into the study. Mean age of patients was 51.6 years (S.D. 23.0) with 60.0% male. Race distribution was 62.5% Chinese, 19.4% Malay, 12.9% Indian and 5.2% others. Trauma consisted 31.2% of calls and medical 68.8%. 9.7% of cases were priority 1 (most severe) and 70.1% priority 2 (moderate severity). Mean call receipt to arrival at scene was 8.0 min (S.D. 4.8). Call volumes in the day were almost twice those at night, with the most calls on Mondays. We found a definite geographical distribution pattern with heavier call volumes in the suburban town centres in the Eastern and Southern part of the country. We characterised the top 35 districts with the highest call volumes by time periods, which will form the basis for ambulance deployment plans. We found a definite geographical distribution pattern of ambulance calls. This study demonstrates the utility of GIS with despatch demand analysis and has implications for maximising the effectiveness of ambulance deployment.

Establishing the Aus-ROC Australian and New Zealand out-of-hospital cardiac arrest Epistry

PubMed Central

Bray, Janet; Smith, Karen; Walker, Tony; Grantham, Hugh; Hein, Cindy; Thorrowgood, Melanie; Smith, Anthony; Smith, Tony; Dicker, Bridget; Swain, Andy; Bailey, Mark; Bosley, Emma; Pemberton, Katherine; Cameron, Peter; Nichol, Graham; Finn, Judith

2016-01-01

Introduction Out-of-hospital cardiac arrest (OHCA) is a global health problem with low survival. Regional variation in survival has heightened interest in combining cardiac arrest registries to understand and improve OHCA outcomes. While individual OHCA registries exist in Australian and New Zealand ambulance services, until recently these registries have not been combined. The aim of this protocol paper is to describe the rationale and methods of the Australian Resuscitation Outcomes Consortium (Aus-ROC) OHCA epidemiological registry (Epistry). Methods and analysis The Aus-ROC Epistry is designed as a population-based cohort study. Data collection started in 2014. Six ambulance services in Australia (Ambulance Victoria, SA Ambulance Service, St John Ambulance Western Australia and Queensland Ambulance Service) and New Zealand (St John New Zealand and Wellington Free Ambulance) currently contribute data. All OHCA attended by ambulance, regardless of aetiology or patient age, are included in the Epistry. The catchment population is approximately 19.3 million persons, representing 63% of the Australian population and 100% of the New Zealand population. Data are collected using Utstein-style definitions. Information incorporated into the Epistry includes demographics, arrest features, ambulance response times, treatment and patient outcomes. The primary outcome is ‘survival to hospital discharge’, with ‘return of spontaneous circulation’ as a key secondary outcome. Ethics and dissemination Ethics approval was independently sought by each of the contributing registries. Overarching ethics for the Epistry was provided by Monash University HREC (Approval No. CF12/3938—2012001888). A population-based OHCA registry capturing the majority of Australia and New Zealand will allow risk-adjusted outcomes to be determined, to enable benchmarking across ambulance providers, facilitate the identification of system-wide strategies associated with survival from OHCA, and allow monitoring of temporal trends in process and outcomes to improve patient care. Findings will be shared with participating ambulance services and the academic community. PMID:27048638

What is dignity in prehospital emergency care?

PubMed

Abelsson, Anna; Lindwall, Lillemor

2017-05-01

Ethics and dignity in prehospital emergency care are important due to vulnerability and suffering. Patients can lose control of their body and encounter unfamiliar faces in an emergency situation. To describe what specialist ambulance nurse students experienced as preserved and humiliated dignity in prehospital emergency care. The study had a qualitative approach. Data were collected by Flanagan's critical incident technique. The participants were 26 specialist ambulance nurse students who described two critical incidents of preserved and humiliated dignity, from prehospital emergency care. Data consist of 52 critical incidents and were analyzed with interpretive content analysis. Ethical considerations: The study followed the ethical principles in accordance with the Declaration of Helsinki. The result showed how human dignity in prehospital emergency care can be preserved by the ambulance nurse being there for the patient. The ambulance nurses meet the patient in the patient's world and make professional decisions. The ambulance nurse respects the patient's will and protects the patient's body from the gaze of others. Humiliated dignity was described through the ambulance nurse abandoning the patient and by healthcare professionals failing, disrespecting, and ignoring the patient. It is a unique situation when a nurse meets a patient face to face in a critical life or death moment. The discussion describes courage and the ethical vision to see another human. Dignity was preserved when the ambulance nurse showed respect and protected the patient in prehospital emergency care. The ambulance nurse students' ethical obligation results in the courage to see when a patient's dignity is in jeopardy of being humiliated. Humiliated dignity occurs when patients are ignored and left unprotected. This ethical dilemma affects the ambulance nurse students badly due to the fact that the morals and attitudes of ambulance nurses are reflected in their actions toward the patient.

Effects of a Public Education Campaign on the Association Between Knowledge of Early Stroke Symptoms and Intention to Call an Ambulance at Stroke Onset: The Acquisition of Stroke Knowledge (ASK) Study

PubMed Central

Nishikawa, Tomofumi; Okamura, Tomonori; Nakayama, Hirofumi; Miyamatsu, Naomi; Morimoto, Akiko; Toyoda, Kazunori; Suzuki, Kazuo; Toyota, Akihiro; Hata, Takashi; Yamaguchi, Takenori

2016-01-01

Background An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services. Methods The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study. Results After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P < 0.05) increased (eg, from 4 to 5 correctly identified symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009). Conclusions Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance. PMID:26441211

Availability of Life Support Equipment and its Utilization by Ambulance Drivers.

PubMed

Acharya, Rija; Badhu, Angur; Shah, Tara; Shrestha, Sharmila

2017-09-08

An effective ambulance is a vital requirement for providing an emergency medical service. Well-equipped ambulances with trained paramedics can save many lives during the golden hours of trauma care. The objective was to document the availability and utilization of basic life support equipment in the ambulances and to assess knowledge on first aid among the drivers. Descriptive design was used. Total of 109 ambulances linked to B.P. Koirala Institute of Health Sciences were enrolled using purposive sampling method. Self- constructed observation checklist and semi structured interview schedule was used for data collection. More than half of the respondents had less than five years of experience and were not trained in first aid. About two-third of the respondents had adequate knowledge on first aid. About 90% of the ambulance had oxygen cylinder and adult oxygen mask which was 'usually' used equipment. More than half of ambulance had equipment less than 23% as compared to that of national guidelines. There was significant association of knowledge with the experience (p = 0.004) and training (p = 0.001). Availability of equipment was associated with training received (p = 0.007),organization (p= 0.032)and district (p = 0.023) in which the ambulance is registered. The study concludes that maximum ambulance linked to BPKIHS, Nepal did not have even one fourth of the equipment for basic life support. Equipment usually used was oxygen cylinder and oxygen mask. Majority of driver had adequate knowledge on first aid and it was associated with training and experience.

Walker devices and microswitch technology to enhance assisted indoor ambulation by persons with multiple disabilities: three single-case studies.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Campodonico, Francesca; Buono, Serafino

2013-07-01

These three single-case studies assessed the use of walker devices and microswitch technology for promoting ambulation behavior among persons with multiple disabilities. The walker devices were equipped with support and weight lifting features. The microswitch technology ensured that brief stimulation followed the participants' ambulation responses. The participants were two children (i.e., Study I and Study II) and one man (i.e., Study III) with poor ambulation performance. The ambulation efforts of the child in Study I involved regular steps, while those of the child in Study II involved pushing responses (i.e., he pushed himself forward with both feet while sitting on the walker's saddle). The man involved in Study III combined his poor ambulation performance with problem behavior, such as shouting or slapping his face. The results were positive for all three participants. The first two participants had a large increase in the number of steps/pushes performed during the ambulation events provided and in the percentages of those events that they completed independently. The third participant improved his ambulation performance as well as his general behavior (i.e., had a decline in problem behavior and an increase in indices of happiness). The wide-ranging implications of the results are discussed. Copyright © 2013 Elsevier Ltd. All rights reserved.

SIBLING CONCORDANCE FOR CLINICAL FEATURES OF DUCHENNE AND BECKER MUSCULAR DYSTROPHIES

PubMed Central

PETTYGROVE, SYDNEY; LU, ZHENQIANG; ANDREWS, JENNIFER G.; MEANEY, F. JOHN; SHEEHAN, DANIEL W.; PRICE, ELINORA T.; FOX, DEBORAH J.; PANDYA, SHREE; OUYANG, LIJING; APKON, SUSAN D.; POWIS, ZOE; CUNNIFF, CHRISTOPHER

2015-01-01

Introduction The correlation of markers of disease severity among brothers with Duchenne or Becker muscular dystrophy has implications for clinical guidance and clinical trials. Methods Sibling pairs with Duchenne or Becker muscular dystrophy (n = 60) were compared for ages when they reached clinical milestones of disease progression, including ceased ambulation, scoliosis of ≥ 20°, and development of cardiomyopathy. Results The median age at which younger brothers reached each milestone, compared with their older brothers ranged from 25 months younger for development of cardiomyopathy to 2 months older for ceased ambulation. For each additional month of ambulation by the older brother, the hazard of ceased ambulation by the younger brother decreased by 4%. Conclusions The ages when siblings reach clinical milestones of disease vary widely between siblings. However, the time to ceased ambulation for older brothers predicts the time to ceased ambulation for their younger brothers. PMID:24030636

Factors associated with ambulance requests for febrile seizures.

PubMed

Sakai, Rie; Marui, Eiji

2008-08-01

The objective of this study was to determine factors associated with ambulance requests for febrile seizures. This study retrospectively investigated medical records of patients who visited the Emergency Care Unit at Tokyo Metropolitan Toshima Hospital in the 5-year period after April 2001. Subjects' basic characteristics (e.g., age and sex), medical history of febrile seizures, sibling and parental medical history of febrile seizures, and distance from hospital were investigated. In total, 310 subjects used ambulances, and 106 came to the hospital without requesting ambulances. The results of binomial logistic analysis indicated that factors associated with ambulance requests included patient's and parents' medical history of febrile seizures. Increasing awareness of febrile seizures and provision of a general public educational campaign are possible strategies to help decrease unnecessary ambulance requests. However, a medical history of febrile seizures among siblings revealed no association, indicating the need to conduct repeated early-stage interventions.

Medical aspects of ambulance design.

PubMed

Snook, R

1972-09-02

Various observations have shown that the interior layout of many ambulances leaves much to be desired. The lighting levels are inadequate, heat loss could be prevented, vehicle identification and passage through traffic could be improved, and measurable differences exist between the ride characteristics of commercially available ambulances, a prototype purpose-built ambulance, and a private car. Moreover the condition of some patients may be affected by the motion of the vehicle either directly or indirectly. Even though they form a small percentage of the total number carried, they represent a very considerable financial risk. A personally conducted survey of ambulance chief officers showed a deep interest and involvement in the upgrading of the service with a general dissatisfaction with many of the vehicles currently available. Hence there is a market for the purpose-built ambulance, which would benefit the patient and the ambulanceman alike.The inadequacies of many vehicles currently in use as ambulances have been shown to work against the interests of the patient requiring life support treatment, and it is suggested that this warrants urgent attention and action. A more extensive research project involving medical observations on the supine sick and injured, attendant task performance, and instrumentation analysis of linear and angular vehicle motions should enable the harmful effects of ride motion to be identified.None of these investigations, however, will be of any value unless they are used in developing future ambulances. Such development must also parallel an increase in the awareness of the importance of ambulance design and its relation to the increased comfort and chance of survival of the patients carried.

Medical Aspects of Ambulance Design

PubMed Central

Snook, Roger

1972-01-01

Various observations have shown that the interior layout of many ambulances leaves much to be desired. The lighting levels are inadequate, heat loss could be prevented, vehicle identification and passage through traffic could be improved, and measurable differences exist between the ride characteristics of commercially available ambulances, a prototype purpose-built ambulance, and a private car. Moreover the condition of some patients may be affected by the motion of the vehicle either directly or indirectly. Even though they form a small percentage of the total number carried, they represent a very considerable financial risk. A personally conducted survey of ambulance chief officers showed a deep interest and involvement in the upgrading of the service with a general dissatisfaction with many of the vehicles currently available. Hence there is a market for the purpose-built ambulance, which would benefit the patient and the ambulanceman alike. The inadequacies of many vehicles currently in use as ambulances have been shown to work against the interests of the patient requiring life support treatment, and it is suggested that this warrants urgent attention and action. A more extensive research project involving medical observations on the supine sick and injured, attendant task performance, and instrumentation analysis of linear and angular vehicle motions should enable the harmful effects of ride motion to be identified. None of these investigations, however, will be of any value unless they are used in developing future ambulances. Such development must also parallel an increase in the awareness of the importance of ambulance design and its relation to the increased comfort and chance of survival of the patients carried. ImagesFIG. 2FIG. 4 PMID:5069643

Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care--an intervention study.

PubMed

Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

2015-01-01

The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

Complexity, fractal dynamics and determinism in treadmill ambulation: Implications for clinical biomechanists.

PubMed

Hollman, John H; Watkins, Molly K; Imhoff, Angela C; Braun, Carly E; Akervik, Kristen A; Ness, Debra K

2016-08-01

Reduced inter-stride complexity during ambulation may represent a pathologic state. Evidence is emerging that treadmill training for rehabilitative purposes may constrain the locomotor system and alter gait dynamics in a way that mimics pathological states. The purpose of this study was to examine the dynamical system components of gait complexity, fractal dynamics and determinism during treadmill ambulation. Twenty healthy participants aged 23.8 (1.2) years walked at preferred walking speeds for 6min on a motorized treadmill and overground while wearing APDM 6 Opal inertial monitors. Stride times, stride lengths and peak sagittal plane trunk velocities were measured. Mean values and estimates of complexity, fractal dynamics and determinism were calculated for each parameter. Data were compared between overground and treadmill walking conditions. Mean values for each gait parameter were statistically equivalent between overground and treadmill ambulation (P>0.05). Through nonlinear analyses, however, we found that complexity in stride time signals (P<0.001), and long-range correlations in stride time and stride length signals (P=0.005 and P=0.024, respectively), were reduced on the treadmill. Treadmill ambulation induces more predictable inter-stride time dynamics and constrains fluctuations in stride times and stride lengths, which may alter feedback from destabilizing perturbations normally experienced by the locomotor control system during overground ambulation. Treadmill ambulation, therefore, may provide less opportunity for experiencing the adaptability necessary to successfully ambulate overground. Investigators and clinicians should be aware that treadmill ambulation will alter dynamic gait characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.

Impact of an after-hours on-call emergency physician on ambulance transports from a county jail.

PubMed

Chan, Theodore C; Vilke, Gary M; Smith, Sue; Sparrow, William; Dunford, James V

2003-01-01

The authors sought to determine if the availability of an after-hours on-call emergency physician by telephone for consultation to the staff at a county jail would safely reduce ambulance emergency department (ED) transport of inmates in the community. The authors conducted a prospective comparison study during the first ten months of an emergency physician on-call program for the county jail in which prospective data were collected on all consultations, including reason for call and disposition (ambulance, deputy, or no ED transport of inmate). They compared this time with a similar period a year before the program in terms of total ambulance transports from the jail. They also reviewed all hospital and jail medical records to assess for any adverse consequences within one month, or subsequent ambulance transport within 24 hours as a result of inmate care after the consultation call. Total after-hours ambulance transports from the jail decreased significantly from 30.3 transports/month (95% confidence interval [CI], 21.0-39.6) to 9.1 transports/month (95% CI, 4.1-14.0) (p < 0.05). The most common reasons for consultation calls were chest pain (16%), trauma (15%), and abnormal laboratory or radiology results (14%). Of all calls, only 30% resulted in ambulance transport to the ED. On review of records, no adverse outcome or subsequent ambulance transport was identified. The initiation of an on-call emergency physician program for after-hours consultation to jail nursing and law enforcement staff safely reduced ambulance transports from a county jail with no adverse outcomes identified.

The Lancashire telemedicine ambulance.

PubMed

Curry, G R; Harrop, N

1998-01-01

An emergency ambulance was equipped with three video-cameras and a system for transmitting slow-scan video-pictures through a cellular telephone link to a hospital accident and emergency department. Video-pictures were trasmitted at a resolution of 320 x 240 pixels and a frame rate of 15 pictures/min. In addition, a helmet-mounted camera was used with a wireless transmission link to the ambulance and thence the hospital. Speech was transmitted by a second hand-held cellular telephone. The equipment was installed in 1996-7 and video-recordings of actual ambulance journeys were made in July 1997. The technical feasibility of the telemedicine ambulance has been demonstrated and further clinical assessment is now in progress.

Free flap reconstruction for diabetic foot limb salvage.

PubMed

Sato, Tomoya; Yana, Yuichiro; Ichioka, Shigeru

2017-12-01

Although free flap is gaining popularity for the reconstruction of diabetic foot ulcers, it is unclear whether free flap reconstruction increases the chances of postoperative independent ambulation. The aim of this study is to evaluate the relationship between free flap success and postoperative ambulation. This study reviewed 23 cases of free flap reconstruction for diabetic foot ulcers between January 2007 and March 2014. Free rectus abdominis, latissimus dorsi, and anterolateral thigh flaps were used in ten, eight, and five patients, respectively. A comparison was made between free flap success and postoperative independent ambulation using Fisher's exact test. Two patients developed congestive heart failure with fatal consequences within 14 days postoperatively, resulting in an in-hospital mortality rate of 8.7%. Five patients lost their flaps (21.7%). Of the 16 patients who had flap success, 12 achieved independent ambulation. Five patients with flap loss did not achieve independent ambulation, except one patient who underwent secondary flap reconstruction using a distally based sural flap. Fisher's exact test revealed that independent ambulation was associated with free flap success (p = 0.047). The present study indicates that free flap reconstruction may increase the possibility of independent ambulation for patients with extensive tissue defects due to diabetic ulcers. Intermediate limb salvage rates and independent ambulation rates were favourable in patients with successful reconstruction. The use of foot orthoses and a team approach with pedorthists were effective to prevent recurrence.

Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

PubMed Central

Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

2015-01-01

The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

Microbial air quality and bacterial surface contamination in ambulances during patient services.

PubMed

Luksamijarulkul, Pipat; Pipitsangjan, Sirikun

2015-03-01

We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram's stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson's correlation coefficient with a p-value of less than 0.050 considered significant. The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m(3) and 522±581cfu/m(3), respectively. Bacterial counts during patient services were 468±607cfu/m(3) and fungal counts were 656±612cfu/m(3). Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm(2) and 1.3±1.1cfu/cm(2), respectively (p<0.001). The predominant isolated bacteria and fungi were Staphylococcus spp. and Aspergillus spp., respectively. Additionally, there was a significantly positive correlation between bacterial (r=0.3, p<0.010) and fungal counts (r=0.2, p=0.020) in air samples and bacterial counts on medical instruments and allocated areas. This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs. Additionally, bacterial and fungal counts in ambulance air showed a significantly positive correlation with the bacterial surface contamination on medical instruments and allocated areas. Further studies should be conducted to determine the optimal intervention to reduce microbial contamination in the ambulance environment.

Reduction in STEMI transfer times utilizing a municipal "911" ambulance service.

PubMed

Tennyson, Joseph C; Quale, Mark R

2014-02-01

The time interval from diagnosis to reperfusion therapy for patients experiencing ST-segment elevation myocardial infarction (STEMI) has a significant impact on morbidity and mortality. It is hypothesized that the time required for interfacility patient transfers from a community hospital to a regional percutaneous coronary intervention (PCI) center using an Advanced Life Support (ALS) transfer ambulance service is no different than utilizing the "911" ALS ambulance. Quality assurance data collected by a tertiary care center cardiac catheterization program were reviewed retrospectively. Data were collected on all patients with STEMI requiring interfacility transfer from a local community hospital to the tertiary care center's PCI suite, approximately 16 miles away by ground, 12 miles by air. In 2009, transfers of patients with STEMI were redirected to the municipal ALS ambulance service, instead of the hospital's contracted ALS transfer service. Data were collected from January 2007 through May 2013. Temporal data were compared between transports initiated through the contracted ALS ambulance service and the municipal ALS service. Data points included time of initial transport request and time of ambulance arrival to the sending facility and the receiving PCI suite. During the 4-year study period, 63 patients diagnosed with STEMI and transferred to the receiving hospital's PCI suite were included in this study. Mean times from the transport request to arrival of the ambulance at the sending hospital's emergency department were six minutes (95% CI, 4-7 minutes) via municipal ALS and 13 minutes (95% CI, 9-16 minutes) for the ALS transfer service. The mean times from the ground transport request to arrival at the receiving hospital's PCI suite when utilizing the municipal ALS ambulance and hospital contracted ALS ambulance services were 48 minutes (95% CI, 33-64 minutes) and 56 minutes (95% CI 52-59 minutes), respectively. This eight-minute period represented a 14% (P = .001) reduction in the mean transfer time to the PCI suite for patients transported via the municipal ALS ambulance. In the appropriate setting, the use of the municipal "911" ALS ambulance service for the interfacility transport of patients with STEMI appears advantageous in reducing door-to-catheterization times.

Improving the coding and classification of ambulance data through the application of International Classification of Disease 10th revision.

PubMed

Cantwell, Kate; Morgans, Amee; Smith, Karen; Livingston, Michael; Dietze, Paul

2014-02-01

This paper aims to examine whether an adaptation of the International Classification of Disease (ICD) coding system can be applied retrospectively to final paramedic assessment data in an ambulance dataset with a view to developing more fine-grained, clinically relevant case definitions than are available through point-of-call data. Over 1.2 million case records were extracted from the Ambulance Victoria data warehouse. Data fields included dispatch code, cause (CN) and final primary assessment (FPA). Each FPA was converted to an ICD-10-AM code using word matching or best fit. ICD-10-AM codes were then converted into Major Diagnostic Categories (MDC). CN was aligned with the ICD-10-AM codes for external cause of morbidity and mortality. The most accurate results were obtained when ICD-10-AM codes were assigned using information from both FPA and CN. Comparison of cases coded as unconscious at point-of-call with the associated paramedic assessment highlighted the extra clinical detail obtained when paramedic assessment data are used. Ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Coding of ambulance data using ICD-10-AM allows for comparison of not only ambulance service users but also with other population groups. WHAT IS KNOWN ABOUT THE TOPIC? There is no reliable and standard coding and categorising system for paramedic assessment data contained in ambulance service databases. WHAT DOES THIS PAPER ADD? This study demonstrates that ambulance paramedic assessment data can be aligned with ICD-10-AM and MDC with relative ease, allowing retrospective coding of large datasets. Representation of ambulance case types using ICD-10-AM-coded information obtained after paramedic assessment is more fine grained and clinically relevant than point-of-call data, which uses caller information before ambulance attendance. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This paper describes a model of coding using an internationally recognised standard coding and categorising system to support analysis of paramedic assessment. Ambulance data coded using ICD-10-AM allows for reliable reporting and comparison within the prehospital setting and across the healthcare industry.

Emergency nursing workload and patient dependency in the ambulance bay: A prospective study.

PubMed

Varndell, Wayne; Ryan, Elizabeth; Jeffers, Alison; Marquez-Hunt, Nadya

2016-11-01

The purpose of this prospective observational study was to characterise patients occupying the ambulance bay and to determine the ensuing nursing workload. The number of patients presenting to ED by ambulance is increasing. During periods of peak demand and access block in the ED, patients with ongoing care needs, requiring continual assessment and symptom management by emergency nurses can remain in the ambulance bay for extended periods of time. The profile of these patients and on the related nursing workload is not well known. A prospective observational study design based upon a convenience sample of patients was conducted over a randomly selected four-week period. Nursing workload was assessing using the Jones Dependency Tool. A modified Work Observation Method By Activity Timing technique was used to estimate direct nursing care time. Of 4068 presentations to ED, 640 (16%) occupied the ambulance bay following triage, of which the majority (n=408; 64%) had arrived by ambulance. Of those occupying the ambulance bay 205 (32%) were evaluated using the JDT. The majority of patients had potentially life-threatening symptoms (ATS 3, n=424; 66%), were moderately dependent (n=134; 65%), and consumed approximately 152.1h of direct nursing care time. A large proportion of direct nursing care time was spent on patient reassessment (60.4h) and pain management (29.6h). Patients occupying the ambulance bay had an average ED length of stay of 5.6h (4.6h), of which 1.8h (SD 1.8h) was spent delayed in the ambulance bay. Early detailed assessment and symptom management of patients occupying the ambulance bay is extensively undertaken by emergency nurses. The frequency and number of patients off-loaded into non-clinical areas is not currently monitored or reported upon. This study has demonstrated that patients managed in the ambulance bay consume large amounts of nursing resources, commonly require acute level care and hospital admission. Copyright © 2016 College of Emergency Nursing Australasia. Published by Elsevier Ltd. All rights reserved.

The care of patients assessed as not in need of emergency ambulance care - Registered nurses' lived experiences.

PubMed

Barrientos, Christian; Holmberg, Mats

2018-05-01

The aim of this study was to describe the care of patients assessed as not in need of emergency ambulance care, from Registered Nurse's lived experiences. Non-emergency patients in need of ambulance care are described as vulnerable and patients in ambulance care have earlier been found to be dependent on the Registered Nurse. However, little is known about the care of non-emergency patients in the ambulance setting, from the perspective of Registered Nurses. A reflective lifeworld research design was chosen. Five Registered Nurses with experience of ambulance care were individually interviewed. The result reveals the essence of the phenomenon as a desire to provide good care in an on-going struggle between one's own and others' expectations. Three meaning constituents emerged in the description; Being in a struggle between different expectations, Being in a questioned professional role, and Being in lack of support and formal directives. Registered Nurses' care for patients assessed as not in need of emergency ambulance care, is a complex struggle between different expectations. This may be related to the encounter between the nurse's and the patient's lifeworld. Copyright © 2018 Elsevier Ltd. All rights reserved.

Effect of intravenous pamidronate therapy on functional abilities and level of ambulation in children with osteogenesis imperfecta.

PubMed

Land, Christof; Rauch, Frank; Montpetit, Kathleen; Ruck-Gibis, Joanne; Glorieux, Francis H

2006-04-01

To evaluate the functional abilities and the level of ambulation during pamidronate therapy in children with moderate to severe osteogenesis imperfecta. Functional abilities, ambulation, and grip force were assessed in 59 patients (mean age, 6.1 years; range, 0.5-15.7 years; 30 girls) during 3 years of pamidronate treatment. Functional skills (mobility and self-care) were both assessed by using the Pediatric Evaluation of Disability Inventory. Ambulation level was assessed by using the modified Bleck score. For 48 patients, results after 3 years of pamidronate treatment could be matched to those of patients with similar age and disease severity who had not received pamidronate. Mobility and self-care scores increased during the study period (+43% and +30%, respectively). The average ambulation score changed from 0.8 to 1.9. Maximal isometric grip force increased by 63%. Mobility and ambulation scores and grip force measures were significantly higher than in patients who had not received pamidronate. The difference in self-care scores did not reach significance. This study suggests that cyclical pamidronate treatment improves mobility, ambulation level, and muscle force in children with moderate to severe osteogenesis imperfecta.

Air ambulance medical transport advertising and marketing.

PubMed

2011-01-01

The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.

Biomechanics of the Ankle-Foot System during Stair Ambulation: Implications for Design of Advanced Ankle-Foot Prostheses

DTIC Science & Technology

2011-12-15

Biomechanics of the ankle–foot system during stair ambulation: Implications for design of advanced ankle–foot prostheses$ Emily H. Sinitski a, Andrew...Wilken). Please cite this article as: Sinitski, E.H., et al., Biomechanics of the ankle–foot system during stair ambulation: Implications for design of...REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Biomechanics Of The Ankle-Foot System During Stair Ambulation

Minnesota Heart Safe Communities: Are community-based initiatives increasing pre-ambulance CPR and AED use?

PubMed

Boland, Lori L; Formanek, Michelle B; Harkins, Kim K; Frazee, Carol L; Kamrud, Jonathan W; Stevens, Andrew C; Lick, Charles J; Yannopoulos, Demetris

2017-10-01

Implementation research that describes how successfully resuscitation guidelines are translated into practice are lacking. We examined whether recent community-based initiatives being conducted as part of the Minnesota Heart Safe (HS) Communities program increase the delivery of CPR and use of automated external defibrillators (AED) by bystanders and first responders prior to ambulance arrival. Non-EMS witnessed out-of-hospital cardiac arrests (OHCA) with presumed cardiac etiology treated by a single ambulance service in 2013-2015 were studied. Data were obtained from the Minnesota HS program and the Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Registry. Pre-ambulance CPR and AED use within HS communities before and after completion of the program were compared. As of July 2016, 17 Minnesota communities within the ambulance service area had achieved HS designation and 294 OHCAs that occurred in these communities met inclusion criteria for analysis (120 before HS designation, 174 after). CPR was initiated by bystanders or first responders prior to ambulance arrival in 83% of OHCA events that occurred before HS designation and in 95% of events that occurred after designation (OR=4.23 [1.80-9.98]). Pre-ambulance AED use increased from 63% to 77% after the community intervention (OR=1.94 [1.16-3.24]). Overall unadjusted survival to hospital discharge increased slightly after HS designation, but this difference was not statistically significant (17% vs 20%, p=0.32). Implementation of the Heart Safe program in communities within our ambulance service area in Minnesota has increased use of CPR and AEDs by bystanders and first responders prior to ambulance arrival. Copyright © 2017 Elsevier B.V. All rights reserved.

Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study.

PubMed

Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

2015-01-01

Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

PubMed Central

Aléx, Jonas; Karlsson, Stig; Björnstig, Ulf; Saveman, Britt-Inger

2015-01-01

Background The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures. Results Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress. PMID:26374468

Association between reliance on devices and people for walking and ability to walk community distances among persons with spinal cord injury.

PubMed

Brotherton, Sandra S; Saunders, Lee L; Krause, James S; Morrisette, David C

2012-05-01

To identify and describe the frequency of reliance on assistive devices and/or people for ambulating distances and stair climbing. Survey. A total of 429 adults with traumatic spinal cord injury who were able to walk at least 10 m were identified through inpatient and outpatient hospital databases at a specialty hospital in the southeast United States. Data were collected using a self-report questionnaire including items related to distances walked and devices used for ambulation. Participants best able to ambulate community distances were those who were independent with ambulation and those who used one cane or crutch. Reliance on people or use of a walker was associated with walking shorter distances. Regression analysis indicated reliance on devices or people for walking predicted variation in ability to ambulate community distances after controlling for demographic and injury characteristics. This study suggests that reliance on devices or a person for assistance is important to consider when assessing potential for achieving functional community ambulation.

What an ambulance nurse needs to know: a content analysis of curricula in the specialist nursing programme in prehospital emergency care.

PubMed

Sjölin, Helena; Lindström, Veronica; Hult, Håkan; Ringsted, Charlotte; Kurland, Lisa

2015-04-01

In Sweden, ambulances must be staffed by at least one registered nurse. Twelve universities offer education in ambulance nursing. There is no national curriculum for detailed course content and there is a lack of knowledge about the educational content that deals with the ambulance nurse practical professional work. The aim of this study was to describe the content in course curricula for ambulance nurses. A descriptive qualitative research design with summative content analysis was used. Data were generated from 49 courses in nursing and medical science. The result shows that the course content can be described as medical, nursing and contextual knowledge with a certain imbalance with largest focus on medical knowledge. There is least focus on nursing, the registered nurses' main profession. This study clarifies how the content in the education for ambulance nurses in Sweden looks today but there are reasons to discuss the content distribution. Copyright © 2014 Elsevier Ltd. All rights reserved.

Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana

PubMed Central

Mould-Millman, Nee-Kofi; Rominski, Sarah D; Bogus, Joshua; Ginde, Adit A; Zakariah, Ahmed N; Boatemaah, Christiana A; Yancey, Arthur H; Akoriyea, Samuel Kaba; Campbell, Thomas B

2015-01-01

Background: Emergency medical services (EMS) systems provide professional prehospital emergency medical care and transportation to help improve outcomes from emergency conditions. Ghana’s national ambulance service has relatively low public utilization in comparison with the large burden of acute disease. Methods: A survey instrument was developed using Pechansky and Thomas’s model of access covering 5 dimensions of availability, accessibility, accommodation, affordability, and acceptability. The instrument was used in a cross-sectional survey in 2013 in Accra, Ghana; eligible participants were those 18 years and older who spoke English, French, or Twi. Although the analysis was mainly descriptive, logistic regression was used to identify factors associated with reported intention to call for an ambulance in the case of a medical emergency. Results: 468 participants completed surveys, with a response rate of 78.4%. Few (4.5%) respondents had ever used an ambulance in prior emergency situations. A substantial proportion (43.8%) knew about the public access medical emergency telephone number, but of those only 37.1% knew it was a toll-free call. Most (54.7%) respondents believed EMTs offered high-quality care, but 78.0% believed taxis were faster than ambulances and 69.2% thought the number of ambulances in Accra insufficient. Many (23.4%) thought using ambulances to transport corpses would be appropriate. In two hypothetical emergency scenarios, respondents most commonly reported taxis as the preferred transportation (63.6% if a family member were burned in a house fire, 64.7% if a pedestrian were struck by a vehicle). About 1 in 5 respondents said they would call an ambulance in either scenario (20.7% if a family member were burned in a house fire, 23.3% if a pedestrian were struck by a vehicle) while 15.5% and 10.2%, respectively, would use any available vehicle. Those aged 18–35 years were more likely than older respondents to prefer an ambulance (odds ratio [OR], 2.27; confidence interval [CI], 1.47 to 3.68), as were those with prior ambulance experience (OR, 1.75; CI, 0.98 to 3.09) (compared with those with no prior experience) and those who believed ambulances were safer than taxis (OR, 2.17; CI, 1.1 to 4.2) (compared with those who did not hold such beliefs). Conclusions: Perceptions of public ambulance services in Accra, Ghana, are generally favorable, although use is low. Public health education to improve awareness of the toll-free medical emergency number and about appropriate use of ambulances while simultaneously improving the capacity of ambulance agencies to receive increased caseload could improve use of the EMS system. PMID:26681705

Barriers to Accessing Emergency Medical Services in Accra, Ghana: Development of a Survey Instrument and Initial Application in Ghana.

PubMed

Mould-Millman, Nee-Kofi; Rominski, Sarah D; Bogus, Joshua; Ginde, Adit A; Zakariah, Ahmed N; Boatemaah, Christiana A; Yancey, Arthur H; Akoriyea, Samuel Kaba; Campbell, Thomas B

2015-12-01

Emergency medical services (EMS) systems provide professional prehospital emergency medical care and transportation to help improve outcomes from emergency conditions. Ghana's national ambulance service has relatively low public utilization in comparison with the large burden of acute disease. A survey instrument was developed using Pechansky and Thomas's model of access covering 5 dimensions of availability, accessibility, accommodation, affordability, and acceptability. The instrument was used in a cross-sectional survey in 2013 in Accra, Ghana; eligible participants were those 18 years and older who spoke English, French, or Twi. Although the analysis was mainly descriptive, logistic regression was used to identify factors associated with reported intention to call for an ambulance in the case of a medical emergency. 468 participants completed surveys, with a response rate of 78.4%. Few (4.5%) respondents had ever used an ambulance in prior emergency situations. A substantial proportion (43.8%) knew about the public access medical emergency telephone number, but of those only 37.1% knew it was a toll-free call. Most (54.7%) respondents believed EMTs offered high-quality care, but 78.0% believed taxis were faster than ambulances and 69.2% thought the number of ambulances in Accra insufficient. Many (23.4%) thought using ambulances to transport corpses would be appropriate. In two hypothetical emergency scenarios, respondents most commonly reported taxis as the preferred transportation (63.6% if a family member were burned in a house fire, 64.7% if a pedestrian were struck by a vehicle). About 1 in 5 respondents said they would call an ambulance in either scenario (20.7% if a family member were burned in a house fire, 23.3% if a pedestrian were struck by a vehicle) while 15.5% and 10.2%, respectively, would use any available vehicle. Those aged 18-35 years were more likely than older respondents to prefer an ambulance (odds ratio [OR], 2.27; confidence interval [CI], 1.47 to 3.68), as were those with prior ambulance experience (OR, 1.75; CI, 0.98 to 3.09) (compared with those with no prior experience) and those who believed ambulances were safer than taxis (OR, 2.17; CI, 1.1 to 4.2) (compared with those who did not hold such beliefs). Perceptions of public ambulance services in Accra, Ghana, are generally favorable, although use is low. Public health education to improve awareness of the toll-free medical emergency number and about appropriate use of ambulances while simultaneously improving the capacity of ambulance agencies to receive increased caseload could improve use of the EMS system. © Mould-Millman et al.

Dynamic ambulance reallocation for the reduction of ambulance response times using system status management.

PubMed

Lam, Sean Shao Wei; Zhang, Ji; Zhang, Zhong Cheng; Oh, Hong Choon; Overton, Jerry; Ng, Yih Yng; Ong, Marcus Eng Hock

2015-02-01

Dynamically reassigning ambulance deployment locations throughout a day to balance ambulance availability and demands can be effective in reducing response times. The objectives of this study were to model dynamic ambulance allocation plans in Singapore based on the system status management (SSM) strategy and to evaluate the dynamic deployment plans using a discrete event simulation (DES) model. The geographical information system-based analysis and mathematical programming were used to develop the dynamic ambulance deployment plans for SSM based on ambulance calls data from January 1, 2011, to June 30, 2011. A DES model that incorporated these plans was used to compare the performance of the dynamic SSM strategy against static reallocation policies under various demands and travel time uncertainties. When the deployment plans based on the SSM strategy were followed strictly, the DES model showed that the geographical information system-based plans resulted in approximately 13-second reduction in the median response times compared to the static reallocation policy, whereas the mathematical programming-based plans resulted in approximately a 44-second reduction. The response times and coverage performances were still better than the static policy when reallocations happened for only 60% of all the recommended moves. Dynamically reassigning ambulance deployment locations based on the SSM strategy can result in superior response times and coverage performance compared to static reallocation policies even when the dynamic plans were not followed strictly. Copyright © 2014 Elsevier Inc. All rights reserved.

Results of a prospective randomized controlled trial of early ambulation for patients with lower extremity autografts.

PubMed

Lorello, David John; Peck, Michael; Albrecht, Marlene; Richey, Karen J; Pressman, Melissa A

2014-01-01

It is common practice to keep those patients with lower extremity autografts immobile until post-operative day (POD) 5. There is however inherent risks associated with even short periods of immobility. As of now there are no randomized controlled trials looking at early ambulation of patients with lower extremity autografts in the burn community.The objective of this study was to show that patients who begin ambulation within 24 hours of lower extremity autografting will have no increased risk of graft failure than those patients who remain immobile until POD 5. Thirty-one subjects who received autografts to the lower extremity were randomized after surgery into either the early ambulation group (EAG;17 subjects) or the standard treatment group (STG;14 subjects). Those subjects randomized to the EAG began ambulating with physical therapy on POD 1. Subjects in the STG maintained bed rest until POD 5. There was no difference in the number of patients with graft loss in either the EAG or STG on POD 5, and during any of the follow-up visits. No subjects required regrafting. There was a significant difference in the mean minutes of ambulation, with the EAG ambulating longer than the STG (EAG 23.4 minutes [SD 12.03], STG 14.1 [SD 9.00], P=.0235) on POD 5. Burn patients with lower extremity autografts can safely ambulate on POD 1 without fear of graft failure compared with those patients that remain on bed rest for 5 days.

A systematic review of the efficacy of gait rehabilitation strategies for spinal cord injury

PubMed Central

Lam, Tania; Eng, Janice J; Wolfe, Dalton L; Hsieh, Jane T; Whittaker, Maura

2012-01-01

OBJECTIVE To systematically review the evidence for the efficacy of different rehabilitation strategies on functional ambulation following spinal cord injury (SCI). METHODS A keyword literature search of original articles was used to identify published literature evaluating the effectiveness of any treatment or therapy on functional ambulation in people with SCI. The rigor and quality of each study were scored on standardized scales by two independent reviewers. RESULTS The search yielded 160 articles, of which 119 were excluded for not meeting our inclusion criteria. The remaining 41 articles covered various strategies for improving gait: bodyweight supported treadmill training (BWSTT) (n=12), functional electrical stimulation (FES) (n=7), braces/orthoses (n=10), or a combination of these (n=12). There is strong evidence from randomized controlled trials that functional ambulation outcomes following body-weight supported treadmill training (BWSTT) are comparable to an equivalent intensity of overground gait training in sub-acute SCI. In chronic SCI, evidence from pre-test/post-test studies shows that BWSTT may be effective in improving functional ambulation. Pre-test/post-test or post-test only studies provide evidence that FES may augment functional ambulation in sub-acute/chronic SCI while braces may afford particular benefits to people with complete SCI to stand up and ambulate with assistive devices. CONCLUSIONS Rehabilitation strategies that facilitate repeated practice of gait offer the greatest benefits to functional ambulation in sub-acute or chronic SCI. Supportive devices may augment functional ambulation particularly in people with incomplete SCI. PMID:22915835

Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test.

PubMed

Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

2015-10-01

The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between -20 and 4 (mean -4.4). The mean changes were -3.79 in the glucocorticoid group, -5.52 in those who stopped at loss of ambulation and -4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Fatigue and mental health in Australian rural and regional ambulance personnel.

PubMed

Pyper, Zoe; Paterson, Jessica L

2016-02-01

Australian ambulance personnel experience stress, fatigue and exposure to traumatic events. These risks have been extensively researched in metropolitan paramedics. However, there has been limited research in rural and regional personnel. Rural and regional ambulance personnel make up a significant proportion of the Australian ambulance workforce and may be exposed to unique stressors. The aim of the current study was to investigate levels of fatigue, stress, and emotional trauma in rural and regional ambulance personnel. A sample of 134 (103 male, 31 female) rural and regional ambulance personnel completed a mixed methods survey assessing fatigue, stress and emotional trauma. Data were analysed using a combination of descriptive analysis and qualitative, deductive analysis that involved data immersion, coding, and categorisation. Participants reported high levels of fatigue and emotional trauma. Qualitative data revealed stressors including community expectations and 'office politics'. Participants also reported negative effects of fatigue including errors in drug administration and falling asleep while driving. The majority of participants reported normal levels of stress. It may be the case that working with known individuals in a community offers some degree of 'protective' impact for stress in rural and regional ambulance personnel. This is one of the first studies to investigate fatigue, stress, and emotional trauma in a rural and regional ambulance population. Results indicate a complex and unique profile of risks and challenges for this critical and understudied community resource. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

42 CFR 414.620 - Publication of the ambulance fee schedule.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Section 414.620 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Fee Schedule for Ambulance Services § 414.620 Publication of the ambulance fee schedule. Changes in payment rates resulting...

Riding Third: Social Work in Ambulance Work

ERIC Educational Resources Information Center

Campbell, Hilary; Rasmussen, Brian

2012-01-01

This research explored the possible role of social work alongside emergency ambulance services. An ethnographic study included semistructured interviews and direct observations collected over 300 hours while riding in ambulances in an urban setting. The data suggest that social work could play a role by providing needed psychosocial care during…

Rushing Roulette

PubMed Central

Scanlan, Larry

1976-01-01

In a Canada-wide survey, CANADIAN FAMILY PHYSICIAN found a startling divergence in provincial standards for ambulance crews and vehicles. While some provinces had developed a well-integrated ambulance system with central dispatching, rigorous standards for attendants and advanced paramedical training programs, in some the ambulances are run almost entirely by local undertakers. PMID:21308032

Art to Heart: The Effects of Staff- Created Art on the Postoperative Rehabilitation of Cardiovascular Surgery Patients.

PubMed

Bowen, Mary Gwyn; Wells, Nancy L; Dietrich, Mary S; Sandlin, Victoria

2015-01-01

Postoperative ambulation is important for reducing complications following surgery. The type of art patients view on the ambulation route may influence the distance patients walk. In this study, patients ambulated greater distances when staff-created art was placed on hallway walls.

Effect of public awareness campaigns on calls to ambulance across Australia.

PubMed

Bray, Janet E; Straney, Lahn; Barger, Bill; Finn, Judith

2015-05-01

The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. Campaign exposure and funding has varied annually and regionally during this time. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions (paid or pro bono advertising). All ambulance services in Australia provided monthly ambulance dispatch data between January 2003 and June 2014. We performed multivariable regression to measure the effect of campaign exposure on the volume of stroke-related emergency calls, after controlling for confounders. The final model indicated that 11 of the 12 National Stroke Foundation campaigns were associated with increases in the volume of stroke-related calls (varying between 1% and 9.9%) in regions with exposure to advertising. This increase lasted ≈3 months, with an additional 10.2% relative increase in the volume of the calls in regions with paid advertising. We found no significant additional effect of the campaigns on stroke calls where ambulance services are publicly funded. The National Stroke Foundation stroke awareness campaigns are associated with increases to calls to ambulance for stroke in regions receiving advertising and promotion. Research is now required to examine whether this increased use in ambulance is for appropriate emergencies. © 2015 American Heart Association, Inc.

Ambulance Design Survey 2011: A Summary Report

PubMed Central

Lee, Y Tina; Kibira, Deogratias; Feeney, Allison Barnard; Marshall, Jennifer

2013-01-01

Current ambulance designs are ergonomically inefficient and often times unsafe for practical treatment response to medical emergencies. Thus, the patient compartment of a moving ambulance is a hazardous working environment. As a consequence, emergency medical services (EMS) workers suffer fatalities and injuries that far exceed those of the average work place in the United States. To reduce injury and mortality rates in ambulances, the Department of Homeland Security Science and Technology Directorate has teamed with the National Institute of Standards and Technology, the National Institute for Occupational Safety and Health, and BMT Designers & Planners in a joint project to produce science-based ambulance patient compartment design standards. This project will develop new crash-safety design standards and improved user-design interface guidance for patient compartments that are safer for EMS personnel and patients, and facilitate improved patient care. The project team has been working with practitioners, EMS workers’ organizations, and manufacturers to solicit needs and requirements to address related issues. This paper presents an analysis of practitioners’ concerns, needs, and requirements for improved designs elicited through the web-based survey of ambulance design, held by the National Institute of Standards and Technology. This paper also introduces the survey, analyzes the survey results, and discusses recommendations for future ambulance patient compartments design. PMID:26401439

Patients' perception of the ambulance services at Hospital Universiti Sains Malaysia.

PubMed

Anisah, A; Chew, K S; Mohd Shaharuddin Shah, C H; Nik Hisamuddin, N A R

2008-08-01

Little is known regarding public opinion of prehospital care in Malaysia. This study was conducted to find out the public's perception and expectations of the ambulance services in one of the university hospitals in Malaysia. A six-month prospective cross-sectional study to look at patients' perception of Hospital Universiti Sains Malaysia's (HUSM) ambulance service was conducted from February 2006 to July 2006. Upon arrival at the hospital, patients or their relatives (who used our hospital's ambulances) were interviewed with a set of questions regarding their perception of the ambulance services and were asked to rate the perception on a Likert Scale from 1 to 10. A convenient sampling method was applied. A total of 87 samples were obtained. Despite the many problems faced by the ambulance service in HUSM, the mean score for each of the questions on patient's perception ranged from 9.33 to 9.70 out of 10. The questions with the highest mean score, which were both 9.70 each, were related to staff attentiveness and staff gentleness. Patients' perceptions can be very subjective, but until further similar studies could be carried out in other parts of Malaysia, this set of data merely represents a numerical measure of public perception of the ambulance services from HUSM.

Microbial Air Quality and Bacterial Surface Contamination in Ambulances During Patient Services

PubMed Central

Luksamijarulkul, Pipat; Pipitsangjan, Sirikun

2015-01-01

Objectives We sought to assess microbial air quality and bacterial surface contamination on medical instruments and the surrounding areas among 30 ambulance runs during service. Methods We performed a cross-sectional study of 106 air samples collected from 30 ambulances before patient services and 212 air samples collected during patient services to assess the bacterial and fungal counts at the two time points. Additionally, 226 surface swab samples were collected from medical instrument surfaces and the surrounding areas before and after ambulance runs. Groups or genus of isolated bacteria and fungi were preliminarily identified by Gram’s stain and lactophenol cotton blue. Data were analyzed using descriptive statistics, t-test, and Pearson’s correlation coefficient with a p-value of less than 0.050 considered significant. Results The mean and standard deviation of bacterial and fungal counts at the start of ambulance runs were 318±485cfu/m3 and 522±581cfu/m3, respectively. Bacterial counts during patient services were 468±607cfu/m3 and fungal counts were 656±612cfu/m3. Mean bacterial and fungal counts during patient services were significantly higher than those at the start of ambulance runs, p=0.005 and p=0.030, respectively. For surface contamination, the overall bacterial counts before and after patient services were 0.8±0.7cfu/cm2 and 1.3±1.1cfu/cm2, respectively (p<0.001). The predominant isolated bacteria and fungi were Staphylococcus spp. and Aspergillus spp., respectively. Additionally, there was a significantly positive correlation between bacterial (r=0.3, p<0.010) and fungal counts (r=0.2, p=0.020) in air samples and bacterial counts on medical instruments and allocated areas. Conclusions This study revealed high microbial contamination (bacterial and fungal) in ambulance air during services and higher bacterial contamination on medical instrument surfaces and allocated areas after ambulance services compared to the start of ambulance runs. Additionally, bacterial and fungal counts in ambulance air showed a significantly positive correlation with the bacterial surface contamination on medical instruments and allocated areas. Further studies should be conducted to determine the optimal intervention to reduce microbial contamination in the ambulance environment. PMID:25960835

Using genetic algorithms to optimise current and future health planning--the example of ambulance locations.

PubMed

Sasaki, Satoshi; Comber, Alexis J; Suzuki, Hiroshi; Brunsdon, Chris

2010-01-28

Ambulance response time is a crucial factor in patient survival. The number of emergency cases (EMS cases) requiring an ambulance is increasing due to changes in population demographics. This is decreasing ambulance response times to the emergency scene. This paper predicts EMS cases for 5-year intervals from 2020, to 2050 by correlating current EMS cases with demographic factors at the level of the census area and predicted population changes. It then applies a modified grouping genetic algorithm to compare current and future optimal locations and numbers of ambulances. Sets of potential locations were evaluated in terms of the (current and predicted) EMS case distances to those locations. Future EMS demands were predicted to increase by 2030 using the model (R2 = 0.71). The optimal locations of ambulances based on future EMS cases were compared with current locations and with optimal locations modelled on current EMS case data. Optimising the location of ambulance stations locations reduced the average response times by 57 seconds. Current and predicted future EMS demand at modelled locations were calculated and compared. The reallocation of ambulances to optimal locations improved response times and could contribute to higher survival rates from life-threatening medical events. Modelling EMS case 'demand' over census areas allows the data to be correlated to population characteristics and optimal 'supply' locations to be identified. Comparing current and future optimal scenarios allows more nuanced planning decisions to be made. This is a generic methodology that could be used to provide evidence in support of public health planning and decision making.

Caring for older people in prehospital emergency care: can nurses make a difference?

PubMed

Melby, Vidar; Ryan, Assumpta

2005-10-01

The aim of this paper is to explore older people's experiences in prehospital emergency care, and identify benefits and difficulties associated with developing a nurse-led ambulance service. Data were collected at sites in Sweden and Norway. Focus group interviews were conducted to enable the collection of data from paramedics, ambulance nurses and nursing students, while individual interviews were utilized to gather data from older people. There is little research on the quality of care older people over 65 years old receive in prehospital emergency care. Older people often present with multiple pathology and diverse needs that nurses are well equipped to deal with, but presently there is no clearly defined role for nurses in prehospital emergency care in the United Kingdom, although other countries such as Sweden and Norway are developing an ambulance nurse role. If the multiple needs of older people were addressed in the prehospital field, a reduction in readmissions and increased functional ability might be achieved. Comprehensive training is required for ambulance staff to enable them to meet such needs. While nurses have a great foundation for this care, additional specialist ambulance training is required alongside a need for education on older people's needs and attitudes to older people. The introduction of ambulance nurses will result in role differentiation between paramedics and ambulance nurses, which has the potential for creating role conflict. To ensure a smooth transition appropriate training and education for nurses and paramedics should be provided. The end result is a potentially greatly enhanced ambulance care provision, enabling high quality care to all patients.

29 CFR 553.215 - Ambulance and rescue service employees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... activities, the applicable standard is the one which applies to the activity in which the employee spends the majority of work time during the work period. (b) Ambulance and rescue service employees of public agencies... 29 Labor 3 2010-07-01 2010-07-01 false Ambulance and rescue service employees. 553.215 Section 553...

Community ambulation: influences on therapists and clients reasoning and decision making.

PubMed

Corrigan, Rosemary; McBurney, Helen

2008-01-01

Community ambulation is an important element of a rehabilitation training programme and its achievement is a goal shared by rehabilitation professionals and clients. The factors that influence a physiotherapist's or health professionals decision making around the preparation of a client for community ambulation and the factors that influence a client's decision to return to walking in their community are unclear. To review the available literature about the factors that have influenced the reasoning and decision making of rehabilitation therapists and clients around the topic of ambulation in the community. Three separate searches of the available literature were undertaken using Ovid, Cinahl, ProQuest, Medline and Ebscohost databases. Databases were searched from 1966 to October 2006.The first search explored the literature for factors that influence the clinical reasoning of rehabilitation therapists. The second search explored the literature for factors that influence client's decision to ambulate in the community. A third search was undertaken to explore the literature for the demands of community ambulation in rural communities. Very few studies were found that explored community ambulation in the context of clinical reasoning and decision making, the facilitators and barriers to a clients return to ambulation in their community or the demands of ambulation in a rural community. Consideration of the environment is key to the successful return to walking in the community of clients with mobility problems yet little literature has been found to guide physiotherapist's decision making about preparing a clients to return to walking in the community. An individual's participation in their society is also a result of the interaction between their personal characteristics and his or her environment. The influence of these characteristics may vary from one individual to another yet the factors that influence a person's decision to return to walking in their community after stroke remain unclear.

Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel – a cross-sectional study

PubMed Central

2012-01-01

Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel. Methods Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%). Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%). The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality. Conclusions Ambulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal problems and the presence of positive organizational support mechanisms that can prevent negative effects from the high levels of emotional demands. PMID:22824415

Older fallers attended to by an ambulance but not transported to hospital: a vulnerable population at high risk of future falls.

PubMed

Tiedemann, Anne; Mikolaizak, A Stefanie; Sherrington, Catherine; Segin, Kerrie; Lord, Stephen R; Close, Jacqueline C T

2013-04-01

This prospective cohort study describes older non-transported fallers seen by the Ambulance Service of New South Wales (ASNSW), quantifies the level of risk and identifies predictors of future falls and ambulance use. Participants were 262 people aged 70 years or older with a fall-related ASNSW attendance who were not transported to an emergency department. They completed a questionnaire about health, medical and physical factors previously associated with falling. Falls were monitored for six months after ambulance attendance with monthly fall calendars. Participants had a high prevalence of chronic medical conditions, functional limitations and past falls. During follow-up, 145 participants (58%) experienced 488 falls. Significant predictors of falls during follow-up were three or more falls in the past year, being unable to walk more than 10 minutes without resting, and requiring assistance for personal-care activities of daily living (ADLs). Sixty-two participants (25%) required repeat, fall-related ambulance attendance during the study. Predictors of repeat ambulance use were: 3+ falls in past year, requiring assistance for personal-care ADLs and having disabling pain in past month. Older, non-transported fallers seen by the ASNSW are a vulnerable population with high rates of chronic health conditions. Onward referral for preventive interventions may reduce future falls and ambulance service calls. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

Medical Requirements for Ambulance Design and Equipment. Emergency Health Series.

ERIC Educational Resources Information Center

National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.

A vehicle must meet certain specific requirements to be classified as an ambulance if it is to satisfy the demands of the physician in terms of emergency care for which properly trained ambulance attendants can be held responsible. Developed by professional and lay experts for use by automotive designers and manufacturing, this publication would…

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 3 2014-10-01 2014-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

42 CFR 422.113 - Special rules for ambulance services, emergency and urgently needed services, and maintenance and...

Code of Federal Regulations, 2012 CFR

2012-10-01

... 42 Public Health 3 2012-10-01 2012-10-01 false Special rules for ambulance services, emergency and... § 422.113 Special rules for ambulance services, emergency and urgently needed services, and maintenance... equivalent, where other means of transportation would endanger the beneficiary's health. (b) Emergency and...

78 FR 48925 - Agency Information Collection Activities: Requests for Comments; Clearance of a New Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-12

... Reduction Act of 1995, FAA invites public comments about our intention to request the Office of Management... included a mandate to begin collection of operational data from Air Ambulance operators. FAA is to... ambulance services. See 49 U.S.C. 44731. The helicopter air ambulance operational data provided to the FAA...

78 FR 46405 - Agency Information Collection Activities: Requests for Comments; Clearance of a New Approval of...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-31

... comments about our intention to request the Office of Management and Budget (OMB) approval for a new... operational data from Air Ambulance operators. FAA is to summarize the data and report to Congress no later... certificate holder were providing helicopter air ambulance services. The helicopter air ambulance operational...

The Influence of Ambulatory Aid on Lower-Extremity Muscle Activation During Gait.

PubMed

Sanders, Michael; Bowden, Anton E; Baker, Spencer; Jensen, Ryan; Nichols, McKenzie; Seeley, Matthew K

2018-05-10

Foot and ankle injuries are common and often require a nonweight-bearing period of immobilization for the involved leg. This nonweight-bearing period usually results in muscle atrophy for the involved leg. There is a dearth of objective data describing muscle activation for different ambulatory aids that are used during the aforementioned nonweight-bearing period. To compare activation amplitudes for 4 leg muscles during (1) able-bodied gait and (2) ambulation involving 3 different ambulatory aids that can be used during the acute phase of foot and ankle injury care. Within-subject, repeated measures. University biomechanics laboratory. Sixteen able-bodied individuals (7 females and 9 males). Each participant performed able-bodied gait and ambulation using 3 different ambulatory aids (traditional axillary crutches, knee scooter, and a novel lower-leg prosthesis). Muscle activation amplitude quantified via mean surface electromyography amplitude throughout the stance phase of ambulation. Numerous statistical differences (P < .05) existed for muscle activation amplitude between the 4 observed muscles, 3 ambulatory aids, and able-bodied gait. For the involved leg, comparing the 3 ambulatory aids: (1) knee scooter ambulation resulted in the greatest vastus lateralis activation, (2) ambulation using the novel prosthesis and traditional crutches resulted in greater biceps femoris activation than knee scooter ambulation, and (3) ambulation using the novel prosthesis resulted in the greatest gastrocnemius activation (P < .05). Generally speaking, muscle activation amplitudes were most similar to able-bodied gait when subjects were ambulating using the knee scooter or novel prosthesis. Type of ambulatory aid influences muscle activation amplitude. Traditional axillary crutches appear to be less likely to mitigate muscle atrophy during the nonweighting, immobilization period that often follows foot or ankle injuries. Researchers and clinicians should consider these results when recommending ambulatory aids for foot or ankle injuries.

Ambulance attendances resulting from self-harm after release from prison: a prospective data linkage study.

PubMed

Borschmann, Rohan; Young, Jesse T; Moran, Paul; Spittal, Matthew J; Heffernan, Ed; Mok, Katherine; Kinner, Stuart A

2017-10-01

Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances. Baseline surveys with 1309 adults within 6 weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression. During 4691 person-years of follow-up (median 3.86 years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14-3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44-4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11-4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31-7.61)] were associated with self-harm attendances. Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population.

Spatial analysis of ambulance response times related to prehospital cardiac arrests in the city-state of Singapore.

PubMed

Earnest, Arul; Hock Ong, Marcus Eng; Shahidah, Nur; Min Ng, Wen; Foo, Chuanyang; Nott, David John

2012-01-01

The main objective of this study was to establish the spatial variation in ambulance response times for out-of-hospital cardiac arrests (OHCAs) in the city-state of Singapore. The secondary objective involved studying the relationships between various covariates, such as traffic condition and time and day of collapse, and ambulance response times. The study design was observational and ecological in nature. Data on OHCAs were collected from a nationally representative database for the period October 2001 to October 2004. We used the conditional autoregressive (CAR) model to analyze the data. Within the Bayesian framework of analysis, we used a Weibull regression model that took into account spatial random effects. The regression model was used to study the independent effects of each covariate. Our results showed that there was spatial heterogeneity in the ambulance response times in Singapore. Generally, areas in the far outskirts (suburbs), such as Boon Lay (in the west) and Sembawang (in the north), fared badly in terms of ambulance response times. This improved when adjusted for key covariates, including distance from the nearest fire station. Ambulance response time was also associated with better traffic conditions, weekend OHCAs, distance from the nearest fire station, and OHCAs occurring during nonpeak driving hours. For instance, the hazard ratio for good ambulance response time was 2.35 (95% credible interval [CI] 1.97-2.81) when traffic conditions were light and 1.72 (95% CI 1.51-1.97) when traffic conditions were moderate, as compared with heavy traffic. We found a clear spatial gradient for ambulance response times, with far-outlying areas' exhibiting poorer response times. Our study highlights the utility of this novel approach, which may be helpful for planning emergency medical services and public emergency responses.

Paramedic Physical Demands Analysis

DTIC Science & Technology

2014-07-01

The five national sites included: British Columbia Ambulance Service (Vancouver, British Columbia - Metro catchment area ), Superior North Emergency...routinely drove within their assigned catchment area between calls, in addition to their driving duties on route to and from a call. Figure 10...been spent driving the ambulance roaming through their catchment area , seated in the ambulance or in a satellite station awaiting a call, or

Suicidal ideation and suicide attempts in a nationwide sample of operational Norwegian ambulance personnel.

PubMed

Sterud, Tom; Hem, Erlend; Lau, Bjørn; Ekeberg, Oivind

2008-01-01

This is the first paper on suicidal ideation and attempts among ambulance personnel. This study aimed to investigate levels of suicidal ideation and suicide attempts among ambulance personnel, and to identify important correlates and the factors to which ambulance personnel attribute their serious suicidal ideation. A comprehensive nationwide questionnaire survey of 1,180 operational ambulance personnel was conducted. Measurements included: Paykel's Suicidal Feelings in the General Population questionnaire, the Hospital Anxiety and Depression scale, the Subjective Health Complaints Questionnaire, the Maslach Burnout Inventory, the Job Satisfaction Scale, the Basic Character Inventory, and the Rosenberg Self-Esteem Scale. Lifetime prevalence ranged from 28% for feelings that life was not worth living to 10.4% for seriously considered suicide and 3.1% for a suicide attempt. Serious suicidal ideation was independently associated with job-related emotional exhaustion (feelings of being overextended and depleted of resources) (OR 1.5, 95% CI 1.1-2.0) and bullying at work (OR 1.7, 95% CI 1.02-2.7), younger age, not married/cohabitant, depression symptoms, low self-esteem and the personality trait reality weakness. In general, suicidal thoughts were hardly attributable to working conditions, since only 1.8% of ambulance personnel attributed suicidal ideation to work problems alone. In conclusion, ambulance personnel reported a moderate level of suicidal ideation and suicide attempts. Although serious suicidal ideation was rarely attributed to working conditions in general, this study suggests that job-related factors like emotional exhaustion and bullying may be of importance.

Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures of Japan.

PubMed

Murakami, Shoko; Miyatake, Nobuyuki; Sakano, Noriko

2012-09-01

Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures, in Japan were evaluated. Data on air temperature were obtained from the Japanese Meteorological Agency. Data on ambulance transports due to heat stroke was directly obtained from the Fire and Disaster Management Agency, Japan. We also used the number of deaths due to heat stroke from the Ministry of Health, Labour and Welfare, Japan, and population data from the Ministry of Internal Affairs and Communications. Chronological changes in parameters of air temperature were analyzed. In addition, the relation between air temperature and ambulance transports due to heat stroke in August 2010 was also evaluated by using an ecological study. Positive and significant changes in the parameters of air temperature that is, the mean air temperature, mean of the highest air temperature, and mean of the lowest air temperature were noted in all 47 prefectures. In addition, changes in air temperature were accelerated when adjusted for observation years. Ambulance transports due to heat stroke was significantly correlated with air temperature in the ecological study. The highest air temperature was significantly linked to ambulance transports due to heat stroke, especially in elderly subjects. Global warming was demonstrated in all 47 prefectures in Japan. In addition, the higher air temperature was closely associated with higher ambulance transports due to heat stroke in Japan.

Microswitch-aided programs to support physical exercise or adequate ambulation in persons with multiple disabilities.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Perilli, Viviana; Oliva, Doretta; Buono, Serafino

2014-09-01

Three microswitch-aided programs were assessed in three single-case studies to enhance physical exercise or ambulation in participants with multiple disabilities. Study I was aimed at helping a woman who tended to have the head bending forward and the arms down to exercise a combination of appropriate head and arms movements. Study II was aimed at promoting ambulation continuity with a man who tended to have ambulation breaks. Study III was aimed at promoting ambulation with appropriate foot position in a girl who usually showed toe walking. The experimental designs of the studies consisted of a multiple probe across responses (Study I), an ABAB sequence (Study II), and an ABABB(1) sequence (Study III). The last phase of each study was followed by a post-intervention check. The microswitches monitored the target responses selected for the participants and triggered a computer system to provide preferred stimuli contingent on those responses during the intervention phases of the studies. Data showed that the programs were effective with each of the participants who learned to exercise head and arms movements, increased ambulation continuity, and acquired high levels of appropriate foot position during ambulation, respectively. The positive performance levels were retained during the post-intervention checks. The discussion focused on (a) the potential of technology-aided programs for persons with multiple disabilities and (b) the need of replication studies to extend the evidence available in the area. Copyright © 2014 Elsevier Ltd. All rights reserved.

Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems.

PubMed

Brown, Lawrence H; Chaiechi, Taha; Buettner, Petra G; Canyon, Deon V; Crawford, J Mac; Judd, Jenni

2013-02-01

To evaluate the impact of changing energy prices on Australian ambulance systems. Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated. © 2013 The Authors. ANZJPH © 2013 Public Health Association of Australia.

Ambulation and survival following surgery in elderly patients with metastatic epidural spinal cord compression.

PubMed

Itshayek, Eyal; Candanedo, Carlos; Fraifeld, Shifra; Hasharoni, Amir; Kaplan, Leon; Schroeder, Josh E; Cohen, José E

2018-07-01

Metastatic epidural spinal cord compression (MESCC) is a disabling consequence of disease progression. Surgery can restore or preserve physical function, improving access to treatments that increase duration of survival; however, advanced patient age may deter oncologists and surgeons from considering surgical management. Evaluate the duration of ambulation and survival in elderly patients following surgical decompression of MESCC. Retrospective file review of a prospective database, under institutional review board (IRB) waiver of informed consent, of consecutive patients treated in an academic tertiary care medical center from August 2008 to March 2015. Patients ≥65 years presenting neurological and/or radiological signs of cord compression because of metastatic disease, who underwent surgical decompression. Duration of ambulation and survival. Patients underwent urgent multidisciplinary evaluation and surgery. Ambulation and survival were compared with age, pre-, and postoperative neurological (American Spinal Injury Association [ASIA] Impairment Scale [AIS]) and performance status (Karnofsky Performance Status [KPS]), and Tokuhashi Score using Kruskal-Wallis and Wilcoxon signed rank tests, Pearson correlation coefficient, Cox regression model, log-rank analysis, and Kaplan-Meier analysis. Forty patients were included (21 male, 54%; mean age 74 years, range 65-87). Surgery was performed a mean 3.8 days after onset of motor symptoms. Mean duration of ambulation and survival were 474 (range 0-1662) and 525 days (range 11-1662), respectively; 53% of patients (21 of 40) survived and 43% (17 of 40) retained ambulation for ≥1 year. There was no significant relationship between survival and ambulation for patients aged 65-69, 70-79, or 80-89 years, although Kaplan-Meier analysis suggested stratification. There was a significant relationship between duration of ambulation and pre- and postoperative AIS (p=.0342, p=.0358, respectively) and postoperative KPS (p=.0221). Tokuhashi score was not significantly related to duration of survival or ambulation, and greatly underestimated life expectancy in 22 of 37 (59%) patients with scores 0-11. Decompressive surgery led to marked improvement in neurological function and performance status. More than 50% of patients survived for >1 year, some for 3 years or more after surgery. Copyright © 2018 Elsevier Inc. All rights reserved.

Profile of Ambulance Runs at the Kennedy Space Center

NASA Technical Reports Server (NTRS)

Scarpa, Philip J.

1999-01-01

The Kennedy Space Center (KSC) has four onsite ambulances staffed with Paramedics at two fire stations that respond to 911 Emergency Medical System (EMS) medical dispatches. These ambulances serve over 22,000 NASA, military, government, and contractor employees in an area of approximately 520 square miles. Included in this coverage are several public areas such as beaches, a wildlife refuge and a popular Visitor Center. Reports are filled out on each patient encountered. However. the only element tracked has been the ambulance response time. Now that reports are filed electronically, it is possible to enter them into an electronic database for analysis. Data analyses reveal trends and assist in better allocation of resources.

A secure 2G-RFID-Sys mechanism for applying to the medical emergency system.

PubMed

Chen, Yu-Yi; Wang, Yao-Jen; Jan, Jinn-Ke

2013-06-01

In the Medical Emergency System, any moment of delay in an emergency such as ambulance dispatch, ambulance diversion and clinical handover communication can significantly reduce a patient's chance of survival. Without the disadvantage of centralized management, a new type of RFID application named 2G-RFID-Sys will be more efficient. It is suitable for the tagged ambulance dispatch management in a huge range. In this article, the prototype of 2G-RFID-Sys and the responsibility of each participant are refined. We take an example of applying the 2G-RFID-Sys to the Medical Emergency System, the traffic condition of the ambulance will be able to ensure.

[The correlation between personality characteristics and burnout syndrome in emergency ambulance workers].

PubMed

Bergmueller, A; Zavgorodnii, I; Zavgorodnia, N; Kapustnik, W; Boeckelmann, I

The work in Emergency Medical Ambulance Service is one of the professions, which is accompanied by high psychological and emotional stress. The aim was to determine the risk of professional burnout syndrome of Emergency Medical Ambulance Service staff and the relationship between burnout syndrome and personality. Ninety-seven doctors (57 women and 40 men, aged 37.0±12.21) of Emergency Medical Ambulance Service were interviewed using the MBI-GS questionnaire and the Freiburg personality questionnaire (FPI). Correlation and regression analysis were used. Nine (11.5%) of respondents had a risk of burnout syndrome and 28 (35.9%) had some symptoms. In the group, aged 45 years and older, the risk of burnout syndrome was not identified. The staff of Emergency Medical Ambulance Service is characterized by stable personality features. It is necessary to identify the prevalence of burnout syndrome and also to identity the causes for its prevention and development of measures on the increase of personal stress resilience.

75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-12

...This proposed rule addresses air ambulance and commercial helicopter operations, part 91 helicopter operations, and load manifest requirements for all part 135 aircraft. From 2002 to 2008, there has been an increase in fatal helicopter air ambulance accidents. To address these safety concerns, the FAA is proposing to implement operational procedures and require additional equipment on board helicopter air ambulances. Many of these proposed requirements currently are found in agency guidance publications and would address National Transportation Safety Board (NTSB) safety recommendations. Some of these safety concerns are not unique to the helicopter air ambulance industry and affect all commercial helicopter operations. Accordingly, the FAA also is proposing to amend regulations pertaining to all commercial helicopter operations conducted under part 135 to include equipment requirements, pilot training, and alternate airport weather minima. The changes are intended to provide certificate holders and pilots with additional tools and procedures that will aid in preventing accidents.

Assessing Pesticide Impact on Human Health in Nebraska: A Survey of Ambulance Services and Rescue Squads. Department Report No. 7.

ERIC Educational Resources Information Center

Vitzthum, Edward F.; And Others

A study examined the employment qualifications, job content, training, and training needs of ambulance service and rescue squad workers in Nebraska. Based on the 268 mail questionnaires that were completed and returned out of a total of 338 sent out, it was concluded that the strengths of the various ambulance and rescue services vary widely. The…

Evaluation of insight training of ambulance drivers in Sweden using DART, a new e-learning tool.

PubMed

Albertsson, Pontus; Sundström, Anna

2011-12-01

The aim of the study was to evaluate whether a new e-learning tool for insight training of ambulance drivers can have an effect on drivers' driving behaviors, perceived driving competence, competence to assess risks, self-reflection, and safety attitudes. A quasi-experimental study design, with participants nonrandomly assigned into a control and intervention group, was used. The intervention group participated in the insight-training course and the control group did not. Both groups completed a self- and peer assessment online questionnaire before and after the training. The main finding is that the ambulance drivers assessed themselves through the instruments after the training, with the e-learning tool Driver Access Recording Tool (DART), as safer drivers in the areas of speed adaptation, closing up, and overtaking. In the answers from the group-based evaluation, the ambulance drivers responded that they were more reflective/analytical, had increased their risk awareness, and had changed their driving behaviors. After insight training, the ambulance drivers in this study assessed themselves as safer drivers in several important areas, including speed adaptation, closing up, and overtaking. In future training of ambulance drivers there should be more focus on insight training instead of previous training focusing on maneuvering capabilities.

Study on advanced life support devices in the ambulances for emergency cases in Klang Valley, Malaysia.

PubMed

Ismail, M S; Hasinah, A B; Syaiful, M N; Murshidah, H B; Thong, T J; Zairi, Z; Idzwan, Z; Herbosa, T J; Johar, M J; Ho, S E; Das, S

2012-01-01

In an effort to improve pre-hospital care, the authors assessed the availability and utility of ambulance devices. The study aimed to identify commonly used devices for managing emergency cases in Klang Valley of Malaysia. This was a prospective study comprising of 1075 emergency ambulances running on 30 days. The study analyzed the availability and utilization of life support equipment in nine ambulance providers of Klang Valley in Malaysia. The devices were classified into: (a) airway and ventilation, (b) immobilization and haemorrhage control and (c) communication. The percentage of device utilization was analysed using computerised software. Results showed only one ambulance service had complete equipment in accordance to international standards. In term of utilisation of life support equipment, oxygen delivery devices were used in 493 (45.86%) runs. The most used devices in immobilisation and haemorrhage control were:- (a) scoop stretcher in 321 (29.86%) runs, (b) wound dressings in 250 (23.26%) runs and (c) rigid spinal board in 206 (19.16%) runs. Two-way radios were used in 745 (69.30%) runs while mobile phones were used in 429 (39.91%) runs. In conclusion, ambulances in Klang Valley had a large variation in the availability of life support devices. This emphasizes a need for standardization of equipment.

A randomized, controlled comparison of home versus institutional rehabilitation of patients with hip fracture.

PubMed

Kuisma, Raija

2002-08-01

To compare ambulation outcomes between home and institutional rehabilitation of patients with hip fracture. Randomized controlled clinical equivalence trial. The Queen Elizabeth Hospital in Hong Kong. Eighty-one patients with hip fracture. Study group patients (40) were discharged directly home from the acute hospital and visited by a physiotherapist an average of 4.6 times. The control group subjects (41) were discharged to a rehabilitation centre for further treatment lasting on average 36.2 days (SD 14.6) and they received physiotherapy daily. Ambulation ability measured on a categorical scale. The mean age of the subjects was 75 years (SD 8.3 years). Females comprised 60% of all the subjects and majority were retired or home makers. Both groups of patients improved in their ambulation ability during their rehabilitation period but neither group achieved their pre-ambulatory status by the time of completion of the study. The study group achieved significantly higher ambulation scores (p < 0.05) for community and household ambulation compared with the control group by the end of the study, a year after operation. Five visits by a physiotherapist in the patient's home after discharge from an acute hospital after surgical treatment for hip fracture yielded better results in ambulation ability than one month of conventional institution-based rehabilitation.

Air ambulance nurses as expert supplement to local emergency services.

PubMed

Wisborg, Torben; Bjerkan, Bjørn

2014-01-01

Flight nurses in the Norwegian National Air Ambulance Service are specialist nurse anesthetists or intensive care nursing specialists. For air ambulance bases far from hospitals, these nurses present otherwise unavailable competencies. This study reports a 6-year experience with flight nurse participation in local emergencies beyond the transportation phase. The fixed-wing air ambulance base in Alta, Northern Norway (20,000 inhabitants), with 2 aircraft and 2 on-call teams is 150 km by road from the nearest hospital. We did a prospective registration of all emergency nonflight missions near the air ambulance base from January 1, 2005, to December 31, 2010. The 217 completed missions corresponded to 3 missions per month, half during daytime. Twenty-three percent of patients were under age 18, injury rate was high (36%), 63% had potentially or manifest life-threatening conditions, and 11% died during treatment. One third of all missions (67/217) resulted in an air ambulance flight to the hospital. Mission frequency did not significantly reduce flight availability, and precision in case selection for this special service was good. The use of flight nurses in the local community promotes equal access to advanced medical services for populations far from hospitals. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Prevalence of PTSD and common mental disorders amongst ambulance personnel: a systematic review and meta-analysis.

PubMed

Petrie, Katherine; Milligan-Saville, Josie; Gayed, Aimée; Deady, Mark; Phelps, Andrea; Dell, Lisa; Forbes, David; Bryant, Richard A; Calvo, Rafael A; Glozier, Nicholas; Harvey, Samuel B

2018-06-05

There is increasing concern regarding the mental health impact of first responder work, with some reports suggesting ambulance personnel may be at particularly high risk. Through this systematic review and meta-analysis we aimed to determine the prevalence of mental health conditions among ambulance personnel worldwide. A systematic search and screening process was conducted to identify studies for inclusion in the review. To be eligible, studies had to report original quantitative data on the prevalence of at least one of the following mental health outcome(s) of interest (PTSD, depression, anxiety, general psychological distress) for ambulance personnel samples. Quality of the studies was assessed using a validated methodological rating tool. Random effects modelling was used to estimate pooled prevalence, as well as subgroup analyses and meta-regressions for five variables implicated in heterogeneity. In total, 941 articles were identified across all sources, with 95 full-text articles screened to confirm eligibility. Of these, 27 studies were included in the systematic review, reporting on a total of 30,878 ambulance personnel. A total of 18 studies provided necessary quantitative information and were retained for entry in the meta-analysis. The results demonstrated estimated prevalence rates of 11% for PTSD, 15% for depression, 15% for anxiety, and 27% for general psychological distress amongst ambulance personnel, with date of data collection a significant influence upon observed heterogeneity. Ambulance personnel worldwide have a prevalence of PTSD considerably higher than rates seen in the general population, although there is some evidence that rates of PTSD may have decreased over recent decades.

Berg Balance Scale score at admission can predict walking suitable for community ambulation at discharge from inpatient stroke rehabilitation.

PubMed

Louie, Dennis R; Eng, Janice J

2018-01-10

This retrospective cohort study identified inpatient rehabilitation admission variables that predict walking ability at discharge and established Berg Balance Scale cut-off scores to predict the extent of improvement in walking. Participants (n=123) were assessed for various cognitive and physical outcomes at admission to inpatient stroke rehabilitation. Multivariate logistic regression identified admission predictors of regaining community ambulation (gait speed ≥0.8 m/s) or unassisted ambulation (no physical assistance) after 4 weeks. Receiver operating characteristic curve analysis identified cut-off admission Berg Balance Scale scores. Mini-Mental State Examination (odds ratio (OR) 1.60, 95% confidence interval (95% CI) 1.19-2.14) was a significant predictor when coupled with admission walking speed for regaining community ambulation speed; stroke type (haemorrhagic/ischaemic) was a significant predictor (OR=0.19, 95% CI 0.05-0.77) when coupled with Berg Balance Scale (OR 1.14, 95% CI 1.09-1.20). Only Berg Balance Scale was a significant predictor of regaining unassisted ambulation (OR 1.11, 95% CI 1.05-1.17). A cut-off Berg Balance Scale score of 29 on admission predicts that an individual will go on to achieve community walking speed (n=123, area under the curve (AUC)=0.88, 95% CI 0.81-0.95); a cut-off score of 12 predicts a non-ambulator to regain unassisted ambulation (n=84, AUC 0.73, 95% CI 0.62-0.84). The Berg Balance Scale can be used at rehabilitation admission to predict the degree of improvement in walking for patients with stroke.

Antenatal Emergency Care Provided by Paramedics: A One-Year Clinical Profile.

PubMed

McLelland, Gayle; McKenna, Lisa; Morgans, Amee; Smith, Karen

2016-01-01

To report on clinical and socio-demographic factors of a one-year caseload of women attended by a statewide ambulance service in Australia, who presented during pregnancy, prior to the commencement of labor. Retrospective clinical data collected via in-field electronic patient care record (VACIS®) by paramedics during clinical management was provided by Ambulance Victoria. Cases were electronically extracted from the Ambulance Victoria Clinical Data Warehouse via comprehensive filtering followed by case review. Over a 12-month period, paramedics were called to 2,098 women with pregnancy as a primary or non-primary clinical consideration. Women's ages ranged from 14 to 48 years. The majority were multigravidas (86%). There was a greater chance that ambulance services would be required during business hours than any other time of the day. Paramedics noted pregnant women required ambulance services for a range of primary presenting symptoms both obstetric (n = 1137) and non-obstetric (n = 961). Some women had pre-existing conditions including asthma, hypertension, and diabetes potentially complicating their pregnancies. Paramedics administered analgesia to one third of the women. Paired t-tests revealed significant improvement in the pain relief and overall vital signs of the women encountered. Less than half the women (n = 986, 47%) required interventions. This is a unique population wide analysis of ambulance service resource use exploring the clinical profile of pregnant women requiring ambulance services in one calendar year. To manage obstetric and non-obstetric complications in this population safely and effectively, paramedics require an understanding of the unique physiological adaptions during pregnancy. This study therefore has both educational and practice implications.

Simulation-based decision support framework for dynamic ambulance redeployment in Singapore.

PubMed

Lam, Sean Shao Wei; Ng, Clarence Boon Liang; Nguyen, Francis Ngoc Hoang Long; Ng, Yih Yng; Ong, Marcus Eng Hock

2017-10-01

Dynamic ambulance redeployment policies tend to introduce much more flexibilities in improving ambulance resource allocation by capitalizing on the definite geospatial-temporal variations in ambulance demand patterns over the time-of-the-day and day-of-the-week effects. A novel modelling framework based on the Approximate Dynamic Programming (ADP) approach leveraging on a Discrete Events Simulation (DES) model for dynamic ambulance redeployment in Singapore is proposed in this paper. The study was based on the Singapore's national Emergency Medical Services (EMS) system. Based on a dataset comprising 216,973 valid incidents over a continuous two-years study period from 1 January 2011-31 December 2012, a DES model for the EMS system was developed. An ADP model based on linear value function approximations was then evaluated using the DES model via the temporal difference (TD) learning family of algorithms. The objective of the ADP model is to derive approximate optimal dynamic redeployment policies based on the primary outcome of ambulance coverage. Considering an 8min response time threshold, an estimated 5% reduction in the proportion of calls that cannot be reached within the threshold (equivalent to approximately 8000 dispatches) was observed from the computational experiments. The study also revealed that the redeployment policies which are restricted within the same operational division could potentially result in a more promising response time performance. Furthermore, the best policy involved the combination of redeploying ambulances whenever they are released from service and that of relocating ambulances that are idle in bases. This study demonstrated the successful application of an approximate modelling framework based on ADP that leverages upon a detailed DES model of the Singapore's EMS system to generate approximate optimal dynamic redeployment plans. Various policies and scenarios relevant to the Singapore EMS system were evaluated. Copyright © 2017 Elsevier B.V. All rights reserved.

Assessing the effectiveness of routine use of post-operative in-patient physical therapy services.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Vuong, Victoria D; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-06-01

The association between functional decline occurring with prolonged bed rest after surgery is well-known. Immediate in-patient post-operative ambulation with the physical therapy (PT) service has been reported to improve pain and disability, while decreasing the incidence of perioperative complications. Whether formal PT evaluation prior to hospital discharge leads to improved ambulation (number of steps ambulated), shorter duration of hospital stay and lower peri-operative complications compared to nurse-assisted ambulation protocols remain unknown. The medical records of 274 patients (No PT: n=87, PT: n=187) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized based on whether PT services were delivered during the post-operative in-patient stay. Patient demographics, comorbidities, and post-operative complication rates were collected and compared. Ambulation status and the number of steps ambulated were recorded. Baseline characteristics were similar in both cohorts. Operative variables were similar between both cohorts, with no significant difference in operative time, estimated blood loss (EBL), and number of fusion levels. Peri-operative complication rates were similar between the cohorts. Compared to patients in the nurse-assisted ambulation cohort (No PT), patients in the PT cohort had a longer duration of hospital stay (4.17 vs. 3.39 days, P=0.15). 30-day readmission rates, although higher in the PT cohort, was not statistically significantly different (PT 6.57% vs. No PT: 2.30%, P=0.13). Our study suggests that the routine use of the PT services compared to nurse-assisted ambulation programs is associated with a modest increase in the duration of hospital stay without any significant reduction in peri-operative complications profile. In a health conscious healthcare climate, appropriate screening mechanisms and risk stratification should be performed to optimize utilization of post-operative in-patient PT services.

Neighborhood Poverty and 9-1-1 Ambulance Contacts.

PubMed

Seim, Josh; English, Joshua; Sporer, Karl

2017-01-01

Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories. For each model, we estimated the incident rate ratios for 10 percentage point increases in tract-level poverty while controlling for geographic patterns in race, citizenship, gender, age, emergency department proximity, population density, and population size. Our study produced three major findings. First, tract-level poverty was positively associated with ambulance contacts (incident rate ratio [IRR] 1.45; 95% confidence interval [CI] 1.34 to 1.57). Second, poverty was positively associated with low severity contacts (IRR 1.48; 95% CI 1.35 to 1.61), medium severity contacts (IRR 1.38; 95% CI 1.28 to 1.49), and high severity contacts (IRR 1.40; 95% CI 1.30 to 1.51). Third, poverty was positively associated with 12 primary impression categories: abdominal (IRR 1.48; 95% CI 1.36 to 1.61), altered level of consciousness (IRR 1.37; 95% CI 1.25 to 1.50), cardiac (IRR 1.28; 95% CI 1.14 to 1.42), overdose/intoxication (IRR 1.59; 95% CI 1.40 to 1.81), pain (IRR 1.56; 95% CI 1.41 to 1.73), psych/behavioral (IRR 1.50; 95% CI 1.34 to 1.67), respiratory (IRR 1.42; 95% CI 1.29 to 1.56) seizure (IRR 1.52; 95% CI 1.38 to 1.68), stroke (IRR 1.14; 95% CI 1.01 to 1.28), syncope/near syncope (IRR 1.23; 95% CI 1.12 to 1.36), trauma (IRR 1.44; 95% CI 1.31 to 1.58), and general weakness (IRR 1.31; 95% CI 1.20 to 1.42). Our study suggests poverty is a positive, strong, and enduring predictor of ambulance contacts at the neighborhood level. The relationship between neighborhood poverty and ambulance utilization should be considered at multiple levels of EMS decision making.

Point prevalence of suboptimal footwear features among ambulant older hospital patients: implications for fall prevention.

PubMed

Chari, Satyan R; McRae, Prue; Stewart, Matthew J; Webster, Joan; Fenn, Mary; Haines, Terry P

2016-09-01

Objective The aim of the present study was to establish the point prevalence of 'suboptimal' features in footwear reported to have been used by older hospital patients when ambulating, and to explore underpinning factors for their choice of footwear. Method A cross-sectional investigation was undertaken on 95 of 149 eligible in-patients across 22 high fall-risk wards in a large metropolitan hospital in Brisbane, Australia. Results Over 70% of participants experienced an unplanned admission. Although most participants had access to some form of footwear in hospital (92%), nearly all reported ambulating in footwear with 'suboptimal' features (99%). Examples included slippers (27%), backless slippers (16%) or bare feet (27%). For patients who ambulated in bare feet, only one-third reported 'lack of access to footwear' as the primary cause, with others citing foot wounds, pain, oedema and personal choice as the main reason for bare foot ambulation. Conclusions Admitted patients frequently use footwear with 'suboptimal' features for ambulation in hospital. While some footwear options (for example well-fitting slippers) could be suited for limited in-hospital ambulation, others are clearly hazardous and might cause falls. Since footwear choices are influenced by multiple factors in this population, footwear education strategies alone may be insufficient to address the problem of hazardous footwear in at-risk patients. Footwear requirements may be more effectively addressed within a multidisciplinary team approach encompassing foot health, mobility and safety. What is known about the topic? Accidental falls while ambulating are an important health and safety concern for older people. Because certain footwear characteristics have been negatively linked to posture and balance, and specific footwear types linked to falls among seniors, the use of footwear with fewer suboptimal characteristics is generally recommended as a means of reducing the risk of falling. While footwear usage and choices have been explored in older people in the community and in residential care settings, there is little comparable data on acutely unwell older hospital patients. What does this paper add? This paper provides prevalence data on the use of footwear with suboptimal characteristics among ambulant older hospital patients, and identifies concurrent factors that may be relevant to patient footwear choices. What are the implications for practitioners? Pain, foot pathology and a desire to retain independence are important concerns for hospitalised patients and are likely to influence their choice of footwear used to ambulate with. Pragmatic team-based approaches that remain sensitive to key patient concerns may be more successful in optimising patient footwear usage than footwear education strategies alone.

Continuous femoral nerve block using 0.125% bupivacaine does not prevent early ambulation after total knee arthroplasty.

PubMed

Beebe, Michael J; Allen, Rachel; Anderson, Mike B; Swenson, Jeffrey D; Peters, Christopher L

2014-05-01

Continuous femoral nerve block has been shown to decrease opioid use, improve postoperative pain scores, and decrease length of stay. However, several studies have raised the concern that continuous femoral nerve block may delay patient ambulation and increase the risk of falls during the postoperative period. This study sought to determine whether continuous femoral nerve block with a single-shot sciatic block prevented early ambulation after total knee arthroplasty (TKA) and whether the technique was associated with adverse effects. Between January 2011 and January 2013, 77 consecutive patients undergoing primary TKAs at an orthopaedic specialty hospital received a continuous femoral nerve block for perioperative analgesia. The femoral block was placed preoperatively with an initial bolus and 76 (99%) patients received a single-shot sciatic nerve block performed at the same time. Fifty-eight percent (n = 45) received an initial bolus of 0.125% bupivacaine and 42% (n = 32) received 0.25% bupivacaine. All 77 patients received 0.125% bupivacaine infusion postoperatively with the continuous femoral nerve block. All patients were provided a knee immobilizer that was worn while they were out of bed and was used until 24 hours after removal of the block. All patients also used a front-wheeled walker to assist with ambulation. All 77 patients had complete records for assessing the end points of interest in this retrospective case series, including distance ambulated each day and whether in-hospital complications could be attributed to the patients' nerve blocks. Thirty-five patients (45%) ambulated for a mean distance of 19 ± 22 feet on the day of surgery. On postoperative Days 1 and 2, all 77 patients successfully ambulated a mean of 160 ± 112 and 205 ± 123 feet, respectively. Forty-eight patients (62%) had documentation of ascending/descending stairs during their hospital stay. No patient fell during the postoperative period, required return to the operating room, or readmission within 90 days of surgery. One patient experienced a transient foot drop related to the sciatic nerve block, which resolved by postoperative Day 1. Continuous femoral nerve block with dilute bupivacaine (0.125%) can be successfully used after TKA without preventing early ambulation. By taking active steps to prevent in-hospital falls, including the use of a knee immobilizer for ambulation while the block is in effect, patients can benefit from the analgesia provided by the block and still ambulate early after TKA. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Mobile phone technology identifies and recruits trained citizens to perform CPR on out-of-hospital cardiac arrest victims prior to ambulance arrival.

PubMed

Ringh, Mattias; Fredman, David; Nordberg, Per; Stark, Tomas; Hollenberg, Jacob

2011-12-01

In a two-parted study, evaluate a new concept were mobile phone technology is used to dispatch lay responders to nearby out-of-hospital cardiac arrests (OHCAs). Mobile phone positioning systems (MPS) can geographically locate selected mobile phone users at any given moment. A mobile phone service using MPS was developed and named Mobile Life Saver (MLS). Simulation study: 25 volunteers named mobile responders (MRs) were connected to MLS. Ambulance time intervals from 22 consecutive OHCAs in 2005 were used as controls. The MRs randomly moved in Stockholm city centre and were dispatched to simulated OHCAs (identical to controls) if they were within a 350 m distance. Real life study: during 25 weeks 1271-1801 MRs trained in CPR were connected to MLS. MLS was activated at the dispatch centre in parallel with ambulance dispatch when an OHCA was suspected. The MRs were dispatched if they were within 500 m from the suspected OHCA. Simulation study: mean response time for the MRs compared to historical ambulance time intervals was reduced by 2 min 20s (44%), p<0.001, (95% CI, 1 min 5s - 3 min 35s). The MRs reached the simulated OHCA prior to the historical control in 72% of cases. Real life study: the MLS was triggered 92 times. In 45% of all suspected and in 56% of all true OHCAs the MRs arrived prior to ambulance. CPR was performed by MRs in 17% of all true OHCAs and in 30% of all true OHCAs if MRs arrived prior to ambulance. Mobile phone technology can be used to identify and recruit nearby CPR-trained citizens to OHCAs for bystander CPR prior to ambulance arrival. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Air ambulance tasking: mechanism of injury, telephone interrogation or ambulance crew assessment?

PubMed

Wilmer, Ian; Chalk, Graham; Davies, Gareth Edward; Weaver, Anne Elizabeth; Lockey, David John

2015-10-01

The identification of serious injury is critical to the tasking of air ambulances. London's Air Ambulance (LAA) is dispatched by a flight paramedic based on mechanism of injury (MOI), paramedical interrogation of caller (INT) or land ambulance crew request (REQ).This study aimed to demonstrate which of the dispatch methods was most effective (in accuracy and time) in identifying patients with serious injury. A retrospective review of 3 years of data (to December 2010) was undertaken. Appropriate dispatch was defined as the requirement for LAA to escort the patient to hospital or for resuscitation on-scene. Inaccurate dispatch was where LAA was cancelled or left the patient in the care of the land ambulance crew. The χ(2) test was used to calculate p values; with significance adjusted to account for multiple testing. There were 2203 helicopter activations analysed: MOI 18.9% (n=417), INT 62.4% (n=1375) and REQ 18.7% (n=411). Appropriate dispatch rates were MOI 58.7% (245/417), INT 69.7% (959/1375) and REQ 72.2% (297/411). INT and REQ were both significantly more accurate than MOI (p<0.0001). There was no significant difference in accuracy between INT and REQ (p=0.36). Combining MOI and INT remotely identified 80.2% of patients, with an overtriage rate of 32.8%. Mean time to dispatch (in minutes) was MOI 4, INT 8 and REQ 21. Telephone interrogation of the caller by a flight paramedic is as accurate as ground ambulance crew requests, and both are significantly better than MOI in identifying serious injury. Overtriage remains an issue with all methods. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

A Stabilization Device That Promotes the Efficiency of Cardiopulmonary Resuscitation during Ambulance Transportation to the Level as under Non-Moving Conditions

PubMed Central

Foo, Ning-Ping; Chang, Jer-Hao; Su, Shih-Bin; Chen, Kow-Tong; Cheng, Ching-Fa; Chen, Pei-Chung

2014-01-01

Background The survival rate of patients with out-of-hospital cardiac arrest is low, and measures to improve the quality of cardiopulmonary resuscitation (CPR) during ambulance transportation are desirable. We designed a stabilization device, and in a randomized crossover trial we found performing CPR in a moving ambulance with the device (MD) could achieve better efficiency than that without the device (MND), but the efficiency was lower than that in a non-moving ambulance (NM). Purpose To evaluate whether a modified version of the stabilization device, can promote further the quality of CPR during ambulance transportation. Methods Participants of the previous study were recruited, and they performed CPR for 10 minutes in a moving ambulance with the modified version of the stabilization device (MVSD). The primary outcomes were effective chest compressions and no-flow fraction recorded by a skill-reporter manikin. The secondary outcomes included back pain, physiological parameters, and the participants' rating about the device after performing CPR. Results The overall effective compressions in 10 minutes were 86.4±17.5% for NM, 60.9±14.6% for MND, 69.7±22.4% for MD, and 86.6%±13.2% for MVSD (p<0.001). Whereas changes in back pain severity and physiology parameters were similar under all conditions, MVSD had the lowest no-flow fraction. Differences in effective compressions and the no-flow fraction between MVSD and NM did not reach statistical significance. Conclusions The use of the modified device can improve quality of CPR in a moving ambulance to a level similar to that in a non-moving condition without increasing the severity of back pain. PMID:25329643

Patients' experiences of cold exposure during ambulance care.

PubMed

Aléx, Jonas; Karlsson, Stig; Saveman, Britt-Inger

2013-06-06

Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients' experiences of cold exposure and to identify related factors. During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients' finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from -22.3°C to 8.4°C. Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons.

Alcohol intoxication in the context of major public holidays, sporting and social events: a time-series analysis in Melbourne, Australia, 2000-2009.

PubMed

Lloyd, Belinda; Matthews, Sharon; Livingston, Michael; Jayasekara, Harindra; Smith, Karen

2013-04-01

To assess the relationship between ambulance attendances, emergency department (ED) presentations and hospital admissions for acute alcohol intoxication and the timing of public holidays, sporting and social events. Time-series analysis was used to explore trends in intoxication in the context of major events. Population of Melbourne, Victoria, Australia between 2000 and 2009. All patients attended by ambulance, presenting to hospital EDs, or admitted to hospital who were classified as acutely alcohol intoxicated. Analysis of daily numbers of presentations for acute alcohol intoxication associated with major events were undertaken, including lead and lag effects. Analyses controlled for day of week and month of year to address temporal and seasonal variations. Alcohol intoxication presentations were significantly elevated the day before all public holidays, with intoxication cases on the day of public holidays only higher on New Year's Day (ambulance 6.57, 95% confidence intervals (CI): 3.4-9.74; ED 3.34, 95% CI: 1.28-5.4) and ANZAC Day (ambulance 3.71, 95% CI: 0.68-6.75). The Australian Football League (AFL) Grand Final (ED 2.37, 95% CI: 0.55-4.19), Commonwealth Games (ED 2.45, 95% CI: 0.6-4.3) and Melbourne Cup Day (ambulance 6.14, 95% CI: 2.42-9.85) represented the sporting events with significant elevations in acute intoxication requiring medical attention. The last working day before Christmas was the only social event where a significant increase in acute intoxication occurred (ambulance 8.98, 95% CI: 6.8-11.15). Acute alcohol intoxication cases requiring ambulance, emergency department and hospital in-patient treatment increase substantially on the day preceding public holidays and other major social events. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Telestroke ambulances in prehospital stroke management: concept and pilot feasibility study.

PubMed

Liman, Thomas G; Winter, Benjamin; Waldschmidt, Carolin; Zerbe, Norman; Hufnagl, Peter; Audebert, Heinrich J; Endres, Matthias

2012-08-01

Pre- and intrahospital time delays are major concerns in acute stroke care. Telemedicine-equipped ambulances may improve time management and identify patients with stroke eligible for thrombolysis by an early prehospital stroke diagnosis. The aims of this study were (1) to develop a telestroke ambulance prototype; (2) to test the reliability of stroke severity assessment; and (3) to evaluate its feasibility in the prehospital emergency setting. Mobil, real-time audio-video streaming telemedicine devices were implemented into advanced life support ambulances. Feasibility of telestroke ambulances and reliability of the National Institutes of Health Stroke Scale assessment were tested using current wireless cellular communication technology (third generation) in a prehospital stroke scenario. Two stroke actors were trained in simulation of differing right and left middle cerebral artery stroke syndromes. National Institutes of Health Stroke Scale assessment was performed by a hospital-based stroke physician by telemedicine, by an emergency physician guided by telemedicine, and "a posteriori" on the basis of video documentation. In 18 of 30 scenarios, National Institutes of Health Stroke Scale assessment could not be performed due to absence or loss of audio-video signal. In the remaining 12 completed scenarios, interrater agreement of National Institutes of Health Stroke Scale examination between ambulance and hospital and ambulance and "a posteriori" video evaluation was moderate to good with weighted κ values of 0.69 (95% CI, 0.51-0.87) and 0.79 (95% CI, 0.59-0.98), respectively. Prehospital telestroke examination was not at an acceptable level for clinical use, at least on the basis of the used technology. Further technical development is needed before telestroke is applicable for prehospital stroke management during patient transport.

Open-field temporal pattern of ambulation in Japanese quail genetically selected for contrasting adrenocortical responsiveness to brief manual restraint.

PubMed

Kembro, J M; Satterlee, D G; Schmidt, J B; Perillo, M A; Marin, R H

2008-11-01

Japanese quail selected for a low-stress (LS), rather than a high-stress (HS), plasma corticosterone response to brief restraint have been shown to possess lower fearfulness and a nonspecific reduction in stress responsiveness. Detrended fluctuation analysis provides information on the organization and complexity of temporal patterns of behavior. The present study evaluated the temporal pattern of ambulation of LS and HS quail in an open field that represented a novel environment. Time series of 4,200 data points were collected for each bird by registering the distance ambulated every 0.5 s during a 35-min test period. Consistent with their known reduced fearfulness, the LS quail initiated ambulation significantly sooner (P < 0.02) and tended to ambulate more (P < 0.09) than did their HS counterparts. Detrended fluctuation analyses showed a monofractal series (i.e., a series with similar complexity at different temporal scales) in 72% of the birds. These birds initiated their ambulatory activity in less than 600 s. Among these birds, a lower (P < 0.03) autosimilarity coefficient (alpha) was found in the LS quail than in their HS counterparts (alpha = 0.76 +/- 0.03 and 0.87 +/- 0.03, respectively), suggesting a more complex (less regular) ambulatory pattern in the LS quail. However, when the patterns of ambulation were reexamined by considering only the active period of the time series (i.e., after the birds had initiated their ambulatory activity), monofractal patterns were observed in 97% of the birds, and no differences were found between the lines. Collectively, the results suggest that during the active period of open-field testing, during which fear responses are likely less strong and other motivations are the driving forces of ambulation, the LS and HS lines have similar ambulatory organization.

Detection and Measurement of Unhealthy, Environment-Derived Aerosol Materials in an Emergency Department.

PubMed

Choi, Bryan Y; Kobayashi, Leo; Pathania, Shivany; Miller, Courtney B; Locke, Emma R; Stearns, Branden C; Hudepohl, Nathan J; Patefield, Scott S; Suner, Selim; Williams, Kenneth A; Machan, Jason T; Jay, Gregory D

2015-01-01

To measure unhealthy aerosol materials in an Emergency Department (ED) and identify their sources for mitigation efforts. Based on pilot findings of elevated ED particulate matter (PM) levels, investigators hypothesized that unhealthy aerosol materials derive from exogenous (vehicular) sources at ambulance receiving entrances. The Aerosol Environmental Toxicity in Healthcare-related Exposure and Risk program was conducted as an observational study. Calibrated sensors monitored PM and toxic gases at Ambulance Triage Exterior (ATE), Ambulance Triage Desk (ATD), and control Public Triage Desk (PTD) on a 3/3/3-day cycle. Cassette sampling characterized PM; meteorological and ambulance traffic data were logged. Descriptive and multiple linear regression analyses assessed for interactions between aerosol material levels, location, temporal variables, ambulance activity, and meteorological factors. Sensors acquired 93,682 PM0.3, 90,250 PM2.5, and 93,768 PM5 measurements over 366 days to generate a data set representing at least 85.6% of planned measurements. PM0.3, PM2.5, and PM5 mean counts were lowest in PTD; 56%, 224%, and 223% higher in ATD; and 996%, 200%, and 63% higher in ATE, respectively (all p < .001). Qualitative analyses showed similar PM compositions in ATD and ATE. On multiple linear regression analysis, PM0.3 counts correlated primarily with location; PM2.5 and PM5 counts correlated most strongly with location and ambulance presence. PM < 2.5 and toxic gas concentrations at ATD and PTD patient care areas did not exceed hazard levels; PM0.3 counts did not have formal safety thresholds for comparison. Higher levels of PM were linked with ED ambulance areas, although their health impact is unclear. © The Author(s) 2015.

A stabilization device that promotes the efficiency of cardiopulmonary resuscitation during ambulance transportation to the level as under non-moving conditions.

PubMed

Foo, Ning-Ping; Chang, Jer-Hao; Su, Shih-Bin; Chen, Kow-Tong; Cheng, Ching-Fa; Chen, Pei-Chung; Lin, Tsung-Yi; Guo, How-Ran

2014-01-01

The survival rate of patients with out-of-hospital cardiac arrest is low, and measures to improve the quality of cardiopulmonary resuscitation (CPR) during ambulance transportation are desirable. We designed a stabilization device, and in a randomized crossover trial we found performing CPR in a moving ambulance with the device (MD) could achieve better efficiency than that without the device (MND), but the efficiency was lower than that in a non-moving ambulance (NM). To evaluate whether a modified version of the stabilization device, can promote further the quality of CPR during ambulance transportation. Participants of the previous study were recruited, and they performed CPR for 10 minutes in a moving ambulance with the modified version of the stabilization device (MVSD). The primary outcomes were effective chest compressions and no-flow fraction recorded by a skill-reporter manikin. The secondary outcomes included back pain, physiological parameters, and the participants' rating about the device after performing CPR. The overall effective compressions in 10 minutes were 86.4±17.5% for NM, 60.9±14.6% for MND, 69.7±22.4% for MD, and 86.6%±13.2% for MVSD (p<0.001). Whereas changes in back pain severity and physiology parameters were similar under all conditions, MVSD had the lowest no-flow fraction. Differences in effective compressions and the no-flow fraction between MVSD and NM did not reach statistical significance. The use of the modified device can improve quality of CPR in a moving ambulance to a level similar to that in a non-moving condition without increasing the severity of back pain.

Call selection for the Helicopter Emergency Medical Service: implications for ambulance control.

PubMed Central

Coats, T J; Newton, A

1994-01-01

The increasing sophistication of pre-hospital care, with paramedics and many types of 'rapid response' units, requires the use of advanced systems of ambulance control. The introduction of call selection by a paramedic in the ambulance control room significantly improved the tasking of the Helicopter Emergency Medical Service. This paper illustrates the need for a system to grade 999 calls, so that the appropriate pre-hospital response can be directed to each patient. PMID:8182675

Demand for Emergency Services Trends in New South Wales Years 2010-2014 (DESTINY): Age and Clinical Factors Associated with Ambulance Transportation to Emergency Departments.

PubMed

Dinh, Michael M; Muecke, Sandy; Berendsen Russell, Saartje; Chalkley, Dane; Bein, Kendall J; Muscatello, David; Nagaraj, Guruprasad; Paoloni, Richard; Ivers, Rebecca

2016-01-01

The study aimed to analyze ambulance transportations to Emergency Departments (EDs) in New South Wales (NSW) and to identify temporal changes in demographics, acuity, and clinical diagnoses. This was a retrospective analysis of a population based registry of ED presentations in New South Wales. The NSW Emergency Department data collection (EDCC) collects patient level data on presentations to designated EDs across NSW. Patients that presented to EDs by ambulance between January 2010 and December 2014 were included. Patients dead on arrival, transferred from another hospital, or planned ED presentations were excluded. A total of 10.8 million ED attendances were identified of which 2.6 million (23%) were transported to ED by ambulance. The crude rate of ambulance transportations to EDs across all ages increased by 3.0% per annum over the five years with the highest rate observed in those 85 years and over (620.5 presentations per 1,000 population). There was an increase in the proportion of category 1 and 2 (life-threatening or potentially life-threatening) cases from 18.1% to 24.0%. Demand for ambulance services appears to be driven by older patients presenting with higher acuity problems. Alternative models of acute care for elderly patients need to be planned and implemented to address these changes.

Effect of Functional Status on the Quality of Bowel Preparation in Elderly Patients Undergoing Screening and Surveillance Colonoscopy

PubMed Central

Kumar, Akash; Lin, Lisa; Bernheim, Oren; Bagiella, Emilia; Jandorf, Lina; Itzkowitz, Steven H.; Shah, Brijen J.

2016-01-01

Background/Aims Optimal bowel preparation is essential for successful screening or for surveillance colonoscopy (SC). Inadequate bowel preparation is associated with older age, the male gender, and the presence of certain comorbidities. However, the association between patients’ functional status and bowel preparation quality has not been studied. We prospectively examined the relationship between functional status, namely, the ability to perform activities of daily living (ADLs) and ambulate, and the quality of bowel preparation in elderly patients undergoing SC. Methods Before undergoing SC, 88 elderly patients were surveyed regarding their functional status, specifically regarding their ability to perform ADLs and ambulate a quarter of a mile. Gastroenterologists then determined the quality of the bowel preparation, which was classified as either adequate or inadequate. Then, the frequency of inadequate bowel preparation in patients who did or did not experience difficulty performing ADLs and ambulating was calculated. Results Difficulty ambulating (unadjusted odds ratio [OR], 4.83; p<0.001), difficulty performing ADLs (OR, 2.93; p=0.001), and history of diabetes (OR, 2.88; p=0.007) were significant univariate predictors of inadequate bowel preparation. After adjusting for the above variables, only difficulty ambulating (adjusted OR, 5.78; p=0.004) was an independent predictor of inadequate bowel preparation. Conclusions Difficulty with ambulation is a strong predictor of inadequate bowel preparation in elderly patients undergoing SC. PMID:27021501

In the line of duty: a study of ambulance drivers during the 2010 conflict in Kashmir.

PubMed

Dhar, Shabir Ahmed; Dar, Tahir Ahmed; Wani, Sharief Ahmed; Hussain, Shahid; Dar, Reyaz Ahmed; Wani, Zaid Ahmed; Aazad, Shah; Yaqoob, Suhail; Mansoor, Imtiyaz; Ali, Murtaza Fazal; Ahmed, Muzaffar; Mumtaz, Imran; Azhar, Idrees

2012-08-01

The purpose of this study was to identify the problems faced by ambulance drivers working in a conflict zone. This study was conducted on ambulance drivers working for the four major hospitals in Kashmir, India. The drivers were interviewed and asked a series of 30 work-related questions. The individual interviews were conducted over a three-month period in the valley of Kashmir that was affected by continuous violence, strict curfew, and strikes. A total of 35 ambulance drivers were interviewed. Drivers worked an average of 60 h/wk, and they drove an average of 160 km/d. Twenty-nine (83%) of the drivers experienced >1 threat of physical harm; 18 (54%) experienced physical assaults; and 31 (89%) reported evidence of psychological morbidity associated with their jobs. The atmosphere of conflict on the streets of Kashmir impacted the ambulance drivers adversely, both physically as well as mentally. The stress faced by these professionals in conflict zones during their duty hours should be recognized, and corrective measures must be put in place.

Day-to-day consistency of lower extremity kinematics during stair ambulation in 24-45 years old athletes.

PubMed

Husa-Russell, Johanna; Ukelo, Thomas; List, Renate; Lorenzetti, Silvio; Wolf, Peter

2011-04-01

Before making interpretations on the effects of interventions or on the features of pathological gait patterns during stair ambulation, the day-to-day consistency of the investigated variables must be established. In this article, the day-to-day consistency was determined for kinematic variables during barefoot stair ambulation. Ten healthy athletes performed two gait analysis sessions, at least one week apart, utilizing a marker set of 47 skin markers, and a functional joint center/axes determination. Being found on limits of agreement and mean differences between the repeated stair ambulation sessions, totally 43 ranges of motions were examined at the hip, knee, ankle, and midfoot joints. The day-to-day consistency was generally in the magnitude of three degrees, irrespective of test condition, investigated joint, or regarded cardinal body plane. The reported values of the day-to-day consistency provide guidelines to distinguish between pathological and healthy gait patterns, and thresholds to determine minimal effects of interventions during stair ambulation. Copyright © 2011 Elsevier B.V. All rights reserved.

[An ambulance helicopter in Jamtland. A survival necessity in a county of tourism].

PubMed

Ek, B; Zetterström, H

2000-03-22

The county of Jämtland is a sparsely populated area in which an ambulance-helicopter has been in use since the middle of the 1970's. A prospective study was undertaken during a six month period with the aim of evaluating the benefits of the helicopter as compared with the use of road-ambulance transport alone. Total number of patients involved was n = 249. Both flight nurses and receiving doctors found that in most cases, patients transported by helicopter manned with a flight nurse were given higher quality care. A follow-up study by specialists from the receiving departments confirmed that for 3% (n = 8), transport by ambulance-helicopter resulted in "probably better prognosis", and that for 2% (n = 6) the result was "lifesaving".

Venous Gas Emboli and Ambulation at 4.3 PSIA (Preliminary)

NASA Technical Reports Server (NTRS)

Conkin, J.; Pollock, N. W.; Natoli, M. J.; Martina, S. D.; Wessel, J. H., III; Gernhardt, M. L.

2016-01-01

Ambulation imparts compressive and decompressive forces into the lower body, potentially creating quasi-stable micronuclei that influence the outcome of hypobaric depressurizations. Hypotheses: ambulation before the conclusion of a denitrogenation (prebreathe) protocol at 14.7 pounds per square inch absolute is not sufficient to increase the incidence of venous gas emboli (VGE) at 4.3 pounds per square inch absolute but is sufficient if performed after tissues become supersaturated with nitrogen at 4.3 pounds per square inch absolute.

Design considerations to enhance the safety of patient compartments in ambulance transporters.

PubMed

Byran, Eyal; Gilad, Issachar

2012-01-01

The safety of the interior of ambulances is dubious and, in the event of sudden impact during emergency transport, potentially perilous to patients they carry. The workplace ergonomics of the interior of the passenger cabin is lacking. This article discusses an improved ergonomic interior design based on study findings, observations and subjective perception. It suggests design aspects and safety concepts aimed at increasing the safety of patients and paramedic staff inside the ambulance as a mobile workstation.

Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone.

PubMed

Casey, Megan L; Nguyen, Duong T; Idriss, Barrie; Bennett, Sarah; Dunn, Angela; Martin, Stephen

2015-12-01

Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control. An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance. A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed. Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant. Waterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.

Fire Engine Support and On-scene Time in Prehospital Stroke Care - A Prospective Observational Study.

PubMed

Puolakka, Tuukka; Väyrynen, Taneli; Erkkilä, Elja-Pekka; Kuisma, Markku

2016-06-01

Introduction On-scene time (OST) previously has been shown to be a significant component of Emergency Medical Services' (EMS') operational delay in acute stroke. Since stroke patients are managed routinely by two-person ambulance crews, increasing the number of personnel available on the scene is a possible method to improve their performance. Hypothesis Using fire engine crews to support ambulances on the scene in acute stroke is hypothesized to be associated with a shorter OST. All patients transported to hospital as thrombolysis candidates during a one-year study period were registered by the ambulance crews using a case report form that included patient characteristics and operational EMS data. Seventy-seven patients (41 [53%] male; mean age of 68.9 years [SD=15]; mean Glasgow Coma Score [GCS] of 15 points [IQR=14-15]) were eligible for the study. Forty-five cases were managed by ambulance and fire engine crews together and 32 by the ambulance crews alone. The median ambulance response time was seven minutes (IQR=5-10) and the fire engine response time was six minutes (IQR=5-8). The number of EMS personnel on the scene was six (IQR=5-7) and two (IQR=2-2), and the OST was 21 minutes (IQR=18-26) and 24 minutes (IQR=20-32; P =.073) for the groups, respectively. In a following regression analysis, using stroke as the dispatch code was the only variable associated with short (<22 minutes) OST with an odds ratio of 3.952 (95% CI, 1.279-12.207). Dispatching fire engine crews to support ambulances in acute stroke care was not associated with a shorter on-scene stay when compared to standard management by two-person ambulance crews alone. Using stroke as the dispatch code was the only variable that was associated independently with a short OST. Puolakka T , Väyrynen T , Erkkilä E-P , Kuisma M . Fire engine support and on-scene time in prehospital stroke care - a prospective observational study. Prehosp Disaster Med. 2016;31(3):278-281.

A Prevalence and Management Study of Acute Pain in Children Attending Emergency Departments by Ambulance.

PubMed

Murphy, Adrian; McCoy, Siobhan; O'Reilly, Kay; Fogarty, Eoin; Dietz, Jason; Crispino, Gloria; Wakai, Abel; O'Sullivan, Ronan

2016-01-01

Pain is the most common symptom in the emergency setting and remains one of the most challenging problems for emergency care providers, particularly in the pediatric population. The primary objective of this study was to determine the prevalence of acute pain in children attending emergency departments (EDs) in Ireland by ambulance. In addition, this study sought to describe the prehospital and initial ED management of pain in this population, with specific reference to etiology of pain, frequency of pain assessment, pain severity, and pharmacological analgesic interventions. A prospective cross-sectional study was undertaken over a 12-month period of all pediatric patients transported by emergency ambulance to four tertiary referral hospitals in Ireland. All children (<16 years) who had pain as a symptom (regardless of cause) at any stage during the prehospital phase of care were included in this study. Over the study period, 6,371 children attended the four EDs by emergency ambulance, of which 2,635 (41.4%, 95% confidence interval 40.2-42.3%) had pain as a documented symptom on the ambulance patient care report (PCR) form. Overall 32% (n = 856) of children who complained of pain were subject to a formal pain assessment during the prehospital phase of care. Younger age, short transfer time to the ED, and emergency calls between midnight and 6 am were independently associated with decreased likelihood of having a documented assessment of pain intensity during the prehospital phase of care. Of the 2,635 children who had documented pain on the ambulance PCR, 26% (n = 689) received some form of analgesic agent prior to ED arrival. Upon ED arrival 54% (n = 1,422) of children had a documented pain assessment and some form of analgesic agent was administered to 50% (n = 1,324). Approximately 41% of children who attend EDs in Ireland by ambulance have pain documented as their primary symptom. This study suggests that the management of acute pain in children transferred by ambulance to the ED in Ireland is currently poor, with documentary evidence of only 26% receiving prehospital analgesic agents.

42 CFR 410.41 - Requirements for ambulance suppliers.

Code of Federal Regulations, 2014 CFR

2014-10-01

... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with the...

42 CFR 410.41 - Requirements for ambulance suppliers.

Code of Federal Regulations, 2011 CFR

2011-10-01

... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with the...

42 CFR 410.41 - Requirements for ambulance suppliers.

Code of Federal Regulations, 2013 CFR

2013-10-01

... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with the...

42 CFR 410.41 - Requirements for ambulance suppliers.

Code of Federal Regulations, 2010 CFR

2010-10-01

... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with the...

42 CFR 410.41 - Requirements for ambulance suppliers.

Code of Federal Regulations, 2012 CFR

2012-10-01

... vehicle. (2) ALS vehicles. In addition to meeting the vehicle staff requirements of paragraph (b)(1) of... ALS services. (c) Billing and reporting requirements. An ambulance supplier must comply with the...

Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study.

PubMed

Shaw, Deborah; Siriwardena, Aloysius Niroshan

2014-08-03

Acute asthma is a common reason for patients to seek care from ambulance services. Although better care of acute asthma can prevent avoidable morbidity and deaths, there has been little research into ambulance clinicians' adherence to national guidelines for asthma assessment and management and how this might be improved. Our research aim was to explore paramedics' attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence. We conducted three focus group interviews of paramedics in a regional UK ambulance trust. We used framework analysis supported by NVivo 8 to code and analyse the data. Seventeen participants, including paramedics, advanced paramedics or paramedic operational managers at three geographical sites, contributed to the interviews. Analysis led to five themes: (1) guidelines should be made more relevant to ambulance service care; (2) there were barriers to assessment; (3) the approach needed to address conflicts between clinicians' and patients' expectations; (4) the complexity of ambulance service processes and equipment needed to be taken into account; (5) and finally there were opportunities for improved prehospital education, information, communication, support and care pathways for asthma. This qualitative study provides insight into paramedics' perceptions of the assessment and management of asthma, including why paramedics may not always follow guidelines for assessment or management of asthma. These findings provide opportunities to strengthen clinical support, patient communication, information transfer between professionals and pathways for prehospital care of patients with asthma.

Electrocardiogram interpretation skills among ambulance nurses.

PubMed

Werner, Kristoffer; Kander, Kristofer; Axelsson, Christer

2016-06-01

To describe ambulance nurses' practical electrocardiogram (ECG) interpretation skills and to measure the correlation between these skills and factors that may impact on the level of knowledge. This study was conducted using a prospective quantitative survey with questionnaires and a knowledge test. A convenience sample collection was conducted among ambulance nurses in three different districts in western Sweden. The knowledge test consisted of nine different ECGs. The score of the ECG test were correlated against the questions in the questionnaire regarding both general ECG interpretation skill and ability to identify acute myocardial infarction using Mann-Whitney U test, Kruskal-Wallis test and Spearman's rank correlation. On average, the respondents had 54% correct answers on the test and identified 46% of the ECGs indicating acute myocardial infarction. The median total score was 9 of 16 (interquartile range 7-11) and 1 of 3 (IQR 1-2) in infarction points. No correlation between ECG interpretation skill and factors such as education and professional experience was found, except that coronary care unit experience was associated with better results on the ECG test. Ambulance nurses have deficiencies in their ECG interpretation skills. This also applies to conditions where the ambulance crew has great potential to improve the outcome of the patient's health, such as myocardial infarction and cardiac arrest. Neither education, extensive experience in ambulance service nor in nursing contributed to an improved result. The only factor of importance for higher ECG interpretation knowledge was prior experience of working in a coronary care unit. © The European Society of Cardiology 2014.

Automated personnel-assets-consumables-drug tracking in ambulance services for more effective and efficient medical emergency interventions.

PubMed

Utku, Semih; Özcanhan, Mehmet Hilal; Unluturk, Mehmet Suleyman

2016-04-01

Patient delivery time is no longer considered as the only critical factor, in ambulatory services. Presently, five clinical performance indicators are used to decide patient satisfaction. Unfortunately, the emergency ambulance services in rapidly growing metropolitan areas do not meet current satisfaction expectations; because of human errors in the management of the objects onboard the ambulances. But, human involvement in the information management of emergency interventions can be reduced by electronic tracking of personnel, assets, consumables and drugs (PACD) carried in the ambulances. Electronic tracking needs the support of automation software, which should be integrated to the overall hospital information system. Our work presents a complete solution based on a centralized database supported by radio frequency identification (RFID) and bluetooth low energy (BLE) identification and tracking technologies. Each object in an ambulance is identified and tracked by the best suited technology. The automated identification and tracking reduces manual paper documentation and frees the personnel to better focus on medical activities. The presence and amounts of the PACD are automatically monitored, warning about their depletion, non-presence or maintenance dates. The computerized two way hospital-ambulance communication link provides information sharing and instantaneous feedback for better and faster diagnosis decisions. A fully implemented system is presented, with detailed hardware and software descriptions. The benefits and the clinical outcomes of the proposed system are discussed, which lead to improved personnel efficiency and more effective interventions. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Clinical handover of patients arriving by ambulance to the emergency department - a literature review.

PubMed

Bost, Nerolie; Crilly, Julia; Wallis, Marianne; Patterson, Elizabeth; Chaboyer, Wendy

2010-10-01

To provide a critical review of research on clinical handover between the ambulance service and emergency department (ED) in hospitals. Data base and hand searches were conducted using the keywords ambulance, handover, handoff, emergency department, emergency room, ER, communication, and clinical handover. Data were extracted, summarised and critically assessed to provide evidence of current clinical handover processes. From 252 documents, eight studies fitted the inclusion criteria of clinical handover and the ambulance to ED patient transfer. Three themes were identified in the review: (1) important information may be missed during clinical handover; (2) structured handovers that include both written and verbal components may improve information exchange; (3) multidisciplinary education about the clinical handover process may encourage teamwork, a shared common language and a framework for minimum patient information to be transferred from the ambulance service to the hospital ED. Knowledge gaps exist concerning handover information, consequences of poor handover, transfer of responsibility, staff perception of handovers, staff training and evaluation of recommended strategies to improve clinical handover. Evidence of strategies being implemented and further research is required to examine the ongoing effects of implementing the strategies. Copyright © 2009 Elsevier Ltd. All rights reserved.

Contralaterally Controlled Neuromuscular Electrical Stimulation for Recovery of Ankle Dorsiflexion

PubMed Central

Knutson, Jayme S.; Hansen, Kristine; Nagy, Jennifer; Bailey, Stephanie N.; Gunzler, Douglas D.; Sheffler, Lynne R.; Chae, John

2013-01-01

Objective Compare the effects of contralaterally controlled neuromuscular electrical stimulation (CCNMES) versus cyclic neuromuscular electrical stimulation (NMES) on lower extremity impairment, functional ambulation, and gait characteristics. Design Twenty-six stroke survivors with chronic (≥6mo) footdrop during ambulation were randomly assigned to six weeks of CCNMES or cyclic NMES. Both groups had ten sessions per week of self-administered home application of either CCNMES or cyclic NMES plus two sessions per week of gait training with a physical therapist. Primary outcomes included lower extremity Fugl-Meyer score, modified Emory Functional Ambulation Profile, and gait velocity. Assessments were made at pretreatment, posttreatment, and at 1 and 3 months posttreatment. Results There were no significant differences between groups in the outcome trajectories for any of the measures. With data from both groups pooled, there were significant but modest and sustained improvements in the Fugl-Meyer score and the modified Emory Functional Ambulation Profile, but not in gait velocity. Conclusions The results support the hypothesis that gait training combined with either CCNMES or cyclic NMES reduces lower extremity impairment and functional ambulation, but do not support the hypothesis that CCNMES is more effective than cyclic NMES in chronic patients. PMID:23867888

Patients’ experiences of cold exposure during ambulance care

PubMed Central

2013-01-01

Background Exposure to cold temperatures is often a neglected problem in prehospital care. Cold exposure increase thermal discomfort and, if untreated causes disturbances of vital body functions until ultimately reaching hypothermia. It may also impair cognitive function, increase pain and contribute to fear and an overall sense of dissatisfaction. The aim of this study was to investigate injured and ill patients’ experiences of cold exposure and to identify related factors. Method During January to March 2011, 62 consecutively selected patients were observed when they were cared for by ambulance nursing staff in prehospital care in the north of Sweden. The field study was based on observations, questions about thermal discomfort and temperature measurements (mattress air and patients’ finger temperature). Based on the observation protocol the participants were divided into two groups, one group that stated it was cold in the patient compartment in the ambulance and another group that did not. Continuous variables were analyzed with independent sample t-test, paired sample t-test and dichotomous variables with cross tabulation. Results In the ambulance 85% of the patients had a finger temperature below comfort zone and 44% experienced the ambient temperature in the patient compartment in the ambulance to be cold. There was a significant decrease in finger temperature from the first measurement indoor compared to measurement in the ambulance. The mattress temperature at the ambulance ranged from −22.3°C to 8.4°C. Conclusion Cold exposure in winter time is common in prehospital care. Sick and injured patients immediately react to cold exposure with decreasing finger temperature and experience of discomfort from cold. Keeping the patient in the comfort zone is of great importance. Further studies are needed to increase knowledge which can be a base for implications in prehospital care for patients who probably already suffer for other reasons. PMID:23742143

A comparison of general and ambulance specific stressors: predictors of job satisfaction and health problems in a nationwide one-year follow-up study of Norwegian ambulance personnel.

PubMed

Sterud, Tom; Hem, Erlend; Lau, Bjørn; Ekeberg, Oivind

2011-03-31

To address the relative importance of general job-related stressors, ambulance specific stressors and individual characteristics in relation to job satisfaction and health complaints (emotional exhaustion, psychological distress and musculoskeletal pain) among ambulance personnel. A nationwide prospective questionnaire survey of ambulance personnel in operational duty at two time points (n = 1180 at baseline, T1 and n = 298 at one-year follow up, T2). The questionnaires included the Maslach Burnout Inventory, The Job Satisfaction Scale, Hopkins Symptom Checklist (SCL-10), Job Stress Survey, the Norwegian Ambulance Stress Survey and the Basic Character Inventory. Overall, 42 out of the possible 56 correlations between job stressors at T1 and job satisfaction and health complaints at T2 were statistically significant. Lower job satisfaction at T2 was predicted by frequency of lack of leader support and severity of challenging job tasks. Emotional exhaustion at T2 was predicted by neuroticism, frequency of lack of support from leader, time pressure, and physical demands. Adjusted for T1 levels, emotional exhaustion was predicted by neuroticism (beta = 0.15, p < .05) and time pressure (beta = 0.14, p < 0.01). Psychological distress at T2 was predicted by neuroticism and lack of co-worker support. Adjusted for T1 levels, psychological distress was predicted by neuroticism (beta = 0.12, p < .05). Musculoskeletal pain at T2 was predicted by, higher age, neuroticism, lack of co-worker support and severity of physical demands. Adjusted for T1 levels, musculoskeletal pain was predicted neuroticism, and severity of physical demands (beta = 0.12, p < .05). Low job satisfaction at T2 was predicted by general work-related stressors, whereas health complaints at T2 were predicted by both general work-related stressors and ambulance specific stressors. The personality variable neuroticism predicted increased complaints across all health outcomes.

Push hard, push fast, if you’re downtown: a citation review of urban-centrism in American and European basic life support guidelines

PubMed Central

2013-01-01

Bystander cardiopulmonary resuscitation (CPR) improves out-of-hospital cardiac arrest (OHCA) survival. In settings with prolonged ambulance response times, skilled bystanders may be even more crucial. In 2010, American Heart Association (AHA) and European Resuscitation Council (ERC) introduced compression-only CPR as an alternative to conventional bystander CPR under some circumstances. The purpose of this citation review and document analysis is to determine whether the evidentiary basis for 2010 AHA and ERC guidelines attends to settings with prolonged ambulance response times or no formal ambulance dispatch services. Primary and secondary citations referring to epidemiological research comparing adult OHCA survival based on the type of bystander CPR were included in the analysis. Details extracted from the citations included a study description and primary outcome measure, the geographic location in which the study occurred, EMS response times, the role of dispatchers, and main findings and summary statistics regarding rates of survival among patients receiving no CPR, conventional CPR or compression-only CPR. The inclusion criteria were met by 10 studies. 9 studies took place exclusively in urban settings. Ambulance dispatchers played an integral role in 7 studies. The cited studies suggest either no survival benefit or harm arising from compression-only CPR in settings with extended ambulance response times. The evidentiary basis for 2010 AHA and ERC bystander CPR guidelines does not attend to settings without rapid ambulance response times or dispatch services. Standardized bystander CPR guidelines may require adaptation or reconsideration in these settings. PMID:23601200

Pseudotachometer for mobile metabolic analyzer

NASA Technical Reports Server (NTRS)

Currie, J. R.

1974-01-01

Metabolic analyzer determines a patient's walking or ambulation speed and simultaneously measures his metabolic parameters. Analyzer is designed to move at some preselected human ambulation speed. During test, patient is connected to system and follows analyzer closely while his metabolic data is being monitored.

Human Performance in Simulated Reduced Gravity Environments

NASA Technical Reports Server (NTRS)

Cowley, Matthew; Harvill, Lauren; Rajulu, Sudhakar

2014-01-01

NASA is currently designing a new space suit capable of working in deep space and on Mars. Designing a suit is very difficult and often requires trade-offs between performance, cost, mass, and system complexity. Our current understanding of human performance in reduced gravity in a planetary environment (the moon or Mars) is limited to lunar observations, studies from the Apollo program, and recent suit tests conducted at JSC using reduced gravity simulators. This study will look at our most recent reduced gravity simulations performed on the new Active Response Gravity Offload System (ARGOS) compared to the C-9 reduced gravity plane. Methods: Subjects ambulated in reduced gravity analogs to obtain a baseline for human performance. Subjects were tested in lunar gravity (1.6 m/sq s) and Earth gravity (9.8 m/sq s) in shirt-sleeves. Subjects ambulated over ground at prescribed speeds on the ARGOS, but ambulated at a self-selected speed on the C-9 due to time limitations. Subjects on the ARGOS were given over 3 minutes to acclimate to the different conditions before data was collected. Nine healthy subjects were tested in the ARGOS (6 males, 3 females, 79.5 +/- 15.7 kg), while six subjects were tested on the C-9 (6 males, 78.8 +/- 11.2 kg). Data was collected with an optical motion capture system (Vicon, Oxford, UK) and was analyzed using customized analysis scripts in BodyBuilder (Vicon, Oxford, UK) and MATLAB (MathWorks, Natick, MA, USA). Results: In all offloaded conditions, variation between subjects increased compared to 1-g. Kinematics in the ARGOS at lunar gravity resembled earth gravity ambulation more closely than the C-9 ambulation. Toe-off occurred 10% earlier in both reduced gravity environments compared to earth gravity, shortening the stance phase. Likewise, ankle, knee, and hip angles remained consistently flexed and had reduced peaks compared to earth gravity. Ground reaction forces in lunar gravity (normalized to Earth body weight) were 0.4 +/- 0.2 on the ARGOS, but only 0.2 +/- 0.1 on the C-9. Discussion: Gait analysis showed differences in joint kinematics and temporal-spatial parameters between the reduced gravity simulators and with respect to earth gravity. Although most of the subjects chose a somewhat unique ambulation style as a result of learning to ambulate in a new environment, all but two were consistent with keeping an Earth-like gait. Learning how reduced gravity affects ambulation will help NASA to determine optimal suit designs, influence mission planning, help train crew, and may shed light on the underlying methods the body uses to optimize gait for energetic efficiency. Conclusion: Kinematic and kinetic analysis demonstrated noteworthy differences between an offloaded environment and 1-g, as would be expected. The analysis showed a trend to change the ambulation style in an offloaded environment to a rolling-loping walk (resembling crosscountry skiing) with increased swing time. This ambulation modification, particularly in the ARGOS, indicated that the relative kinetic energy of the subject was increased, on average, per the static body weight compared to the 1-g condition. How much of this was influenced by the active offloading of the ARGOS system is unknown.

4. OVERALL VIEW TO NORTH SHOWING (LEFT TO RIGHT) AMBULANT ...

Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

4. OVERALL VIEW TO NORTH SHOWING (LEFT TO RIGHT) AMBULANT QUARTERS, STOREHOUSE, BOILER HOUSE (LARGELY OBSCURED), SMOKESTACK, STATION GARAGE, ANIMAL HOUSE, AND WATER SOFTENER BUILDING - VA Medical Center, Aspinwall Division, 5103 Delafield Avenue (O'Hara Township), Aspinwall, Allegheny County, PA

Self-paced brain-computer interface control of ambulation in a virtual reality environment.

PubMed

Wang, Po T; King, Christine E; Chui, Luis A; Do, An H; Nenadic, Zoran

2012-10-01

Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. The average offline training performance across subjects was 77.2 ± 11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26 × 10(-23)), with chance performance being 50%. The average online performance was 8.5 ± 1.1 (out of 10) successful stops and 303 ± 53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p < 0.05) in 44 of the 45 online sessions. By using a data-driven machine learning approach to decode users' KMI, this BCI-VRE system enabled intuitive and purposeful self-paced control of ambulation after only 10 minutes training. The ability to achieve such BCI control with minimal training indicates that the implementation of future BCI-lower extremity prosthesis systems may be feasible.

Functional neuromuscular stimulator for short-distance ambulation by certain thoracic-level spinal-cord-injured paraplegics.

PubMed

Graupe, D; Kohn, K H

1998-09-01

Functional Neuromuscular Stimulation (FNS) for unbraced short-distance ambulation by traumatic complete/near-complete T4 to T12 paraplegics is based on work by Graupe et al (1982), Kralj et al (1980), Liberson et al (1961), and others. This paper discusses methodology, performance, training, admissibility criteria, and medical observations for FNS-ambulation using the Parastep-I system, which is the first and only such system to have received FDA approval (1994) and which emanated from these previous works. The Parastep system is a transcutaneous non-invasive and microcomputerized electrical stimulation system built into a Walkman-size unit powered by eight AA batteries that is controlled by finger-touch buttons located on a walker's handbars for manual selection of stimulation menus. The microcomputer shapes, controls, and distributes trains of stimulation signals that trigger action potentials in selected peripheral nerves. Walker support is used for balance. The patient can don the system in under 10 minutes. At least 32 training sessions are required. Approximately 400 patients have used the Parastep system, essentially all achieving standing and at least 30 feet of ambulation, with a few reaching as much as 1 mile at a time. Recent literature presents data on the medical benefits of using the Parastep system-beyond the exercise benefits of short distance ambulation at will-such as increased blood flow to the lower extremities, lower HR at subpeak work intensities, increased peak work capability, reduced spasticity, and psychological benefits. We believe that the Parastep FNS system, which is presently commercially available by prescription, is easily usable for independent short-distance ambulation. We believe that its exercise benefits and its other medical and psychological benefits, as discussed, make it an important option for thoracic-level traumatic paraplegics.

[Examination of diagnosis procedure combination survey data that influence function evaluation coefficient II].

PubMed

Nakajima, Hisato; Yano, Kouya; Nagasawa, Kaoko; Kobayashi, Eiji; Yokota, Kuninobu

2015-01-01

On the basis of Diagnosis Procedure Combination (DPC) survey data, the factors that increase the value of function evaluation coefficient II were considered. A total of 1,505 hospitals were divided into groups I, II, and III, and the following items were considered. 1. Significant differences in function evaluation coefficient II and DPC survey data. 2. Examination of using the Mahalanobis-Taguchi (MT) method. 3. Correlation between function evaluation coefficient II and each DPC survey data item. 1. Function evaluation coefficient II was highest in group II. Group I hospitals showed the highest bed capacity, and numbers of hospitalization days, operations, chemotherapies, radiotherapies and general anesthesia procedures. 2. Using the MT method, we found that the number of ambulance conveyances was effective factor in group I hospitals, the number of general anesthesia procedures was effective factor in group II hospitals, and the bed capacity was effective factor in group III hospitals. 3. In group I hospitals, function evaluation coefficient II significantly correlated to the numbers of ambulance conveyances and chemotherapies. In group II hospitals, function evaluation coefficient II significantly correlated to bed capacity, the numbers of ambulance conveyances, hospitalization days, operations, general anesthesia procedures, and mean hospitalization days. In group III hospitals, function evaluation coefficient II significantly correlated to all items. The factors that improve the value of function evaluation coefficient II were the increases in the numbers of ambulance conveyances, chemotherapies and radiotherapies in group I hospitals, increases in the numbers of hospitalization days, operations, ambulance conveyances and general anesthesia procedures in group II hospitals, and increases in the numbers of hospitalization days, operations and ambulance conveyances. These results indicate that the profit of a hospital will increase, which will lead to medical services of good quality.

Army Air Ambulance Blood Product Program in the Combat Zone and Challenges to Best Practices.

PubMed

Powell-Dunford, Nicole; Quesada, Jose F; Gross, Kirby R; Shackelford, Stacy A

2016-08-01

Identify challenges and best practices in the development of an austere air ambulance transfusion program. A search of PubMed using combinations of the key terms 'prehospital,' 'blood product,' 'red blood cells,' 'damage control resuscitation,' 'transfusion,' 'air ambulance,' 'medical evacuation,' and 'medevac' yielded 196 articles for further analysis, with 14 articles suitable for addressing the background of prehospital transfusion within a helicopter. Retrospective analysis of unclassified briefs, after action reports, and procedures was also undertaken along with interview of subject matter experts. The initial series of 15 transfusions were discussed telephonically among flight crew, trauma surgeons, and lab specialists. Review of Joint Theater System data was readily available for 84 U.S. Army air ambulance transfusions between May-December 2012, with December marking the redeployment of the 25(th) Combat Aviation Brigade. Standardized implementation enabled safe blood product administration for 84 causalities from May-December 2012 without blood product shortage, expiration, or transfusion reaction. Challenges included developing transfusion competency, achieving high quality blood support, countering the potential for anti-U.S. sentiment, and diversity in coalition transfusion practices. Blood product administration aboard the air ambulance is logistically complex, requiring blood bank integration. Repetitive training enabled emergency medical technicians (EMTs) with basic medical training to safely perform transfusion in accordance with clinical operating guidelines. In the austere environment, logistic factors are significant challenges and political sensitivities are important considerations. Best practices may facilitate new en route transfusion programs. Powell-Dunford N, Quesada JF, Gross KR, Shackelford SA. Army air ambulance blood product program in the combat zone and challenges to best practices. Aerosp Med Hum Perform. 2016; 87(8):728-734.

The attentional demands of ambulating with an assistive device in older adults with Alzheimer's disease.

PubMed

Muir-Hunter, S W; Montero-Odasso, M

2017-05-01

Ambulation with a mobility aid is a unique real-life situation of multi-tasking. These simultaneous motor tasks place increased demands on executive function in healthy young and older adults, but the demands have not been evaluated in people with Alzheimer's disease (AD). Mobility problems are common among adults with AD, leading to provision of a mobility aid to optimize independent activity. The study objectives were: (i) to determine the dual-task cost (DTC) associated with the use of a mobility aid in straight and complex path walking, and (ii) to evaluate the association between executive function and ambulation with a mobility aid in older adults with AD and age-sex matched cognitively normal controls. Fourteen people (mean age±SD, 72.6±9.9years) with a diagnosis of probable AD (MMSE range 12-25) and controls (mean age±SD, 72.9±9.5) walked at a self-selected pace and using a 4-wheeled walker in a 6m straight path and a Figure of 8 Test. Ambulation with the walker in a straight path produced a low DTC that was not different between the groups. Ambulation with the 4-wheeled walker in the complex path produced a significantly different DTC in the group with AD at -38.1±23.5% compared to -19.7±21.4% (p=0.041). Lower scores on executive function were associated with longer times across test conditions. Ambulation with a 4-wheeled walker, in particular maneuvering around obstacles, requires greater attentional costs in dementia. Future research should explore the timing for safely introducing mobility aids in AD and the role of improving executive function. Copyright © 2017 Elsevier B.V. All rights reserved.

Urban sprawl and delayed ambulance arrival in the U.S.

PubMed

Trowbridge, Matthew J; Gurka, Matthew J; O'Connor, Robert E

2009-11-01

Minimizing emergency medical service (EMS) response time is a central objective of prehospital care, yet the potential influence of built environment features such as urban sprawl on EMS system performance is often not considered. This study measures the association between urban sprawl and EMS response time to test the hypothesis that features of sprawling development increase the probability of delayed ambulance arrival. In 2008, EMS response times for 43,424 motor-vehicle crashes were obtained from the Fatal Analysis Reporting System, a national census of crashes involving > or =1 fatality. Sprawl at each crash location was measured using a continuous county-level index previously developed by Ewing et al. The association between sprawl and the probability of a delayed ambulance arrival (> or =8 minutes) was then measured using generalized linear mixed modeling to account for correlation among crashes from the same county. Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival (p=0.03). This probability increases quadratically as the severity of sprawl increases while controlling for nighttime crash occurrence, road conditions, and presence of construction. For example, in sprawling counties (e.g., Fayette County GA), the probability of a delayed ambulance arrival for daytime crashes in dry conditions without construction was 69% (95% CI=66%, 72%) compared with 31% (95% CI=28%, 35%) in counties with prominent smart-growth characteristics (e.g., Delaware County PA). Urban sprawl is significantly associated with increased EMS response time and a higher probability of delayed ambulance arrival following motor-vehicle crashes in the U.S. The results of this study suggest that promotion of community design and development that follows smart-growth principles and regulates urban sprawl may improve EMS performance and reliability.

Performance of an automated external defibrillator in a moving ambulance vehicle.

PubMed

Yun, Jong Geun; Jeung, Kyung Woon; Lee, Byung Kook; Ryu, Hyun Ho; Lee, Hyoung Youn; Kim, Mu Jin; Heo, Tag; Min, Yong Il; You, Yeonho

2010-04-01

The available data suggest that automated external defibrillators (AED) can be safely used in vibration-like moving conditions such as rigid inflatable boats and aircraft environments. However, little literature exists examining their performance in a moving ambulance. The present study was undertaken to determine whether an AED is able to analyse the heart rhythm correctly during ambulance transport. An ambulance was driven on paved (20-100 km/h) and unpaved (10 km/h) roads. The performance of two AED devices (CU ER 2, CU Medical Systems Inc., Korea, and Heartstart MRx, Phillips, USA) was determined in a moving ambulance using manikins. Vibration intensity was measured simultaneously with a digital vibrometer. AED performance was then evaluated again on manikins and on a swine model under simulated vibration intensities (0.5-5m/s(2)) measured by the vibrometer in the previous phase of the investigation. The vibration intensity increased with increasing speeds on paved roads (1.98+/-0.44 m/s(2) at 100 km/h). While driving on unpaved roads, it increased to 6.40+/-1.06 m/s(2). Both AED algorithms analysed the heart rhythm correctly under resting state. When tested on pigs, both algorithms showed substantially degraded performances, even at low vibration intensities of 0.5-1m/s(2), which corresponded to vibration intensities while driving on paved roads at 20-60 km/h. This study also showed that electrocardiograms generated on manikins were more resistant to motion artifacts than were the pig electrocardiograms. Ambulance personnel should consider the possibility of misinterpretation by an AED when this device is used while transporting a patient. Copyright (c) 2010 Elsevier Ireland Ltd. All rights reserved.

Ambulance Services at Hospital Universiti Sains Malaysia and Hospital Kota Bharu: A Retrospective Study of Calls

PubMed Central

Shah Che Hamzah, Mohd Shaharudin; Ahmad, Rashidi; Nik Abdul Rahman, Nik Hisamuddin; Pardi, Kasmah Wati; Jaafar, Naimah; Wan Adnan, Wan Aasim; Jaalam, Kamaruddin; Sahil Jamalullail, Syed Mohsin

2005-01-01

This retrospective study attempted to identify the pattern of ambulance calls for the past two years at the Hospital Universiti Sains Malaysia (HUSM) and Hospital Kota Bharu (HKB). This study will provide a simple method of acquiring information related to ambulance response time (ART) and to test whether it met the international standards and needs of the client. Additionally, this paper takes into account the management of emergency calls. This included ambulance response time, which was part of Emergency Medical Services (EMS) episode: onset of ART, which started when details like phone number of the caller, exact location of the incident and the nature of the main complaint had been noted. ART ended when the emergency team arrived at the scene of incident. Information regarding ambulance calls from the record offices of HUSM and HKB was recorded for the year 2001 and 2002, tabulated and analyzed. There was a significant difference in the total number of calls managed by HUSM and HKB in the year 2001. It was noted that 645 calls were managed by HUSM while 1069 calls were recorded at HKB. In the year 2002, however, HUSM led with 613 extra numbers of calls as compare to HKB with 1193 numbers of calls. The pattern of ambulance calls observed is thought to possibly be influenced by social activities like local festivities, school holidays and the seasons. Further, it is observed that no studies were previously undertaken to compare the ART at both the HUSM and HKB to that of the international standards. In fact, a literature review undertaken so far showed no similar studies have been done for the whole Malaysia. PMID:22605956

Understanding the prehospital physician controversy. Step 2: analysis of on-scene treatment by ambulance nurses and helicopter emergency medical service physicians.

PubMed

van Schuppen, Hans; Bierens, Joost

2015-12-01

In our previous study, we identified the similarities and differences in competencies of ambulance nurses and helicopter emergency medical service (HEMS) physicians in the Netherlands. This ensuing study aims to quantify the frequency with which the additional therapeutic competencies of the HEMS physician are utilized and to determine whether this is the main reason for usefulness as perceived by ambulance nurses and HEMS physicians. A prospective observational study was carried out over a 2-month period, with one HEMS station covering six ambulance regions. Provider registration was recorded, supplemented by interviews of ambulance nurses and HEMS physicians. Competencies were categorized depending on whether the competency was specific for the nurse or physician, mutual or mutual with a qualitative difference. A total of 225 HEMS dispatches resulted in 117 cases with HEMS on-scene in the study region and 78 patients were included. In 35 (45%) patients, the HEMS physician provided additional treatment: in 19 (24%) patients, a physician-specific therapeutic competency, in nine (12%) patients, a mutual competency with a qualitative difference and in seven (9%) patients, both categories. The presence of the HEMS physician was considered more useful by both ambulance nurses (89 vs. 60%) and HEMS physicians (97 vs. 81%) when additional treatment was provided by the HEMS physician. HEMS physicians provide additional treatment in 45% of patients. The additional treatment increases the perceived usefulness of the HEMS physician. The presence of the HEMS physician was also considered useful when the physician did not provide any additional treatment, possibly because of diagnostic competence and clinical decision-making.

Promoting ambulation responses among children with multiple disabilities through walkers and microswitches with contingent stimuli.

PubMed

Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Oliva, Doretta; Smaldone, Angela; La Martire, Maria L; Stasolla, Fabrizio; Castagnaro, Francesca; Groeneweg, Jop

2010-01-01

Children with severe or profound intellectual and motor disabilities often present problems of balance and ambulation and spend much of their time sitting or lying, with negative consequences for their development and social status. Recent research has shown the possibility of using a walker (support) device and microswitches with preferred stimuli to promote ambulation with these children. This study served as a replication of the aforementioned research and involved five new children with multiple disabilities. For four children, the study involved an ABAB design. For the fifth child, only an AB sequence was used. All children succeeded in increasing their frequencies of step responses during the B (intervention) phase(s) of the study, although the overall frequencies of those responses varied largely across them. These findings support the positive evidence already available about the effectiveness of this intervention approach in motivating and promoting children's ambulation. Practical implications of the findings are discussed. 2010 Elsevier Ltd. All rights reserved.

Mobile coronary care provided by ambulance personnel.

PubMed

White, N M; Parker, W S; Binning, R A; Kimber, E R; Ead, H W; Chamberlain, D A

1973-09-22

Mobile coronary care has been provided in Brighton by ambulance personnel without immediate help from physicians or nurses. No additional vehicles or staff were required. The capital cost of the experiment was therefore small and additional running costs were negligible. The results have been monitored by retrospective analysis of electrocardiograms recorded in the ambulance and stored on magnetic tape. In the first 12 months of operation to July 1972, 1,082 patients with suspected cardiac emergencies were carried in two vehicles. Subsequent analysis showed that 76% of these patients had acute symptoms from ischaemic heart disease or had circulatory arrest. Eighty-six per cent. of arrhythmias were diagnosed correctly by the ambulance attendants. Though only eight cases of primary ventricular fibrillation occurred during or shortly before transit all were successfully reversed, and five of these patients subsequently left hospital alive. Other benefits of the scheme have included an appreciable reduction in the median delay between onset of presenting symptoms in patients with acute myocardial ischaemia and their admission to hospital.

[Paradigm shift in the management of metastatic epidural spinal cord compression: the importance of preserving ambulation].

PubMed

Itshayek, Eyal

2013-12-01

In 2005, a Landmark study showed that direct decompressive surgery, followed by postoperative external beam radiotherapy (EBRT) is superior to EBRT alone in patients with metastatic epidural spinal cord compression (MESCC). Patients undergoing both surgery and EBRT had similar median survival but experienced longer ambulation than with EBRT alone. Additional studies have shown improvements in quality-of-life, higher cost-effectiveness, improved pain control, and higher functional status with surgery plus EBRT. Improved neurological outcome also improved the patients' ability to undergo postoperative adjuvant therapy. According to our experience, even patients over 65 or patients with aggressive primary tumors and additional metastases have benefited from surgical intervention, living longer than expected with preservation of ambulation and sphincter control until death or shortly before. Preserving ambulation is critical. With current surgical devices and techniques, patients with MESCC who present with a single area of cord compression, back pain, neurological deficit, or progressive deformity, may benefit from surgery prior to adjuvant radiation-based treatment or chemotherapy.

Seeking ambulance treatment for ‘primary care’ problems: a qualitative systematic review of patient, carer and professional perspectives

PubMed Central

Booker, Matthew J; Purdy, Sarah; Shaw, Alison R G

2017-01-01

Objectives To understand the reasons behind, and experience of, seeking and receiving emergency ambulance treatment for a ‘primary care sensitive’ condition. Design A comprehensive, qualitative systematic review. Medline, Embase, PsychInfo, Cumulative Index of Nursing and Allied Health, Health Management Information Systems, Healthcare Management Information Consortium, OpenSigle, EThOS and Digital Archive of Research Theses databases were systematically searched for studies exploring patient, carer or healthcare professional interactions with ambulance services for ‘primary care sensitive’ problems. Studies using wholly qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. An analytical thematic synthesis was undertaken, using a line-by-line qualitative coding method and a hierarchical inductive approach. Results Of 1458 initial results, 33 studies met the first level (relevance) inclusion criteria, and six studies met the second level (methodology and quality) criteria. The analysis suggests that patients define situations worthy of ‘emergency’ ambulance use according to complex socioemotional factors, as well as experienced physical symptoms. There can be a mismatch between how patients and professionals define ‘emergency’ situations. Deciding to call an ambulance is a process shaped by practical considerations and a strong emotional component, which can be influenced by the views of caregivers. Sometimes the value of a contact with the ambulance service is principally in managing this emotional component. Patients often wish to hand over responsibility for decisions when experiencing a perceived emergency. Feeling empowered to take control of a situation is a highly valued aspect of ambulance care. Conclusions When responding to a request for ‘emergency’ help for a low-acuity condition, urgent-care services need to be sensitive to how the patient's emotional and practical perception of the situation may have shaped their decision-making and the influence that carers may have had on the process. There may be novel ways to deliver some of the valued aspects of urgent care, more geared to the resource-limited environment. PMID:28775192

Dispatch and prehospital transport for acute septic patients: an observational study.

PubMed

Pedersen, Peter Bank; Henriksen, Daniel Pilsgaard; Mikkelsen, Søren; Lassen, Annmarie Touborg

2017-05-12

In order to dispatch ambulances with the correct level of urgency, the dispatch center has to balance the perceived urgency and traffic safety considerations with the available resources. As urgency is not clear in all clinical situations, some high urgency patients may end up with a suboptimal mode of transport. Patients with severe sepsis or septic shock suffer from highly time dependent conditions but they present with a wide range of symptoms, which might be difficult to identify in the dispatch system. The aim of the study is to investigate the modes of prehospital transport among acute admitted patients with sepsis, severe sepsis and septic shock. We included all adult patients (≥15 years) presenting to an acute medical unit at Odense University Hospital with a first-time admission of community-acquired sepsis between September 2010-August 2011. Cases and prehospital ambulance transport were identified by structured manual chart review. In all cases it was registered, whether the ordinary ambulance was assisted by the mobile emergency care unit (MECU), manned by anesthesiologists. We included 1,713 patients median age 72 years (IQR 57-81), 793 (46.3%) male, 621 (36.3%) had sepsis, 1,071 (62.5%) severe sepsis, and 21 (1.2%) septic shock. In the group of sepsis patients, 390 (62.8%) arrived without public prehospital transport, 197 (31.7%) were transported by ambulance, and 34 (5.5%) were assisted by MECU. In the group of severe sepsis patients, the same percentage 62.8% arrived without public pre-hospital transport, a lower percentage 28.2% were transported by ambulance, and a larger percentage 9.0% were transported by MECU. Among 21 patients with septic shock, 10 arrived without public pre-hospital transport (47.7%), 7 (33.3%) were transported by ambulance, and 4 (19.0%) by MECU. The 30-day mortality hazard ratio was associated with mode of transport, with the adjusted highest hazard ratio found in the group of MECU transported patients 1.76 (95%Cl 1.16-2.66). A substantial proportion of patients with severe sepsis and septic shock arrive to hospital without public prehospital transport or by unspecialized ambulances.

Ambulance ride: fixed or floating stretcher?

PubMed Central

Snook, R; Pacifico, R

1976-01-01

The alternatives of a purpose-bult ambulance and a specially designed stretcher suspension system were considered and the features of the latter assessed by subjective and objective tests. The results showed a significant improvement in the quality of the ride offered to the patient. Images FIG 2 PMID:947448

Utility of Ambulance Data for Real-Time Syndromic Surveillance: A Pilot in the West Midlands Region, United Kingdom.

PubMed

Todkill, Dan; Loveridge, Paul; Elliot, Alex J; Morbey, Roger A; Edeghere, Obaghe; Rayment-Bishop, Tracy; Rayment-Bishop, Chris; Thornes, John E; Smith, Gillian

2017-12-01

Introduction The Public Health England (PHE; United Kingdom) Real-Time Syndromic Surveillance Team (ReSST) currently operates four national syndromic surveillance systems, including an emergency department system. A system based on ambulance data might provide an additional measure of the "severe" end of the clinical disease spectrum. This report describes the findings and lessons learned from the development and preliminary assessment of a pilot syndromic surveillance system using ambulance data from the West Midlands (WM) region in England. Hypothesis/Problem Is an Ambulance Data Syndromic Surveillance System (ADSSS) feasible and of utility in enhancing the existing suite of PHE syndromic surveillance systems? An ADSSS was designed, implemented, and a pilot conducted from September 1, 2015 through March 1, 2016. Surveillance cases were defined as calls to the West Midlands Ambulance Service (WMAS) regarding patients who were assigned any of 11 specified chief presenting complaints (CPCs) during the pilot period. The WMAS collected anonymized data on cases and transferred the dataset daily to ReSST, which contained anonymized information on patients' demographics, partial postcode of patients' location, and CPC. The 11 CPCs covered a broad range of syndromes. The dataset was analyzed descriptively each week to determine trends and key epidemiological characteristics of patients, and an automated statistical algorithm was employed daily to detect higher than expected number of calls. A preliminary assessment was undertaken to assess the feasibility, utility (including quality of key indicators), and timeliness of the system for syndromic surveillance purposes. Lessons learned and challenges were identified and recorded during the design and implementation of the system. The pilot ADSSS collected 207,331 records of individual ambulance calls (daily mean=1,133; range=923-1,350). The ADSSS was found to be timely in detecting seasonal changes in patterns of respiratory infections and increases in case numbers during seasonal events. Further validation is necessary; however, the findings from the assessment of the pilot ADSSS suggest that selected, but not all, ambulance indicators appear to have some utility for syndromic surveillance purposes in England. There are certain challenges that need to be addressed when designing and implementing similar systems. Todkill D , Loveridge P , Elliot AJ , Morbey RA , Edeghere O , Rayment-Bishop T , Rayment-Bishop C , Thornes JE , Smith G . Utility of ambulance data for real-time syndromic surveillance: a pilot in the West Midlands region, United Kingdom. Prehosp Disaster Med. 2017;32(6):667-672.

Comparative Study of Assisted Ambulation and Perceived Exertion With the Wheeled Knee Walker and Axillary Crutches in Healthy Subjects.

PubMed

Kocher, Benjamin K; Chalupa, Robyn L; Lopez, Donna M; Kirk, Kevin L

2016-11-01

Functional limitations after lower extremity surgery often require the use of an assistive device for ambulation during rehabilitation and recovery. There are no known objective data evaluating the wheeled knee walker as an assistive device for protected ambulation. The purpose of this study was to compare assisted ambulation and perceived exertion with the wheeled knee walker and the axillary crutches in healthy participants. A prospective, randomized crossover study was performed using 24 healthy volunteers. Each participant performed a 6-minute walk test (6MWT) using each assistive device in a crossover manner. Preactivity and postactivity heart rates were recorded. The self-selected walking velocity (SSWV) was calculated and the participant's rating of perceived exertion was recorded using the OMNI Rating of Perceived Exertion (OMNI-RPE). Participant's preference for assistive device was identified. The 6MWT, SSWV, and the Omni-RPE were evaluated using paired t tests and determined to be statistically significant for the wheeled knee walker compared with axillary crutches. Evaluation of the preactivity and postactivity heart rates demonstrated a statistically significant difference for the wheeled knee walker compared with axillary crutches. The wheeled knee walker was preferred by 88% of participants. The wheeled knee walker provided increased assisted ambulation and had a lower rating of perceived exertion than axillary crutches on level surfaces in healthy participants. Level III, comparative study. © The Author(s) 2016.

Declining trends in injuries and ambulance calls for road traffic crashes in Bahrain post new traffic laws of 2015.

PubMed

Awadhalla, Muyssar Sabri; Asokan, Govindaraj Vaithinathan; Matooq, Amina; Kirubakaran, Richard

2016-06-01

Road traffic crashes (RTC) are of serious global health concern. To identify whether the number of ambulance calls, injuries, and deaths has declined after the implementation of the new traffic law (NTL) 2015 in Bahrain, de-identified administrative RTC data obtained from the tertiary care center, and the General Directorate of Traffic (GDT) of Bahrain were used. A quasi-experimental design was employed to trend the impact of the NTL on RTC and associated healthcare events. Bahrainis and non-Bahrainis who met with RTC, either in a vehicle or as a pedestrian, between February 8 and May 8 in 2013, 2014 (pre NTL), and 2015 (post NTL) were included in the study. Our results show a reduction in the number of ambulance calls from vehicular and pedestrian RTC victims. The ambulance calls from pedestrian RTC victims were <10% compared to the number of ambulance calls from vehicular RTC victims. There was a significant reduction in minor injuries post 2015, whereas no obvious difference was seen for serious injuries and deaths. A longer follow-up study to confirm the sustained decline in RTC, enforcing a zero tolerance policy toward traffic transgressions, and raising public awareness on the "critical four minutes" and "golden hour" is recommended. Copyright © 2016 Ministry of Health, Saudi Arabia. Published by Elsevier Ltd. All rights reserved.

A biomechanical and subjective assessment and comparison of three ambulance cot design configurations.

PubMed

Sommerich, Carolyn M; Lavender, Steven A; Radin Umar, Radin Zaid; Le, Peter; Mehta, Jay; Ko, Pei-Ling; Farfan, Rafael; Dutt, Mohini; Park, SangHyun

2012-01-01

Effects of ambulance cot design features (handle design and leg folding mechanism) were evaluated. Experienced ambulance workers performed tasks simulating loading and unloading a cot to and from an ambulance, and a cot raising task. Muscle activity, ratings of perceived exertion, and performance style were significantly affected by cot condition (p < 0.05). Erector Spinae activity was significantly less when using Cot-2's stretcher-style handles. Shoulder muscle activity was significantly less when using Cot-2's loop handle. During loading and unloading, operators allowed the cot to support its own weight most often with Cot-2's stretcher-style handles. Preference for Cot-2 (either handles) over Cot-1 (with loop handle) was consistent across tasks. Handle effects were influenced by operator stature; taller participants received more benefit from Cot-2's stretcher-style handles; shoulder muscles' demands were greater for shorter participants due to handle location. Providing handle options and automatic leg folding/unfolding operation can reduce cot operator's effort and physical strain. Practitioner Summary: Paramedics frequently incur musculoskeletal injuries associated with patient-handling tasks. A controlled experiment was conducted to assess effects of ambulance cot design features on physical stress of operators, as seen through muscle activity and operator's perceptions. Differences between cots were found, signalling that intentional design can reduce operator's physical stress.

An inventory of ambulance service regulatory programs in California.

PubMed

Narad, R A

1998-01-01

Ambulance regulation in California is the responsibility of numerous agencies on the state and local levels. By identifying and analyzing the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. This study surveyed all California local EMS agencies (LEMSAs: California's equivalent of regional EMS organizations) to identify the types of regulatory programs used, the foci of these programs (e.g., equipment and personnel), and their application (e.g., public and private providers). All data acquired were analyzed using population parameters rather than inferential statistics. A response rate of 100% was obtained. Among the regulatory tools used are ordinances, contracts, and franchises. Regulatory standards vary widely as do their applications. Large counties and those that operate their own LEMSA have more extensive regulatory programs than do smaller counties and those who participate in multicounty agencies. Many of the enforcement mechanisms available are weak. This study suggests several policy implications for California and other states. The wide variation in the types of regulatory programs and the standards that are used suggest that the purpose and impact of regulatory programs should be studied further. The decentralization of the ambulance regulatory program and the lack of integration of ambulance regulations into EMS system planning also raise policy questions. In addition, the role of multicounty EMS agencies, as it relates to regulation of ambulance services, should be reviewed.

Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup.

PubMed

Deakin, Charles D; Thompson, Fizz; Gibson, Caroline; Green, Mark

2007-06-01

Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. All emergency calls to the Hampshire Ambulance Service NHS Trust (currently the Hampshire Division of South Central Ambulance Service, Winchester, UK) during the first weekend of the 2006 World Cup football matches were analysed by call volume and classification of call (call type). On the day of the first football match, call volume was over 50% higher than that on a typical Saturday, with distinct peaks before and after the inaugural match. Call profile analysis showed increases in alcohol-related emergencies, including collapse, unconsciousness, assault and road traffic accidents. The increase in assaults was particularly marked at the end of each match and increased again into the late evening. A detailed mapping of call volumes and profiles during the World Cup football shows a significant increase in overall emergency calls, mostly alcohol related. Mapping of limited resources to these patterns will allow improved responses to emergency calls.

Effects of international football matches on ambulance call profiles and volumes during the 2006 World Cup

PubMed Central

Deakin, Charles D; Thompson, Fizz; Gibson, Caroline; Green, Mark

2007-01-01

Background Prompt ambulance attendance is aimed at improving patient care. With finite resources struggling to meet performance targets, unforeseen demand precludes the ability to tailor resources to cope with increased call volumes, and can have a marked detrimental effect on performance and hence patient care. The effects of the 2006 World Cup football matches on call volumes and profiles were analysed to understand how public events can influence demands on the ambulance service. Methods All emergency calls to the Hampshire Ambulance Service NHS Trust (currently the Hampshire Division of South Central Ambulance Service, Winchester, UK) during the first weekend of the 2006 World Cup football matches were analysed by call volume and classification of call (call type). Results On the day of the first football match, call volume was over 50% higher than that on a typical Saturday, with distinct peaks before and after the inaugural match. Call profile analysis showed increases in alcohol‐related emergencies, including collapse, unconsciousness, assault and road traffic accidents. The increase in assaults was particularly marked at the end of each match and increased again into the late evening. Conclusion A detailed mapping of call volumes and profiles during the World Cup football shows a significant increase in overall emergency calls, mostly alcohol related. Mapping of limited resources to these patterns will allow improved responses to emergency calls. PMID:17513536

30 CFR 77.1702 - Arrangements for emergency medical assistance and transportation for injured persons; reporting...

Code of Federal Regulations, 2010 CFR

2010-07-01

... shall make arrangements with a licensed physician, medical service, medical clinic, or hospital to... name, title and address of the physician, medical service, medical clinic, hospital, or ambulance... medical service, medical clinic, hospital, or ambulance service with which such person or persons are...

Making Facilities Accessible to the Physically Handicapped.

ERIC Educational Resources Information Center

State Univ. Construction Fund, Albany, NY.

Guidelines on performance criteria for the State University of New York consider two main types of handicapped: the ambulant and semi-ambulant, including some physically handicapped, the visually and aurally handicapped, and persons with cardiac conditions; and persons confined to wheel chairs. The handicapped and planning for them are discussed.…

42 CFR 414.610 - Basis of payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... charge as payment in full and may not bill or collect from the beneficiary any amount other than the... provider or supplier to sanctions, as provided by law (part 402 of this chapter). (c) Formula for... loaded ambulance mile greater than 50 (that is, miles 51 and greater) for ambulance transports...

Interventions for improving community ambulation in individuals with stroke.

PubMed

Barclay, Ruth E; Stevenson, Ted J; Poluha, William; Ripat, Jacquie; Nett, Cristabel; Srikesavan, Cynthia S

2015-03-13

Community ambulation refers to the ability of a person to walk in their own community, outside of their home and also indoors in private or public locations. Some people choose to walk for exercise or leisure and may walk with others as an important aspect of social functioning. Community ambulation is therefore an important skill for stroke survivors living in the community whose walking ability has been affected. To determine: (1) whether interventions improve community ambulation for stroke survivors, and (2) if any specific intervention method improves community ambulation more than other interventions. We searched the Cochrane Stroke Group Trials Register (September 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), PubMed (1946 to November 2013), EMBASE (1980 to November 2013), CINAHL (1982 to November 2013), PsycINFO (1887 to November 2013), Scopus (1960 to November 2013), Web of Science (1900 to November 2013), SPORTDiscus (1975 to November 2013), and PEDro, CIRRIE and REHABDATA (November 2013). We also searched ongoing trials registers (November 2013) and reference lists, and performed a cited reference search. Selection criteria included parallel-group randomised controlled trials (RCTs) and cross-over RCTs, studies in which participants are adult (aged 18 years or more) stroke survivors, and interventions that were aimed at improving community ambulation. We defined the primary outcome as participation; secondary outcomes included activity level outcomes related to gait and self-efficacy. One review author independently screened titles. Two review authors screened abstracts and full text articles, with a third review author was available to resolve any disagreements. Two review authors extracted data and assessed risk of bias. All outcomes were continuous. The analysis for the primary outcome used the generic inverse variance methods for meta-analysis, using the standardised mean difference (SMD) and standard error (SE) from the participation outcomes. Analyses for secondary outcomes all used SMD or mean difference (MD). We completed analyses for each outcome with all studies, and by type of community ambulation intervention (community or outdoor ambulation practice, virtual practice, and imagery practice). We considered trials for each outcome to be of low quality due to some trial design considerations, such as who knew what group the participants were in, and the number of people who dropped out of the studies. We included five studies involving 266 participants (136 intervention; 130 control). All participants were adult stroke survivors, living in the community or a care home. Programmes to improve community ambulation consisted of walking practice in a variety of settings and environments in the community, or an indoor activity that mimicked community walking (including virtual reality or mental imagery). Three studies were funded by government agencies, and two had no funding.From two studies of 198 people there was low quality evidence for the effect of intervention on participation compared with control (SMD, 0.08, 95% confidence interval (CI) -0.20 to 0.35 (using inverse variance). The CI for the effect of the intervention on gait speed was wide and does not exclude no difference (MD 0.12, 95% CI -0.01 to 0.24; four studies, 98 participants, low quality evidence). We considered the quality of the evidence to be low for all the remaining outcomes in our review: Community Walk Test (MD -6.35, 95% CI -21.59 to 8.88); Walking Ability Questionnaire (MD 0.53, 95% CI -5.59 to 6.66); Six-Minute Walk Test (MD 39.62 metres, 95% CI -8.26 to 87.51) and self-efficacy (SMD 0.32, 95% CI -0.09 to 0.72). We downgraded the quality of the evidence because of a high risk of bias and imprecision. There is currently insufficient evidence to establish the effect of community ambulation interventions or to support a change in clinical practice. More research is needed to determine if practicing outdoor or community walking will improve participation and community ambulation skills for stroke survivors living in the community.

Determinants of ambulance response time: A study in Sabah, Malaysia

NASA Astrophysics Data System (ADS)

Chin, Su Na; Cheah, Phee Kheng; Arifin, Muhamad Yaakub; Wong, Boh Leng; Omar, Zaturrawiah; Yassin, Fouziah Md; Gabda, Darmesah

2017-04-01

Ambulance response time (ART) is one of the standard key performance indicators (KPI) in measuring the emergency medical services (EMS) delivery performances. When the mean time of ART of EMS system reaches the KPI target, it shows that the EMS system performs well. This paper considers the determinants of ART, using data sampled from 967 ambulance runs in a government hospital in Sabah. Multiple regression analysis with backward elimination was proposed for the identification of significant factors. Amongst the underlying factors, travel distance, age of patients, type of treatment and peak hours were identified to be significantly affecting ART. Identifying factors that influence ART helps the development of strategic improvement planning for reducing the ART.

Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations. Extension of temporary moratoria.

PubMed

2017-07-28

This document announces the extension of statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non-emergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children's Health Insurance Program in those states.

Air ambulance services--integrated emergency care.

PubMed

Ferdinand, M

1994-10-01

In the name of cost-conscious care, air ambulance program directors and service contractors are seeing the dawn of integrated networks as a boon to their business. As integrated networks form, facilities will become increasingly specialized in the types of services they provide. Patients will need to be moved around the system, resulting in more frequent patient transport and more points of transfer. Many programs are considering aircraft replacement and additions, rather than leasing. Financial benefits could come on depreciation and the high resale value of aircraft. Unless reimbursement levels increase, more program mergers and affiliations may take place to spread and reduce cost. Air ambulance services will increasingly become part of a facility's strategic plan.

Emergency Medical Technician-Ambulance: National Standard Curriculum. Course Guide (Third Edition).

ERIC Educational Resources Information Center

National Highway Traffic Safety Administration (DOT), Washington, DC.

This course guide is intended to assist course coordinators in planning and managing a course to train emergency medical technicians to work with ambulance or other specialized rescue services. Materials are presented to enable students to perform the following functions: recognize the nature and seriousness of the patient's condition or extent of…

[Locomotive syndrome and frailty. Musculoskeletal ambulation disorder symptom complex and locomotive syndrome].

PubMed

Yamamoto, Noriaki

2012-04-01

Musculoskeletal ambulation disorder symptom complex is the new concept of musculoskeletal disorders with disability in walking and balance, which lead to the high risk of fall and lower activity in elderly. Locomotive syndrome is another concept to aware of healthy locomotive organ for early prevention of orthopedic disease.

Use of 3G mobile phone links for teleconsultation between a moving ambulance and a hospital base station.

PubMed

Banitsas, Konstantinos A; Perakis, Konstantinos; Tachakra, Sapal; Koutsouris, Dimitrios

2006-01-01

We developed a mobile teleconsultation system based on third-generation mobile phone links. The system comprised a laptop computer and a digital camcorder. It was installed inside an ambulance to allow video-conferencing between the moving vehicle and a doctor at a base station. In addition to video and voice, high-quality still images could also be transmitted. A series of 17 trial runs with real ambulance patients was conducted in the city of Athens. In general, the videoconferencing sessions produced relatively clear video. The bandwidth was high enough for a satisfactory video of 10-15 frames/s. During a total testing period of 23 h and in an area of about 180 km2, there were nine instances of signal loss, amounting to a total of 17 min. The general opinion formed by the doctors was that the system produced good results. All initial diagnoses made using the system agreed with the final diagnoses of the patients. The study showed that the mobile system could reduce the time before an ambulance patient is seen by a doctor.

Response interval comparison between urban fire departments and ambulance services.

PubMed

Jermyn, B D

1999-01-01

To measure the response intervals of fire departments compared with ambulance services in three urban centers to determine whether defibrillators should be added to fire vehicles. A prospective sample of 1,882 code 4 (life-threatening) tiered calls were collected over a six-month period from March 1, 1994, to August 31, 1994. A matched pairs experimental design compared the response interval of the fire department with that of the ambulance service for each call. This emergency medical services (EMS) system encompasses three urban centers with populations of 80,000, 95,000, and 170,000. In two of three of the urban centers, the fire department arrived on scene more than a minute sooner than the ambulance service: Cambridge (n = 571, mean = 2.22 min, p < 0.0001); Kitchener (n = 1,011, mean = 1.24 min, p < 0.003); and Waterloo (n = 300, mean = 0.69 min, p < 0.98). The shorter response interval of fire departments suggests placing defibrillators on fire response vehicles in an effort to decrease the time to defibrillation for cardiac arrest victims in this EMS system.

The 6 minute walk test and performance of upper limb in ambulant duchenne muscular dystrophy boys.

PubMed

Pane, Marika; Mazzone, Elena Stacy; Sivo, Serena; Fanelli, Lavinia; De Sanctis, Roberto; D'Amico, Adele; Messina, Sonia; Battini, Roberta; Bianco, Flaviana; Scutifero, Marianna; Petillo, Roberta; Frosini, Silvia; Scalise, Roberta; Vita, Gian Luca; Bruno, Claudio; Pedemonte, Marina; Mongini, Tiziana; Pegoraro, Elena; Brustia, Francesca; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Busato, Fabio; Bonfiglio, Serena; Rolle, Enrica; Colia, Giulia; Bonetti, Annamaria; Palermo, Concetta; Graziano, Alessandra; D'Angelo, Grazia; Pini, Antonella; Corlatti, Alice; Gorni, Ksenija; Baranello, Giovanni; Antonaci, Laura; Bertini, Enrico; Politano, Luisa; Mercuri, Eugenio

2014-10-07

The Performance of Upper Limb (PUL) test was specifically developed for the assessment of upper limbs in Duchenne muscular dystrophy (DMD). The first published data have shown that early signs of involvement can also be found in ambulant DMD boys. The aim of this longitudinal Italian multicentric study was to evaluate the correlation between the 6 Minute Walk Test (6MWT) and the PUL in ambulant DMD boys. Both 6MWT and PUL were administered to 164 ambulant DMD boys of age between 5.0 and 16.17 years (mean 8.82). The 6 minute walk distance (6MWD) ranged between 118 and 557 (mean: 376.38, SD: 90.59). The PUL total scores ranged between 52 and 74 (mean: 70.74, SD: 4.66). The correlation between the two measures was 0.499. The scores on the PUL largely reflect the overall impairment observed on the 6MWT but the correlation was not linear. The use of the PUL appeared to be less relevant in the very strong patients with 6MWD above 400 meters, who, with few exceptions had near full scores. In patients with lower 6MWD the severity of upper limb involvement was more variable and could not always be predicted by the 6MWD value or by the use of steroids. Our results confirm that upper limb involvement can already be found in DMD boys even in the ambulant phase.

Development and Pilot Testing of 24/7 In-Ambulance Telemedicine for Acute Stroke: Prehospital Stroke Study at the Universitair Ziekenhuis Brussel-Project.

PubMed

Valenzuela Espinoza, Alexis; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; de Keyser, Jacques; Convents, Andre; Fernandez Tellez, Helio; Dupont, Alain; Putman, Koen; Brouns, Raf

2016-01-01

In-ambulance telemedicine is a recently developed and a promising approach to improve emergency care. We implemented the first ever 24/7 in-ambulance telemedicine service for acute stroke. We report on our experiences with the development and pilot testing of the Prehospital Stroke Study at the Universitair Ziekenhuis Brussel (PreSSUB) to facilitate a wider spread of the knowledge regarding this technique. Successful execution of the project involved the development and validation of a novel stroke scale, design and creation of specific hardware and software solutions, execution of field tests for mobile internet connectivity, design of new care processes and information flows, recurrent training of all professional caregivers involved in acute stroke management, extensive testing on healthy volunteers, organisation of a 24/7 teleconsultation service by trained stroke experts and 24/7 technical support, and resolution of several legal issues. In all, it took 41 months of research and development to confirm the safety, technical feasibility, reliability, and user acceptance of the PreSSUB approach. Stroke-specific key information can be collected safely and reliably before and during ambulance transportation and can adequately be communicated with the inhospital team awaiting the patient. This paper portrays the key steps required and the lessons learned for successful implementation of a 24/7 expert telemedicine service supporting patients with acute stroke during ambulance transportation to the hospital. © 2016 S. Karger AG, Basel.

PreSSUB II: The prehospital stroke study at the Universitair Ziekenhuis Brussel II

PubMed Central

Espinoza, Alexis Valenzuela; Van Hooff, Robbert-Jan; De Smedt, Ann; Moens, Maarten; Yperzeele, Laetitia; Nieboer, Koenraad; Hubloue, Ives; De Keyser, Jacques; Dupont, Alain; De Wit, Liesbet; Putman, Koen; Brouns, Raf

2015-01-01

Rationale Stroke is a time-critical medical emergency requiring specialized treatment. Prehospital delay contributes significantly to delayed or missed treatment opportunities. In-ambulance telemedicine can bring stroke expertise to the prehospital arena and facilitate this complex diagnostic and therapeutic process. Aims This study evaluates the efficacy, safety, feasibility, reliability and cost-effectiveness of in-ambulance telemedicine for patients with suspicion of acute stroke. We hypothesize that this approach will reduce the delay to in-hospital treatment by streamlining the diagnostic process and that prehospital stroke care will be improved by expert stroke support via telemedicine during the ambulance transportation. Design PreSSUB II is an interventional, prospective, randomized, open-blinded, end-point, single-center trial comparing standard emergency care by the Paramedic Intervention Team of the Universitair Ziekenhuis Brussel (control) with standard emergency care complemented with in-ambulance teleconsultation service by stroke experts (PreSSUB). Study Outcomes The primary efficacy endpoint is the call-to-brain imaging time. Secondary endpoints for the efficacy analysis include the prevalence of medical events diagnosed and corrected during in-ambulance teleconsultation, the proportion of patients with ischemic stroke receiving recanalization therapy, the assessment of disability, functional status, quality of life and overall well-being. Mortality at 90 days after stroke is the primary safety endpoint. Secondary safety analysis will involve the registration of any adverse event. Other analyses include assessment of feasibility and reliability and a health economic evaluation. PMID:27847888

Trends in fall-related ambulance use and hospitalisation among older adults in NSW, 2006-2013: a retrospective, population-based study.

PubMed

Paul, Serene S; Harvey, Lara; Carroll, Therese; Li, Qiang; Boufous, Soufiane; Priddis, Annabel; Tiedemann, Anne; Clemson, Lindy; Lord, Stephen R; Muecke, Sandy; Close, Jacqueline Ct; Lo, Serigne; Sherrington, Catherine

2017-10-11

Objective and importance of study: To describe characteristics and temporal trends of fall-related ambulance service use and hospital admission in older adults in New South Wales (NSW), Australia. Such information will facilitate a more targeted approach to planning and delivery of health services to prevent falls and their adverse sequelae in different groups of older adults. Retrospective population-based descriptive study. Fall-related ambulance use and hospital admissions for all falls and injurious falls in NSW residents aged ≥65 years between 2006 and 2013 were obtained from two discrete sources of routinely collected data. Rates of use are presented descriptively. There were 314 041 occasions of fall-related ambulance use by older adults and 331 311 fall-related hospitalisations, of which 69% (n = 227 753) were for injurious falls. Fractures accounted for 57% of injurious hospitalisations. Slips and trips were the most common mechanism of falls requiring hospitalisation (52%). Residents of aged care facilities had a greater proportion of fall injury hospitalisations compared with people living in the community (85% and 65%, respectively). Rates of fall-related ambulance use and hospitalisation were similar and continued to increase over time. Increased effort is needed to prevent falls and associated injury among older people in NSW, particularly among people living in aged care facilities. Ongoing monitoring of rates and the characteristics of people who fall are needed to determine the long-term impact of fall prevention interventions.

A correction factor for estimating statewide agricultural injuries from ambulance reports.

PubMed

Scott, Erika E; Earle-Richardson, Giulia; Krupa, Nicole; Jenkins, Paul

2011-10-01

Agriculture ranks as one of the most hazardous industries in the nation. Agricultural injury surveillance is critical to identifying and reducing major injury hazards. Currently, there is no comprehensive system of identifying and characterizing fatal and serious non-fatal agricultural injuries. Researchers sought to calculate a multiplier for estimating the number of agricultural injury cases based on the number of times the farm box indicator was checked on the ambulance report. Farm injuries from 2007 that used ambulance transport were ascertained for 10 New York counties using two methods: (1) ambulance reports including hand-entered free text; and (2) community surveillance. The resulting multiplier that was developed from contrasting these two methods was then applied to the statewide Emergency Medical Services database to estimate the total number of agricultural injuries for New York state. There were 25,735 unique ambulance runs due to injuries in the 10 counties in 2007. Among these, the farm box was checked a total of 90 times. Of these 90, 63 (70%) were determined to be agricultural. Among injury runs where the farm box was not checked, an additional 59 cases were identified from the free text. Among these 122 cases (63 + 59), four were duplicates. Twenty-four additional unique cases were identified from the community surveillance for a total of 142. This yielded a multiplier of 142/90 = 1.578 for estimating all agricultural injuries from the farm box indicator. Sensitivity and specificity of the ambulance report method were 53.4% and 99.9%, respectively. This method provides a cost-effective way to estimate the total number of agricultural injuries for the state. However, it would not eliminate the more labor intensive methods that are required to identify of the actual individual case records. Incorporating an independent source of case ascertainment (community surveillance) increased the multiplier by 17%. Copyright © 2011 Elsevier Inc. All rights reserved.

Quantification of NSW Ambulance Record Linkages with Multiple External Datasets.

PubMed

Carroll, Therese; Muecke, Sandy; Simpson, Judy; Irvine, Katie; Jenkins, André

2015-01-01

This study has two aims: 1) to describe linkage rates between ambulance data and external datasets for "episodes of care" and "patient only" linkages in New South Wales (NSW), Australia; and 2) to detect and report any systematic issues with linkage that relate to patients, and operational or clinical variables that may introduce bias in subsequent studies if not adequately addressed. During 2010-11, the Centre for Health Record Linkage (CHeReL) in NSW, linked the records for patients attended by NSW Ambulance paramedics for the period July 2006 to June 2009, with four external datasets: Emergency Department Data Collection; Admitted Patient Data Collection; NSW Registry of Births, Deaths and Marriages death registration data; and the Australian Bureau of Statistics mortality data. This study reports linkage rates in terms of those "expected" to link and those who were "not expected" to link with external databases within 24 hours of paramedic attendance. Following thorough data preparation processes, 2,041,728 NSW Ambulance care episodes for 1,116,509 patients fulfilled the inclusion criteria. The overall episode-specific hospital linkage rate was 97.2%. Where a patient was not transported to hospital following paramedic care, 8.6% of these episodes resulted in an emergency department attendance within 24 hours. For all care episodes, 5.2% linked to a death record at some time within the 3-year period, with 2.4% of all death episodes occurring within 7 days of a paramedic encounter. For NSW Ambulance episodes of care that were expected to link to an external dataset but did not, nonlinkage to hospital admission records tended to decrease with age. For all other variables, issues relating to rates of linkage and nonlinkage were more indiscriminate. This quantification of the limitations of this large linked dataset will underpin the interpretation and results of ensuing studies that will inform future clinical and operational policies and practices at NSW Ambulance.

Does crash risk increase when emergency vehicles are driving with lights and sirens?

PubMed

Missikpode, Celestin; Peek-Asa, Corinne; Young, Tracy; Hamann, Cara

2018-04-01

Emergency vehicles, such as police, ambulances, and fire vehicles, need to arrive at the scene of emergencies as quickly as possible, and thus they often travel in emergency mode - using their lights and sirens and often bypassing traffic signals. We examined whether travelling in emergency mode increased crash risk among police, ambulance and fire vehicles. We conducted a quasi-induced exposure analysis using data from the Iowa Crash Database for the period of 2005 through 2013. The data are maintained by the Iowa Department of Transportation (IADOT), Office of Driver Services (ODS) and includes all investigating police officer's reports of motor vehicle crashes. The quasi-induced exposure method is an approach to calculate crash risk in the absence of exposure data using vehicles without a contributing cause (did not contribute to the crash) as a proxy for the baseline driving population. From 2005 - 2013, police vehicles were involved in 2406 crashes and ambulances and fire vehicles were involved in 528 crashes. Police vehicles were 1.8 times more likely to crash while driving in emergency mode than usual mode; this was a statistically significant increase. Ambulance and fire vehicles were not more likely to crash in emergency mode compared with usual mode. For police, other factors that contributed to crash risk included gender, age, icy/snowy roads, unpaved roads, and intersections. For ambulances and fire vehicles, other factors that contributed to crash risk included gender, age, weekends, icy/snowy roads and urban locations. Crash risk increased when police vehicles drove with lights and sirens but did not increase for ambulance and fire vehicles. Further research is necessary to develop and evaluate strategies to mitigate crash risk among police vehicles. Cultural approaches which prioritize transportation safety in conjunction with reaching the scene as quickly as possible may be warranted. Copyright © 2018 Elsevier Ltd. All rights reserved.

Availability and Quality of Prehospital Care on Pakistani Interurban Roads

PubMed Central

Bhatti, Junaid A.; Waseem, Hunniya; Razzak, Junaid A.; Shiekh, Naeem-ul-lah; Khoso, Ajmal Khan; Salmi, L.-Rachid

2013-01-01

Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27–46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30–60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3–10), and the median paramedic training was 3 days (IQR=2–3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage. PMID:24406963

Characteristics of Japanese Patients with Becker Muscular Dystrophy and Intermediate Muscular Dystrophy in a Japanese National Registry of Muscular Dystrophy (Remudy): Heterogeneity and Clinical Variation.

PubMed

Mori-Yoshimura, Madoka; Mitsuhashi, Satomi; Nakamura, Harumasa; Komaki, Hirofumi; Goto, Kanako; Yonemoto, Naohiro; Takeuchi, Fumi; Hayashi, Yukiko K; Murata, Miho; Takahashi, Yuji; Nishino, Ichizo; Takeda, Shin'ichi; Kimura, En

2018-01-01

Obtaining an adequate number of patients to conduct a natural history study for rare diseases such as Becker muscular dystrophy (BMD) is difficult. The present study used data from Remudy, a national registry for neuromuscular diseases in Japan, to conduct a phenotypic analysis of BMD. We analyzed Remudy data of participants with dystrophinopathy. All participants who were aged 17 and older and were ambulant at age 13 were included in this study. Participants were divided into two groups: those with BMD who were ambulant at age 17, and those with intermediate muscular dystrophy (IMD) who lost ambulation by age 17. Frequent mutations were analyzed by age at ambulation, cardiopulmonary function, and genotype. For clinical comparisons, participants who were administered steroids were excluded. From July 2009 through September 2015, 192 participants had registered with Remudy. Mean participant age was 34.80±13.3 (range, 17-78) years, and 52.1% of participants were ambulant. Of the entire study population, 50.5% had cardiomyopathy and 35.9% had respiratory failure. Three participants required invasive ventilation and 30 required non-invasive ventilation. Nineteen of the 30 non-invasive ventilator users were part-time users. In total, 138 (71.9%) had BMD and 54 (28.1%) had IMD. The most frequent mutation was ex45_ex47del (36 participants). Among participants with frequent in-frame mutations, those with the ex45-49del mutation lost their ambulation earlier than those with the ex45_ex47del mutation. A total of 67 different exon deletions and duplications were identified in the study population. We clarified the clinical phenotypes of Japanese patients with BMD/IMD using data from Remudy. Our results suggest that not only IMD but also BMD are associated with risk of respiratory dysfunction.

[Risk assessment of rescue helicopter or ambulance transport of patients ingesting hazardous volatile materials].

PubMed

Takegawa, Ryosuke; Ohnishi, Mitsuo; Hirose, Tomoya; Hatano, Yayoi; Imada, Yuko; Endo, Yoko; Shimazu, Takeshi

2016-03-01

In cases of transport by rescue helicopter or ambulance of patients having ingested hazardous substances, medical personnel may be at a certain risk of inhaling the substances. However, few reports have addressed such risk of causing secondary casualties. This simulation study aimed to assess the risk of inhalation of hydrogen sulfide and chlo-opicrin in the cabin of a helicopter or an ambulance transporting a patient who has ingested calcium polysulfide or chloropicrin, which were previously reported to cause secondary casualties. Concentrations of hydrogen sulfide and chloropicrin were assessed on the following as-umptions :The patient ingested 100 mL of the causative or original chemical. All chemical substances reacted with the gastric juice or were thoroughly vomited and evaporated uniformly within the cabin space of the helicopter or ambulance. Environmental conditions were 20 *degrees at 1 atmosphere of pres-ure in a 5 m3 cabin volume in the helicopter and a 13.5 m3 cabin volume in the ambulance. In the case of calcium polysulfide ingestion which produced hydrogen sulfide, its concen-ration reached 774 ppm in the helicopter and 287 ppm in the ambulance. For chloropicrin ingestion, the concentrations were 4,824 ppm and 1,787 ppm, respectively. The simulated concentration of hydrogen sulfide was more than 500 ppm in the heli-opter, which may lead to respiratory paralysis and death. The simulated concentration of chloropicrin was more than 300 ppm, which has a risk of death within 10 minutes. Currently, as far as Japanese laws are concerned, there are no restrictions requiring pretransport assessment or setting criteria for transporting patients who might have ingested hazardous substances that could cause secondary casu-lties when vomited. When patients who might have ingested hazardous chemicals are transported, it is important to recognize the risk of causing secondary casualties by vomiting the chemicals.

Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument--an observational study.

PubMed

Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F

2016-03-08

In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0.11) or observed non-technical skills performance (r(s) = 0.4, p = 0.1). This study describes a framework which characterises the non-technical skills required by critical care air ambulance clinicians, and distinguishes higher and lower levels of performance. The AeroNOTS framework could be used to facilitate education and training in non-technical skills for air ambulance clinicians, and further evaluation of this rating system is merited.

Electrocardiographic Indicators of Acute Coronary Syndrome are More Common in Patients with Ambulance Transport Compared to Those who Self-Transport to the Emergency Department Journal of Electrocardiology

PubMed Central

Pickham, David; Pelter, Michele M

2016-01-01

Introduction The American Heart Association recommends individuals with symptoms suggestive of acute coronary syndrome (ACS) activate the Emergency Medical Services’ (EMS) 911 system for ambulance transport to the emergency department (ED), which enables treatment to begin prior to hospital arrival. Despite this recommendation, the majority of patients with symptoms suspicious of ACS continue to self-transport to the ED. The IMMEDIATE AIM study was a prospective study that enrolled individuals who presented to the ED with ischemic symptoms. Objectives The purpose of this secondary analysis was to determine differences in patients presenting the ED for possible ACS who arrive by ambulance versus self-transport on: 1) Time-to-initial hospital electrocardiogram (ECG), 2) presence of ischemic ECG changes, and 3) patient characteristics. Methods Initial 12-lead ECGs acquired upon patient arrival to the ED were evaluated for ST-elevation, ST-depression, and T-wave inversion. ECG signs of ischemia were analyzed both individually and collapsed into an independent dichotomous variable (ED ECG ischemia yes/no) for statistical analysis. Patient characteristics tested included: gender, age, race, ethnicity, English speaking, living alone, mode of transport, and presenting symptoms (chest pain, jaw pain, shortness of breath, nausea/vomiting, syncope, and clinical history). Results In 1299 patients (mean age 63.9, 46.7% male), 384 (29.6%) patients arrived by ambulance to the ED. The mean time-to-initial ECG was 47 minutes for ambulance patients versus 53 minutes for self-transport patients (p<0.001). Mode of transport was found to be an independent predictor for time-to-initial ECG controlling for age, gender, and race (p=0.004). There were significantly higher rates of ECG changes of ischemia for patients who arrived by ambulance versus self-transport (p=0.02), and patient characteristics differed by mode of transport to the ED. Discussion Our findings indicate that less than 30% of individuals with symptoms of ACS activate the EMS ‘911’ system for ambulance transport to the ED. Individuals more likely to activate 911 have timelier ECG but higher rates of ischemic changes, specifically ST-depression and T-wave inversion. Individuals least likely to activate 911 are women, younger individuals, Latino ethnicity, live with a significant other, and those experiencing chest or jaw pain. PMID:27614946

Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time-series analysis.

PubMed

McAuley, Andrew; Bouttell, Janet; Barnsdale, Lee; Mackay, Daniel; Lewsey, Jim; Hunter, Carole; Robinson, Mark

2017-02-01

It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid-related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid-related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call-outs to opioid-related overdose incidents and the cumulative number of 'take-home naloxone' (THN) kits in issue; and is there evidence of an association between ambulance call-outs to opioid-related overdose incidents in early adopter (pilot) or later adopting (non-pilot) regions and the cumulative number of THN kits issued in those areas? Controlled time-series analysis. Scotland, UK, 2008-15. Pre-NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post-implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid-related overdose were recorded for the pre-NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post-implementation period (mean 24.8 attendances per week). Scotland's NNP; formally implemented on 1 April 2011. Primary outcome measure was weekly incidence (counts) of call-outs to opioid-related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call-outs to heroin-related overdose in the London Borough area acquired from the London Ambulance Service. There was no significant association between SAS call-outs to opioid-related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = -0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call-outs did not differ significantly between pilot and non-pilot regions (interaction test, P = 0.62). The supply of take-home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid-related overdose incidents in the 4-year period after it was implemented in April 2011. © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

Evaluating the impact of a national naloxone programme on ambulance attendance at overdose incidents: a controlled time–series analysis

PubMed Central

Bouttell, Janet; Barnsdale, Lee; Mackay, Daniel; Lewsey, Jim; Hunter, Carole; Robinson, Mark

2016-01-01

Abstract Background and Aims It has been suggested that distributing naloxone to people who inject drugs (PWID) will lead to fewer attendances by emergency medical services at opioid‐related overdose incidents if peer administration of naloxone was perceived to have resuscitated the overdose victim successfully. This study evaluated the impact of a national naloxone programme (NNP) on ambulance attendance at opioid‐related overdose incidents throughout Scotland. Specifically, we aimed to answer the following research questions: is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents and the cumulative number of ‘take‐home naloxone’ (THN) kits in issue; and is there evidence of an association between ambulance call‐outs to opioid‐related overdose incidents in early adopter (pilot) or later adopting (non‐pilot) regions and the cumulative number of THN kits issued in those areas? Design Controlled time–series analysis. Setting Scotland, UK, 2008–15. Participants Pre‐NNP implementation period for the evaluation was defined as 1 April 2008 to 31 March 2011 and the post‐implementation period as 1 April 2011 to 31 March 2015. In total, 3721 ambulance attendances at opioid‐related overdose were recorded for the pre‐NNP implementation period across 158 weeks (mean 23.6 attendances per week) and 5258 attendances across 212 weeks in the post‐implementation period (mean 24.8 attendances per week). Intervention Scotland's NNP; formally implemented on 1 April 2011. Measurements Primary outcome measure was weekly incidence (counts) of call‐outs to opioid‐related overdoses at national and regional Health Board level. Data were acquired from the Scottish Ambulance Service (SAS). Models were adjusted for opioid replacement therapy using data acquired from the Information Services Division on monthly sums of all dispensed methadone and buprenorphine in the study period. Models were adjusted further for a control group: weekly incidence (counts) of call‐outs to heroin‐related overdose in the London Borough area acquired from the London Ambulance Service. Findings There was no significant association between SAS call‐outs to opioid‐related overdose incidents and THN kits in issue for Scotland as a whole (coefficient 0.009, 95% confidence intervals = −0.01, 0.03, P = 0.39). In addition, the magnitude of association between THN kits and SAS call‐outs did not differ significantly between pilot and non‐pilot regions (interaction test, P = 0.62). Conclusions The supply of take‐home naloxone kits through a National Naloxone Programme in Scotland was not associated clearly with a decrease in ambulance attendance at opioid‐related overdose incidents in the 4‐year period after it was implemented in April 2011. PMID:27614084

Analyzing Who, When, and Where: Data for Better Targeting of Resources for School-Based Asthma Interventions

ERIC Educational Resources Information Center

Raun, Loren H.; Campos, Laura A.; Stevenson, Elizabeth; Ensor, Katherine B.; Johnson, Gwen; Persse, David

2017-01-01

Background: Rates of uncontrolled asthma vary by demographics, space, and time. This article uses data on ambulance-treated asthma attacks in children to analyze these variations so that school districts can improve their asthma management interventions. Methods: Incidence rates of 1826 ambulance-treated asthma attacks for children aged 5-18 years…

Ambulance Attendant. D.O.T. No. 355.374-010. Individualized Study Guide [with Teachers' Packet]. First Edition.

ERIC Educational Resources Information Center

East Texas State Univ., Commerce. Occupational Curriculum Lab.

Developed for students in a cooperative training program in health occupations education, this study guide is designed for individualized study of competencies for ambulance attendants. It follows the general responsibilities outlined in the Dictionary of Occupational Titles. The occupational outlook and job description are first presented.…

The Effect of a Microprocessor Prosthetic Foot on Function and Quality of Life in Transtibial Amputees Who Are Limited Community Ambulators

DTIC Science & Technology

with greater range of motion and active power, will translate into improved functional performance, ambulatory safety (risk of falls) and quality of... life in trans-tibial amputees (TTA) who function as limited community ambulators. We will assess these outcomes in 54 veterans with TTA by randomizing

10-year experience of CO2-laser application in ambulance gynecology

NASA Astrophysics Data System (ADS)

Stachanov, Michael L.; Masychev, Victor I.; Velsher, Leonid Z.; Kirkin, Vladimir V.; Zhashkov, Roman V.; Kocharian, Emilia A.

2000-10-01

CO2-laser surgical systems have come to stay in everyday practice of modern physicians and are successfully used in colposcopic and laparoscopic surgery. Results, obtained in ambulance gynecology are especially impressing. CO2- laser provides high medical- and cost-effective treatment. Presented work describes many-years experience of CO2- laser application. 439 patients with various vulvaric and cervix diseases were operated within this period. Laser beam parameters were selected according to requirements ((tau) =4 J/cm2) treatment without carbonization. Analyses of the results showed that the laser successfully destructs uterine cervix erosion, endocervicosis, dysplasia, leukoplakia, eritoplakia of uterine cervix, various benignant pathologies and focus degenerative process in ambulate conditions.

Infection control implications of the laundering of ambulance staff uniforms and reusable mops.

PubMed

Mackay, W G; Whitehead, S; Purdue, N; Smith, M; Redhead, N; Williams, C; Wilson, S

2017-05-01

There is a lack of published studies on laundering in ambulance services. We performed bacterial culture on soiled and unsoiled uniforms and reusable mop heads artificially contaminated with Escherichia coli, Staphylococcus aureus, and Clostridium difficile spores. Current laundering processes used for routine cleans in the ambulances appears, from our simulations, to be effective at reducing vegetative pathogenic bacteria to undetectable levels, <3.398log 10 colony-forming units (S. aureus and E. coli). Reduced levels of C. difficile were still detected after laundering but the risk this poses for infection is unknown, as background levels of these spores in the environment are unknown. Copyright © 2017 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Predicted utilization of emergency medical services telemedicine in decreasing ambulance transports.

PubMed

Haskins, Paul A; Ellis, David G; Mayrose, James

2002-01-01

To determine predicted utilization, decrease in ambulance transports, and target population for emergency medical services (EMS) if telemedicine capabilities were available to the medic units in the field. A retrospective chart review of 345 consecutive ambulance transports to four hospitals (Level I urban trauma center, urban tertiary care center, children's hospital and suburban community hospital) was performed by a panel of three board-certified emergency medicine physicians experienced and credentialed in emergency telemedicine. They independently reviewed the emergency department (ED) and EMS records and were asked to determine whether patients required ambulance transport for evaluation or whether disposition could be made following paramedic and emergency physician assessment via telemedicine. A five-point Likert scale was used to grade feasibility of telemedicine disposition (definitely yes, probably yes, maybe, probably no, definitely no). Other variables analyzed included age, sex, race, chief complaint, phone, private medical doctor, and call location by patient zip code, call site, and receiving hospital. In 14.7% of cases (6% definitely yes and 8.7% probably yes), disposition could be made without transport using telemedicine. The age range for eliminating transport was 2 weeks through 92 years, with mean age of 26.6 years. Under the age of 50 years, 46 out of 238 patients (19.3%) could have possibly been managed by telemedicine. Use of EMS telemedicine could result in an approximately 15% decrease in ambulance transports when it alone is added to the prehospital care provider's armamentarium. Emphasis for implementation should be placed on younger patients and an identified subset of chief complaints conducive to management using telemedicine.

Meeting national response time targets for priority 1 incidents in an urban emergency medical services system in South Africa: More ambulances won't help.

PubMed

Stein, Christopher; Wallis, Lee; Adetunji, Olufemi

2015-09-19

Response time is viewed as a key performance indicator in most emergency medical services (EMS) systems. To determine the effect of increased emergency vehicle numbers on response time performance for priority 1 incidents in an urban EMS system in Cape Town, South Africa, using discrete-event computer simulation. A simulation model was created, based on input data from part of the EMS operations. Two different versions of the model were used, one with primary response vehicles and ambulances and one with only ambulances. In both cases the models were run in seven different scenarios. The first scenario used the actual number of emergency vehicles in the real system, and in each subsequent scenario vehicle numbers were increased by adding the baseline number to the cumulative total. The model using only ambulances had shorter response times and a greater number of responses meeting national response time targets than models using primary response vehicles and ambulances. In both cases an improvement in response times and the number of responses meeting national response time targets was observed with the first incremental addition of vehicles. After this the improvements rapidly diminished and eventually became negligible with each successive increase in vehicle numbers. The national response time target for urban areas was never met, even with a seven-fold increase in vehicle numbers. The addition of emergency vehicles to an urban EMS system improves response times in priority 1 incidents, but alone is not capable of the magnitude of response time improvement needed to meet the national response time targets.

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross‐sectional survey

PubMed Central

Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne

2015-01-01

Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398

Deaths following prehospital safety incidents: an analysis of a national database.

PubMed

Yardley, Iain E; Donaldson, Liam J

2016-10-01

Ensuring patient safety in the prehospital environment is difficult due to the unpredictable nature of the workload and the uncontrolled situations that care is provided in. Studying previous safety incidents can help understand risks and take action to mitigate them. We present an analysis of safety incidents related to patient deaths in ambulance services in England. All incidents related to a patient death reported to the National Reporting and Learning System from an ambulance service between 1 June 2010 and 31 October 2012 were subjected to thematic analysis to identify the failings that led to the incident. Sixty-nine incidents were analysed, equating to one safety incident-related death per 168 000 calls received. Just three event categories were identified: delayed response (59%, 41/69), shortfalls in clinical care (35%, 24/69) and injury during transit (6%, 4/69). Primary failures differed for the categories: problems with dispatch caused the majority of delays in response, with equipment problems and bad weather accounting for the remainder. Failure to provide necessary care was predominantly caused by clinical misjudgements by ambulance staff and equipment issues underlay incidents that led to a patient injury. Improvements intended to address safety related mortality in the ambulance service should include ensuring adequate equipping and resourcing of ambulance services, improving coordination and decision-making during dispatch and supporting individual staff members in the difficult decisions they are faced with. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Osteogenesis imperfecta in childhood: effects of spondylodesis on functional ability, ambulation and perceived competence.

PubMed

Tolboom, N; Cats, E A; Helders, P J M; Pruijs, J E H; Engelbert, R H H

2004-03-01

We studied the effects of spondylodesis on spinal curvature, functional outcome, level of ambulation and perceived competence in 11 children with osteogenesis imperfecta (OI). Mean age at surgical intervention was 13.1 years (SD 2.5 years) and follow-up amounted to 3.4 years (SD 2.3 years). Spinal curvature was measured according to Cobb. The level of ambulation was scored according to the modified criteria of Bleck. Functional abilities and the amount of parental assistance were scored using the Dutch version of the Pediatric Evaluation of Disability Inventory (PEDI). Perceived competence was measured using the Harter Self-Perception Profile for Children. The amount of fatigue, spinal pain and presence of subjective dyspnea were scored with a visual analog scale. The median progression per year before spondylodesis was 6.1 degrees (interquartile range 2.9 degrees -12.9 degrees ) and after the spondylodesis it was 5.0 degrees (interquartile range 1.6 degrees -11.0 degrees ). No significant progression or regression in the level of ambulation was found. Perceived competence improved slightly. In the total score of the perceived competence, a borderline significant increase was found ( P-value 0.068). We concluded that spinal fusion in children with OI does not materially influence functional ability and level of ambulation. Self-perceived competence seemed to improve after surgery. The amount of pain, fatigue and subjective dyspnea seemed to diminish after spinal surgery. Progression of scoliosis proceeded, as did development of spinal curvature at the junction of the spondylodesis. Therefore, oral or intravenous bisphosphonates before and after spinal surgery should be considered.

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol

PubMed Central

Riou, Marine; Ball, Stephen; Williams, Teresa A; Whiteside, Austin; O’Halloran, Kay L; Bray, Janet; Perkins, Gavin D; Cameron, Peter; Fatovich, Daniel M; Inoue, Madoka; Bailey, Paul; Brink, Deon; Smith, Karen; Della, Phillip; Finn, Judith

2017-01-01

Introduction Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch. Methods and analysis A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research. Ethics and dissemination The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals. PMID:28694349

Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan.

PubMed

Bhatti, Junaid A; Razzak, Junaid A; Lagarde, Emmanuel; Salmi, Louis-Rachid

2011-03-22

Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI) for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED) datasets on an interurban road section in Pakistan. The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS), and five hospital EDs in Karachi during 2008 (Jan to Dec) were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants) and outcome (died or injured). Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs) than in ambulance (10 per 100 RTIs) and hospital ED records (9 per 100 RTIs). Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs) than in ambulance (17 per 100 RTIs) and hospital ED records (43 per 100 RTIs). Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.

Multi-Agent Simulation of Allocating and Routing Ambulances Under Condition of Street Blockage after Natural Disaster

NASA Astrophysics Data System (ADS)

Azimi, S.; Delavar, M. R.; Rajabifard, A.

2017-09-01

In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.

An Action Learning Approach to the Question: Are Ambulance Response Time Targets Achievable?

ERIC Educational Resources Information Center

Slater, Alan

2017-01-01

In recent years, NHS Ambulance Trusts throughout the UK have consistently failed to achieve their response time targets for both actual and potential life-threatening calls. To avoid a media and public outcry, the NHS response has been to change the basic parameters upon which the response time targets are calculated. An action learning study,…

Striding Towards Better Physical Therapy

NASA Technical Reports Server (NTRS)

2003-01-01

This paper presents a discussion on a new rehabilitative device that promises to improve physical therapy for patients working to regain the ability to walk after facing traumatic injuries or a degenerative illness. Produced by Enduro Medical Technology, of East Hartford, Connecticut, the Secure Ambulation Module (S.A.M.) creates a stable and secure environment for patients as they stand during ambulation therapy.

VehiHealth: An Emergency Routing Protocol for Vehicular Ad Hoc Network to Support Healthcare System.

PubMed

Bhoi, S K; Khilar, P M

2016-03-01

Survival of a patient depends on effective data communication in healthcare system. In this paper, an emergency routing protocol for Vehicular Ad hoc Network (VANET) is proposed to quickly forward the current patient status information from the ambulance to the hospital to provide pre-medical treatment. As the ambulance takes time to reach the hospital, ambulance doctor can provide sudden treatment to the patient in emergency by sending patient status information to the hospital through the vehicles using vehicular communication. Secondly, the experienced doctors respond to the information by quickly sending a treatment information to the ambulance. In this protocol, data is forwarded through that path which has less link breakage problem between the vehicles. This is done by calculating an intersection value I v a l u e for the neighboring intersections by using the current traffic information. Then the data is forwarded through that intersection which has minimum I v a l u e . Simulation results show VehiHealth performs better than P-GEDIR, GyTAR, A-STAR and GSR routing protocols in terms of average end-to-end delay, number of link breakage, path length, and average response time.

The ambulance services in northern Norway 2004–2008: improved competence, more tasks, better logistics and increased costs

PubMed Central

Elsbak, Trond M.

2010-01-01

Background The ambulance services in northern Norway have undergone significant development during recent years. Aims The objective of this study was to describe these changes in terms of tasks performed, distance driven, resources spent and level of competence in terms of education. Methods A retrospective analysis was performed. The ambulance fleet’s activity during the time period 2004–2008 was analysed. The subject was the ambulance fleet in northern Norway and its crew members. Tasks done, kilometres driven, resources spent per thousand inhabitants and level of competence were the main outcome measures. Results The major findings were almost doubled costs (92%), increasing number of tasks performed (13%) and a stable situation concerning kilometres driven. We also revealed improving competence in terms of education. A 20% absolute increase in crew members having a certificate of competence (fagbrev) was observed. Conclusions Significant economic resources have been invested in the fleet. Improved level of competence and an upgraded coordination system have improved logistics and hopefully treatment outcome. The latter should be further elucidated when the electronic patient record (EPR) system has been implemented. PMID:20606813

Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians.

PubMed

Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark

2014-01-01

This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Effect of introduction of electronic patient reporting on the duration of ambulance calls.

PubMed

Kuisma, Markku; Väyrynen, Taneli; Hiltunen, Tuomas; Porthan, Kari; Aaltonen, Janne

2009-10-01

We examined the effect of the change from paper records to the electronic patient records (EPRs) on ambulance call duration. We retrieved call duration times 6 months before (group 1) and 6 months after (group 2) the introduction of EPR. Subgroup analysis of group 2 was fulfilled depending whether the calls were made during the first or last 3 months after EPR introduction. We analyzed 37 599 ambulance calls (17 950 were in group 1 and 19 649 were in group 2). The median call duration in group 1 was 48 minutes and in group 2 was 49 minutes (P = .008). In group 2, call duration was longer during the first 3 months after EPR introduction. In multiple linear regression analysis, urgency category (P < .0001), unit level (P < .0001), and transportation decision (P < .0001) influenced the call duration. The documentation method was not a significant factor. Electronic patient record system can be implemented in an urban ambulance service in such a way that documentation method does not become a significant factor in determining call duration in the long run. Temporary performance drop during the first 3 months after introduction was noticed, reflecting adaptation process to a new way of working.

Calgary, Edmonton and the University of Alberta: the extraordinary medical mobilization by Canada’s newest province

PubMed Central

Da Cambra, Mark P.; McAlister, Vivian C.

2017-01-01

Summary The Canadian contribution of medical services to the British Empire during the First World War was a national endeavour. Physicians from across the country enlisted in local regiments to join. No other region provided more physicians per capita than the newly formed province of Alberta. Largely organized through the Medical School of the University of Alberta, the No. 11 Canadian Field Ambulance out of Edmonton and the No. 8 Canadian Field Ambulance out of Calgary ultimately enlisted between one-third and half of the province’s doctors to the war campaign. Many individuals from this region distinguished themselves, including LCol J.N. Gunn from Calgary, who commanded the No. 8 Canadian Field Ambulance; Maj Heber Moshier, one of the founders of the School of Pharmacy at the University of Alberta; and Dr. A.C. Rankin, who would go on to be the first Dean of Medicine at the University of Alberta. These Canadian heroes, and the many others like them who served with the No. 8 and 11 Field Ambulances, personify the sacrifice, strength and resilience of the medical community in Alberta and should not be forgotten. PMID:28930035

[The Swedish ambulance services 1935-1936 of Gunnar Agge].

PubMed

Gustavsson, Pär; Nilsson, Peter M

2006-01-01

The fact that Sweden has been spared from war on its soil for almost 200 years, has not stopped Swedish citizens from participating in conflicts worldwide during this period. This has been described, especially from the soldiers perspective. The contribution of Swedish physicians has not been written about to the same extent. When Mussolini's Italy in October 1935 invaded the poor and underdeveloped country of Ethiopia (former Abyssinia) an ambulance was immediately organized by the Swedish Red Cross. To lead such an expedition, a great knowledge of Ethiopian culture och maybe most importantly, of the weather and geographical conditions, was undoubtedly demanded. Therefore, the Swedish Red Cross turned to two Ethiopian veterans. Doctor Fride Hylander, a missionary-son who had been working on a hospital project in the Ethiopian province of Harrar and his friend since school years, doctor Gunnar Agge, were assigned the leadership of the ambulance. Dr Agge had also participated in improving the Ethiopian health care both in Harrar and later as civilian and military doctor in the province of Ogaden, where he was medically responsible for the more than 9 000 men strong army that the Ethiopian emperor had stationed there after Italian provocations. Most of the other members of the ambulance were handpicked by these two leaders and many of them had, just like themselves, a stong religious belief. A money-raise was immediately initiated and in less than six weeks 700 000 Swedish crowns had been collected, more then twice the sum the ambulance was calculated to cost. In early november 1935 the ambulance was clear to go. Their primary objective was to travel through British Somaliland and establish a field-hospital in the province of Harrar. However, the Ethiopian emperor had other things in mind. He wanted to reorganize the ambulance and divide it in two and place it closer to the front line. The ambulance decided to go along with his wish. Both groups started eventually their dangerous journey towards the front, in the erratic hands of the weather-gods and the harsh environment. Roads, in a European sense, almost never existed and when the rain turned them into fields of mud, in which the cars constantly got stuck, the prospect of the ambulance did not seem good. For the minor group, for which Dr Agge was the assigned leader, it took more then two months to reach the eastern parts of Ethiopia. The other larger group reached its destination Mälka Dida on december 19th. It didn't take long before the Italian airforce started to show an alarming interest for their camp. On December 30th, despite the fact that the field-hospital was marked with the flag of the Red Cross according to the Geneva Convention, Italian pilots dropped more then one hundred bombs over the area and totally destroyed the field-hospital and more or less all medical equipment. This day remains as maybe the darkest in the history of the International Red Cross. The Swedish medical orderly Gunnar Lundström later past away due to the injuries he suffered. Doctor Hylander was also seriously wounded but fortunately he could fully recover. The remaing crew of the ambulance was forced to retreat and after spending some time in the capital Addis Abeba they joined the smaller group. In the beginning of May 1936 it was time for the ambulance to try to make its way home. The crew was running out of medical equipment and it seemed just like a matter of time before the Italian pilots would detect them. After a hazardous journey through a nation in complete anarchy after the collapse of the Ethiopian military they could finally put themselves in security in British Kenya. This paper concludes that the ambulance indeed made a great humanitarian effort, by making its way through the harsh environment, establishing it close to the front line and treating thousands of patients, including both civilians and soldiers. This was an extraordinary performance that brought some balance to the view of the Ethiopian people of the "white world" Gunnar Agge was driven by his strong religious beliefs and a great sense of humanism and compassion. This followed him throughout his lifetime an he can without a doubt be compared with another well-known physician, the Canadian surgeon Norman Bethune (1890-1939). His work was characterized by soldarity and a foundamental and honest view of equity with a people living in a different continent, that was in many ways the opposite to the general view held in Europe.

Aspects of neutrality: two Dutch ambulances at the eastern front in the First World War.

PubMed

van Bergen, Leo

2010-01-01

The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.

Habitual Physical Activity in Children With Cerebral Palsy Aged 4 to 5 Years Across All Functional Abilities.

PubMed

Keawutan, Piyapa; Bell, Kristie L; Oftedal, Stina; Davies, Peter S W; Ware, Robert S; Boyd, Roslyn N

2017-01-01

To compare ambulatory status in children with cerebral palsy aged 4 to 5 years with their habitual physical activity and time spent sedentary, and to compare their activity with physical activity guidelines. Sixty-seven participants-independently ambulant, marginally ambulant, and nonambulant-wore accelerometers for 3 days. Time spent sedentary as a percentage of wear time and activity counts were compared between groups. There were significant differences in time spent sedentary and activity counts between groups. Children who were independently ambulant were more likely to meet physical activity guidelines. Children with cerebral palsy spent more than half of their waking hours in sedentary time. Interventions to reduce sedentary behavior and increase habitual physical activity are needed in children with cerebral palsy at age 4 to 5 years.

An Exclusive Interview.

DTIC Science & Technology

1998-02-01

1035/36/38. Articles should be submitted to: DEPARTMENT Video In The Ambulance: Future Battlefield Technology Today OF THE ARMY, ARMY RDA, 9900 BELVOiR...teaching methods. Instructors are video work weapon systems and MS policy and direc- tele-teaching (VTT) courses, so that class- tives must be...A 33 Video In The Ambulance... FUTURE BATTLEFIELD TECHNOLOGY TODAY By LTC Thomas Knuth, MC, Barry Kruse, and James Zadinsky Introduction Eisenhower

Training of Ambulance Personnel and Others Responsible for Emergency Care of the Sick and Injured at the Scene and During Transport.

ERIC Educational Resources Information Center

National Academy of Sciences - National Research Council, Washington, DC. Div. of Medical Sciences.

Ambulance personnel must be able to (1) appraise the extent of first aid rendered by others, (2) carry out additional measures at the scene and en route, (3) operate vehicles safely, (4) maintain communication with traffic authorities, dispatchers, and emergency departments, and (5) keep records for medical and other authorities. Guidelines for…

Factors Associated With Incidence of "?Inappropriate"? Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

ERIC Educational Resources Information Center

Poltavski, Dmitri; Muus, Kyle

2005-01-01

Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

Factors Associated with Incidence of "Inappropriate" Ambulance Transport in Rural Areas in Cases of Moderate to Severe Head Injury in Children

ERIC Educational Resources Information Center

Poltavski, Dmitri; Muus, Kyle

2005-01-01

Context: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research.…

Mathematical model of ambulance resources in Saint-Petersburg

NASA Astrophysics Data System (ADS)

Shavidze, G. G.; Balykina, Y. E.; Lejnina, E. A.; Svirkin, M. V.

2016-06-01

Emergency medical system is one of the main elements in city infrastructure. The article contains analysis of existing system of ambulance resource distribution. Paper considers the idea of using multiperiodicity as a tool to increase the efficiency of the Emergency Medical Services. The program developed in programming environment Matlab helps to evaluate the changes in the functioning of the system of emergency medical service.

Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan.

PubMed

Hanaki, Nao; Yamashita, Kazuto; Kunisawa, Susumu; Imanaka, Yuichi

2016-12-09

In Japan, ambulance staff sometimes must make request calls to find hospitals that can accept patients because of an inadequate information sharing system. This study aimed to quantify effects of the number of request calls on the time interval between an emergency call and hospital arrival. A cross-sectional study of an ambulance records database in Nara prefecture, Japan. A total of 43 663 patients (50% women; 31.2% aged 80 years and over): (1) transported by ambulance from April 2013 to March 2014, (2) aged 15 years and over, and (3) with suspected major illness. The time from call to hospital arrival, defined as the time interval from receipt of an emergency call to ambulance arrival at a hospital. The mean time interval from emergency call to hospital arrival was 44.5 min, and the mean number of requests was 1.8. Multilevel linear regression analysis showed that ∼43.8% of variations in transportation times were explained by patient age, sex, season, day of the week, time, category of suspected illness, person calling for the ambulance, emergency status at request call, area and number of request calls. A higher number of request calls was associated with longer time intervals to hospital arrival (addition of 6.3 min per request call; p<0.001). In an analysis dividing areas into three groups, there were differences in transportation time for diseases needing cardiologists, neurologists, neurosurgeons and orthopaedists. The study revealed 6.3 additional minutes needed in transportation time for every refusal of a request call, and also revealed disease-specific delays among specific areas. An effective system should be collaboratively established by policymakers and physicians to ensure the rapid identification of an available hospital for patient transportation in order to reduce the time from the initial emergency call to hospital arrival. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan

PubMed Central

Hanaki, Nao; Yamashita, Kazuto; Kunisawa, Susumu; Imanaka, Yuichi

2016-01-01

Objectives In Japan, ambulance staff sometimes must make request calls to find hospitals that can accept patients because of an inadequate information sharing system. This study aimed to quantify effects of the number of request calls on the time interval between an emergency call and hospital arrival. Design and setting A cross-sectional study of an ambulance records database in Nara prefecture, Japan. Cases A total of 43 663 patients (50% women; 31.2% aged 80 years and over): (1) transported by ambulance from April 2013 to March 2014, (2) aged 15 years and over, and (3) with suspected major illness. Primary outcome measures The time from call to hospital arrival, defined as the time interval from receipt of an emergency call to ambulance arrival at a hospital. Results The mean time interval from emergency call to hospital arrival was 44.5 min, and the mean number of requests was 1.8. Multilevel linear regression analysis showed that ∼43.8% of variations in transportation times were explained by patient age, sex, season, day of the week, time, category of suspected illness, person calling for the ambulance, emergency status at request call, area and number of request calls. A higher number of request calls was associated with longer time intervals to hospital arrival (addition of 6.3 min per request call; p<0.001). In an analysis dividing areas into three groups, there were differences in transportation time for diseases needing cardiologists, neurologists, neurosurgeons and orthopaedists. Conclusions The study revealed 6.3 additional minutes needed in transportation time for every refusal of a request call, and also revealed disease-specific delays among specific areas. An effective system should be collaboratively established by policymakers and physicians to ensure the rapid identification of an available hospital for patient transportation in order to reduce the time from the initial emergency call to hospital arrival. PMID:27940625

Cross-sectional study of the prehospital management of adult patients with a suspected seizure (EPIC1).

PubMed

Dickson, Jon M; Taylor, Louise H; Shewan, Jane; Baldwin, Trevor; Grünewald, Richard A; Reuber, Markus

2016-02-23

Suspected seizures are a common reason for emergency calls to ambulance services. Prehospital management of these patients is an important element of good quality care. The aim of this study, conducted in a regional ambulance service in the UK, was to quantify the number of emergency telephone calls for suspected seizures in adults, the associated costs, and to describe the patients' characteristics, their prehospital management and their immediate outcomes. Quantitative cross-sectional study using routinely collected data and a detailed review of the clinical records of a consecutive series of adult patients (≥ 16 years). A regional ambulance service within the National Health Service in England. Cross-sectional data from all 605,481 adult emergency incidents managed by the ambulance service from 1 April 2012 to 31 March 2013. We selected a consecutive series of 178 individual incidents from May 2012 for more detailed analysis (132 after exclusions and removal of non-seizure cases). Suspected seizures made up 3.3% of all emergency incidents. True medical emergencies were uncommon but 3.3% had partially occluded airways, 6.8% had ongoing seizure activity and 59.1% had clinical problems in addition to the seizure (29.1% involving injury). Emergency vehicles were dispatched for 97.2% of suspected seizures, the seizure had terminated on arrival in 93.2% of incidents, 75% of these patients were transported to hospital. The estimated emergency management cost per annum of suspected seizures in the English ambulance services is £45.2 million (€64.0 million, $68.6 million). Many patients with suspected seizures could potentially be treated more effectively and at lower cost by modifying ambulance call handling protocols. The development of innovative care pathways could give call handlers and paramedics alternatives to hospital transportation. Increased adoption of care plans could reduce 999 calls and could increase the rates of successful home or community treatment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Transport of pregnant women and obstetric emergencies in India: an analysis of the '108' ambulance service system data.

PubMed

Singh, Samiksha; Doyle, Pat; Campbell, Oona M R; Rao, G V R; Murthy, G V S

2016-10-21

The transport of pregnant women to an appropriate health facility plays a pivotal role in preventing maternal deaths. In India, state-run call-centre based ambulance systems ('108' and '102'), along with district-level Janani Express and local community-based innovations, provide transport services for pregnant women. We studied the role of '108' ambulance services in transporting pregnant women routinely and obstetric emergencies in India. This study was an analysis of '108' ambulance call-centre data from six states for the year 2013-14. We estimated the number of expected pregnancies and obstetric complications for each state and calculated the proportions of these transported using '108'. The characteristics of the pregnant women transported, their obstetric complications, and the distance and travel-time for journeys made, are described for each state. The estimated proportion of pregnant women transported by '108' ambulance services ranged from 9.0 % in Chhattisgarh to 20.5 % in Himachal Pradesh. The '108' service transported an estimated 12.7 % of obstetric emergencies in Himachal Pradesh, 7.2 % in Gujarat and less than 3.5 % in other states. Women who used the service were more likely to be from rural backgrounds and from lower socio-economic strata of the population. Across states, the ambulance journeys traversed less than 10-11 km to reach 50 % of obstetric emergencies and less than 10-21 km to reach hospitals from the pick-up site. The overall time from the call to reaching the hospital was less than 2 h for 89 % to 98 % of obstetric emergencies in 5 states, although this percentage was 61 % in Himachal Pradesh. Inter-facility transfers ranged between 2.4 % -11.3 % of all '108' transports. A small proportion of pregnant women and obstetric emergencies made use of '108' services. Community-based studies are required to study knowledge and preferences, and to assess the potential for increasing or rationalising the use of '108' services.

Bed rest duration after sheath removal following percutaneous coronary interventions: a systematic review and meta-analysis.

PubMed

Mohammady, Mina; Atoof, Fatemeh; Sari, Ali Akbari; Zolfaghari, Mitra

2014-06-01

To explore the effect of bed rest duration after sheath removal following percutaneous coronary interventions on the incidence of vascular complications, back pain and urinary problems. According to the literature, the duration of bed rest after sheath removal following percutaneous coronary interventions ranges from 2-24 hours. Several studies have assessed the effect of duration of bed rest on vascular complications, but a clear final conclusion about the exact duration of bed rest has not been reached. Systematic review and meta-analysis. Cochrane Library, MEDLINE, SCOPUS, CINAHL, IranMedex and IranDoc were searched. No language limitation was applied. RCTs that used two different periods for ambulation were included. Two reviewers separately assessed the quality of each included study and extracted the data. Dichotomous outcomes were recorded as odds ratio with 95% confidence interval. Five studies involving 1115 participants were included in the review. Among them, two studies had three comparison groups. The studies considered a variety of periods as early and late ambulation, ranging from 2-10 hours. Totally, there were no statistically significant differences in the incidence of bleeding, pseudoaneurysm, arteriovenous fistula and urinary problems between early and late ambulation. There was a statistically significant reduction in the risk of haematoma formation at four to six hours of bed rest compared with eight hours of bed rest (odds ratio = 0·37, 95% CI: 0·15, 0·91). Back pain was reported in one study evaluating three hours of bed rest with an odds ratio of 0·45 (95% confidence interval: 0·28, 0·71) when compared with 10 hours of bed rest. Early ambulation after percutaneous coronary interventions is safe and feasible; however, the results should be used with caution as the majority of included studies had methodological flaws. The results of this study suggest that patients could be ambulated three to four hours after sheath removal following percutaneous coronary interventions and early ambulation dose does not increase the risk of vascular complications, but it moderates back pain occurrence. © 2013 John Wiley & Sons Ltd.

Outdoor dynamic subject-specific evaluation of internal stresses in the residual limb: hydraulic energy-stored prosthetic foot compared to conventional energy-stored prosthetic feet.

PubMed

Portnoy, Sigal; Kristal, Anat; Gefen, Amit; Siev-Ner, Itzhak

2012-01-01

The prosthetic foot plays an important role in propelling, breaking, balancing and supporting body loads while the amputee ambulates on different grounds. It is therefore important to quantify the effect of the prosthetic foot mechanism on biomechanical parameters, in order to prevent pressure ulcers and deep tissue injury. Our aim was to monitor the internal stresses in the residuum of transtibial amputation (TTA) prosthetic-users ambulating on different terrains, which the amputees encounter during their daily activities, i.e. paved floor, grass, ascending and descending stairs and slope. We specifically aimed to compare between the internal stresses in the TTA residuum of amputees ambulating with a novel hydraulic prosthetic foot compared to conventional energy storage and return (ESR) prosthetic feet. Monitoring of internal stresses was accomplished using a portable subject-specific real-time internal stress monitor. We found significant decrease (p<0.01) in peak internal stresses and in the loading rate of the amputated limb, while walking with the hydraulic foot, compared to walking with ESR feet. The loading rate calculated while ambulating with the hydraulic foot was at least three times lower than the loading rate calculated while ambulating with the ESR foot. Although the average decrease in internal stresses was ≈ 2-fold larger when replacing single-toe ESR feet with the hydraulic foot than when replacing split-toed ESR feet with the hydraulic foot, the differences were statistically insignificant. Our findings suggest that using a hydraulic prosthetic foot may protect the distal tibial end of the TTA residuum from high stresses, therefore preventing pressure-related injury and pain. Copyright © 2011 Elsevier B.V. All rights reserved.

Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings.

PubMed

Drolet, Anne; DeJuilio, Patti; Harkless, Sherri; Henricks, Sherry; Kamin, Elizabeth; Leddy, Elizabeth A; Lloyd, Joanna M; Waters, Carissa; Williams, Sarah

2013-02-01

Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays. The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay. A quasi-experimental design was used before and after intervention in a 16-bed adult medical/surgical intensive care unit (ICU) and a 26-bed adult intermediate care unit (IMCU) at a large community hospital. A multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical therapists or occupational therapists when appropriate. Daily ambulation status reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or longer. In the 3 months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of the ICU patients and 15.5% (54 of 349) of the IMCU patients ambulated during the first 72 hours of their hospitalization. During the 6 months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively. The study was carried out at only one center. The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.

Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India.

PubMed

Prinja, Shankar; Manchanda, Neha; Aggarwal, Arun Kumar; Kaur, Manmeet; Jeet, Gursimer; Kumar, Rajesh

2013-12-01

Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency. Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the efficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation. The cost of referral transport per year varied from [symbol: see text] 5.2 million in Narnaul to [symbol: see text] 9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average [symbol: see text] 15.5 per km to [symbol: see text] 9.57 per km. Our results showed that the publicly delivered referral transport services in Haryana were operating at an efficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances.

Longitudinal Prediction of Quality-of-Life Scores and Locomotion in Individuals With Traumatic Spinal Cord Injury.

PubMed

Hiremath, Shivayogi V; Hogaboom, Nathan S; Roscher, Melissa R; Worobey, Lynn A; Oyster, Michelle L; Boninger, Michael L

2017-12-01

To examine (1) differences in quality-of-life scores for groups based on transitions in locomotion status at 1, 5, and 10 years postdischarge in a sample of people with spinal cord injury (SCI); and (2) whether demographic factors and transitions in locomotion status can predict quality-of-life measures at these time points. Retrospective case study of the National SCI Database. Model SCI Systems Centers. Individuals with SCI (N=10,190) from 21 SCI Model Systems Centers, identified through the National SCI Model Systems Centers database between the years 1985 and 2012. Subjects had FIM (locomotion mode) data at discharge and at least 1 of the following: 1, 5, or 10 years postdischarge. Not applicable. FIM-locomotion mode; Severity of Depression Scale; Satisfaction With Life Scale; and Craig Handicap Assessment and Reporting Technique. Participants who transitioned from ambulation to wheelchair use reported lower participation and life satisfaction, and higher depression levels (P<.05) than those who maintained their ambulatory status. Participants who transitioned from ambulation to wheelchair use reported higher depression levels (P<.05) and no difference for participation (P>.05) or life satisfaction (P>.05) compared with those who transitioned from wheelchair to ambulation. Demographic factors and locomotion transitions predicted quality-of-life scores at all time points (P<.05). The results of this study indicate that transitioning from ambulation to wheelchair use can negatively impact psychosocial health 10 years after SCI. Clinicians should be aware of this when deciding on ambulation training. Further work to characterize who may be at risk for these transitions is needed. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Mobile Telestroke During Ambulance Transport Is Feasible in a Rural EMS Setting: The iTREAT Study.

PubMed

Lippman, Jason M; Smith, Sherita N Chapman; McMurry, Timothy L; Sutton, Zachary G; Gunnell, Brian S; Cote, Jack; Perina, Debra G; Cattell-Gordon, David C; Rheuban, Karen S; Solenski, Nina J; Worrall, Bradford B; Southerland, Andrew M

2016-06-01

The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology. We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus. Mobile connectivity testing was performed along six primary ambulance routes in a rural network. Audiovisual (AV) quality was assessed simultaneously by both an in-vehicle and an in-hospital rater using a standardized 6-point rating scale (≥4 indicating feasibility). We sought to achieve 9 min of continuous AV connectivity presumed sufficient to perform mobile telestroke assessments. Thirty test runs were completed: 93% achieved a minimum of 9 min of continuous video transmission with a mean mobile connectivity time of 18 min. Mean video and audio quality ratings were 4.51 (4.54 vehicle; 4.48 hospital) and 5.00 (5.13 in-vehicle; 4.87 hospital), respectively. Total initial cost of the system was $1,650 per ambulance. In this small, single-centered study we maintained high-quality continuous video transmission along primary ambulance corridors using a low-cost mobile telemedicine platform. The system is designed to be portable and adaptable, with generalizability for rapid assessment of emergency conditions in which direct observational exam may improve prehospital diagnosis and treatment. Thus mobile telestroke assessment is feasible using low-cost components and commercial wireless connectivity. More research is needed to demonstrate clinical reliability and efficacy in a live-patient setting.

Cost & efficiency evaluation of a publicly financed & publicly delivered referral transport service model in three districts of Haryana State, India

PubMed Central

Prinja, Shankar; Manchanda, Neha; Aggarwal, Arun Kumar; Kaur, Manmeet; Jeet, Gursimer; Kumar, Rajesh

2013-01-01

Background & objectives: Various models of referral transport services have been introduced in different States in India with an aim to reduce maternal and infant mortality. Most of the research on referral transport has focussed on coverage, quality and timeliness of the service with not much information on cost and efficiency. This study was undertaken to analyze the cost of a publicly financed and managed referral transport service model in three districts of Haryana State, and to assess its cost and technical efficiency. Methods: Data on all resources spent for delivering referral transport service, during 2010, were collected from three districts of Haryana State. Costs incurred at State level were apportioned using appropriate methods. Data Envelopment Analysis (DEA) technique was used to assess the technical efficiency of ambulances. To estimate the efficient scale of operation for ambulance service, the average cost was regressed on kilometres travelled for each ambulance station using a quadratic regression equation. Results: The cost of referral transport per year varied from ₹5.2 million in Narnaul to ₹9.8 million in Ambala. Salaries (36-50%) constituted the major cost. Referral transport was found to be operating at an average efficiency level of 76.8 per cent. Operating an ambulance with a patient load of 137 per month was found to reduce unit costs from an average ₹ 15.5 per km to ₹ 9.57 per km. Interpretation & conclusions: Our results showed that the publicly delivered referral transport services in Haryana were operating at an efficient level. Increasing the demand for referral transport services among the target population represents an opportunity for further improving the efficiency of the underutilized ambulances. PMID:24521648

Five-year mortality after acute poisoning treated in ambulances, an Emergency outpatient clinic and hospitals in Oslo

PubMed Central

2013-01-01

Background The long-term mortality after prehospital treatment for acute poisoning has not been studied previously. Thus, we aimed to estimate the five-year mortality and examine the causes of death and predictors of death for all acutely poisoned patients treated in ambulances, the emergency outpatient clinic, and hospitals in Oslo during 2003–2004. Methods A prospective cohort study included all adults (≥16 years; n=2045, median age=35 years, male=58%) who were discharged after treatment for acute poisoning in ambulances, the emergency outpatient clinic, and the four hospitals in Oslo during one year. The patients were observed until the end of 2008. Standardized mortality rates (SMRs) were calculated and multivariate Cox regression analysis was applied. Results The study comprised 2045 patients; 686 treated in ambulances, 646 treated in the outpatient clinic, and 713 treated in hospitals. After five years, 285 (14%) patients had died (four within one week). The SMRs after ambulance, outpatient, and hospital treatment were 12 (CI 9–14), 10 (CI 8–12), and 6 (CI 5–7), respectively. The overall SMR was 9 (CI 8–10), while the SMR after opioid poisoning was 27 (CI 21–32). The most frequent cause of death was accidents (38%). In the regression analysis, opioids as the main toxic agents (HR 2.3, CI 1.6–3.0), older age (HR 1.6, CI 1.5–1.7), and male sex (HR 1.4, CI 1.1–1.9) predicted death, whereas the treatment level did not predict death. Conclusions The patients had high mortality compared with the general population. Those treated in hospital had the lowest mortality. Opioids were the major predictor of death. PMID:23965589

Nervous system excitability and joint stiffness following short-term dynamic ankle immobilization.

PubMed

Stirling, Alyssa M; McBride, Jeffrey M; Merritt, Edward K; Needle, Alan R

2018-01-01

Joint immobilization has been demonstrated to modify neural excitability in subsets of healthy populations, leading to disinhibition of cortical and reflexive pathways. However, these findings may have limited clinical application as most models have investigated casting and rigid immobilization, while many musculoskeletal injuries often utilize dynamic immobilization devices such as boot immobilizers and pneumatic splints that allow for modified ambulation. We therefore aimed to determine the short-term effects of ambulation in ankle immobilization devices on nervous system excitability and stiffness in able-bodied individuals. A repeated-measures design was implemented where 12 healthy individuals were tested for cortical excitability to the ankle musculature using transcranial magnetic stimulation, reflexive excitability using the Hoffmann reflex, and ankle joint stiffness using arthrometry before and after 30min of ambulation with a boot immobilizer, pneumatic leg splint, or barefoot. Motor evoked potential (MEP), cortical silent period (CSP), H max to M max ratio, and ankle joint displacement were extracted as dependent variables. Results indicated that despite the novel motor demands of walking in immobilization devices, no significant changes in cortical excitability (F≥0.335, P≥0.169), reflexive excitability (F≥0.027, P≥0.083), or joint stiffness (F≥0.558, P≥0.169) occurred. These findings indicate that short-term ambulation in dynamic immobilization devices does not modify neural excitability despite forced constraints on the sensorimotor system. We may therefore conclude that modifications to neural excitability in previous immobilization models are mediated by long-term nervous system plasticity rather than acute mechanisms, and there appear to be no robust changes in corticomotor or spinal excitability acutely posed by ambulation with immobilization devices. Copyright © 2017 Elsevier B.V. All rights reserved.

Resuscitation quality assurance for out-of-hospital cardiac arrest--setting-up an ambulance defibrillator telemetry network.

PubMed

Lyon, R M; Clarke, S; Gowens, P; Egan, G; Clegg, G R

2010-12-01

Out-of-hospital cardiac arrest (OHCA) is a leading cause of pre-hospital mortality. Chest compressions performed during cardiopulmonary resuscitation aim to provide adequate perfusion to the vital organs during cardiac arrest. Poor resuscitation technique and the quality of pre-hospital CPR influences outcome from OHCA. Transthoracic impedance (TTI) measurement is a useful tool in the assessment of the quality of pre-hospital resuscitation by ambulance crews but TTI telemetry has not yet been performed in the United Kingdom. We describe a pilot study to implement a data network to collect defibrillator TTI data via telemetry from ambulances. Prospective, observational pilot study over a 5-month period. Modems were fitted to 40 defibrillators on ambulances based in Edinburgh. TTI data was sent to a receiving computer after resuscitation attempts for OHCA. 58 TTI traces were transmitted during the pilot period. Compliance with the telemetry system was high. The mean ratio of chest compressions was 73% (95% CI 69-77%), the mean chest compression rate was 128 (95% CI 122-134). The mean time interval from chest compression interruption to shock delivery was 27 s (95% CI 22-32 s). Trans-thoracic impedance analysis is an effective means of recording important measures of resuscitation quality including the hands-on-the-chest time, compression rate and defibrillation interval time. TTI data transmission via telemetry is straightforward, efficient and allows resuscitation data to be captured and analysed from a large geographical area. Further research is warranted on the impact of post-resuscitation reporting on the quality of resuscitation delivered by ambulance crews. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey.

PubMed

Phung, Viet-Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne; Siriwardena, Aloysius N

2016-02-01

Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). We used a self-administered online questionnaire survey sent to front-line clinicians in all 12 English ambulance services. We conducted a cross-sectional analysis of quantitative data and qualitative analysis of free-text responses. There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre-hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large-scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Twenty-three generations of mice bidirectionally selected for open-field thigmotaxis: selection response and repeated exposure to the open field.

PubMed

Leppänen, Pia K; Ravaja, N; Ewalds-Kvist, S B M

2006-03-01

We examined: (a) the response to bidirectional selection for open-field (OF) thigmotaxis in mice for 23 generations and (b) the effects of repeated exposure (during 5 days) on different OF behaviors in the selectively bred high OF thigmotaxis (HOFT) and low OF thigmotaxis (LOFT) mice. A total of 2049 mice were used in the study. Prior to the testing in the selection experiment, the mice were exposed to the OF apparatus for approximately 2 min on each of 4 consecutive days. Thus, the selection was based on the scores registered on the 5th day after the four habituation periods. The HOFT mice were more thigmotactic than the LOFT mice in almost each generation. The HOFT mice also tended to rear less than the LOFT mice, which was explained by the inverse relationship between emotionality and exploratory tendencies. The lines did not generally differ in ambulation. Sex differences were found in thigmotaxis, ambulation, and rearing. In the repeated exposure experiment, the development of nine different OF behaviors across the 5 days of testing was addressed. Both lines ambulated, explored, and reared most on the 1st, 4th, and 5th days. Grooming and radial latency decreased and thigmotaxis increased linearly across the testing days. Line differences were found in ambulation, exploration, grooming, and rearing, while sex differences were manifested in ambulation and exploration. The line difference in thigmotaxis was evident only on the 5th day. Temporal changes were partially at variance with the general assumptions. OF thigmotaxis was found to be a powerful characteristic for producing two diverging lines of mice.

Factors Associated With Early Functional Outcome After Hip Fracture Surgery

PubMed Central

Cong, Guang-Ting; Nwachukwu, Benedict U.; Patt, Minda L.; Desai, Pingal; Zambrana, Lester; Lane, Joseph M.

2016-01-01

Background: Hip fractures are common in the elderly and are likely to become more prevalent as the US population ages. Early functional status is an indicator of longer term outcome, yet in-hospital predictors of functional recovery, particularly time of surgery and composition of support staff, after hip fracture surgery have not been well studied. Methods: Ninety-nine consecutive patients underwent hip fracture surgery by a single surgeon between 2009 and 2013. Surgery after 48 hours was deemed as surgical delay, and surgery after 5 pm was deemed as after hours. Surgical support staff experience was determined by experts from our institution as well as documented level of training. Functional status was determined by independent ambulation on postoperative day (POD) 3. Results: On POD3, 48 (79%) of 62 patients with no delay were able to ambulate, whereas only 14 (38%) of 37 patients with delayed surgery were able to ambulate (P < .001). This relationship persisted when adjusted for American Society of Anesthesiologist classification. No delay in patients older than 80 (odds ratio [OR], 6.91; 95% confidence interval [CI], 2.16-22.10) and females (OR, 7.05; 95% CI, 2.34-21.20) was associated with greater chance of early ambulation. After-hours surgery was not associated with ambulation (P = .35). Anesthesiologist and circulating nurse experience had no impact on patient’s ambulatory status; however, nonorthopedic scrub technicians were associated with worse functional status (OR 7.50; 95% CI, 1.46-38.44, P = .01). Conclusion: Surgical delay and nonorthopedic scrub technicians are associated with worse early functional outcome after hip fracture surgery. Surgical delay should be avoided in older patients and women. More work should be done to understand the impact of surgical team composition on outcome. PMID:26929850

The linguistic and interactional factors impacting recognition and dispatch in emergency calls for out-of-hospital cardiac arrest: a mixed-method linguistic analysis study protocol.

PubMed

Riou, Marine; Ball, Stephen; Williams, Teresa A; Whiteside, Austin; O'Halloran, Kay L; Bray, Janet; Perkins, Gavin D; Cameron, Peter; Fatovich, Daniel M; Inoue, Madoka; Bailey, Paul; Brink, Deon; Smith, Karen; Della, Phillip; Finn, Judith

2017-07-09

Emergency telephone calls placed by bystanders are crucial to the recognition of out-of-hospital cardiac arrest (OHCA), fast ambulance dispatch and initiation of early basic life support. Clear and efficient communication between caller and call-taker is essential to this time-critical emergency, yet few studies have investigated the impact that linguistic factors may have on the nature of the interaction and the resulting trajectory of the call. This research aims to provide a better understanding of communication factors impacting on the accuracy and timeliness of ambulance dispatch. A dataset of OHCA calls and their corresponding metadata will be analysed from an interdisciplinary perspective, combining linguistic analysis and health services research. The calls will be transcribed and coded for linguistic and interactional variables and then used to answer a series of research questions about the recognition of OHCA and the delivery of basic life-support instructions to bystanders. Linguistic analysis of calls will provide a deeper understanding of the interactional dynamics between caller and call-taker which may affect recognition and dispatch for OHCA. Findings from this research will translate into recommendations for modifications of the protocols for ambulance dispatch and provide directions for further research. The study has been approved by the Curtin University Human Research Ethics Committee (HR128/2013) and the St John Ambulance Western Australia Research Advisory Group. Findings will be published in peer-reviewed journals and communicated to key audiences, including ambulance dispatch professionals. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The impact of post-resuscitation feedback for paramedics on the quality of cardiopulmonary resuscitation.

PubMed

Bleijenberg, Eduard; Koster, Rudolph W; de Vries, Hendrik; Beesems, Stefanie G

2017-01-01

The Guidelines place emphasis on high-quality cardiopulmonary resuscitation (CPR). This study aims to measure the impact of post-resuscitation feedback on the quality of CPR as performed by ambulance personnel. Two ambulances are dispatched for suspected cardiac arrest. The crew (driver and paramedic) of the first arriving ambulance is responsible for the quality of CPR. The crew of the second ambulance establishes an intravenous access and supports the first crew. All resuscitation attempts led by the ambulance crew of the study region were reviewed by two research paramedics and structured feedback was given based on defibrillator recording with impedance signal. A 12-months period before introduction of post-resuscitation feedback was compared with a 19-months period after introduction of feedback, excluding a six months run-in interval. Quality parameters were chest compression fraction (CCF), chest compression rate, longest peri-shock pause and longest non-shock pause. In the pre-feedback period 55 cases were analyzed and 69 cases in the feedback period. Median CCF improved significantly in the feedback period (79% vs 86%, p<0.001). The mean chest compression rate was within the recommended range of 100-120/min in 87% of the cases in the pre-feedback period and in 90% of the cases in the feedback period (p=0.65). The duration of longest non-shock pause decreased significantly (40s vs 19s, p<0.001), the duration of the longest peri-shock pause did not change significantly (16s vs 13s, p=0.27). Post-resuscitation feedback improves the quality of resuscitation, significantly increasing CCF and decreasing the duration of longest non-shock pauses. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Cardiovascular disease (CVD) in the Norwegian Arctic. Air ambulance operations 1999-2009 and future challenges in the region.

PubMed

Norum, Jan

2010-01-01

Air ambulance operations in the Arctic have to deal with remote locations, long distances, rough weather conditions, seasonable darkness, and almost no alternative for landing. Despite these challenges, people expect high quality, specialist health care. This study aimed to analyse air ambulance operations due to cardiovascular disease (CVD) in the Arctic and employ the result as an instrument for future suggestions. Melting ice in the Arctic Sea opens new prospects for shipping, adventures, and oil/gas industry. In February 2010 all air ambulance operations performed in the Arctic during the period 1999 to 2009 were analysed. The population of this study covered patients with CVD. The state of emergency, state of seriousness (the National Advisory Committee on Aeronautics (NACA) scale was used), flight time, destination, and flying time were the main outcome measures. A total of 45 patients (myocardial infarction 31, angina pectoris 11, and heart failure 4 patients) were identified. There were 39 Norwegians and 6 people of other nationalities. The mean age was 57 years (range 43-83 years) Thirteen cardiac incidents occurred in June and July. Most cases (26 patients) were considered urgent or emergent, and the mean NACA score was 4 (range 3-6). The adjusted female/male ratio was 0.222, and the median flying time (one way) was 3 h 25 min (range 1 h-6 h 40 min). Four flights were delayed, and one fifth of patients were transported during the night (midnight to 8.00 AM). Air ambulance operations in the Arctic experience significant challenges. In the near future more shipping and polar adventure operations together with new oil and gas installations will increase the demand for health care support. Telemedical installations onboard vessels and rigs will be important for remote consultation and treatment.

METABOLIC SYNDROME AND DAILY AMBULATION IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS

PubMed Central

Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.

2012-01-01

Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (p<0.001) and fat mass (p<0.01). Group difference in average cadence was no longer significant after adjusting for body fat percentage (p=0.683) and fat mass (p=0.973). Conclusion Children, adolescents, and young adults with metabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038

Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury.

PubMed

Yang, Ajax; Asselin, Pierre; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M

2015-01-01

Individuals with spinal cord injury (SCI) often use a wheelchair for mobility due to paralysis. Powered exoskeletal-assisted walking (EAW) provides a modality for walking overground with crutches. Little is known about the EAW velocities and level of assistance (LOA) needed for these devices. The primary aim was to evaluate EAW velocity, number of sessions, and LOA and the relationships among them. The secondary aims were to report on safety and the qualitative analysis of gait and posture during EAW in a hospital setting. Twelve individuals with SCI ≥ 1.5 years who were wheelchair users participated. They wore a powered exoskeleton (ReWalk; ReWalk Robotics, Inc., Marlborough, MA) with Lofstrand crutches to complete 10-meter (10 MWT) and 6-minute (6MWT) walk tests. LOA was defined as modified independence (MI), supervision (S), minimal assistance (Min), and moderate assistance (Mod). Best effort EAW velocity, LOA, and observational gait analysis were recorded. Seven of 12 participants ambulated ≥ 0.40 m/s. Five participants walked with MI, 3 with S, 3 with Min, and 1 with Mod. Significant inverse relationships were noted between LOA and EAW velocity for both 6 MWT (Z value = 2.63, Rho = 0.79, P = .0086) and 10 MWT (Z value = 2.62, Rho = 0.79, P = .0088). There were 13 episodes of mild skin abrasions. MI and S groups ambulated with 2-point alternating crutch pattern, whereas the Min and Mod groups favored 3-point crutch gait. Seven of 12 individuals studied were able to ambulate at EAW velocities ≥ 0.40 m/s, which is a velocity that may be conducive to outdoor activity-related community ambulation. The ReWalk is a safe device for in-hospital ambulation.

Guilt, shame and need for a container: a study of post-traumatic stress among ambulance personnel.

PubMed

Jonsson, Anders; Segesten, Kerstin

2004-10-01

Post-traumatic stress symptoms among ambulance personnel are regarded as a natural behaviour and reaction to working with the severely injured, suicides, injured children and dead people. The findings show that post-traumatic stress symptoms, guilt, shame and self-reproach are common after duty-related traumatic events. To handle these overwhelming feelings it is necessary to talk about them with fellow workers, friends or family members. By using another person as a container it is possible to internalise the traumatic experience. Poor and un-emphatic behaviour towards a patient and their relatives can have its origin in untreated traumatic experiences. Personnel in ambulance organisations who perform defusing, debriefing and counselling have to be informed of the importance that the roll of guilt and shame may play in the developing of post-traumatic stress symptoms.

Clinical decision-making described by Swedish prehospital emergency care nurse students - An exploratory study.

PubMed

Nilsson, Tomas; Lindström, Veronica

2016-07-01

The purpose of this study was to explore the PECN students' clinical decision-making during a seven-week clinical rotation in the ambulance services. Developing expertise in prehospital emergency care practices requires both theoretical and empirical learning. A prehospital emergency care nurse (PECN) is a Registered Nurse (RN) with one year of additional training in emergency care. There has been little investigation of how PECN students describe their decision-making during a clinical rotation. A qualitative study design was used, and 12 logbooks written by the Swedish PECN students were analysed using content analysis. The students wrote about 997 patient encounters - ambulance assignments during their clinical rotation. Four themes emerged as crucial for the students' decision-making: knowing the patient, the context-situation awareness in the ambulance service, collaboration, and evaluation. Based on the themes, students made decisions on how to respond to patients' illnesses. The PECN students used several variables in their decision-making. The decision- making was an on-going process during the whole ambulance assignment. The university has the responsibility to guide the students during their transition from an RN to a PECN. The findings of the study can support the educators and clinical supervisors in developing the programme of study for becoming a PECN. Copyright © 2015 Elsevier Ltd. All rights reserved.

The Benefits of Indirect Exposure to Trauma: The Relationships among Vicarious Posttraumatic Growth, Social Support, and Resilience in Ambulance Personnel in China.

PubMed

Kang, Xiaofei; Fang, Yueyan; Li, Sihan; Liu, Yadong; Zhao, Di; Feng, Xiujuan; Wang, Yaqi; Li, Ping

2018-04-27

Ambulance personnel who witness trauma experienced by patients have been reported to experience positive changes, known as vicarious posttraumatic growth (VPTG). We examined VPTG and its relationship with social support and resilience among ambulance personnel. The sample (n=227) was recruited from six emergency centers in China. The measures included the Posttraumatic Growth Inventory (PTGI), the Social Support Rating Scale (SSRS), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Structure Equation Modeling (SEM) and the bootstrapping procedure were used to examine indirect effects. The participants' mean score for VPTG was 68.96 (SD=15.51). Social support had significant direct effects on resilience (β=0.51, p<0.001) and VPTG (β=0.25, p=0.001), and resilience (β=0.58, p<0.001) had a significant direct effect on VPTG. Furthermore, social support had a significant indirect effect (0.51×0.58=0.30, p<0.001) on VPTG through resilience. Although the nature of the work of ambulance personnel is not expected to change, the negative effects of the trauma they encounter can be reduced by providing them with more support resources and interventions to foster their resilience, which in turn, promote VPTG.

The Benefits of Indirect Exposure to Trauma: The Relationships among Vicarious Posttraumatic Growth, Social Support, and Resilience in Ambulance Personnel in China

PubMed Central

Kang, Xiaofei; Fang, Yueyan; Li, Sihan; Liu, Yadong; Zhao, Di; Feng, Xiujuan; Wang, Yaqi; Li, Ping

2018-01-01

Objective Ambulance personnel who witness trauma experienced by patients have been reported to experience positive changes, known as vicarious posttraumatic growth (VPTG). We examined VPTG and its relationship with social support and resilience among ambulance personnel. Methods The sample (n=227) was recruited from six emergency centers in China. The measures included the Posttraumatic Growth Inventory (PTGI), the Social Support Rating Scale (SSRS), and the 10-item Connor-Davidson Resilience Scale (CD-RISC-10). Structure Equation Modeling (SEM) and the bootstrapping procedure were used to examine indirect effects. Results The participants’ mean score for VPTG was 68.96 (SD=15.51). Social support had significant direct effects on resilience (β=0.51, p<0.001) and VPTG (β=0.25, p=0.001), and resilience (β=0.58, p<0.001) had a significant direct effect on VPTG. Furthermore, social support had a significant indirect effect (0.51×0.58=0.30, p<0.001) on VPTG through resilience. Conclusion Although the nature of the work of ambulance personnel is not expected to change, the negative effects of the trauma they encounter can be reduced by providing them with more support resources and interventions to foster their resilience, which in turn, promote VPTG. PMID:29695152

Improving value in primary total joint arthroplasty care pathways: changes in inpatient physical therapy staffing.

PubMed

Pelt, Christopher E; Anderson, Mike B; Pendleton, Robert; Foulks, Matthew; Peters, Christopher L; Gililland, Jeremy M

2017-03-01

An early physical therapy (PT) care pathway was implemented to provide same-day ambulation after total joint arthroplasty by changing PT staffing hours. After receiving an exemption from our institutional review board, we performed a secondary data analysis on a cohort of patients that underwent primary TJA of the hip or knee 6 months before and 12 months after implementation of the change. Data on same-day ambulation rates, length of stay (LOS), and in-hospital costs were reviewed. Early evaluation and mobilization of patients by PT improved on postoperative day (POD) 0 from 64% to 85% after the change ( P ≤ .001). The median LOS before the change was 3.27 days compared to 3.23 days after the change ( P  = .014). Patients with higher American Society of Anesthesiologists scores were less likely to ambulate on POD 0 ( P  = .038) and had longer hospital stays ( P < .001). Early mobilization in the entire cohort was associated with a greater cost savings ( P < .001). A relatively simple change to staffing hours, using resources currently available to us, and little additional financial or institutional investment resulted in a significant improvement in the number of patients ambulating on POD 0, with a modest reduction in both LOS and inpatient costs.

Informing clinical policy decision-making practices in ambulance services.

PubMed

Muecke, Sandy; Curac, Nada; Binks, Darryn

2013-12-01

This study aims to identify the processes and frameworks that support an evidence-based approach to clinical policy decision-making practices in ambulance services. This literature review focused on: (i) the setting (pre-hospital); and (ii) the process of evidence translation, for studies published after the year 2000. Searches of Medline, CINAHL and Google were undertaken. Reference lists of eligible publications were searched for relevant articles. A total of 954 articles were identified. Of these, 20 full text articles were assessed for eligibility and seven full text articles met the inclusion criteria. Three provided detailed descriptions of the evidence-based practice processes used to inform ambulance service protocol or guideline development or review. There is little published literature that describes the processes involved, and frameworks required, to inform clinical policy decision making within ambulance services. This review found that processes were iterative and involved collaborations across many internal and external stakeholders. In several jurisdictions, these were coordinated by a dedicated team. Success appears dependent on committed leadership and purposive human and structural resources. Although time consuming, structured processes have been developed in some jurisdictions to assist decision-making processes. Further insight is likely to be obtained from literature published by those from other disciplines. © 2013 The Authors. International Journal of Evidence-Based Healthcare © 2013 The Joanna Briggs Institute.

[Emergency service utilization and athletic injuries--data collection from the Fulda district].

PubMed

Raschka, C; Witzel, K

1996-06-01

Throughout the period of one year all sports accidents, which implied the need of medical services (n = 59), in the district of Fulda with 195,000 inhabitants were analysed. The bulk of the accidents took place during soccer matches (37.3%). The share of women was 25.4%. A repeated trauma was registered in 69.5% of the cases. 16% of the casualties received outpatient treatment. The ambulance was already at the site of the accident in 35.6% of the cases. The greater part of the accidents happened in the afternoon (57.6%). The accident was caused due to another athlete in 44.1% of the accidents. An ambulance with a doctor on board was needed four times, because the injury demanded treatment by an internist. The principle measure of first aid, taken by the ambulance men, was the positioning of the injured limb on a splint (n = 44). The incidence of sports accidents with need for medical service is 30/100,000 inhabitants. The part of sports accidents in relation to all ambulance actions is 2.3% (internal medicine only 0.18% and surgery only 15.3%). The percentage of sports accidents demanding a doctor in relation to all rescues with the need for a doctor is 0.3%.

Effects of a Static Bicycling Programme on the Functional Ability of Young People with Cerebral Palsy Who Are Non-Ambulant

ERIC Educational Resources Information Center

Williams, Heather; Pountney, Teresa

2007-01-01

This study investigated the effects of exercise on the motor function of 11 young people (10 females, one male; age range 11-15y; mean age 12y 7mo [SD 1y 4mo]) with cerebral palsy (CP) who were non-ambulant (Gross Motor Function Classification System Levels IV or V), using an adapted static bicycle. Three participants had dyskinetic quadriplegia,…

Organizational health and quality of life: survey among ambulance nurses in prehospital emergency care.

PubMed

Sili, A; Fida, Roberta; Vellone, E; Gianlorenzi, Alessandra; Alvaro, Rosaria

2011-01-01

The workplace plays a central role in causing stress and different kinds of syndromes and diseases. More generally, organizational procedures and practices could have an impact on nurses' quality of life. Although several studies have investigated this link, none of them considered nurses working in prehospital emergency care. To investigate the role of organizational health factors that affect the quality of life and psychosomatic complaints of ambulance nurses. Our sample included 411 ambulance nurses. Workers were administered two questionnaires to assess organizational health and quality of life. Descriptive and correlational analyses were used to test our assumptions. Several organizational health dimensions provided an explanation for the complaints reported by nurses working in prehospital emergency care in terms of quality of life and psychosomatic disorders. The results allowed identification of possible interventions focusing on specific duties and organizational aspects that would improve the quality of nurses' health.

A new preparedness policy for EMS logistics.

PubMed

Lee, Seokcheon

2017-03-01

Response time in emergency medical services (EMS) is defined as the interval for an ambulance to arrive the scene after receipt of a 911 call. When several ambulances are available upon the receipt of a new call, a decision of selecting an ambulance has to be made in an effort to reduce response time. Dispatching the closest unit available is commonly used in practice; however, recently the Preparedness policy was designed that is in a simplistic form yet being capable of securing a long-term efficiency. This research aims to improve the Preparedness policy, resolving several critical issues inherent in the current form of the policy. The new Preparedness policy incorporates a new metric of preparedness based on the notion of centrality and involves a tuning parameter, weight on preparedness, which has to be appropriately chosen according to operational scenario. Computational experiment shows that the new policy significantly improves the former policy robustly in various scenarios.

[Ambulant compression therapy for crural ulcers; an effective treatment when applied skilfully].

PubMed

de Boer, Edith M; Geerkens, Maud; Mooij, Michael C

2015-01-01

The incidence of crural ulcers is high. They reduce quality of life considerably and create a burden on the healthcare budget. The key treatment is ambulant compression therapy (ACT). We describe two patients with crural ulcers whose ambulant compression treatment was suboptimal and did not result in healing. When the bandages were applied correctly healing was achieved. If correctly applied ACT should provide sufficient pressure to eliminate oedema, whilst taking local circumstances such as bony structures and arterial qualities into consideration. To provide pressure-to-measure regular practical training, skills and regular quality checks are needed. Knowledge of the properties of bandages and the proper use of materials for padding under the bandage enables good personalised ACT. In trained hands adequate compression and making use of simple bandages and dressings provides good care for patients suffering from crural ulcers in contrast to inadequate ACT using the same materials.

Prehospital Trauma Care in Singapore.

PubMed

Ho, Andrew Fu Wah; Chew, David; Wong, Ting Hway; Ng, Yih Yng; Pek, Pin Pin; Lim, Swee Han; Anantharaman, Venkataraman; Hock Ong, Marcus Eng

2015-01-01

Prehospital emergency care in Singapore has taken shape over almost a century. What began as a hospital-based ambulance service intended to ferry medical cases was later complemented by an ambulance service under the Singapore Fire Brigade to transport trauma cases. The two ambulance services would later combine and come under the Singapore Civil Defence Force. The development of prehospital care systems in island city-state Singapore faces unique challenges as a result of its land area and population density. This article defines aspects of prehospital trauma care in Singapore. It outlines key historical milestones and current initiatives in service, training, and research. It makes propositions for the future direction of trauma care in Singapore. The progress Singapore has made given her circumstances may serve as lessons for the future development of prehospital trauma systems in similar environments. Key words: Singapore; trauma; prehospital emergency care; emergency medical services.

[Telecardiology in the management of acute myocardial infarction: the experience of the provincial network of Mantova].

PubMed

Zanini, Roberto; Romano, Michele; Buffoli, Francesca; Lettieri, Corrado; Baccaglioni, Nicola; Schiavone, Giorgio; Aroldi, Marco; Tomasi, Luca; Kuwornu, Helène; Izzo, Antonio

2005-03-01

Since June 2001 we activated a program for the treatment of acute myocardial infarction, based on the early assessment of the patient's risk profile, on telematic connection among care centers and optimization of critical pathways for access to care. The aim of this work was to assess the effectiveness of telemedicine in the reduction of time to treatment. Mantova, a province of eastern Lombardy (northern Italy) is provided with one single sanitary district with one (tertiary hospital) referring hospital equipped with a cath lab on call 24/24 hours for primary coronary angioplasty (PTCA) and cardiac surgery and 6 community hospitals: 2 with coronary care units, 2 with a cardiology section, and 2 rehabilitation hospitals. The emergency medical system transport, activated 24/24 hours, consists of 6 advanced life support (ALS) ambulances and 11 basic life support (BLS) ambulances (2 with trained nurse staff). Each ALS ambulance is equipped with a semiautomatic defibrillator LIFEPACK 12 coupled with cellular telephone GSM transmission of the 12-lead ECG. In the first 3-year activity of the project 340 patients with acute myocardial infarction underwent primary PTCA: 248 (73%) referred to first aid of the nearest hospital reached either by BLS ambulance or by their own means of transport and were hence transferred to the referring hospital for primary PTCA (group A), while 92 patients (27%) were aided at their own house by ALS ambulances and, after transmission of the 12-lead ECG to the referring coronary care unit, were directly transferred to the cath lab (group B). Decisional delay was 144 +/- 65 min in group A while 74 +/- 37 min in group B. Mean door-to-balloon time was 76 +/- 26 min in group A and 47 +/- 21 min in group B. High incidence of post-procedural TIMI 3 flow was achieved in both groups. In-hospital mortality was 6.8% in group A e 5.4% in group B. Our data show that patients referring directly to ALS ambulances had a lower decisional delay. Transmission of the patient's ECG and clinical parameters allows an early and accurate diagnosis and assessment of the individual risk profile with a consistent reduction in time to treatment and positive effects on the mortality rate.

An epidemiological approach to mass casualty incidents in the Principality of Asturias (Spain).

PubMed

Castro Delgado, Rafael; Naves Gómez, Cecilia; Cuartas Álvarez, Tatiana; Arcos González, Pedro

2016-02-24

Mass Casualty Incidents (MCI) have been rarely studied from epidemiological approaches. The objective of this study is to establish the epidemiological profile of MCI in the autonomous region of the Principality of Asturias (Spain) and analyse ambulance deployment and severity of patients. This is a population-based prospective study run in 2014. Inclusion criteria for MCI is "every incident with four or more people affected that requires ambulance mobilisation". Thirty-nine MCI have been identified in Asturias in 2014. Thirty-one (79%) were road traffic accidents, three (7.5%) fires and five (12.8%) other types. Twenty-one incidents (56.7%) had four patients, and only three of them (8%) had seven or more patients. An average of 2.41 ambulances per incident were deployed (standard error = 0.18). Most of the patients per incident were minor injured patients (mean = 4; standard error = 0.2), and 0,26 were severe patients (standard error = 0.08). There was a positive significant correlation (p < 0.01) between the total number of patients and the total number of ambulances deployed and between the total number of patients and Advanced Life Support (ALS) ambulances deployed (p < 0.001). The total number of non-ALS ambulances was not related with the total number of patients. Population based research in MCI is essential to define MCI profile. Quantitative definition of MCI, adapted to resources, avoid selection bias and present a more accurate profile of MCI. As espected, road traffic accidents are the most frequent MCI in our region. This aspect is essential to plan training and response to MCI. Analysis of total response to MCI shows that for almost an hour, we should plan extra resources for daily emergencies. This data is an important issue to bear in mind when planning MCI response. The fact that most patients are classified as minor injured and more advanced life support units than needed are deployed shows that analysis of resources deployment and patient severity helps us to better plan future MCI response. Road traffic accidents with minor injured patients are the most frequent MCI in our region. More advanced life support units than needed have been initially deployed, which might compromise response to daily emergencies during an MCI.

Manager-employee interaction in ambulance services: an exploratory study of employee perspectives on management communication.

PubMed

Nordby, Halvor

2015-01-01

Managers of ambulance stations face many communicative challenges in their interaction with employees working in prehospital first-line services. The article presents an exploratory study of how paramedics experience these challenges in communication with station leaders. On the basis of a dialogue perspective in qualitative method, 24 paramedics were interviewed in one-to-one and focus group settings. Naturalistic and phenomenological approaches were used to analyze the interviews. All the paramedics said that they wished to be more involved in decision processes and that station managers should provide better explanations of information "from above." The paramedics understood that it was difficult for the managers to find time for extensive dialogue, but many thought that the managers should give more priority to communication. The paramedics' views correspond to theoretical assumptions in human resource management. According to this model, employees should be involved in decision processes on management levels, as long as it is realistically possible to do so. Furthermore, expressing emotional support and positive attitudes does not take much time, and the study suggests that many ambulance managers should focus more on interpersonal relations to employees. It has been extensively documented that management communication affects organizational performance. The study indicates that managers of ambulance stations should be more aware of how their leadership style affects professional commitment and motivation in the first-line services.

Prehospital Emergency Care in Childhood Arterial Ischemic Stroke.

PubMed

Stojanovski, Belinda; Monagle, Paul T; Mosley, Ian; Churilov, Leonid; Newall, Fiona; Hocking, Grant; Mackay, Mark T

2017-04-01

Immediately calling an ambulance is the key factor in reducing time to hospital presentation for adult stroke. Little is known about prehospital care in childhood arterial ischemic stroke (AIS). We aimed to determine emergency medical services call-taker and paramedic diagnostic sensitivity and to describe timelines of care in childhood AIS. This is a retrospective study of ambulance-transported children aged <18 years with first radiologically confirmed AIS, from 2008 to 2015. Interhospital transfers of children with preexisting AIS diagnosis were excluded. Twenty-three children were identified; 4 with unavailable ambulance records were excluded. Nineteen children were included in the study. Median age was 8 years (interquartile range, 3-14); median Pediatric National Institutes of Stroke Severity Scale score was 8 (interquartile range, 3-16). Emergency medical services call-taker diagnosis was stroke in 4 children (21%). Priority code 1 (lights and sirens) ambulances were dispatched for 13 children (68%). Paramedic diagnosis was stroke in 5 children (26%), hospital prenotification occurred in 8 children (42%), and 13 children (68%) were transported to primary stroke centers. Median prehospital timelines were onset to emergency medical services contact 13 minutes, call to scene 12 minutes, time at scene 14 minutes, transport time 43 minutes, and total prehospital time 71 minutes (interquartile range, 60-85). Emergency medical services call-taker and paramedic diagnostic sensitivity and prenotification rates are low in childhood AIS. © 2017 American Heart Association, Inc.

Is there still a place for emergency department thrombolysis following the introduction of the amended Joint Royal Colleges Ambulance Liaison Committee criteria for thrombolysis?

PubMed

Castle, N R; Owen, R C; Hann, M

2007-12-01

To apply the current (2004) and the amended (2006) Joint Royal Colleges Ambulance Liaison Committee (JRCALC) criteria for paramedic initiated thrombolysis to all patients who received thrombolytic treatment in an emergency department (ED) to determine if the amendments increase the proportion suitable for paramedic initiated thrombolysis. Retrospective descriptive analysis. The ED clinical notes, ambulance clinical record and the first recorded ECG (ED or ambulance) of all patients thrombolysed in the ED during a 12 month period were reviewed against the previous JRCALC guidelines (2004) and the amended JRCALC guidelines (2006) for thrombolysis. Using the JRCALC guidelines (2004), 26 of the 147 patients (17.7%) were eligible for paramedic initiated thrombolysis. Using the JRCALC guidelines (2006), this increased to 41 (27.9%). This difference was statistically significant (McNemar's I2 test with 1 degree of freedom = 15.00; p<0.001). The change to the blood pressure, age and pulse rate parameters has increased the percentage eligible for paramedic initiated thrombolysis by 10.2% (95% confidence interval 4.6% to 15.8%). The amended JRCALC guidelines (2006) for paramedic initiated thrombolysis have successfully increased the proportion of patients suitable for prehospital thrombolysis by approximately 10%, although the ED retains an important role in the provision of prompt thrombolytic treatment for a proportion of patients.

Measuring Returns to Hospital Care: Evidence from Ambulance Referral Patterns

PubMed Central

Doyle, Joseph; Graves, John; Gruber, Jonathan

2014-01-01

Medicare spending exceeds 4% of GDP in the US each year, and there are concerns that moral hazard problems have led to overspending. This paper considers whether hospitals that treat patients more aggressively and receive higher payments from Medicare improve health outcomes for their patients. An innovation is a new lens to compare hospital performance for emergency patients: plausibly exogenous variation in ambulance-company assignment among patients who live near one another. Using Medicare data from 2002–2010, we show that ambulance company assignment importantly affects hospital choice for patients in the same ZIP code. Using data for New York State from 2000–2006 that matches exact patient addresses to hospital discharge records, we show that patients who live very near each other but on either side of ambulance service area boundaries go to different types of hospitals. Both identification strategies show that higher-cost hospitals achieve better patient outcomes for a variety of emergency conditions. Using our Medicare sample, the estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point reduction in mortality (10% compared to the mean). Taking into account one-year spending after the health shock, the implied cost per at least one year of life saved is approximately $80,000. These results are found across different types of hospitals and patients, as well across both identification strategies. PMID:25750459

Ambulance vehicles as a source of multidrug-resistant infections: a multicenter study in Assiut City, Egypt

PubMed Central

2018-01-01

Background Ambulances may represent a potential source of infection to patients, patients’ relatives, and paramedical staffs. In this study, we analyzed the extent of bacterial contamination in ambulance vehicles and measured the degree of antimicrobial resistance among isolated pathogens. Materials and methods Twenty-five vehicles were included and 16 sampling points were swabbed in each vehicle. Then the swabs were immediately transferred to the laboratory to identify bacterial contaminants utilizing standard microbiological procedures and API® systems. Antibiotic susceptibility testing and screening for methicillin-resistant staphylococci and extended spectrum β-lactamases (ESBLs)-producing Gram-negative rods were carried out. Results A total of 400 samples were collected, 589 bacteria were isolated and 286 (48.6%) of the isolates were potentially pathogenic. The highest contamination rate with pathogenic bacteria was detected in suction devices (75.8%) and stethoscopes (67.7%). Staphylococci were the most frequently detected microorganisms (n=184) followed by Klebsiella spp. (49), Escherichia coli (40), Citrobacter spp. (7), and Proteus spp. (6). Staphylococci were mostly sensitive to vancomycin, whereas Gram-negative bacteria were sensitive to imipenem. Overall, 46.1% of Staphylococcus aureus were methicillin resistant, whereas 20.4% of the coagulase-negative staphylococci were methicillin resistant. Moreover, 36.7% of Klebsiella spp. and 27.5% of E. coli were ESBL producers. Conclusion Our study provides evidence that ambulances represent a source of prehospital multidrug-resistant infections. PMID:29731647

Upper limb module in non-ambulant patients with spinal muscular atrophy: 12 month changes.

PubMed

Sivo, Serena; Mazzone, Elena; Antonaci, Laura; De Sanctis, Roberto; Fanelli, Lavinia; Palermo, Concetta; Montes, Jacqueline; Pane, Marika; Mercuri, Eugenio

2015-03-01

Recent studies have suggested that in non-ambulant patients affected by spinal muscular atrophy the Upper Limb Module can increase the range of activities assessed by the Hammersmith Functional Motor Scale Expanded. The aim of this study was to establish 12-month changes in the Upper Limb Module in a cohort of non-ambulant spinal muscular atrophy patients and their correlation with changes on the Hammersmith Functional Motor Scale Expanded. The Upper Limb Module scores ranged between 0 and 17 (mean 10.23, SD 4.81) at baseline and between 1 and 17 at 12 months (mean 10.27, SD 4.74). The Hammersmith Functional Motor Scale Expanded scores ranged between 0 and 34 (mean 12.43, SD 9.13) at baseline and between 0 and 34 at 12 months (mean 12.08, SD 9.21). The correlation betweeen the two scales was 0.65 at baseline and 0.72 on the 12 month changes. Our results confirm that the Upper Limb Module can capture functional changes in non-ambulant spinal muscular atrophy patients not otherwise captured by the other scale and that the combination of the two measures allows to capture changes in different subgroups of patients in whom baseline scores and functional changes may be influenced by several variables such as age. Copyright © 2014 Elsevier B.V. All rights reserved.

Analysis of actual pressure point using the power flexible capacitive sensor during chest compression.

PubMed

Minami, Kouichiro; Kokubo, Yota; Maeda, Ichinosuke; Hibino, Shingo

2017-02-01

In chest compression for cardiopulmonary resuscitation (CPR), the lower half of the sternum is pressed according to the American Heart Association (AHA) guidelines 2010. These have been no studies which identify the exact location of the applied by individual chest compressions. We developed a rubber power-flexible capacitive sensor that could measure the actual pressure point of chest compression in real time. Here, we examined the pressure point of chest compression by ambulance crews during CPR using a mannequin. We included 179 ambulance crews. Chest compression was performed for 2 min. The pressure position was monitored, and the quality of chest compression was analyzed by using a flexible pressure sensor (Shinnosukekun™). Of the ambulance crews, 58 (32.4 %) pressed the center and 121 (67.6 %) pressed outside the proper area of chest compression. Many of them pressed outside the center; 8, 7, 41, and 90 pressed on the caudal, left, right, and cranial side, respectively. Average compression rate, average recoil, average depth, and average duty cycle were 108.6 counts per minute, 0.089, 4.5 cm, and 48.27 %, respectively. Many of the ambulance crews did not press on the sternal lower half definitely. This new device has the potential to improve the quality of CPR during training or in clinical practice.

Disaster planning: transportation resources and considerations for managing a burn disaster.

PubMed

Kearns, Randy D; Hubble, Michael W; Holmes, James H; Cairns, Bruce A

2014-01-01

A disaster scenario with a significant number of burn-injured patients creates a tremendous challenge for disaster planners. Directing the transport of patients to the most appropriate receiving facility as soon as reasonably possible remains the aim. This review focused on both the overall process as well as an analysis of one specific state (as an example). This included the capability and limitations of the intrastate and interstate resources should a burn disaster occur. Although the results for one state may be interesting, it is the process that is essential for those involved in burn disaster planning. An overview of the quantity and quality of available ambulances and how to access these resources is provided. Ground-based ambulances have an array of capacities and levels of services ranging from basic life support to advanced (paramedic) services and include ambulance buses. This review also included private and hospital-based specialty care ambulances and aeromedical services. Finally, the review identified military or federal resources that may be an option as well. There are various local, state, and federal resources that can be called upon to meet the transportation needs of these critically injured patients. Yet, there are barriers to access and limitations to their response. It is just as important to know both availability and capability as it is to know how to access these resources. A disaster is not the time to realize these hurdles.

Registered nurses' experiences of their decision-making at an Emergency Medical Dispatch Centre.

PubMed

Ek, Bosse; Svedlund, Marianne

2015-04-01

To describe registered nurses' experiences at an Emergency Medical Dispatch Centre. It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patient's arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses. A qualitative design was used for this study. Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used. Two themes emerged during the analysis: 'Having a profession with opportunities and obstacles' and 'Meeting serious and difficult situations', with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned. Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses. Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame-free culture are important factors to attract and retain employees. © 2014 John Wiley & Sons Ltd.

Ambulance traffic accidents in Taiwan.

PubMed

Chiu, Po-Wei; Lin, Chih-Hao; Wu, Chen-Long; Fang, Pin-Hui; Lu, Chien-Hsin; Hsu, Hsiang-Chin; Chi, Chih-Hsien

2018-04-01

Ambulance traffic accidents (ATAs) are the leading cause of occupation-related fatalities among emergency medical service (EMS) personnel. We aim to use the Taiwan national surveillance system to analyze the characteristics of ATAs and to assist EMS directors in developing policies governing ambulance operations. A retrospective, cross-sectional and largely descriptive study was conducted using Taiwan national traffic accidents surveillance data from January 1, 2011 to October 31, 2016. Among the 1,627,217 traffic accidents during the study period, 715 ATAs caused 8 deaths within 24 h and 1844 injured patients. On average, there was one ATA for every 8598 ambulance runs. Compared to overall traffic accidents, ATAs were 1.7 times more likely to result in death and 1.9 times more likely to have injured patients. Among the 715 ATAs, 8 (1.1%) ATAs were fatal and 707 (98.9%) were nonfatal. All 8 fatalities were associated with motorcycles. The urban areas were significantly higher than the rural areas in the annual number of ATAs (14.2 ± 7.3 [7.0-26.7] versus 3.1 ± 1.9 [0.5-8.4], p = 0.013), the number of ATA-associated fatalities per year (0.2 ± 0.2 [0.0-0.7] versus 0.1 ± 0.1 [0.0-0.2], p = 0.022), and the annual number of injured patients (who needed urgent hospital visits) in ATAs (19.4 ± 7.3 [10.5-30.9] versus 5.2 ± 3.8 [0.9-15.3], p < 0.001). The ATA-associated fatality rate in Taiwan was high, and all fatalities were associated with motorcycles. ATAs in a highly motorcycle-populated area may require further investigation. An ambulance traffic accident reporting system should be built to provide EMS policy guidance for ATA reduction and outcome improvements. Copyright © 2018. Published by Elsevier B.V.

Ambulance cardiopulmonary resuscitation: outcomes and associated factors in out-of-hospital cardiac arrest.

PubMed

Rosell Ortiz, Fernando; García Del Águila, Javier; Fernández Del Valle, Patricia; J Mellado-Vergel, Francisco; Vergara-Pérez, Santiago; R Ruiz-Montero, María; Martínez-Lara, Manuela; Gómez-Jiménez, Francisco José; Gonzáez-Lobato, Ismael; García-Escudero, Guillermo; Ruiz-Bailén, Manuel; Caballero-García, Auxiliadora; Vivar-Díaz, Itziar; Olavarría-Govantes, Luis

2018-06-01

To assess factors associated with survival of out-of-hospital cardiac arrest (OHCA) in patients who underwent cardiopulmonary resuscitation (CPR) during ambulance transport. Retrospective analysis of a registry of OHCA cases treated between 2008 and 2014. We included patients who had not recovered circulation at the time it was decided to transport to a hospital and who were rejected as non-heart-beating donors. Multivariate analysis was used to explore factors associated with the use of ambulance CPR, survival, and neurologic outcome. Out of a total of 7241 cases, 259 (3.6%) were given CPR during emergency transport. The mean (SD) age was 51.6 (23.6) years; 27 (10.1%) were aged 16 years or younger. The following variables were associated with the use of CPR during transport: age 16 years or under (odds ratio [OR], 6.48; 95% CI, 3.91-10.76); P<.001)], witnessed OHCA (OR, 1.62; 95% CI, 1.16-2.26; P=.004), cardiac arrest outside the home (OR, 3.17; 95% CI, 2.38-4.21; P<.001), noncardiac cause (OR, 1.47; 95% CI, 1.07-2.02; P=.019], initially shockable rhythm (OR, 1.67; 95% CI, 1.17-2.37; P=.004), no prior basic life support (OR, 3.48; 95% CI, 2.58-4.70; P<.001), and orotracheal intubation (OR, 1.93; 95% CI, 1.24-2.99; P=.003). One patient (0.38%) survived to discharge with good neurologic outcome. Ambulance CPR by a physician on board is applied in few OHCA cases. Young patient age, cardiac arrest outside the home, the presence of a witness, lack of a shockable rhythm on responder arrival, lack of basic life support prior to responder arrival, noncardiac cause, and orotracheal intubation are associated with the use of ambulance CPR, a strategy that can be considered futile.

Prehospital analgesia in New South Wales, Australia.

PubMed

Bendall, Jason C; Simpson, Paul M; Middleton, Paul M

2011-12-01

With at least 20% of ambulance patients reporting pain of moderate to severe intensity, pain management has become a primary function of modern ambulance services. The objective of this study was to describe the use of intravenous morphine, inhaled methoxyflurane, and intranasal fentanyl when administered in the out-of-hospital setting by paramedics within a large Australian ambulance service. A retrospective analysis was conducted using data from ambulance patient health care records (PHCR) for all cases from 01 July 2007 through 30 June 2008 in which an analgesic agent was administered (alone or in combination). During the study period, there were 97,705 patients ≤ 100 years of age who received intravenous (IV) morphine, intranasal (IN) fentanyl, or inhaled methoxyflurane, either alone or in combination. Single-agent analgesia was administered in 87% of cases. Methoxyflurane was the most common agent, being administered in almost 60% of cases. Females were less likely to receive an opiate compared to males (RR = 0.83, 95% CI, 0.82-0.84, p <0.0001). Pediatric patients were less likely to receive opiate analgesia compared to adults (RR = 0.65, 95% CI, 0.63-0.67, p <0.0001). The odds of opiate analgesia (compared to pediatric patients 0-15 years) were 1.47; 2.10; 2.56 for 16-39 years, 40-59 years, and ≥ 60 years, respectively. Pediatric patients were more likely to receive fentanyl than morphine (RR = 1.69, 95% CI, 1.64-1.74, p < 0.0001). In this ambulance service, analgesia most often is provided through the use of a single agent. The majority of patients receive non-opioid analgesia with methoxyflurane, most likely because all levels of paramedics are authorized to administer that analgesic. Females and children are less likely to receive opiate-based analgesia than their male and adult counterparts, respectively. Paramedics appear to favor intranasal opiate delivery over intravenous delivery in children with acute pain.

Impact of Pharmacists' audit on improving the quality of prescription of dabigatran etexilate methanesulfonate: a retrospective study.

PubMed

Shimizu, Teppei; Momose, Yoshio; Ogawa, Ryuichi; Takahashi, Masahiro; Echizen, Hirotoshi

2017-01-01

Appropriate prescription of dabigatran etexilate methanesulfonate (JAN) is more complicated than assumed, because there are totally 10 items of contraindications and instructions for dosage reduction depending on patients' characteristics. We aimed to study whether the routine audit of first-time prescriptions of dabigatran performed by pharmacists is effective in improving the quality of prescription. A retrospective re-audit was performed on all the prescriptions of dabigatran issued at Kitahara International Hospital, Tokyo between March 2011 and February 2014, by evaluating the prescriptions rigorously against the approved prescribing information of the drug. The original routine audit of the prescriptions for inpatients was performed by hospital pharmacists using electronic medical records (EMR), whereas the audit for ambulant patients receiving external prescriptions was performed by community pharmacists using information obtained mainly by questioning patients. The frequencies of inappropriate prescriptions detected by the re-audit in the two groups were compared. Two hundred and twenty-eight patients (131 ambulant patients and 97 inpatients) were prescribed dabigatran for the first time during the study period. All patients met the approved indications. While 33% of the prescriptions for ambulant patients showed at least one violation of the approved usage, only 11% of the prescriptions for inpatients showed violations ( p  < 0.001). Two ambulant patients with creatinine clearance < 30 mL/min were dispensed dabigatran, whereas no such case was found among inpatients. A significantly greater proportion of ambulant patients aged ≥70 years showed violation of the instruction for dosage reduction compared to inpatients of the same age group (18 and 4%, respectively). The present study suggests that pharmacists may achieve better performance in auditing prescriptions of dabigatran when medical records are fully available than when information is available mainly by questioning patients. Further large-scale studies are required to clarify whether the audit of dabigatran prescriptions improves ultimate therapeutic outcomes or complications.

North Star Ambulatory Assessment, 6-minute walk test and timed items in ambulant boys with Duchenne muscular dystrophy.

PubMed

Mazzone, Elena; Martinelli, Diego; Berardinelli, Angela; Messina, Sonia; D'Amico, Adele; Vasco, Gessica; Main, Marion; Doglio, Luca; Politano, Luisa; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Carlesi, Adelina; Bonetti, Anna Maria; Zucchini, Elisabetta; De Sanctis, Roberto; Scutifero, Marianna; Bianco, Flaviana; Rossi, Francesca; Motta, Maria Chiara; Sacco, Annalisa; Donati, Maria Alice; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Pane, Marika; Pasquini, Elisabetta; Bruno, Claudio; Vita, Giuseppe; de Waure, Chiara; Bertini, Enrico; Mercuri, Eugenio

2010-11-01

The North Star Ambulatory Assessment is a functional scale specifically designed for ambulant boys affected by Duchenne muscular dystrophy (DMD). Recently the 6-minute walk test has also been used as an outcome measure in trials in DMD. The aim of our study was to assess a large cohort of ambulant boys affected by DMD using both North Star Assessment and 6-minute walk test. More specifically, we wished to establish the spectrum of findings for each measure and their correlation. This is a prospective multicentric study involving 10 centers. The cohort included 112 ambulant DMD boys of age ranging between 4.10 and 17 years (mean 8.18±2.3 DS). Ninety-one of the 112 were on steroids: 37/91 on intermittent and 54/91 on daily regimen. The scores on the North Star assessment ranged from 6/34 to 34/34. The distance on the 6-minute walk test ranged from 127 to 560.6 m. The time to walk 10 m was between 3 and 15 s. The time to rise from the floor ranged from 1 to 27.5 s. Some patients were unable to rise from the floor. As expected the results changed with age and were overall better in children treated with daily steroids. The North Star assessment had a moderate to good correlation with 6-minute walk test and with timed rising from floor but less with 10 m timed walk/run test. The 6-minute walk test in contrast had better correlation with 10 m timed walk/run test than with timed rising from floor. These findings suggest that a combination of these outcome measures can be effectively used in ambulant DMD boys and will provide information on different aspects of motor function, that may not be captured using a single measure. Copyright © 2010. Published by Elsevier B.V.

Ethical values in emergency medical services: A pilot study.

PubMed

Bremer, Anders; Herrera, María Jiménez; Axelsson, Christer; Martí, Dolors Burjalés; Sandman, Lars; Casali, Gian Luca

2015-12-01

Ambulance professionals often address conflicts between ethical values. As individuals' values represent basic convictions of what is right or good and motivate behaviour, research is needed to understand their value profiles. To translate and adapt the Managerial Values Profile to Spanish and Swedish, and measure the presence of utilitarianism, moral rights and/or social justice in ambulance professionals' value profiles in Spain and Sweden. The instrument was translated and culturally adapted. A content validity index was calculated. Pilot tests were carried out with 46 participants. This study conforms to the ethical principles for research involving human subjects and adheres to national laws and regulations concerning informed consent and confidentiality. Spanish professionals favoured justice and Swedish professionals' rights in their ambulance organizations. Both countries favoured utilitarianism least. Gender differences across countries showed that males favoured rights. Spanish female professionals favoured justice most strongly of all. Swedes favour rights while Spaniards favour justice. Both contexts scored low on utilitarianism focusing on total population effect, preferring the opposite, individualized approach of the rights and justice perspectives. Organizational investment in a utilitarian perspective might jeopardize ambulance professionals' moral right to make individual assessments based on the needs of the patient at hand. Utilitarianism and a caring ethos appear as stark opposites. However, a caring ethos in its turn might well involve unreasonable demands on the individual carer's professional role. Since both the justice and rights perspectives portrayed in the survey mainly concern relationship to the organization and peers within the organization, this relationship might at worst be given priority over the equal treatment and moral rights of the patient. A balanced view on ethical perspectives is needed to make professionals observant and ready to act optimally - especially if these perspectives are used in patient care. Research is needed to clarify how justice and rights are prioritized by ambulance services and whether or not these organization-related values are also implemented in patient care. © The Author(s) 2014.

Action observation training of community ambulation for improving walking ability of patients with post-stroke hemiparesis: a randomized controlled pilot trial.

PubMed

Park, Hyun-Ju; Oh, Duck-Won; Choi, Jong-Duk; Kim, Jong-Man; Kim, Suhn-Yeop; Cha, Yong-Jun; Jeon, Su-Jin

2017-08-01

To investigate the effects of action observation training involving community-based ambulation for improving walking ability after stroke. Randomized, controlled pilot study. Inpatient rehabilitation hospital. A total of 25 inpatients with post-stroke hemiparesis were randomly assigned to either the experimental group ( n = 12) or control group ( n = 13). Subjects of the experimental group watched video clips demonstrating four-staged ambulation training with a more complex environment factor for 30 minutes, three times a week for four weeks. Meanwhile, subjects of the control group watched video clips, which showed different landscape pictures. Walking function was evaluated before and after the four-week intervention using a 10-m walk test, community walk test, activities-specific balance confidence scale, and spatiotemporal gait measures. Changes in the values for the 10-m walk test (0.17 ±0.19 m/s vs. 0.05 ±0.08 m/s), community walk test (-151.42 ±123.82 seconds vs. 67.08 ±176.77 seconds), and activities-specific balance confidence (6.25 ±5.61 scores vs. 0.72 ±2.24 scores) and the spatiotemporal parameters (i.e. stride length (19.00 ±11.34 cm vs. 3.16 ±11.20 cm), single support (5.87 ±5.13% vs. 0.25 ±5.95%), and velocity (15.66 ±12.34 cm/s vs. 2.96 ±10.54 cm/s)) indicated a significant improvement in the experimental group compared with the control group. In the experimental group, walking function and ambulation confidence was significantly different between the pre- and post-intervention, whereas the control group showed a significant difference only in the 10-m walk test. Action observation training of community ambulation may be favorably used for improving walking function of patients with post-stroke hemiparesis.

Assessment of In-Hospital Walking Velocity and Level of Assistance in a Powered Exoskeleton in Persons with Spinal Cord Injury

PubMed Central

Yang, Ajax; Asselin, Pierre; Knezevic, Steven; Kornfeld, Stephen

2015-01-01

Background: Individuals with spinal cord injury (SCI) often use a wheelchair for mobility due to paralysis. Powered exoskeletal-assisted walking (EAW) provides a modality for walking overground with crutches. Little is known about the EAW velocities and level of assistance (LOA) needed for these devices. Objective: The primary aim was to evaluate EAW velocity, number of sessions, and LOA and the relationships among them. The secondary aims were to report on safety and the qualitative analysis of gait and posture during EAW in a hospital setting. Methods: Twelve individuals with SCI ≥1.5 years who were wheelchair users participated. They wore a powered exoskeleton (ReWalk; ReWalk Robotics, Inc., Marlborough, MA) with Lofstrand crutches to complete 10-meter (10MWT) and 6-minute (6MWT) walk tests. LOA was defined as modified independence (MI), supervision (S), minimal assistance (Min), and moderate assistance (Mod). Best effort EAW velocity, LOA, and observational gait analysis were recorded. Results: Seven of 12 participants ambulated ≥0.40 m/s. Five participants walked with MI, 3 with S, 3 with Min, and 1 with Mod. Significant inverse relationships were noted between LOA and EAW velocity for both 6MWT (Z value = 2.63, Rho = 0.79, P = .0086) and 10MWT (Z value = 2.62, Rho = 0.79, P = .0088). There were 13 episodes of mild skin abrasions. MI and S groups ambulated with 2-point alternating crutch pattern, whereas the Min and Mod groups favored 3-point crutch gait. Conclusion: Seven of 12 individuals studied were able to ambulate at EAW velocities ≥0.40 m/s, which is a velocity that may be conducive to outdoor activity-related community ambulation. The ReWalk is a safe device for in-hospital ambulation. PMID:26364279

The Effects of Terrain and Navigation on Human Extravehicular Activity Walkback Performance on the Moon

NASA Technical Reports Server (NTRS)

Norcross, Jason; Stroud, Leah C.; Schaffner, Grant; Glass, Brian J.; Lee, Pascal C.; Jones, Jeff A.; Gernhardt, Michael L.

2008-01-01

Results of the EVA Walkback Test showed that 6 male astronauts were able to ambulate 10 km on a level treadmill while wearing a prototype EVA suit in simulated lunar gravity. However, the effects of lunar terrain, topography, and real-time navigation on ambulation performance are unknown. Primary objective: To characterize the effect of lunar-like terrain and navigation on VO2 and distance traveled during an unsuited 10 km (straight-line distance) ambulatory return in earth gravity.

Success and Failure in Doctrinal Innovation: A Comparison of the U.S. Army Medical Department and Logistics Branch, 1990- 2010

DTIC Science & Technology

2012-03-01

Treatment Vehicle ARFORGEN Army Force AR Army Regulation ARTEP Army AXP Ambulance Exchange Point BCT Brigade Combat Team BDE Brigade BFV ...program, with newer versions of Abrams tanks and Bradley fighting vehicles ( BFV ), which further exacerbated the already slow Vietnam-era medical...DoD agencies on yet another revision of the cancelled AMEV design based on the BFV . The Army began investigating the need for a newer ambulance

Implementing IEP or 504 Goals and Objectives into General Physical Education: What Does the Physical Educator Do when a Student with a Disability Has Goals and Objectives that Differ from the Class Goals and Objectives?

ERIC Educational Resources Information Center

Kowalski, Ellen; Lieberman, Lauren; Pucci, Gina; Mulawka, Carin

2005-01-01

Pierre, a second-grade student, has cerebral palsy and uses a wheelchair to ambulate. He is very social and enjoys interaction with his peers. Pierre has a paraeducator named Maria, who is assigned to assist him. His Individualized Education Program (IEP) goals were independence in ambulation, fine motor skills, and flexibility. His special…

Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

NASA Technical Reports Server (NTRS)

Carl, J. G.; Furukawa, S.

1975-01-01

A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

[Diagnosis of musculoskeletal ambulation disability symptom complex (MADS)].

PubMed

Ito, Hiromoto

2008-11-01

It was described to diagnosis of Musculoskeletal Ambulation Disability Symptom Complex (MADS). The definition of MADS is an person of advanced years with lower leveled balance and walking ability, high risk for fall, and who is keeping to the house. The diagnosis of MADS was decided to a history of 11 musculoskeletal disorders and evaluation of balanced and walking function. The determination method of time of one leg standing and 3 m timed timed up and go test were described.

Effect on Passive Range of Motion and Functional Correlates After a Long-Term Lower Limb Self-Stretch Program in Patients With Chronic Spastic Paresis.

PubMed

Pradines, Maud; Baude, Marjolaine; Marciniak, Christina; Francisco, Gerard; Gracies, Jean-Michel; Hutin, Emilie; Bayle, Nicolas

2018-03-02

In current health care systems, long-duration stretching, performed daily, cannot be obtained through prescriptions of physical therapy. In addition, the short-term efficacy of the various stretching techniques is disputed, and their long-term effects remain undocumented. To evaluate changes in extensibility in 6 lower limb muscles and in ambulation speed after a ≥1-year self-stretch program, the Guided Self-rehabilitation Contract (GSC), in individuals with chronic spastic paresis. Retrospective study comparing self-stretched and nonself-stretched muscles. Neurorehabilitation clinic. Patients diagnosed with hemiparesis or paraparesis at least 1 year before the initiation of a GSC and who were then involved in the GSC program for at least 1 year. For each patient, specific muscles were identified for intervention among the following: gluteus maximus, hamstrings, vastus, rectus femoris, soleus, and gastrocnemius. Prescriptions and training for a daily, high-load, prolonged, home self-stretching program were primarily based on the baseline coefficient of shortening, defined as C SH = [(X N -X V1 )/X N ] (X V1 = PROM, passive range of motion; X N = normally expected amplitude). Six assessments were performed per year, measuring the Tardieu X V1 or maximal slow stretch range of motion angle (PROM), C SH , 10-m ambulation speed, and its functional ambulation category (Perry's classification: household, limited, or full). Changes from baseline in self-stretched and nonself-stretched muscles were compared, with meaningful X V1 change defined as ΔX V1 >5° for plantar flexors and >10° for proximal muscles. Correlation between the composite X V1 (mean PROM for the 6 muscles) and ambulation speed also was evaluated. Twenty-seven GSC participants were identified (14 women, mean age 44 years, range 29-59): 18 with hemiparesis and 9 with paraparesis. After 1 year, 47% of self-stretched muscles showed meaningful change in PROM (ΔX V1 ) versus 14% in nonself-stretched muscles (P < .0001, χ 2 ). ΔC SH was -31% (95% confidence interval [95% CI] -41.5 to -15.2) in self-stretched versus -7% (95% CI -11.9 to -2.1) in nonself-stretched muscles (P < .0001, t-test). Ambulation speed increased by 41% (P < .0001) from 0.81 m/s (95% CI 0.67-0.95) to 1.15 m/s (95% CI 1.01-1.29). Eight of the 12 patients (67%) who were in limited or household categories at baseline moved to a higher functional ambulation category. There was a trend for a correlation between composite X V1 and ambulation speed (r = 0.44, P = .09) in hemiparetic patients. Therapists should consider prescribing and monitoring a long-term lower limb self-stretch program using GSC, as this may increase muscle extensibility in adult-onset chronic paresis. Copyright © 2018 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

Management of patients brought in by ambulance to the emergency department: role of the Advanced Musculoskeletal Physiotherapist.

PubMed

Kinsella, Rita; Collins, Tom; Shaw, Bridget; Sayer, James; Cary, Belinda; Walby, Andrew; Cowan, Sallie

2017-05-09

Objective The aim of the present study was to evaluate the role of the Advanced Musculoskeletal Physiotherapist (AMP) in managing patients brought in by ambulance to the emergency department (ED). Methods This study was a dual-centre observational study. Patients brought in by ambulance to two Melbourne hospitals over a 12-month period and seen by an AMP were compared with a matched group seen by other ED staff. Primary outcome measures were wait time and length of stay (LOS) in the ED. Results Data from 1441 patients within the Australasian Triage Scale (ATS) Categories 3-5 with musculoskeletal complaints were included in the analysis. Subgroup analysis of 825 patients aged ≤65 years demonstrated that for Category 4 (semi-urgent) patients, the median wait time to see the AMP was 9.5min (interquartile range (IQR) 3.25-18.00min) compared with 25min (IQR 10.00-56.00min) to see other ED staff (P ≤ 0.05). LOS analysis was undertaken on patients discharged home and demonstrated that there was a 1.20 greater probability (95% confidence interval 1.07-1.35) that ATS Category 4 patients managed by the AMP were discharged within the 4-hour public hospital target compared with patients managed by other ED staff: 87.04% (94/108) of patients managed by the AMPs met this standard compared with 72.35% (123/170) of patients managed by other ED staff (P=0.002). Conclusions Patients aged ≤65 years with musculoskeletal complaints brought in by ambulance to the ED and triaged to ATS Category 4 are likely to wait less time to be seen and are discharged home more quickly when managed by an AMP. This study has added to the evidence that AMPs improve patient flow in the ED, freeing up time for other ED staff to see higher-acuity, more complex patients. What is known about the topic? There is a growing body of evidence establishing that AMPs improve the flow of patients presenting with musculoskeletal conditions to the ED through reduced wait times and LOS and, at the same time, providing good-quality care and enhanced patient satisfaction. What does this paper add? Within their primary contact capacity, AMPs also manage patients who are brought in by ambulance presenting with musculoskeletal conditions. To the authors' knowledge, there is currently no available literature documenting the performance of AMPs in the management of this cohort of patients. What are the implications for practitioners? This study has added to the body of evidence that AMPs improve patient flow in the ED and illustrates that AMPs, by seeing patients brought in by ambulance, are able to have a positive impact on the pressures increasingly facing the Victorian Ambulance Service and emergency hospital care.

[Rescue operations with helicopter ambulances in the Barents sea].

PubMed

Haagensen, R; Sjøborg, K A; Rossing, A; Ingilae, H; Markengbakken, L; Steen, P A

2001-03-30

Search and rescue helicopters from the Royal Norwegian Air Force conduct ambulance and search and rescue missions in the Barents Sea. The team on board includes an anaesthesiologist and a paramedic. Operations in this area are challenging due to long distances, severe weather conditions and winter darkness. 147 ambulance and 29 search and rescue missions in the Barents Sea during 1994-99 were studied retrospectively with special emphasis on operative conditions and medical results. 35% of the missions were carried out in darkness. Median time from alarm to first patient contact was 3.3 hours and median duration of the missions was 7.3 hours. 48% of the missions involved ships of foreign nationality. About half of the patients had acute illness, dominated by gastrointestinal and heart diseases. Most of the injuries resulted from on-board accidents; open or closed fractures, amputations, and soft tissue damage. 90% of the patients were hospitalised; 7.5% would probably not have survived without early medical treatment and rapid transportation to hospital.

[Non-pharmaceutical therapy of candidates for geriatric rehabilitation: Non-pharmaceutical therapy prescribed by SHI-accredited doctors after application for outpatient geriatric rehabilitative care].

PubMed

Krupp, Sonja; Schnoor, Maike; Lohse, Kristina; Katalinic, Alexander; Willkomm, Martin

2015-06-01

The rejection of an application for ambulant geriatric rehabilitation (AGRV) is usually justified by the argument that non-pharmaceutical therapy prescribed by doctors accredited by social housing institutions (SHI) would suffice. The reality in healthcare during the 6 months following an application is unknown. In this study 203 patients who had made an application for AGRV in the second half of 2010 in Flensburg, Lübeck or Ratzeburg were interviewed by telephone. The survey revealed that 25.7% of the applications for AGRV had been rejected. The majority of these patients received no ambulant non-pharmaceutical therapy (e.g. physical therapy, physiotherapy, occupational therapy, speech therapy or psychological therapy), less than 20% received more than 12 therapy sessions and in most cases exclusively physiotherapy. The 141 successful AGRV applicants received additional ambulant therapies of a similar magnitude. The difference between the intensified interdisciplinary therapy offered in the AGRV and additionally and the offer to rejected applicants is substantial.

Hypobaric bupivacaine spinal anesthesia for cystoscopic intervention: the impact of adding fentanyl.

PubMed

Atallah, Mohamed M; Helal, Mostafa A; Shorrab, Ahmed A

2003-10-01

Addition of fentanyl to hyperbaric bupivacaine spinal anesthesia prolonged the duration of sensory block. This study seeks to test the hypothesis that adding fentanyl to small dose hypobaric spinal anesthesia will improve intraoperative patients and surgeon satisfaction without delay in recovery. Patients (n = 80) subjected to minor cystoscopic surgery were randomly assigned to have spinal anesthesia with either 5 mg bupivacaine 0.1% or 5 mg bupivacaine 0.1% mixed with 20 micrograms fentanyl. The main outcome measures included intraoperative patient and endoscopist satisfaction, sedative/analgesic supplementation, postoperative side effects and time to ambulation. Patients in the bupivacaine group needed more analgesic supplementation. Analgesia was more adequate in the bupivacaine-fentanyl group. Pruritus was the main side effect in the bupivacaine fentanyl group. Ambulation and discharge of patients were nearly the same in both groups. Spinal anesthesia with small dose (5 mg) hypobaric (0.1%) bupivacaine mixed with fentanyl (20 micrograms) produced adequate anesthesia for short cystoscopic procedures with minimal side effects and without delay in ambulation.

Ambulatory rehabilitation in multiple sclerosis.

PubMed

Kelleher, Kevin John; Spence, William; Solomonidis, Stephan; Apatsidis, Dimitrios

2009-01-01

Multiple sclerosis (MS) is an autoimmunogenic disease involving demyelination within the central nervous system. Many of the typical impairments associated with MS can affect gait patterns. With walking ability being one of the most decisive factors when assessing quality of life and independent living, this review focuses on matters, which are considered of significance for maintaining and supporting ambulation. This article is an attempt to describe current research and available interventions that the caring healthcare professional can avail of and to review the present trends in research to further these available options. Evidence-based rehabilitation techniques are of interest in the care of patients with MS, given the various existing modalities of treatment. In this review, we summarise the primary factors affecting ambulation and highlight available treatment methods. We review studies that have attempted to characterise gait deficits within this patient population. Finally, as ambulatory rehabilitation requires multidisciplinary interventions, we examine approaches, which may serve to support and maintain ambulation within this patient group for as long as possible.

Medicare, Medicaid, and Children's Health Insurance Programs: Announcement of the Extension of Temporary Moratoria on Enrollment of Part B Non-Emergency Ground Ambulance Suppliers and Home Health Agencies in Designated Geographic Locations. Extension of temporary moratoria.

PubMed

2018-01-30

This document announces the extension of statewide temporary moratoria on the enrollment of new Medicare Part B non-emergency ground ambulance providers and suppliers and Medicare home health agencies, subunits, and branch locations in Florida, Illinois, Michigan, Texas, Pennsylvania, and New Jersey, as applicable, to prevent and combat fraud, waste, and abuse. This extension also applies to the enrollment of new non-emergency ground ambulance suppliers and home health agencies, subunits, and branch locations in Medicaid and the Children's Health Insurance Program in those states. For purposes of these moratoria, providers that were participating as network providers in one or more Medicaid managed care organizations prior to January 1, 2018 will not be considered "newly enrolling" when they are required to enroll with the State Medicaid agency pursuant to a new statutory requirement, and thus will not be subject to the moratoria.

Early Ambulation After Microsurgical Reconstruction of the Lower Extremity.

PubMed

Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel

2018-06-01

Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.

Prehospital care in Hong Kong.

PubMed

Lo, C B; Lai, K K; Mak, K P

2000-09-01

A quick and efficient prehospital emergency response depends on immediate ambulance dispatch, patient assessment, triage, and transport to hospital. During 1999, the Ambulance Command of the Hong Kong Fire Services Department responded to 484,923 calls, which corresponds to 1329 calls each day. Cooperation between the Fire Services Department and the Hospital Authority exists at the levels of professional training of emergency medical personnel, quality assurance, and a coordinated disaster response. In response to the incident at the Hong Kong International Airport in the summer of 1999, when an aircraft overturned during landing, the pre-set quota system was implemented to send patients to designated accident and emergency departments. Furthermore, the 'first crew at the scene' model has been adopted, whereby the command is established and triage process started by the first ambulance crew members to reach the scene. The development of emergency protocols should be accompanied by good field-to-hospital and interhospital communication, the upgrading of decision-making skills, a good monitoring and auditing structure, and commitment to training and skills maintenance.

The Analgesic Effect of Obturator Nerve Block Added to a Femoral Triangle Block After Total Knee Arthroplasty: A Randomized Controlled Trial.

PubMed

Runge, Charlotte; Børglum, Jens; Jensen, Jan Mick; Kobborg, Tina; Pedersen, Anette; Sandberg, Jon; Mikkelsen, Lone Ramer; Vase, Morten; Bendtsen, Thomas Fichtner

2016-01-01

Total knee arthroplasty (TKA) is associated with severe pain, and effective analgesia is essential for the quality of postoperative care and ambulation. The analgesic effects of adding an obturator nerve block (ONB) to a femoral triangle block (FTB) after TKA have not been tested previously. We hypothesized that combined ONB and FTB will reduce opioid consumption and pain compared with those of a single FTB or local infiltration analgesia (LIA). Seventy-eight patients were randomized to combined ONB and FTB, single FTB, or LIA after primary unilateral TKA. The primary outcome was morphine consumption during the first 24 postoperative hours. Secondary outcomes included morphine consumption during the first 48 postoperative hours, pain at rest and passive knee flexion, nausea and vomiting, cumulated ambulation score, and Timed Up and Go test. Seventy-five patients were included in the analysis. The total intravenous morphine consumption during the first 24 postoperative hours was 2 mg (interquartile range [IQR], 0-15) in the combined ONB and FTB group, 20 mg (IQR, 10-26) in the FTB group (P = 0.0007), and 17 mg (IQR, 10-36) in the LIA group (P = 0.002). The combined ONB and FTB group displayed reduced pain, nausea, and vomiting compared with the other groups. The ambulation tests showed no statistically significant differences between the groups. Addition of ONB to FTB significantly reduced opioid consumption and pain after TKA compared with a single FTB or LIA, without impaired ambulation.

Ambulance dispatches to schools during a 5-year period in Fukui Prefecture.

PubMed

Takinami, Yoshikazu; Maeda, Shinji

2017-01-01

To determine the characteristics and trends of medical emergencies during school activities by analyzing information provided by fire departments. During a 5-year period from January 2009 to December 2013, all nine fire departments in Fukui Prefecture handled 850 emergencies at schools. We investigated the 850 cases with the age range of 0-63 years. It was found that 21.5% of ambulance dispatches to schools were on weekends and there were more dispatches for non-faculty members of all age groups on weekends than on weekdays. The percentage of weekend dispatches was particularly high for students aged ≥19 years. Emergency calls for junior high school students and younger students accounted for the majority of weekday calls. There were a total of 524 ambulance dispatches for the three categories "sprains, contusions, dislocations, and fractures" ( n = 245), "seizures, epilepsy, and syncope" ( n = 171), and "cuts, bruises, lacerations, trauma, amputations, and burns" ( n = 108), with dispatches for these three categories accounting for 61.6% of all dispatches. Almost all dispatches for "heat stroke and dehydration" were during school hours and were concentrated between the months of July and September. Heat stroke was most common among high school students and most often occurred during the summer/fall season and on weekends. Heat stroke was the fourth most frequent condition that required an ambulance dispatch after the above three conditions. Heat stroke is predictable, indicating that it is necessary to prevent heat stroke during high school club activities.

[The evaluation of the suitability of our cases for referral to a level I trauma center].

PubMed

Taviloğlu, K; Aydin, A; Cuhali, B D; Demiralp, T; Güloğlu, R; Ertekin, C

2001-07-01

This study was performed on 200 patients with a prospective method, between July and October 1998. The aim of the study was to analyze the patients who were admitted directly or referred from another hospital, if they were suitable with the transfer criteria to a level I trauma center. One hundred and seven patients (53.5%) were admitted without ambulance and 93 patients (46.5%) by ambulance to our center. 34% of those patients applied directly and 66% of them were sent from other hospitals. Private ambulances consisted 70%, and 30% the belonged to the national health service. Only 26% of the ambulances had doctor as staff. The most common trauma etiologies were: traffic accidents (42.5%), falling from a height (37.5%) and assaults (11.5%). The mean Glasgow coma score (GCS) of the patients was calculated as 13.9 and mean revised trauma score was 11.7. The Glasgow coma score, revised trauma score and appropriateness to the transfer criteria of the American College of Surgeons were statistically analyzed according to the Fischer Exact test. The results revealed that 96% of the patients with RTS, 86% of the patients with GCS and 60% of the patients with ACS were not appropriate to the transfer criteria to a level I trauma center. In conclusion; we believe that GCS will predict better results in the triage of trauma patients with head trauma in our country.

Barriers to Implementation of Recommendations for Transport of Children in Ground Ambulances.

PubMed

Woods, Rashida H; Shah, Manish; Doughty, Cara; Gilchrest, Anthony

2017-10-16

The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers. We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed. Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment. Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.

A Survey of Restraint Methods for the Safe Transport of Children in Ground Ambulances.

PubMed

Woods, Rashida H; Shah, Manish; Doughty, Cara; Gilchrest, Anthony

2018-03-01

The National Highway Traffic Safety Administration (NHTSA) released draft recommendations in 2010 on the safe transport of children in ground ambulances. The purpose of this study was to assess awareness of these guidelines among emergency medical service (EMS) agencies and to identify implementation barriers. We conducted a cross-sectional, anonymous online survey of 911-responding, ground transport EMS agencies in Texas. Demographics, modes of transport based on case scenarios, and barriers to implementation were assessed. Of 62 eligible EMS agencies that took the survey, 35.7% were aware of the NHTSA guidelines, 62.5% agreed they would improve safety, and 41.1% planned to implement them. Seventy-five percent of EMS agencies used the ideal or acceptable alternative to transport children requiring continuous monitoring, and 69.5% chose ideal or acceptable alternatives for children requiring spinal immobilization. The ideal or acceptable alternative was not chosen for children who were not injured or ill (93.2%), ill or injured but not requiring continuous monitoring (53.3%), and situations when multiple patients required transport (57.6%). The main requirements for implementation were provider education, ambulance interior modifications, new guidelines in the EMS agency, and purchase of new equipment. Few EMS agencies are aware of the NHTSA guidelines on safe transport of children in ground ambulances. Although most agencies appropriately transport children who require monitoring, interventions, or spinal immobilization, they use inappropriate means to transport children in situations with multiple patients, lack of injury or illness, or lack of need for monitoring.

Ergonomic evaluation of the ambulance interior to reduce paramedic discomfort and posture stress.

PubMed

Gilad, Issachar; Byran, Eyal

2007-12-01

This study aims to evaluate safety and accessibility of an advanced life support (ALS) ambulance interior. The standard ambulance's interior design is unsatisfactory based on perceived discomfort and postures that constrain paramedics and medical staff, resulting in unsafe treatment of patients, mainly when being transported. Two procedures were used to evaluate performance during a wide range of rescue tasks: a survey, based on questionnaires, interviews, and observation of paramedics performing routine tasks; and upper body and back posture analysis, based on postural considerations. Findings revealed that 74% of the paramedics stated that the location of the paramedic's seat is inefficient while they perform clinical procedures; 94% found the bench uncomfortable; 77% felt that the vertical distance between the bench and the stretcher is too far; and 86% needed to steady themselves when the vehicle was moving. Posture analysis showed that paramedics undergo several nonneutral back postures, including twisted back (>20 degrees) and sitting with back flexion between 20 degrees and 45 degrees. Because the interior of the ALS ambulance was found to be unsatisfactory both to paramedics and patients, alternative design issues are proposed. The suggested practical layout contains four main modifications: (a) replacing the bench with two adjustable paramedic seats, (b) redesigning the medical cabinet for easy access, (c) adding an adjustable folding seat opposite the two new seats, and (d) adding a swiveling base and lifting apparatus that will accommodate the stretcher and enable better accessibility to patients by the paramedic personnel.

The public vs private debate: separating facts from values.

PubMed

Narad, R A; Gillespie, W

1998-01-01

The choice between public and private emergency ambulance services is generally based on histological experience within the community. No empirical evidence exists that supports an argument that either public or private emergency ambulance services are better, per se. On a macro level, this debate is based on the question of the role of government and the role of the marketplace in the delivery of public services and medical care, and the comparative efficiencies of public and private organizations. On a micro or community level, these philosophical concerns are supplemented with issues relating to protection of individual jobs and investments, upholding of community tradition, and maintenance of existing relationships. Other specific values that are considered include the role of profit and equity--fairness of coverage. A rational choice would be based on consideration of efficiency and effectiveness. The effectiveness of an emergency medical services system is primarily based on its ability to provide patients with the level of care that they need within a clinically appropriate time. Efficiency is the ratio between inputs and outputs. One factor that can increase efficiency is the availability of excess production capacity that can be used to provide emergency ambulance service, with a low marginal cost of adding this to the other functions. A rational model is intended to change the level of the debate to one that is less based on values, but it is impossible for a community to select an ambulance provider in a value-free environment.

Educating the ambulance technician, paramedic, and clinical supervisor: using factor analysis to inform the curriculum

PubMed Central

Kilner, T

2004-01-01

Methods: Data generated by a Delphi study investigating the desirable attributes of ambulance technician, paramedic, and clinical supervisor were subject to factor analysis to explore inter-relations between the variables or desirable attributes. Variables that loaded onto any factor at a correlation level of >0.3 were included in the analysis. Results: Three factors emerged in each of the occupational groups. In respect of the ambulance technician these factors may be described as; core professional skills, individual and collaborative approaches to health and safety, and the management of self and clinical situations. For the paramedic the themes are; core professional skills, management of self and clinical situations, and approaches to health and safety. For the clinical supervisor there is again a theme described as core professional skills, with a further two themes described as role model and lifelong learning. Conclusions: The profile of desirable attributes emerging from this study are remarkably similar to the generic benchmark statements for health care programmes outlined by the Quality Assurance Agency for Higher Education. It seems that a case is emerging for a revision of the curriculum currently used for the education and training of ambulance staff, which is more suited to a consumer led health service and which reflects the broader professional base seen in programmes associated with other healthcare professions. This study has suggested outline content, and module structure for the education of the technician, paramedic, and clinical supervisor, based on empirical evidence. PMID:15107389

Paravertebral block can be an alternative to unilateral spinal anaesthesia for inguinal hernia repair.

PubMed

Mandal, M C; Das, S; Gupta, Sunil; Ghosh, T R; Basu, S R

2011-11-01

Inguinal hernia repair can be performed under satisfactory anaesthetic conditions using general, regional and peripheral nerve block anaesthesia. Unilateral spinal anaesthesia provides optimal anaesthesia, with stable haemodynamics and minimal adverse events. The paravertebral block, being segmental in nature, can be expected to produce some advantages regarding haemodynamic stability and early ambulation and may be a viable alternative. Fifty-four consenting male patients posted for inguinal hernia repair were randomized into two groups, to receive either the two-segment paravertebral block (group-P, n=26) at T10 and L1 or unilateral spinal anaesthesia (group-S, n=28), respectively. The time to ambulation (primary outcome), time to the first analgesic, total rescue analgesic consumption in the first 24-hour period and adverse events were noted. Block performance time and time to reach surgical anaesthesia were significantly higher in the patients of group-P (P<0.001). Time to ambulation was significantly shorter in group-P compared to group-S (P<0.001), while postoperative sensory block was prolonged in patients of group-S; P<0.001. A significantly higher number of patients could bypass the recovery room in group-P compared to group-S, (45% versus 0%, respectively, P<0.001). No statistically significant difference in adverse outcomes was recorded. Both the paravertebral block and unilateral spinal anaesthesia are effective anaesthetic techniques for uncomplicated inguinal hernia repair. However, the paravertebral block can be an attractive alternative as it provides early ambulation and prolonged postoperative analgesia with minimal adverse events.

Economic regulation of ambulance services in California.

PubMed

Narad, R A

1997-01-01

This study was intended to identify economic regulatory programs used by California counties (including ambulance franchising and rate setting), to inventory their foci and application, and to identify differences around the state. By studying the variety of programs used in one state, this study establishes a framework for evaluation of state and local regulatory programs elsewhere. This study surveyed all California local EMS agencies (LEMSAs); these are California's equivalent of regional EMS organizations. The survey achieved a 100% response rate, and all data involve population parameters obviating the need for inferential statistics. Seventy-three percent of California counties use economic regulations. Large-population counties and those that operate their own LEMSAs are more likely to use economic regulations than are small counties and those that participate in multicounty EMS agencies. Despite a preference for competition in the authorizing statute, most franchises were granted without competition to existing providers. The majority of franchises in the state were granted to public services. Most ambulance rate setting occurs outside of a competitive process. Economic regulations that were intended to provide a structured marketplace are often being used to protect existing providers, particularly public services, from competition. The growing interest by fire departments in entering the market for emergency ambulance service, along with the existing bias toward them in granting of franchises, does not bode well for use of the competitive process. The growth of managed care may change or eliminate the need for economic regulations but, if they are to continue, more state oversight should be considered.

A coproduced patient and public event: An approach to developing and prioritizing ambulance performance measures.

PubMed

Irving, Andy; Turner, Janette; Marsh, Maggie; Broadway-Parkinson, Andrea; Fall, Dan; Coster, Joanne; Siriwardena, A Niroshan

2018-02-01

Patient and public involvement (PPI) is recognized as an important component of high-quality health services research. PPI is integral to the Pre-hospital Outcomes for Evidence Based Evaluation (PhOEBE) programme. The PPI event described in detail in this article focusses on the process of involving patients and public representatives in identifying, prioritizing and refining a set of outcome measures that can be used to support ambulance service performance measurement. To obtain public feedback on little known, complex aspects of ambulance service performance measurement. The event was codesigned and coproduced with the PhOEBE PPI reference group and PhOEBE research team. The event consisted of brief researcher-led presentations, group discussions facilitated by the PPI reference group members and electronic voting. Data were collected from eighteen patient and public representatives who attended an event venue in Yorkshire. The results of the PPI event showed that this interactive format and mode of delivery was an effective method to obtain public feedback and produced a clear indication of which ambulance performance measures were most highly favoured by event participants. The event highlighted valuable contributions the PPI reference group made to the design process, supporting participant recruitment and facilitation of group discussions. In addition, the positive team working experience of the event proved a catalyst for further improvements in PPI within the PhOEBE project. © 2017 The Authors Health Expectations Published by John Wiley & Sons Ltd.

Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care

PubMed Central

Snooks, Helen; Anthony, Rebecca; Chatters, Robin; Cheung, Wai-Yee; Dale, Jeremy; Donohoe, Rachael; Gaze, Sarah; Halter, Mary; Koniotou, Marina; Logan, Phillippa; Lyons, Ronan; Mason, Suzanne; Nicholl, Jon; Phillips, Ceri; Phillips, Judith; Russell, Ian; Siriwardena, A Niroshan; Wani, Mushtaq; Watkins, Alan; Whitfield, Richard; Wilson, Lynsey

2012-01-01

Introduction Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. Design Pragmatic cluster randomised trial. Methods and analysis We randomly allocated 25 participating ambulance stations (clusters) in three services to intervention or control group. Intervention paramedics received training and clinical protocols for assessing and referring older people who have fallen to community-based falls services when appropriate, while control paramedics deliver care as usual. Patients are eligible for the trial if they are aged 65 or over; resident in a participating falls service catchment area; and attended by a trial paramedic following an emergency call coded as a fall without priority symptoms. The principal outcome is the rate of further emergency contacts (or death), for any cause and for falls. Secondary outcomes include further falls, health-related quality of life, ‘fear of falling’, patient satisfaction reported by participants through postal questionnaires at 1 and 6 months, and quality and pathways of care at the index incident. We shall compare National Health Service (NHS) and patient/carer costs between intervention and control groups and estimate quality-adjusted life years (QALYs) gained from the intervention and thus incremental cost per QALY. We shall estimate wider system effects on key-performance indicators. We shall interview 60 intervention patients, and conduct focus groups with contributing NHS staff to explore their experiences of the assessment and referral service. We shall analyse quantitative trial data by ‘treatment allocated’; and qualitative data using content analysis. Ethics and dissemination The Research Ethics Committee for Wales gave ethical approval and each participating centre gave NHS Research and Development approval. We shall disseminate study findings through peer-reviewed publications and conference presentations. Trial Registration: ISRCTN 60481756 PMID:23148348

An effective support system of emergency medical services with tablet computers.

PubMed

Yamada, Kosuke C; Inoue, Satoshi; Sakamoto, Yuichiro

2015-02-27

There were over 5,000,000 ambulance dispatches during 2010 in Japan, and the time for transportation has been increasing, it took over 37 minutes from dispatch to the hospitals. A way to reduce transportation time by ambulance is to shorten the time of searching for an appropriate facility/hospital during the prehospital phase. Although the information system of medical institutions and emergency medical service (EMS) was established in 2003 in Saga Prefecture, Japan, it has not been utilized efficiently. The Saga Prefectural Government renewed the previous system in an effort to make it the real-time support system that can efficiently manage emergency demand and acceptance for the first time in Japan in April 2011. The objective of this study was to evaluate if the new system promotes efficient emergency transportation for critically ill patients and provides valuable epidemiological data. The new system has provided both emergency personnel in the ambulance, or at the scene, and the medical staff in each hospital to be able to share up-to-date information about available hospitals by means of cloud computing. All 55 ambulances in Saga are equipped with tablet computers through third generation/long term evolution networks. When the emergency personnel arrive on the scene and discern the type of patient's illness, they can search for an appropriate facility/hospital with their tablet computer based on the patient's symptoms and available medical specialists. Data were collected prospectively over a three-year period from April 1, 2011 to March 31, 2013. The transportation time by ambulance in Saga was shortened for the first time since the statistics were first kept in 1999; the mean time was 34.3 minutes in 2010 (based on administrative statistics) and 33.9 minutes (95% CI 33.6-34.1) in 2011. The ratio of transportation to the tertiary care facilities in Saga has decreased by 3.12% from the year before, 32.7% in 2010 (regional average) and 29.58% (9085/30,709) in 2011. The system entry completion rate by the emergency personnel was 100.00% (93,110/93,110) and by the medical staff was 46.11% (14,159/30,709) to 47.57% (14,639/30,772) over a three-year period. Finally, the new system reduced the operational costs by 40,000,000 yen (about $400,000 US dollars) a year. The transportation time by ambulance was shorter following the implementation of the tablet computer in the current support system of EMS in Saga Prefecture, Japan. The cloud computing reduced the cost of the EMS system.

Identification and characteristics of biological agents in work environment of medical emergency services in selected ambulances.

PubMed

Bielawska-Drózd, Agata; Cieślik, Piotr; Wlizło-Skowronek, Bożena; Winnicka, Izabela; Kubiak, Leszek; Jaroszuk-Ściseł, Jolanta; Depczyńska, Daria; Bohacz, Justyna; Korniłłowicz-Kowalska, Teresa; Skopińska-Różewska, Ewa; Kocik, Janusz

2017-06-19

Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. The levels of air contamination were from 0 to 2.3×10¹ colony-forming unit (CFU)/m³ for bacteria and for yeast and filamentous fungi were from 0 to 1.8×10¹ CFU/m³. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×10¹ to 4.2×10¹ CFU/m³ and yeast and filamentous fungi from 0 to 1.9×10¹ CFU/m³. For surface contamination the mean bacterial count in ambulances has been between 1.0×10¹ and 1.3×10² CFU/25 cm² and in offices - between 1.1×10¹ and 8.5×10¹ CFU/25 cm². Mean fungal count has reached the level from 2.8×10⁰ to 4.2×10¹ CFU/25 cm² in ambulances and 1.3×10¹ to 5.8×10¹ CFU/25 cm² in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces), coagulase - negative Staphylococci (air and surfaces), Aspergillus and Penicillium genera (air and surfaces). The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup Med Environ Health 2017;30(4):617-627. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Real time workload classification from an ambulatory wireless EEG system using hybrid EEG electrodes.

PubMed

Matthews, R; Turner, P J; McDonald, N J; Ermolaev, K; Manus, T; Shelby, R A; Steindorf, M

2008-01-01

This paper describes a compact, lightweight and ultra-low power ambulatory wireless EEG system based upon QUASAR's innovative noninvasive bioelectric sensor technologies. The sensors operate through hair without skin preparation or conductive gels. Mechanical isolation built into the harness permits the recording of high quality EEG data during ambulation. Advanced algorithms developed for this system permit real time classification of workload during subject motion. Measurements made using the EEG system during ambulation are presented, including results for real time classification of subject workload.

An Audiovisual Teaching Module to Assist Examiners in the Administration of a Practical Performance Examination for the Emergency Medical Technician-Ambulance (EMT-A). Consisting of a 90-Minute Audiovisual Presentation In Either 16mm Sound or 3/4" Video-Cassette Plus a "User's Guide" Describing in Detail the Total Examination Procedure. Final Report.

ERIC Educational Resources Information Center

National Registry of Emergency Medical Technicians, Columbus, OH.

A structured, time-referenced, performance examination was designed as part of the certification procedure for Emergency Medical Technicians-Ambulance in an attempt to increase objectivity and standardization. This examination is based on a model developed by the University of Southern California, School of Medicine, Department of Emergency…

Trauma operating room in conjunction with an air ambulance system: indications, interventions, and outcomes.

PubMed

Law, D K; Law, J K; Brennan, R; Cleveland, H C

1982-09-01

We report a retrospective study of 198 trauma patients brought directly to a trauma operating room by an air ambulance system. Despite rapid transport, expert prehospital resuscitation, and the capability of early surgical intervention, the overall mortality was high (57%). There was no significant salvage of patients arriving without pulse, blood pressure or cardiac activity. Optimal trauma care failed to show encouraging results in this preselected group of patients with predominantly blunt and multisystem injury. The justification and cost effectiveness of this system of trauma care is discussed.

Classification of walking ability of household walkers versus community walkers based on K-BBS, gait velocity and upright motor control.

PubMed

Joa, K L; Kwon, S Y; Choi, J W; Hong, S E; Kim, C H; Jung, H Y

2015-10-01

Few guidelines are available to assist clinicians with assessment of whether a patient is a household or community walker. To assess the Korean Berg balance scale (K-BBS) and gait velocity cut-off points of a household walker versus a community walker and evaluate which combinations of the three scales (K-BBS, upright motor control test (UMCT), and gait velocity) best assessed walking ability. Cross-sectional study. Outpatient. A total of 124 stroke patients with walking difficulty. Participants were classified into one of six walking classifications (three household walkers and three community walkers) and K-BBS, UMCT, and gait velocity were evaluated. The optimal cut-off scores for walking classification were determined based on received operator characteristic (ROC) analyses. The cut-off value of K-BBS for dividing the household walker versus the community walker was 42 points. The cut-off value of gait velocity was 48 m/s for the community walker. The area under the ROC curve of the combined K-BBS and gait velocity values was larger than that of each individual scale and those of the other combined scales. The results suggest that K-BBS, gait velocity, and UMCT are useful instruments for classifying household ambulation and community ambulation. The authors recommend K-BBS as single scale and K-BBS and gait velocity as combined scales for evaluating community ambulation in stroke patients In this report, we have some clinical implication. We recommend 3 outcome measures to assess walking ability about home or community; K-BBS (>42 points), gait speed (>48 m/min), UMCT (strong grade in either knee flexion of extension). Suggesting cut-off points of Korean Berg balance scale, gait velocity, and level of upright motor control test for community ambulation could be used as outcome measures to evaluate patient's actual performance level. It is also important to combine several scales for determining walking classification. We suggest to evaluate walking ability by combining K-BBS and UMCT to best predict community ambulation.

Geographic Access to US Neurocritical Care Units Registered with the Neurocritical Care Society

PubMed Central

Shutter, Lori A.; Branas, Charles C.; Adeoye, Opeolu; Albright, Karen C.; Carr, Brendan G.

2018-01-01

Background Neurocritical care provides multidisciplinary, specialized care to critically ill neurological patients, yet an understanding of the proportion of the population able to rapidly access specialized Neurocritical Care Units (NCUs) in the United States is currently unknown. We sought to quantify geographic access to NCUs by state, division, region, and for the US as a whole. In addition, we examined how mode of transportation (ground or air ambulance), and prehospital transport times affected population access to NCUs. Methods Data were obtained from the Neurocritical Care Society (NCS), US Census Bureau and the Atlas and Database of Air Medical Services. Empirically derived prehospital time intervals and validated models estimating prehospital ground and air travel times were used to calculate total prehospital times. A discrete total prehospital time interval was calculated for each small unit of geographic analysis (block group) and block group populations were summed to determine the proportion of Americans able to reach a NCU within discrete time intervals (45, 60, 75, and 90 min). Results are presented for different geographies and for different modes of prehospital transport (ground or air ambulance). Results There are 73 NCUs in the US using ground transportation alone, 12.8, 20.5, 27.4, and 32.6% of the US population are within 45, 60, 75, and 90 min of an NCU, respectively. Use of air ambulances increases access to 36.8, 50.4, 60, and 67.3 within 45, 60, 75, and 90 min, respectively. The Northeast has the highest access rates in the US using ground ambulances and for 45, 60, and 75 min transport times with the addition of air ambulances. At 90 min, the West has the highest access rate. The Southern region has the lowest ground and air access to NCUs access rates for all transport times. Conclusions Using NCUs registered with the NCS, current geographic access to NCUs is limited in the US, and geographic disparities in access to care exist. While additional NCUs may exist beyond those identified by the NCS database, we identify geographies with limited access to NCUs and offer a population-based planning perspective on the further development of the US neurocritical care system. PMID:22045246

Upper Limb Evaluation in Duchenne Muscular Dystrophy: Fat-Water Quantification by MRI, Muscle Force and Function Define Endpoints for Clinical Trials.

PubMed

Ricotti, Valeria; Evans, Matthew R B; Sinclair, Christopher D J; Butler, Jordan W; Ridout, Deborah A; Hogrel, Jean-Yves; Emira, Ahmed; Morrow, Jasper M; Reilly, Mary M; Hanna, Michael G; Janiczek, Robert L; Matthews, Paul M; Yousry, Tarek A; Muntoni, Francesco; Thornton, John S

2016-01-01

A number of promising experimental therapies for Duchenne muscular dystrophy (DMD) are emerging. Clinical trials currently rely on invasive biopsies or motivation-dependent functional tests to assess outcome. Quantitative muscle magnetic resonance imaging (MRI) could offer a valuable alternative and permit inclusion of non-ambulant DMD subjects. The aims of our study were to explore the responsiveness of upper-limb MRI muscle-fat measurement as a non-invasive objective endpoint for clinical trials in non-ambulant DMD, and to investigate the relationship of these MRI measures to those of muscle force and function. 15 non-ambulant DMD boys (mean age 13.3 y) and 10 age-gender matched healthy controls (mean age 14.6 y) were recruited. 3-Tesla MRI fat-water quantification was used to measure forearm muscle fat transformation in non-ambulant DMD boys compared with healthy controls. DMD boys were assessed at 4 time-points over 12 months, using 3-point Dixon MRI to measure muscle fat-fraction (f.f.). Images from ten forearm muscles were segmented and mean f.f. and cross-sectional area recorded. DMD subjects also underwent comprehensive upper limb function and force evaluation. Overall mean baseline forearm f.f. was higher in DMD than in healthy controls (p<0.001). A progressive f.f. increase was observed in DMD over 12 months, reaching significance from 6 months (p<0.001, n = 7), accompanied by a significant loss in pinch strength at 6 months (p<0.001, n = 9) and a loss of upper limb function and grip force observed over 12 months (p<0.001, n = 8). These results support the use of MRI muscle f.f. as a biomarker to monitor disease progression in the upper limb in non-ambulant DMD, with sensitivity adequate to detect group-level change over time intervals practical for use in clinical trials. Clinical validity is supported by the association of the progressive fat transformation of muscle with loss of muscle force and function.

Community first responders and responder schemes in the United Kingdom: systematic scoping review.

PubMed

Phung, Viet-Hai; Trueman, Ian; Togher, Fiona; Orner, Roderick; Siriwardena, A Niroshan

2017-06-19

Community First Responder (CFR) schemes support lay people to respond to medical emergencies, working closely with ambulance services. They operate widely in the UK. There has been no previous review of UK literature on these schemes. This is the first systematic scoping review of UK literature on CFR schemes, which identifies the reasons for becoming a CFR, requirements for training and feedback and confusion between the CFR role and that of ambulance service staff. This study also reveals gaps in the evidence base for CFR schemes. We conducted a systematic scoping review of the published literature, in the English language from 2000 onwards using specific search terms in six databases. Narrative synthesis was used to analyse article content. Nine articles remained from the initial search of 15,969 articles after removing duplicates, title and abstract and then full text review. People were motivated to become CFRs through an altruistic desire to help others. They generally felt rewarded by their work but recognised that the help they provided was limited by their training compared with ambulance staff. There were concerns about the possible emotional impact on CFRs responding to incidents. CFRs felt that better feedback would enhance their learning. Ongoing training and support were viewed as essential to enable CFRs to progress. They perceived that public recognition of the CFR role was low, patients sometimes confusing them with ambulance staff. Relationships with the ambulance service were sometimes ambivalent due to confusion over roles. There was support for local autonomy of CFR schemes but with greater sharing of best practice. Most studies dated from 2005 and were descriptive rather than analytical. In the UK and Australia CFRs are usually lay volunteers equipped with basic skills for responding to medical emergencies, whereas in the US they include other emergency staff as well as lay people. Opportunities for future research include exploring experiences and perceptions of patients who have been treated by CFRs and other stakeholders, while also evaluating the effectiveness and costs of CFR schemes.

The feasibility, acceptability and preliminary testing of a novel, low-tech intervention to improve pre-hospital data recording for pre-alert and handover to the Emergency Department.

PubMed

Fitzpatrick, David; Maxwell, Douglas; Craigie, Alan

2018-06-25

Poor communication during patient handover is recognised internationally as a root cause of a significant proportion of preventable deaths. Data used in handover is not always easily recorded using ambulance based tablets, particularly in time-critical cases. Paramedics have therefore developed pragmatic workarounds (writing on gloves or scrap paper) to record these data. However, such practices can conflict with policy, data recorded can be variable, easily lost and negatively impact on handover quality. This study aimed to measure the feasibility and acceptability of a novel, low tech intervention, designed to support clinical information recording and delivery during pre-alert and handover within the pre-hospital and ED setting. A simple pre and post-test design was used with a historical control. Eligible participants included all ambulance clinicians based at one large city Ambulance Station (n = 69) and all nursing and physician staff (n = 99) based in a city Emergency Department. Twenty five (36%) ambulance clinicians responded to the follow-up survey. Most felt both the pre-alert and handover components of the card were either 'useful-very useful' (n = 23 (92%); and n = 18 (72%) respectively. Nineteen (76%) used the card to record clinical information and almost all (n = 23 (92%) felt it 'useful' to 'very useful' in supporting pre-alert. Similarly, 65% (n = 16) stated they 'often' or 'always' used the card to support handover. For pre-alert information there were improvements in the provision of 8/11 (72.7%) clinical variables. ​ Results from the post-test survey measuring ED staff (n = 37) perceptions of handover demonstrated small (p < 0.05) improvements in handover in 3/5 domains measured. This novel low-tech intervention was highly acceptable to ambulance clinician participants, improving their data recording and information exchange processes. However, further well conducted studies are required to test the impact of this intervention on information exchange during pre-alert and handover.

Postoperative Pain Management After Primary Total Knee Arthroplasty: The Value of Liposomal Bupivacaine.

PubMed

Sporer, Scott M; Rogers, Thea

2016-11-01

Multimodal pain protocols have been proposed to achieve improved long-acting postoperative analgesia. Controlling postoperative pain after joint arthroplasty is especially important as it relates to patient satisfaction and outcomes. The purpose of this study was to compare the postoperative pain, time to ambulation, and overall narcotic usage between patients who received either a femoral nerve block with a periarticular bupivacaine injection or a periarticular bupivacaine and extended-release liposomal bupivacaine injection after primary total knee arthroplasty. A total of 597 consecutive primary total knee arthroplasties performed between September 1, 2012 and August 31, 2014 received preoperative celecoxib, oxycodone, and transdermal scopolamine. Intraoperatively, patients either received a single-dose bupivacaine femoral nerve block along with 30-mL 0.25% bupivacaine periarticular injection (group A) or a 60-mL periarticular injection alone (20-mL liposomal bupivacaine, 30-mL 0.25% bupivacaine, and 10-mL saline; group B). The postoperative pain scores, narcotic usage, and time to ambulation were retrospectively collected from the electronic medical record. These outcomes were compared between treatment groups. There were 325 patients in group A compared with 272 in group B during the time frame. There was no difference among age, gender, race, and body mass index between the groups. Group B demonstrated a decreased need for breakthrough pain medication (16.9% vs 36.3% P < .001), decreased pain 12 hours postoperatively (3.2 vs 3.6 P < .003), and an earlier time to ambulation (29.5 hours vs 32.2 hours, P < .017). There was no difference in hospital length of stay (2.8 vs 2.6 days, P = .123). On controlling for demographic factors, patients in group B were able to ambulate 2.3 hours earlier than those in group A (coefficient = -2.3, P = .049). Liposomal bupivacaine resulted in a decrease need for breakthrough pain medication, improved pain scores at 12 hours, and an earlier time to ambulation compared to a combined femoral nerve block and periarticular bupivacaine injection. Copyright © 2016 Elsevier Inc. All rights reserved.

A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment.

PubMed

Le Moing, Anne-Gaëlle; Seferian, Andreea Mihaela; Moraux, Amélie; Annoussamy, Mélanie; Dorveaux, Eric; Gasnier, Erwan; Hogrel, Jean-Yves; Voit, Thomas; Vissière, David; Servais, Laurent

2016-01-01

Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD) patients (mean age 18.5 ± 5.5 years) collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test) and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment. ClinicalTrials.gov NCT01611597.

Adaptation and Promotion of Emergency Medical Service Transportation for Climate Change

PubMed Central

Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

2014-01-01

Abstract The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI. PMID:25501065

Initial experience in setting up a medical student first responder scheme in South Central England.

PubMed

Seligman, William H; Ganatra, Sameer; England, David; Black, John J M

2016-02-01

Prehospital emergency medicine (PHEM) is a recently recognised subspecialty of emergency medicine, and anaesthetics, intensive care and acute medicine, in the UK, and yet it receives little to no mention in many undergraduate medical curricula. However, there is growing interest in PHEM among medical students and junior doctors. Several programmes are in existence across the UK that serve to provide teaching and exposure of prehospital care to medical students and junior doctors. However, relatively few students are able to gain significant first-hand experience of treating patients in the prehospital phase. In this short report, we discuss our experience of launching the student first responder (SFR) scheme across three counties in the Thames Valley. Medical students are trained by the regional ambulance service and respond to life-threatening medical emergencies in an ambulance response vehicle. The scheme is likely to benefit the ambulance service by providing a wider pool of trained volunteer first responders able to attend to emergency calls, to benefit patients by providing a quick response at their time of need, and to benefit medical students by providing first-hand experience of medical emergencies in the community. In its first 15 months of operation, SFRs were dispatched to 343 incidents. This scheme can serve as a training model for other ambulance services and medical schools across the UK. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Appraisal of work ability in relation to job-specific health requirements in ambulance workers.

PubMed

van Schaaijk, A; Boschman, J S; Frings-Dresen, M H W; Sluiter, J K

2017-01-01

To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Workers Health Surveillance cross-sectional data of 506 ambulance workers (236 drivers and 270 paramedics) were used. The tests for specific job requirements were divided into six categories. Work ability was appraised as overall, physical and mental/emotional. Multiple linear stepwise regression analyses were used to model the associations. Outcomes in 'raised alertness and judgment ability' (R 2  = 0.09), 'job-specific physical abilities' (R 2  = 0.10) and 'emotional peak load' (R 2  = 0.07) significantly explained appraised overall, physical and mental/emotional work ability. Physical and mental/emotional work ability together explained 48.3% of the variance of overall work ability. The explained variance by physical and mental/emotional work ability was almost 4% higher in drivers than in paramedics. Overall work ability was significantly explained by outcomes in 'raised alertness and judgment ability' and 'emotional peak load.' Physical work ability was significantly explained by 'job-specific physical abilities' and 'raised alertness and judgment ability' outcomes, while 'emotional peak load' and 'raised alertness and judgment ability' outcomes significantly explained mental/emotional work ability. Physical and mental/emotional work ability explains the same proportion of variance in overall work ability.

Integration of cognitive-behavioral therapy with gait training for a 58-year-old male with a fear of falling: a case report.

PubMed

Vendrely, Ann; Messmer, Eric; Moseley, Jennifer

2012-04-01

Fear of falling is a common concern among adults over age 65, which results in decreased activity levels. Cognitive-behavioral therapy (CBT) uses psychological techniques to redirect negative cognitive, emotional, or behavioral affects for improvement of self-efficacy and reduced fear of falling. The purpose of this case study is to describe the integration of CBT into the physical therapy (PT) management of a middle-aged male with fear of falling and difficulty walking. The single subject was a 58-year-old male with complaints of frequently losing his balance, feeling unstable while walking, and requiring the use of a walker to ambulate. During the initial PT examination his primary impairment was difficulty ambulating in open spaces. Dynamic Gait Index (DGI) was 8/24 and the Modified Falls Efficacy Score (MFES) was 6.36/10. The interventions began with a general lower extremity strengthening program, balance exercises, and gait training. At visit 9, CBT techniques of cognitive restructuring were added. Visualization of correct gait patterns was added to the program during visit 10, which continued until discharge after visit 14. Measurements on the DGI improved to 23/24 and MFES improved to 9.43/10 at discharge. Gait pattern improved with the ability to ambulate indoors without an assistive device and using only a straight cane for community ambulation. The use of CBT is well documented as a group intervention for older adults with fear of falling, but CBT techniques may also be helpful for younger adults with fear of falling.

Adaptation and promotion of emergency medical service transportation for climate change.

PubMed

Pan, Chih-Long; Chiu, Chun-Wen; Wen, Jet-Chau

2014-12-01

The purpose of this study is to find a proper prehospital transportation scenario planning of an emergency medical service (EMS) system for possible burdensome casualties resulting from extreme climate events. This project focuses on one of the worst natural catastrophic events in Taiwan, the 88 Wind-caused Disasters, caused by the Typhoon Morakot; the case of the EMS transportation in the Xiaolin village is reviewed and analyzed. The sequential-conveyance method is designed to promote the efficiency of all the ambulance services related to transportation time and distance. Initially, a proposed mobile emergency medical center (MEMC) is constructed in a safe location near the area of the disaster. The ambulances are classified into 2 categories: the first-line ambulances, which reciprocate between the MEMC and the disaster area to save time and shorten the working distances and the second-line ambulances, which transfer patients in critical condition from the MEMC to the requested hospitals for further treatment. According to the results, the sequential-conveyance method is more efficient than the conventional method for EMS transportation in a mass-casualty incident (MCI). This method improves the time efficiency by 52.15% and the distance efficiency by 56.02%. This case study concentrates on Xiaolin, a mountain village, which was heavily destroyed by a devastating mudslide during the Typhoon Morakot. The sequential-conveyance method for the EMS transportation in this research is not only more advantageous but also more rational in adaptation to climate change. Therefore, the findings are also important to all the decision-making with respect to a promoted EMS transportation, especially in an MCI.

The characteristics of acute non-fatal medication-related events attended by ambulance services in the Melbourne Metropolitan Area 1998-2002.

PubMed

Hutton, Jennie; Dent, Andrew; Buykx, Penny; Burgess, Stephen; Flander, Louisa; Dietze, Paul

2010-01-01

To describe the characteristics of non-fatal medication-related ambulance attendances in Melbourne. A retrospective analysis of 16 705 patient care records completed by ambulance paramedics in Melbourne where medications had a causal role in the attendance. A single medication only was implicated in 11 765 cases (70% of the total). Of these, 85% involved one of six types of medication: benzodiazepines (52%), paracetamol (15%), selective serotonin re-uptake inhibitors (6.5%), combination paracetamol and opioids (4%), phenothiazines (3.4%) and tricyclic antidepressants (TCA) (3.7%). Cases involving benzodiazepines were significantly (P < 0.001) older (Average = 37 years) than those involving paracetamol (Average = 30 years). Thirty-four per cent of cases involved concurrent alcohol use, and this varied according to drug type (paracetamol 26%, benzodiazepines 40%, selective serotonin re-uptake inhibitors 35%, paracetamol and opioids 35%). An abnormal Glasgow Coma Scale score was found in 19% of cases, again varying according to drug type (paracetamol 10%, TCA 39%, benzodiazepines 21%, paracetamol and opioids 17%, phenothiazines 15%). Ten per cent of cases were not transported to hospital ranging from 3% for TCA to 13% for benzodiazepines. The majority of non-fatal medication events attended by ambulance paramedics involve one of six substances. Benzodiazepines were most commonly implicated and, as management may require only simple supportive treatment, significant numbers are not transported to hospital. The unique clinical population is identified in this study and the ongoing medical and psychiatric treatment of these patients not transported to hospital in the study period needs to be considered.

Performance of regional oxygen saturation monitoring by near-infrared spectroscopy (NIRS) in pediatric inter-hospital transports with special reference to air ambulance transports: a methodological study.

PubMed

Hamrin, Tova Hannegård; Radell, Peter J; Fläring, Urban; Berner, Jonas; Eksborg, Staffan

2017-12-28

The aim of the present study was to evaluate the performance of regional oxygen saturation (rSO 2 ) monitoring with near infrared spectroscopy (NIRS) during pediatric inter-hospital transports and to optimize processing of the electronically stored data. Cerebral (rSO 2 -C) and abdominal (rSO 2 -A) NIRS sensors were used during transport in air ambulance and connecting ground ambulance. Data were electronically stored by the monitor during transport, extracted and analyzed off-line after the transport. After removal of all zero and floor effect values, the Savitzky-Golay algorithm of data smoothing was applied on the NIRS-signal. The second order of smoothing polynomial was used and the optimal number of neighboring points for the smoothing procedure was evaluated. NIRS-data from 38 pediatric patients was examined. Reliability, defined as measurements without values of 0 or 15%, was acceptable during transport (> 90% of all measurements). There were, however, individual patients with < 90% reliable measurements during transport, while no patient was found to have < 90% reliable measurements in hospital. Satisfactory noise reduction of the signal, without distortion of the underlying information, was achieved when 20-50 neighbors ("window-size") were used. The use of NIRS for measuring rSO 2 in clinical studies during pediatric transport in ground and air-ambulance is feasible but hampered by unreliable values and signal interference. By applying the Savitzky-Golay algorithm, the signal-to-noise ratio was improved and enabled better post-hoc signal evaluation.

Obesity-specific neural cost of maintaining gait performance under complex conditions in community-dwelling older adults.

PubMed

Osofundiya, Olufunmilola; Benden, Mark E; Dowdy, Diane; Mehta, Ranjana K

2016-06-01

Recent evidence of obesity-related changes in the prefrontal cortex during cognitive and seated motor activities has surfaced; however, the impact of obesity on neural activity during ambulation remains unclear. The purpose of this study was to determine obesity-specific neural cost of simple and complex ambulation in older adults. Twenty non-obese and obese individuals, 65years and older, performed three tasks varying in the types of complexity of ambulation (simple walking, walking+cognitive dual-task, and precision walking). Maximum oxygenated hemoglobin, a measure of neural activity, was measured bilaterally using a portable functional near infrared spectroscopy system, and gait speed and performance on the complex tasks were also obtained. Complex ambulatory tasks were associated with ~2-3.5 times greater cerebral oxygenation levels and ~30-40% slower gait speeds when compared to the simple walking task. Additionally, obesity was associated with three times greater oxygenation levels, particularly during the precision gait task, despite obese adults demonstrating similar gait speeds and performances on the complex gait tasks as non-obese adults. Compared to existing studies that focus solely on biomechanical outcomes, the present study is one of the first to examine obesity-related differences in neural activity during ambulation in older adults. In order to maintain gait performance, obesity was associated with higher neural costs, and this was augmented during ambulatory tasks requiring greater precision control. These preliminary findings have clinical implications in identifying individuals who are at greater risk of mobility limitations, particularly when performing complex ambulatory tasks. Copyright © 2016 Elsevier Ltd. All rights reserved.

Physical behavior and function early after hip fracture surgery in patients receiving comprehensive geriatric care or orthopedic care--a randomized controlled trial.

PubMed

Taraldsen, Kristin; Sletvold, Olav; Thingstad, Pernille; Saltvedt, Ingvild; Granat, Malcolm H; Lydersen, Stian; Helbostad, Jorunn L

2014-03-01

This study is a part of the randomized controlled trial, the Trondheim Hip Fracture Trial, and it compared physical behavior and function during the first postoperative days for hip fracture patients managed with comprehensive geriatric care (CGC) with those managed with orthopedic care (OC). Treatment comprised CGC with particular focus on mobilization, or OC. A total of 397 hip fracture patients, age 70 years or older, home dwelling, and able to walk 10 m before the fracture, were included. Primary outcome was measurement of upright time (standing and walking) recorded for 24 hours the fourth day postsurgery by a body-worn accelerometer-based activity monitor. Secondary outcomes were number of upright events on Day 4, need for assistance in ambulation measured by the Cumulated Ambulation score on Days 1-3, and lower limb function measured by the Short Physical Performance Battery on Day 5 postsurgery. A total of 317 (CGC n = 175, OC n = 142) participants wore the activity monitor for a 24-hour period. CGC participants had significantly more upright time (mean 57.6 vs 45.1 min, p = .016), higher number of upright events (p = .005) and better Short Physical Performance Battery scores (p = .002), than the OC participants. Cumulated Ambulation score did not differ between groups (p = .234). When treated with CGC, compared with OC, older persons suffering a hip fracture spent more time in upright, had more upright events, and had better lower limb function early after surgery despite no difference in their need for assistance during ambulation.

Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback.

PubMed

Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald

2010-01-01

Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting. Randomised cross-over trial. Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007. European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties. CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control. Quality of chest compression during resuscitation. Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), p<0.0001) with this effect becoming steadily larger over time. Applied work was less in the feedback group compared to controls (373+/-448 cm x compression; p<0.001). Feedback did not influence ideal compression depth significantly. There was some indication of a learning effect of the feedback device. Real time automated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

NASA Astrophysics Data System (ADS)

Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

2015-08-01

The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

Poor chest compression quality with mechanical compressions in simulated cardiopulmonary resuscitation: a randomized, cross-over manikin study.

PubMed

Blomberg, Hans; Gedeborg, Rolf; Berglund, Lars; Karlsten, Rolf; Johansson, Jakob

2011-10-01

Mechanical chest compression devices are being implemented as an aid in cardiopulmonary resuscitation (CPR), despite lack of evidence of improved outcome. This manikin study evaluates the CPR-performance of ambulance crews, who had a mechanical chest compression device implemented in their routine clinical practice 8 months previously. The objectives were to evaluate time to first defibrillation, no-flow time, and estimate the quality of compressions. The performance of 21 ambulance crews (ambulance nurse and emergency medical technician) with the authorization to perform advanced life support was studied in an experimental, randomized cross-over study in a manikin setup. Each crew performed two identical CPR scenarios, with and without the aid of the mechanical compression device LUCAS. A computerized manikin was used for data sampling. There were no substantial differences in time to first defibrillation or no-flow time until first defibrillation. However, the fraction of adequate compressions in relation to total compressions was remarkably low in LUCAS-CPR (58%) compared to manual CPR (88%) (95% confidence interval for the difference: 13-50%). Only 12 out of the 21 ambulance crews (57%) applied the mandatory stabilization strap on the LUCAS device. The use of a mechanical compression aid was not associated with substantial differences in time to first defibrillation or no-flow time in the early phase of CPR. However, constant but poor chest compressions due to failure in recognizing and correcting a malposition of the device may counteract a potential benefit of mechanical chest compressions. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

Pakistan: the new target of terrorism. Are Karachi's emergency medical response systems adequately prepared?

PubMed

Siddiqui, Muhammad Ahmed; Jawad, Ahmed; Minhas, Saeed; Ansari, Asma; Siddiqui, Afrah; Mehtab, Sana

2009-07-01

To assess the efficacy and preparedness of the pre-hospital and hospital emergency medical systems and post graduate trainees in the city to deal with a massive terrorist strike. A cross-sectional survey of postgraduate trainees was conducted at Jinnah Postgraduate Medical Center and Civil Hospital Karachi from 21st July 2007 to 24th July 2007, to evaluate the preparedness and self identified deficiencies of doctors involved in massive trauma casualty management. To assess the pre-hospital care in Karachi, structured telephonic interviews were conducted of administrators of two private run charity based ambulance services. Out of the 90 respondents questioned regarding a self assessment of their training, only 3 (3.3%) of them were confident about their management of bomb blast victims. Eighty-seven (96.6%) of the respondents felt they required some further training (44.4%) or comprehensive training (52.2%). No simulated drills or courses had been conducted for disaster management in the emergency department of the surveyed Hospitals. Most of the ambulance drivers had no paramedic training. Ambulances are equipped with a stretcher and an oxygen cylinder only. No resuscitation measures are available in the ambulances. With an increasing number of terrorist attacks in the country, massive influx of casualties in a relatively short time span has become a regular feature of the Pakistani hospital system. Lack of adequate training at pre-hospital and in hospital levels may translate into increasing morbidities and mortalities. It is imperative that training of junior doctors and paramedical staff be conducted regularly and an effective regional communication base established for efficient interdepartmental coordination.

BURNOUT SYNDROM AMONG PUBLIC AMBULANCE STAFF.

PubMed

Iorga, Magdalena; Dascalu, Neonila; Soponaru, Camelia; Ioan, Beatrice

2015-01-01

Healthcare professionals are frequently confronted with urgent situations and a high-risk human intervention. They are usually exposed to what is called burnout syndrome. To identify the effects of burnout syndrome on the professional conduct and attitudes of doctors and nurses who work in the Romanian public ambulance service. Secondary, the causal relationships between burnout and various socio-demographic variables were analyzed. The 20-item Toronto Alexithymia Scale (TAS- 20), Maslach Burnout Inventory and Job Satisfaction Questionnaire were administered to 122 ambulance doctors, nurses and drivers (62 females and 60 males). The degree of job satisfaction is the most important indicator of burnout syndrome. Significant differences were found between low and high alexithymic subjects. Women are more susceptible to experience higher levels of burnout than men. The level of burnout is influenced by the combined effect of job satisfaction and alexithymia. Burnout syndrome is a common problem among people working in the emergency medical system. The causes of job-related burnout have to be identified in order to apply an appropriate level of burnout intervention program and to increase the efficiency of coping strategies.

[Examination of work-related stress and coping strategies among ambulance- and air-ambulance workers].

PubMed

Schiszler, Bence; Karamánné Pakai, Annamária; Szabó, Zoltán; Raposa, László Bence; Pónusz, Róbert; Radnai, Balázs; Endrei, Dóra

2016-11-01

Among Hungary's health sector workers the presence of a high level of stress is known, which can affect the individual. The aim of the authors was to uncover major risk factors causing work-related stress, as well as its extent, and positive and negative coping strategies among ground and aerial rescue workers. From June until October 2015, a national survey was conducted among Hungarian rescue workers. An own questionnaire and Rahe Stress and coping validated short questionnaire online form were used. A total of 141 persons took part in the survey. As compared to air-ambulance workers, ground rescue workers were exposed to higher work-related stress effects (p<0.01), resulting in a much larger variety of physical and psychological symptoms (p<0.05). Based on Global Stress and Coping Index effective coping mechanisms were observed among air rescue workers (p<0.01). It is important to perform regular professional theoretical and practical training. Human resource management should pay attention on occupational stress reduction. Orv. Hetil., 2016, 157(45), 1802-1808.

Ambulance personnel's experience of pain management for patients with a suspected hip fracture: A qualitative study.

PubMed

Jakopovic, D; Falk, A-C; Lindström, V

2015-07-01

Pain management is described to be insufficient for patients suffering from a hip fracture, and the management for this vulnerable group of patients may be challenging due to their medical history (multiple comorbidities) and polypharmacy. Previous research has mainly focused on fast tracks aiming to reduce time to surgery. But the research on how pain management is handled for these patients in the prehospital context has been sparse. Therefore, the purpose of this study was to describe the ambulance personnel's experience of managing the pain of patients with a suspected hip fracture. A descriptive and qualitative design with Critical Incident Technique was used for collecting data. Moreover, a qualitative content analysis was used for analysing the collected data. Twenty-two participants communicated their experiences and 51 incidents were analysed. The main finding in the study was that the ambulance personnel, by using their clinical knowledge and by empowering the patients to participate in their own care, managed to individualize the pain relief for patients with a suspected hip fracture through a variety of interventions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Hitting and missing targets by ambulance services for emergency calls: effects of different systems of performance measurement within the UK

PubMed Central

Bevan, Gwyn; Hamblin, Richard

2009-01-01

Following devolution, differences developed between UK countries in systems of measuring performance against a common target that ambulance services ought to respond to 75% of calls for what may be immediately life threatening emergencies (category A calls) within 8 minutes. Only in England was this target integral to a ranking system of ‘star rating’, which inflicted reputational damage on services that failed to hit targets, and only in England has this target been met. In other countries, the target has been missed by such large margins that services would have been publicly reported as failing, if they had been covered by the English system of star ratings. The paper argues that this case-study adds to evidence from comparisons of different systems of hospital performance measurement that, to have an effect, these systems need to be designed to inflict reputational damage on those that have performed poorly; and it explores implications of this hypothesis. The paper also asks questions about the adequacy of systems of performance measurement of ambulance services in UK countries. PMID:19381327

Challenges for environmental hygiene practices in Australian paramedic-led health care: A brief report.

PubMed

Barr, Nigel; Holmes, Mark; Roiko, Anne; Dunn, Peter; Lord, Bill

2018-06-01

This study explored the self-reported behaviors and perceptions of Australian paramedics in relation to their environmental hygiene practices. A national online survey was conducted with Paramedics Australasia members (N = 417). Participants reported working in ambulances often contaminated with body fluids. Widespread noncompliance with routine and deep cleaning of ambulances, and misunderstandings about environmental hygiene practices were apparent. Improvements to environmental hygiene practices of Australian paramedics are recommended to avoid pathogen transmission and ensure patient safety. Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Componentry for lower extremity prostheses.

PubMed

Friel, Karen

2005-09-01

Prosthetic components for both transtibial and transfemoral amputations are available for patients of every level of ambulation. Most current suspension systems, knees, foot/ankle assemblies, and shock absorbers use endoskeletal construction that emphasizes total contact and weight distribution between bony structures and soft tissues. Different components offer varying benefits to energy expenditure, activity level, balance, and proprioception. Less dynamic ambulators may use fixed-cadence knees and non-dynamic response feet; higher functioning walkers benefit from dynamic response feet and variable-cadence knees. In addition, specific considerations must be kept in mind when fitting a patient with peripheral vascular disease or diabetes.

Leading lights.

PubMed

2001-06-01

Christine Hancock led a delegation of nurses to Surrey Ambulance Service NHS Trust last month as one of her last engagements as RCN general secretary. Leading nurses from across the south east visited the trust, which has established a traffic light system so that A&E nurses divert ambulance crews from busy units. Trust managers also hope to cut referrals to A&E by 40 per cent by using a 'whole-system' approach to treating patients. (Left to right) RCN council member for Oxford region Debbie Pearman, senior call co-ordinator Linda Tee, Miss Hancock and RCN A&E Nursing Association chair Lynda Holt.

Phenytoin dosage in ambulant epileptic patients.

PubMed Central

Terrence, C; Alberts, M

1978-01-01

Ambulant patients with recently diagnosed generalised or psychomotor seizure disorders or both were randomly assigned to two dosage regimens of phenytoin. Drug compliance was evaluated with subsequent blood phenytoin levels four to eight weeks after initial enrollment into the study. Although the two groups had similar mg-kg daily dosages of phenytoin, the mean blood levels were statistically different between the two groups, favoring the simplified dosage regimen. Once or twice a day dosage regimens of phenytoin had a beneficial effect on drug compliance when compared to more frequent regimens as measured by phenytoin blood levels. PMID:660211

The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

PubMed Central

Halliday, Megan H.; Bouland, Andrew J.; Lawner, Benjamin J.; Comer, Angela C.; Ramos, Daniel C.; Fletcher, Mark

2016-01-01

Introduction A lack of coordination between emergency medical services (EMS), emergency departments (ED) and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD) placed a medical duty officer (MDO) in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time. Methods The MDO was implemented on November 11, 2013. A senior EMS paramedic was assigned to the position and was placed in the fire communication bureau from 9 a.m. to 9 p.m., seven days a week. We defined the pre-intervention period as August 2013 – October 2013 and the post-intervention period as December 2013 – February 2014. We also compared the post-intervention period to the “seasonal match control” one year earlier to adjust for seasonal variation in EMS volume. The MDO was tasked with the prospective management of city EMS resources through intensive monitoring of unit availability and hospital ED traffic. The MDO could suggest alternative transport destinations in the event of ED crowding. We collected and analyzed data from BCFD computer-aided dispatch (CAD) system for the following: ambulance response times, ambulance at-hospital interval, hospital diversion and alert status, and “suppression wait time” (defined as the total time suppression units remained on scene until ambulance arrival). The data analysis used a pre/post intervention design to examine the MDO impact on the BCFD EMS system. Results There were a total of 15,567 EMS calls during the pre-intervention period, 13,921 in the post-intervention period and 14,699 in the seasonal match control period one year earlier. The average at-hospital time decreased by 1.35 minutes from pre- to post-intervention periods and 4.53 minutes from the pre- to seasonal match control, representing a statistically significant decrease in this interval. There was also a statistically significant decrease in hospital alert time (approximately 1,700 hour decrease pre- to post-intervention periods) and suppression wait time (less than one minute decrease from pre- to post- and pre- to seasonal match control periods). The decrease in ambulance response time was not statistically significant. Conclusion Proactive deployment of a designated MDO was associated with a small, contemporaneous reduction in at-hospital time within an urban EMS jurisdiction. This project emphasized the importance of better communication between EMS systems and area hospitals as well as uniform reporting of variables for future iterations of this and similar projects. PMID:27625737

Development and evaluation of a novel, real time mobile telesonography system in management of patients with abdominal trauma: study protocol.

PubMed

Ogedegbe, Chinwe; Morchel, Herman; Hazelwood, Vikki; Chaplin, William F; Feldman, Joseph

2012-12-18

Despite the use of e-FAST in management of patients with abdominal trauma, its utility in prehospital setting is not widely adopted. The goal of this study is to develop a novel portable telesonography (TS) system and evaluate the comparability of the quality of images obtained via this system among healthy volunteers who undergo e-FAST abdominal examination in a moving ambulance and at the ED. We hypothesize that: (1) real-time ultrasound images of acute trauma patients in the pre-hospital setting can be obtained and transmitted to the ED via the novel TS system; and (2) Ultrasound images transmitted to the hospital from the real-time TS system will be comparable in quality to those obtained in the ED. Study participants are three healthy volunteers (one each with normal, overweight and obese BMI category). The ultrasound images will be obtained by two ultrasound-trained physicians The TS is a portable sonogram (by Sonosite) interfaced with a portable broadcast unit (by Live-U). Two UTPs will conduct e-FAST examinations on healthy volunteers in moving ambulances and transmit the images via cellular network to the hospital server, where they are stored. Upon arrival in the ED, the same UTPs will obtain another set of images from the volunteers, which are then compared to those obtained in the moving ambulances by another set of blinded UTPs (evaluators) using a validated image quality scale, the Questionnaire for User Interaction Satisfaction (QUIS). Findings from this study will provide needed data on the validity of the novel TS in transmitting live images from moving ambulances to images obtained in the ED thus providing opportunity to facilitate medical care of a patient located in a remote or austere setting.

Psychosocial care for persons affected by emergencies and major incidents: a Delphi study to determine the needs of professional first responders for education, training and support.

PubMed

Drury, John; Kemp, Verity; Newman, Jonathan; Novelli, David; Doyle, Christopher; Walter, Darren; Williams, Richard

2013-10-01

The role of ambulance clinicians in providing psychosocial care in major incidents and emergencies is recognised in recent Department of Health guidance. The study described in this paper identified NHS professional first responders' needs for education about survivors' psychosocial responses, training in psychosocial skills, and continuing support. Ambulance staff participated in an online Delphi questionnaire, comprising 74 items (Round 1) on 7-point Likert scales. Second-round and third-round participants each received feedback based on the previous round, and responded to modified versions of the original items and to new items for clarification. One hundred and two participants took part in Round 1; 47 statements (64%) achieved consensus. In Round 2, 72 people from Round 1 participated; 15 out of 39 statements (38%) achieved consensus. In Round 3, 49 people from Round 2 participated; 15 out of 27 statements (59%) achieved consensus. Overall, there was consensus in the following areas: 'psychosocial needs of patients' (consensus in 34/37 items); 'possible sources of stress in your work' (8/9); 'impacts of distress in your work' (7/10); 'meeting your own emotional needs' (4/5); 'support within your organisation' (2/5); 'needs for training in psychosocial skills for patients' (15/15); 'my needs for psychosocial training and support' (5/6). Ambulance clinicians recognise their own education needs and the importance of their being offered psychosocial training and support. The authors recommend that, in order to meet patients' psychosocial needs effectively, ambulance clinicians are provided with education and training in a number of skills and their own psychosocial support should be enhanced.

Duloxetine and Subacute Pain after Knee Arthroplasty when Added to a Multimodal Analgesic Regimen: A Randomized, Placebo-controlled, Triple-blinded Trial.

PubMed

YaDeau, Jacques T; Brummett, Chad M; Mayman, David J; Lin, Yi; Goytizolo, Enrique A; Padgett, Douglas E; Alexiades, Michael M; Kahn, Richard L; Jules-Elysee, Kethy M; Fields, Kara G; Goon, Amanda K; Gadulov, Yuliya; Westrich, Geoffrey

2016-09-01

Duloxetine is effective for chronic musculoskeletal and neuropathic pain, but there are insufficient data to recommend the use of antidepressants for postoperative pain. The authors hypothesized that administration of duloxetine for 15 days would reduce pain with ambulation at 2 weeks after total knee arthroplasty. In this triple-blinded, randomized, placebo-controlled trial, patients received either duloxetine or placebo for 15 days, starting from the day of surgery. Patients also received a comprehensive multimodal analgesic regimen including neuraxial anesthesia, epidural analgesia, an adductor canal block, meloxicam, and oxycodone/acetaminophen as needed. The primary outcome was the pain score (0 to 10 numeric rating scale) with ambulation on postoperative day 14. One hundred six patients were randomized and analyzed. On day 14, duloxetine had no effect on pain with ambulation; mean pain was 3.8 (SD, 2.3) for placebo versus 3.5 (SD, 2.1) for duloxetine (difference in means [95% CI], 0.4 [-0.5 to 1.2]; P = 0.386). Symptoms potentially attributable to duloxetine discontinuation at study drug completion (nausea, anxiety) occurred among nine patients (duloxetine) and five patients (placebo); this was not statistically significant (P = 0.247). Statistically significant secondary outcomes included opioid consumption (difference in mean milligram oral morphine equivalents [95% CI], 8.7 [3.3 to 14.1], P = 0.002 by generalized estimating equation) over the postoperative period and nausea on day 1 (P = 0.040). There was no difference in other side effects or in anxiety and depression scores. When included as a part of a multimodal analgesic regimen for knee arthroplasty, duloxetine does not reduce subacute pain with ambulation.

Automated external defibrillator (AED) utilization rates and reasons fire and police first responders did not apply AEDs.

PubMed

Lerner, E Brooke; Billittier, Anthony J; Newman, Mary M; Groh, William J

2002-01-01

To determine the rate at which fire and police first responders (FRs) apply automated external defibrillators (AEDs) and to ascertain reasons for not applying them. Twenty-one emergency medical services (EMS) systems whose FRs had been supplied with AEDs by a philanthropic foundation provided data for all out-of-hospital cardiac arrest (OHCA) patients. Data including the incidence of AED application and explanations for not applying AEDs were analyzed using descriptive statistics. A total of 2,456 OHCAs were reported. AED application information was available for 2,439 patients and revealed that FRs had not applied AEDs to 1,025 patients (42%). Fire FRs were more likely than police FRs to have applied AEDs (relative risk 1.87, 95% confidence interval 1.65-2.12). Reasons for not applying AEDs were listed for 664 (65%) of the OHCA patients to whom AEDs had not been applied. The predominant reason the FRs did not apply an AED was that the transporting ambulance defibrillator had already been applied (74%). However, when response times for FRs and the transporting ambulances were compared for these OHCA patients, it was found that the transporting ambulances arrived after the FRs 23% the time, simultaneously with the FRs 45% of the time, and before the FRs only 32% of the time. Fire and police FRs did not apply AEDs to a significant number of OHCA patients. Use of the transport ambulance defibrillator was the primary reason given for not applying the FR AED. Given low AED application rates by FRs, future studies are needed to determine the characteristics of communities in which equipping FRs with AEDs is the most beneficial deployment strategy, and how to increase AED application by FRs in communities with FR AED programs.

Health promotion across occupational groups: one size does not fit all.

PubMed

Tsiga, E; Panagopoulou, E; Niakas, D

2015-10-01

Although several studies have examined the link between specific working conditions and health behaviours, very few have comparatively assessed the health behaviours of different occupational groups. To compare protective and risky health behaviours among police officers, ambulance workers, hospital staff (doctors and nurses) and office workers, prompted by the need to identify key areas for interventions tailored to the needs of different occupational groups. A cross-sectional postal survey using the Health Behaviours Inventory, assessing health behaviours which are risky (alcohol intake, smoking, coffee consumption, fast food meals and painkiller consumption) and protective (physical activity, eating breakfast and hours of sleep). The sample consisted of 1451 employees. Ambulance workers smoked the most cigarettes per day (F (4, 1405) = 8.63, P < 0.01), while doctors consumed twice as many fast food meals as any other occupational group (F (4, 1415) = 78.45, P < 0.01) and had the highest daily caffeine consumption (F (4, 1440) = 11.17, P < 0.01). Ambulance workers and doctors reported the highest frequency of alcohol consumption per week (F (4, 1421) = 10.13, P < 0.01). In regard to protective health behaviours, office workers reported the highest number of breakfast meals per week (F (4, 1431) = 5.7, P < 0.01) and sleeping hours per night (F (4, 1438) = 170.34, P < 0.01), while police officers and ambulance workers exercised more frequently (F (4, 1420) = 5.764, P < 0.01). The results of the study highlight key priorities for health promotion for different occupational groups which need to be taken into consideration in policy making and developing workplace interventions. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

The UK Out of Hospital Cardiac Arrest Outcome (OHCAO) project.

PubMed

Perkins, Gavin D; Brace-McDonnell, Samantha J

2015-10-01

Reducing premature death is a key priority for the UK National Health Service (NHS). NHS Ambulance services treat approximately 30 000 cases of suspected cardiac arrest each year but survival rates vary. The British Heart Foundation and Resuscitation Council (UK) have funded a structured research programme--the Out of Hospital Cardiac Arrest Outcomes (OHCAO) programme. The aim of the project is to establish the epidemiology and outcome of OHCA, explore sources of variation in outcome and establish the feasibility of setting up a national OHCA registry. This is a prospective observational study set in UK NHS Ambulance Services. The target population will be adults and children sustaining an OHCA who are attended by an NHS ambulance emergency response and where resuscitation is attempted. The data collected will be characterised broadly as system characteristics, emergency medical services (EMS) dispatch characteristics, patient characteristics and EMS process variables. The main outcome variables of interest will be return of spontaneous circulation and medium-long-term survival (30 days to 10-year survival). Ethics committee permissions were gained and the study also has received approval from the Confidentiality Advisory Group Ethics and Confidentiality committee which provides authorisation to lawfully hold identifiable data on patients without their consent. To identify the key characteristics contributing to better outcomes in some ambulance services, reliable and reproducible systems need to be established for collecting data on OHCA in the UK. Reports generated from the registry will focus on data completeness, timeliness and quality. Subsequent reports will summarise demographic, patient, process and outcome variables with aim of improving patient care through focus quality improvement initiatives. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The importance of manager support for the mental health and well-being of ambulance personnel

PubMed Central

Petrie, Katherine; Gayed, Aimée; Bryan, Bridget T.; Deady, Mark; Madan, Ira; Savic, Anita; Wooldridge, Zoe; Counson, Isabelle; Calvo, Rafael A.; Glozier, Nicholas; Harvey, Samuel B.

2018-01-01

Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622). Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee’s perception of the priority management places upon mental health issues (manager psychosocial safety climate) and managers’ observed behaviours (manager behaviour) on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6%) were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, p<0.01) and well-being (13%, p<0.01). Manager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, p<0.01) and well-being (10% of variance, p<0.05). The perceived importance management places on mental health and managers’ actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations. PMID:29791510

The importance of manager support for the mental health and well-being of ambulance personnel.

PubMed

Petrie, Katherine; Gayed, Aimée; Bryan, Bridget T; Deady, Mark; Madan, Ira; Savic, Anita; Wooldridge, Zoe; Counson, Isabelle; Calvo, Rafael A; Glozier, Nicholas; Harvey, Samuel B

2018-01-01

Interventions to enhance mental health and well-being within high risk industries such as the emergency services have typically focused on individual-level factors, though there is increasing interest in the role of organisational-level interventions. The aim of this study was to examine the importance of different aspects of manager support in determining the mental health of ambulance personnel. A cross-sectional survey was completed by ambulance personnel across two Australian states (N = 1,622). Demographics, manager support and mental health measures were assessed. Hierarchical multiple linear regressions were conducted to determine the explanatory influence of the employee's perception of the priority management places upon mental health issues (manager psychosocial safety climate) and managers' observed behaviours (manager behaviour) on employee common mental disorder and well-being within ambulance personnel. Of the 1,622 participants, 123 (7.6%) were found to be suffering from a likely mental disorder. Manager psychosocial safety climate accounted for a significant amount of the variance in levels of employee common mental health disorder symptoms (13%, p<0.01) and well-being (13%, p<0.01). Manager behaviour had a lesser, but still statistically significant influence upon symptoms of common mental disorder (7% of variance, p<0.01) and well-being (10% of variance, p<0.05). The perceived importance management places on mental health and managers' actual behaviour are related but distinct concepts, and each appears to impact employee mental health. While the overall variance explained by each factor was limited, the fact that each is potentially modifiable makes this finding important and highlights the significance of organisational and team-level interventions to promote employee well-being within emergency services and other high-risk occupations.

Impact of preoperative regular physical activity on postoperative course after open abdominal aortic aneurysm surgery.

PubMed

Hayashi, Kazuhiro; Hirashiki, Akihiro; Kodama, Akio; Kobayashi, Kiyonori; Yasukawa, Yuto; Shimizu, Miho; Kondo, Takahisa; Komori, Kimihiro; Murohara, Toyoaki

2016-04-01

Early ambulation after open abdominal aortic aneurysm (AAA) surgery is assumed to play a key role in preventing postoperative complications and reducing hospital length of stay. However, the factors predicting early ambulation after open AAA surgery have not yet been sufficiently investigated. Here, we investigated which preoperative and intraoperative variables are associated with start time for ambulation in patients after open AAA surgery. A total of 67 consecutive patients undergoing open AAA surgery were included in the study [male, 62 (92 %); mean age, 68 years (range, 47-82 years), mean AAA diameter, 53 mm (range, 28-80 mm)]. Preoperative physical activity was examined by means of 6-min walk distance (6MWD) and a medical interview. Patients were divided into two groups, according to when independence in walking was attained: early group <3 days (n = 36) and late group ≥3 days (n = 31), and the pre-, intra-, and postoperative recovery data were compared. There were no significant differences in patient baseline characteristics or intraoperative data between the two groups. The number of patients engaging in preoperative regular physical activity and 6MWD were significantly greater (p = 0.042 and p = 0.034, respectively) in the early group than in the late group. In addition, time to hospital discharge was significantly shorter in the early group than in the late group (p = 0.031). Binary logistic regression analysis showed that preoperative regular physical activity was the only independent factor for identifying patients in the early group (odds ratio 2.769, 95 % confidence interval 1.024-7.487, p = 0.045). These results suggest that engaging in regular physical activity is an effective predictor of early ambulation after open AAA surgery.

Inspiratory muscular weakness is most evident in chronic stroke survivors with lower walking speeds.

PubMed

Pinheiro, M B; Polese, J C; Faria, C D; Machado, G C; Parreira, V F; Britto, R R; Teixeira-Salmela, L F

2014-06-01

Respiratory muscular weakness and associated changes in thoracoabdominal motion have been poorly studied in stroke subjects, since the individuals' functional levels were not previously considered in the investigations. To investigate the breathing patterns, thoracoabdominal motion, and respiratory muscular strength in chronic stroke subjects, who were stratified into two groups, according to their walking speeds. Cross-sectional, observational study. University laboratory. Eighty-nine community-dwelling chronic stroke subjects The subjects, according to their gait speeds, were stratified into community (gait speed ≥0.8 m/s) and non-community ambulators (gait speed <0.8 m/s). Variables related to pulmonary function, breathing patterns, and thoracoabdominal motions were assessed. Measures of maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were obtained and were compared with the reference values for the Brazilian population. The MIP and MEP values were expressed as percentages of the predicted values. Mann-Whitney-U or independent Student t-tests were employed to compare the differences between the two groups for the selected variables. No significant between-group differences were found for the variables related to the breathing patterns and thoracoabdominal motions (0.01 < z/t < 1.51; 0.14

Knee flexion contractures in institutionalized elderly: prevalence, severity, stability, and related variables.

PubMed

Mollinger, L A; Steffen, T M

1993-07-01

The purpose of this study was to document the prevalence, severity, and progression of knee flexion contractures (KFCs) in a population of institutionalized elderly and to identify relationships between knee extension and other variables. The subjects were 112 nursing home residents who exhibited a broad range of ambulation and cognitive function abilities. Data were collected initially (T1) and after a 10-month period (T2). Only 25% of the population had extension in the 0- to 5-degree (lacking full extension) range bilaterally at T1 and T2, leaving the majority of subjects with some degree of unilateral KFC. Most of the subjects with a KFC greater than 20 degrees were nonambulatory and had a significantly higher occurrence of resistance to motion than did nonambulators with a KFC of less than 20 degrees. Knee extension measurements did not change in most subjects between T1 and T2. The knees that did show a change in KFC (either an increase or a decrease) had a significantly higher occurrence of resistance to passive motion than did other knees. Compared with the subjects who gained extension, the subjects who lost extension over the study period more frequently had minimal KFC at T1, were ambulatory at T1, showed a regression in ambulation at T2, and developed resistance to motion at T2. The data confirmed significant positive correlations between degree of KFC and presence of resistance to passive knee motion, cognitive impairment, impaired ambulation, and presence of knee pain. Physical therapy assessment and intervention may be appropriate in nonambulatory nursing home residents with resistance to passive motion, residents with KFC approaching 20 degrees, and ambulatory residents with minimal KFC who develop resistance and begin to regress in ambulation. Several areas for future study are suggested.

Two-Thumb Encircling Technique Over the Head of Patients in the Setting of Lone Rescuer Infant CPR Occurred During Ambulance Transfer: A Crossover Simulation Study.

PubMed

Jo, Choong Hyun; Cho, Gyu Chong; Lee, Chang Hee

2017-07-01

The purpose of this study was to determine if the over-the-head 2-thumb encircling technique (OTTT) provides better overall quality of cardiopulmonary resuscitation compared with conventional 2-finger technique (TFT) for a lone rescuer in the setting of infant cardiac arrest in ambulance. Fifty medical emergency service students were voluntarily recruited to perform lone rescuer infant cardiopulmonary resuscitation for 2 minutes on a manikin simulating a 3-month-old baby in an ambulance. Participants who performed OTTT sat over the head of manikins to compress the chest using a 2-thumb encircling technique and provide bag-valve mask ventilations, whereas those who performed TFT sat at the side of the manikins to compress using 2-fingers and provide pocket-mask ventilations. Mean hands-off time was not significantly different between OTTT and TFT (7.6 ± 1.1 seconds vs 7.9 ± 1.3 seconds, P = 0.885). Over-the-head 2-thumb encircling technique resulted in greater depth of compression (42.6 ± 1.4 mm vs 41.0 ± 1.4 mm, P < 0.001) and faster rate of compressions (114.4 ± 8.0 per minute vs 112.2 ± 8.2 per minute, P = 0.019) than TFT. Over-the-head 2-thumb encircling technique resulted in a smaller fatigue score than TFT (1.7 ± 1.5 vs 2.5 ± 1.6, P < 0.001). In addition, subjects reported that compression, ventilation, and changing compression to ventilation were easier in OTTT than in TFT. The use of OTTT may be a suitable alternative to TFT in the setting of cardiac arrest of infants during ambulance transfer.

Multidisciplinary Treatment of Severe Osteogenesis Imperfecta: Functional Outcomes at Skeletal Maturity.

PubMed

Montpetit, Kathleen; Palomo, Telma; Glorieux, Francis H; Fassier, François; Rauch, Frank

2015-10-01

To determine the functional outcomes associated with long-term multidisciplinary treatment, intravenous bisphosphonate treatment, orthopedic surgery, and rehabilitation in children with severe osteogenesis imperfecta (OI) (diagnosed clinically as OI types III or IV). Retrospective study where outcomes were measured prospectively. Pediatric orthopedic hospital. Adolescents (N=41; age range, 15-21y) with severe OI (OI type III: n=17; OI type IV: n=24) who had started therapy before the age of 6 years, had received treatment for at least 10 years, and had achieved final height. Intravenous bisphosphonate treatment, orthopedic surgery, and rehabilitation. Pediatric Evaluation of Disability Inventory. At the time of the last available follow-up examination, none of the individuals diagnosed with OI type III (most severely affected group) was able to ambulate without ambulation aids, whereas 20 (83%) patients with OI type IV were able to ambulate without ambulation aids. Regarding self-care, we specifically assessed 8 skills that we deemed essential for living independently (grooming; dressing; toileting; bed, chair, toilet, tub, and car transfers). Only 6 (35%) of the youths with OI type III were able to complete all 8 items, whereas 23 (96%) individuals with OI type IV managed to perform all tasks. Teens with OI type III often needed assistance for the transfer to toilet, tub, and car and for personal hygiene and clothing management associated with toileting, usually because of limitations in upper-extremity function. These observations suggest that further improvements in the functional status of the most severely affected children with OI are contingent on advances in the clinical management of upper-extremity issues. Copyright © 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity: a nested mixed-methods randomised-controlled study.

PubMed

Boden, Ianthe; El-Ansary, Doa; Zalucki, Nadia; Robertson, Iain K; Browning, Laura; Skinner, Elizabeth H; Denehy, Linda

2018-06-01

To (1) assess memorability and treatment fidelity of pre-operative physiotherapy education prior to elective upper abdominal surgery and, (2) to explore patient opinions on pre-operative education. Mixed-methods analysis of a convenience sample within a larger parallel-group, double-blinded, randomised controlled trial with concealed allocation and intention-to-treat analysis. Tertiary Australian hospital. Twenty-nine patients having upper abdominal surgery attending pre-admission clinic within six-weeks of surgery. The control group received an information booklet about preventing pulmonary complications with early ambulation and breathing exercises. The experimental group received an additional face-to-face 30-minute physiotherapy education and training session on pulmonary complications, early ambulation, and breathing exercises. Primary outcome was proportion of participants who remembered the taught breathing exercises following surgery. Secondary outcomes were recall of information sub-items and attainment of early ambulation goals. These were measured using standardised scoring of a semi-scripted digitally-recorded interview on the 5th postoperative day, and the attainment of early ambulation goals over the first two postoperative days. Experimental group participants were six-times more likely to remember the breathing exercises (95%CI 1.7 to 22) and 11-times more likely (95%CI 1.6 to 70) to report physiotherapy as the most memorable part of pre-admission clinic. Participants reported physiotherapy education content to be detailed, interesting, and of high value. Some participants reported not reading the booklet and professed a preference for face-to-face information delivery. Face-to-face pre-operative physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity. ACTRN-12613000664741. Copyright © 2017 Chartered Society of Physiotherapy. All rights reserved.

Functional status of acute stroke patients in University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia.

PubMed

Rameezan, B A R; Zaliha, O

2005-12-01

Stroke is a leading cause of death and disability in most developed countries and developing nations. Majority of the stroke survivors are left with significant physical and cognitive impairments. In addition to the improved acute stroke care, they often benefit from rehabilitation in improving their function. This was the first study done to document function for post stroke patients in Malaysia. It was prospective study conducted to document functional status of acute stroke patients upon admission, discharge and at 3 months post stroke. Assessment of functional status for these patients are based on their activities of daily living and ambulation i.e. self-care, sphincter control, mobility, locomotion, communication and social cognition. It is also aimed to describe their demographic and clinical characteristics. Correlation of functional status at 3 months post stroke with the initial severity of stroke was also explored. A total of fifty-one patients with acute stroke in University Malaya Medical Centre (UMMC) were recruited. The patient's age ranged from 38 to 83 years with a mean of 60.2 years. Thirty-six patients (71%) were first stroke sufferers and fifteen patients (29%) had recurrent stroke. At discharge from acute stay, 13% of patients were able to ambulate with aids and 87% needed assistance for ambulation in varying degrees. Eighty-two percent of patients showed improvement in overall function (both motor and cognition) at 3 months post stroke. Sixty percent of patients were independent in ambulation and 40% required assistance. Significant correlation was seen between the initial severity of stroke and functional status at 3 months post stroke. Functional status of patients with stroke has improved at 3 months post stroke. A comprehensive rehabilitation medicine programme should be incorporated into management of stroke patients to expedite functional recovery and improve patient's independence.

The combined use of mechanical CPR and a carry sheet to maintain quality resuscitation in out-of-hospital cardiac arrest patients during extrication and transport.

PubMed

Lyon, Richard M; Crawford, Anna; Crookston, Colin; Short, Steven; Clegg, Gareth R

2015-08-01

Quality of manual cardiopulmonary resuscitation (CPR) during extrication and transport of out-of-hospital cardiac arrest victims is known to be poor. Performing manual CPR during ambulance transport poses significant risk to the attending emergency medical services crew. We sought to use pre-hospital video recording to objectively analyse the impact of introducing mechanical CPR with an extrication sheet (Autopulse, Zoll) to an advanced, second-tier cardiac arrest response team. The study was conducted prospectively using defibrillator downloads and analysis of pre-hospital video recording to measure the quality of CPR during extrication from scene and ambulance transport of the OHCA patient. Adult patients with non-traumatic OHCA were included. The interruption to manual CPR to during extrication and to deploy the mechanical CPR device was analysed. In the manual CPR group, 53 OHCA cases were analysed for quality of CPR during extrication. The median time that chest compression was interrupted to allow the patient to be carried from scene to the ambulance was 270 s (IQR 201-387 s). 119 mechanical CPR cases were analysed. The median time interruption from last manual compression to first Autopulse compression was 39 s (IQR 29-47 s). The range from last manual compression to first Autopulse compression was 14-118 s. Mechanical CPR used in combination with an extrication sheet can be effectively used to improve the quality of resuscitation during extrication and ambulance transport of the refractory OHCA patient. The time interval to deploy the mechanical CPR device can be shortened with regular simulation training. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Long-Term Follow-up to a Randomized Controlled Trial Comparing Peroneal Nerve Functional Electrical Stimulation to an Ankle Foot Orthosis for Patients With Chronic Stroke.

PubMed

Bethoux, Francois; Rogers, Helen L; Nolan, Karen J; Abrams, Gary M; Annaswamy, Thiru; Brandstater, Murray; Browne, Barbara; Burnfield, Judith M; Feng, Wuwei; Freed, Mitchell J; Geis, Carolyn; Greenberg, Jason; Gudesblatt, Mark; Ikramuddin, Farha; Jayaraman, Arun; Kautz, Steven A; Lutsep, Helmi L; Madhavan, Sangeetha; Meilahn, Jill; Pease, William S; Rao, Noel; Seetharama, Subramani; Sethi, Pramod; Turk, Margaret A; Wallis, Roi Ann; Kufta, Conrad

2015-01-01

Evidence supports peroneal nerve functional electrical stimulation (FES) as an effective alternative to ankle foot orthoses (AFO) for treatment of foot drop poststroke, but few long-term, randomized controlled comparisons exist. Compare changes in gait quality and function between FES and AFOs in individuals with foot drop poststroke over a 12-month period. Follow-up analysis of an unblinded randomized controlled trial (ClinicalTrials.gov #NCT01087957) conducted at 30 rehabilitation centers comparing FES to AFOs over 6 months. Subjects continued to wear their randomized device for another 6 months to final 12-month assessments. Subjects used study devices for all home and community ambulation. Multiply imputed intention-to-treat analyses were utilized; primary endpoints were tested for noninferiority and secondary endpoints for superiority. Primary endpoints: 10 Meter Walk Test (10MWT) and device-related serious adverse event rate. Secondary endpoints: 6-Minute Walk Test (6MWT), GaitRite Functional Ambulation Profile, and Modified Emory Functional Ambulation Profile (mEFAP). A total of 495 subjects were randomized, and 384 completed the 12-month follow-up. FES proved noninferior to AFOs for all primary endpoints. Both FES and AFO groups showed statistically and clinically significant improvement for 10MWT compared with initial measurement. No statistically significant between-group differences were found for primary or secondary endpoints. The FES group demonstrated statistically significant improvements for 6MWT and mEFAP Stair-time subscore. At 12 months, both FES and AFOs continue to demonstrate equivalent gains in gait speed. Results suggest that long-term FES use may lead to additional improvements in walking endurance and functional ambulation; further research is needed to confirm these findings. © The Author(s) 2015.

Emerging organizational structures in the ambulance industry in the United States.

PubMed

Narad, R A

2000-01-01

This analysis seeks to identify emerging forms of organizations in emergency medical services (EMS) in the United States, to provide examples of them, to relate them to changes in healthcare generally, and to apply a classification scheme. Public policy issues related to these new forms of organizations and lessons from other areas of the healthcare system are identified. Recent changes in the healthcare system in the United States have been marked by modifications in the structure of organizations that provide and pay for health services. New forms of organizations and alliances among existing organizations have emerged in an effort to improve the efficiency of the services provided and to improve organizations' market positions. Reflecting increased competition within EMS and the demands of the changing health-care delivery system, several types of organizations have begun to emerge in EMS that resemble those occurring in health care generally. These include forms of horizontal integration, such as consolidated ambulance services and various models of ambulance service networks; and forms of vertical integration, such as demand management programs and public-private joint ventures. The ultimate end might be complete integration with a carve-out of all non-scheduled care. Although changes in EMS organizations result largely from marketplace decisions by sellers and purchasers, this does not mean that there is no public policy role. While new organizational forms may increase the ambulance industry's efficiency, public policy makers must be concerned about quality and access as well. Some policy responses will promote marketplace changes, others will accept them generally, but will seek to correct problems, and a third group will attempt to restrain the market.

Genetics and emerging treatments for Duchenne and Becker muscular dystrophy.

PubMed

Wein, Nicolas; Alfano, Lindsay; Flanigan, Kevin M

2015-06-01

Mutations in the DMD gene result in Duchenne or Becker muscular dystrophy due to absent or altered expression of the dystrophin protein. The more severe Duchenne muscular dystrophy typically presents around ages 2 to 5 with gait disturbance, and historically has led to the loss of ambulation by age 12. It is important for the practicing pediatrician, however, to be aware of other presenting signs, such as delayed motor or cognitive milestones, or elevated serum transaminases. Becker muscular dystrophy is milder, often presenting after age 5, with ambulation frequently preserved past 20 years and sometimes into late decades. Copyright © 2015 Elsevier Inc. All rights reserved.

Patient Presentations and Medical Logistics at Full and Half Ironman Distance Triathlons.

PubMed

Turris, Sheila A; Lund, Adam; Bowles, Ron R; Camporese, Michael; Green, Tom

We describe logistical challenges, illness/injury rates, as well as medical and ambulance transfer rates (ATR) at an annual large-scale half/full triathlon in a remote location. Prospective observational study; registry data. Data on patient presentation rates, percentage of patients transferred by ambulance, transfer to hospital rates (TTHR), ATR, and medical usage rates were collected and analyzed. In total, 1923 athletes participated in the 2016 triathlon (1404 in the full-length race and 519 in the half) and 181 patient encounters were documented. The patient presentation rate (PPR) was 94 in 1000 patients, and 1.6% of patients seen onsite required offsite medical care. TTHR and ATR were 1.6 in 1000 and 0.5 in 1000, respectively. Gastrointestinal issues were the most common presentation (50/181; 27.6%), followed by musculoskeletal injury (46/181; 25.4%) and nonspecific dizziness (37/181; 20.4%). The incorporation of a coordinated event medical plan and team, with integrated on-course and at-finish coverage, may have minimized presentations of patients to local health care services; therefore, decreasing the effect on the local ambulance service and health infrastructure of the host community.

Ambulance services in London and Great Britain from 1860 until today: a glimpse of history gleaned mainly from the pages of contemporary journals.

PubMed

Pollock, Alexander

2013-03-01

Little has been published on the subject of civil ambulance services and their development from the mid-19th century in the UK until modern times. There is limited secondary literature available which provides useful background information on the subject and most organisations may give brief histories of their early days but these sources lack historical adequacy in terms of detail. This article shows part of the uncertain path which the history followed towards the service which we enjoy today. From the pages of the British Medical Journal and the Lancet and Hansard, the battle to set up the service is followed and an indication of the drivers towards change over the period is revealed in the attitudes expressed. In particular, the two World Wars are seen to be the stepwise stimuli to providing a necessary service to the British population where the will to achieve this had hitherto been lacking at a parliamentary level. The history of the London Ambulance Service is chosen because more is written about it in these journals but services in other British cities and the USA are mentioned since they played a part in influencing change.

Hospital in the field: prehospital management of GHB intoxication by medical assistance teams.

PubMed

Dutch, Martin J; Austin, Kristy B

2012-10-01

Recreational use of gamma-hydroxybutyrate (GHB) is increasingly common at mass-gathering dance events in Australia. Overdose often occurs in clusters, and places a significant burden on the surrounding health care infrastructure. To describe the clinical presentation, required interventions and disposition of patrons with GHB intoxication at dance events, when managed by dedicated medical assistance teams. Retrospective analysis of all patrons attending St. John Ambulance medical assistance teams at dance events in the state of Victoria (Australia), from January 2010 through May 2011. Main outcome measures Clinical presentation, medical interventions and discharge destination. Sixty-one patients with GHB intoxication attended medical teams during the study period. The median age was 22 years, and 64% were male. Altered conscious state was present in 89% of attendances, and a GCS <9 in 44%. Hypotension, bradycardia and hypothermia were commonly encountered. Endotracheal intubation was required in three percent of patrons. Median length of stay onsite was 90 minutes. Ambulance transport to hospital was avoided in 65% of presentations. The deployment of medical teams at dance events and music festivals successfully managed the majority of GHB intoxications onsite and avoided acute care ambulance transfer and emergency department attendance.

Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

PubMed Central

Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

2014-01-01

Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822

Modeling of patient's blood pressure variation during ambulance transportation

NASA Astrophysics Data System (ADS)

Sakatani, Kenji; Ono, Takahiko; Kobayasi, Yasuhide; Hikita, Shinichi; Saito, Mitsuyuki

2007-12-01

In an emergency transportation by ambulance, a patient is transported in a supine position. In this position, a patient's blood pressure (BP) variation depending on an inertial force which occurs when an ambulance accelerates or decelerates. This BP variation causes a critical damage for a patent with brain disorder. In order to keep a patient stable during transportation, it is required to maintain small BP variation. To analyze the BP variation during transportation, a model of the BP variation has so far been made. But, it can estimate the BP variation only in braking. The purpose of this paper is to make a dynamical model of the BP variation which can simulate it in both braking and accelerating. First, to obtain the data to construct the model, we used a tilting bed to measure a head-to-foot acceleration and BP of fingertip. Based on this data, we build a mathematical model whose input is the head-to-foot acceleration and output is the Mean BP variation. It is a switched model which switches two models depending on the jerk. We add baroreceptor reflex to the model as a offset value.

[Successful use of an AED following anterior myocardial infarction].

PubMed

Harding, Ulf; Reifferscheid, Florian; von Olshausen, Klaus

2007-05-01

A participant of the annual Hamburg marathon collapses on the finish line. Medics at the scene find a conscious patient and prepare transport to the finish area medical center. During transport the patient becomes unconscious and pulseless. The medics immediately perform basic life support and cardiopulmonary resuscitation (CPR). An automated external defibrillator (AED) is attached and after analysis of the patient}s heart rhythm the patient is defibrillated twice. The ambulance service reach the scene with a delay. The emergency physician}s ECG shows ventricular fibrillation (VF) and two more defibrillations are delivered. Return of spontaneous circulation can be achieved. After stabilisation the patient is taken to hospital by ambulance. The ECG shows an anterior myocardial infarction and right bundle-branch block. The coronary angioplasty (PTCA) shows single-vessel disease with complete stenosis of the proximal part of the anterior interventricular branch. Revasucarisation is successful and a coronary stent is applied. The patient survives neurologically intact. This case report demonstrates the importance of readily available AED and specially trained medics. By immediately using the AED this patient was defibrillated before the ambulance service and emergency physician arrived at the scene. Spontaneous circulation was restored.

Impaired locomotor activity and exploratory behavior in mice lacking histamine H1 receptors

PubMed Central

Inoue, Isao; Yanai, Kazuhiko; Kitamura, Daisuke; Taniuchi, Ichiro; Kobayashi, Takashi; Niimura, Kaku; Watanabe, Takehiko; Watanabe, Takeshi

1996-01-01

From pharmacological studies using histamine antagonists and agonists, it has been demonstrated that histamine modulates many physiological functions of the hypothalamus, such as arousal state, locomotor activity, feeding, and drinking. Three kinds of receptors (H1, H2, and H3) mediate these actions. To define the contribution of the histamine H1 receptors (H1R) to behavior, mutant mice lacking the H1R were generated by homologous recombination. In brains of homozygous mutant mice, no specific binding of [3H]pyrilamine was seen. [3H]Doxepin has two saturable binding sites with higher and lower affinities in brains of wild-type mice, but H1R-deficient mice showed only the weak labeling of [3H]doxepin that corresponds to lower-affinity binding sites. Mutant mice develop normally, but absence of H1R significantly increased the ratio of ambulation during the light period to the total ambulation for 24 hr in an accustomed environment. In addition, mutant mice significantly reduced exploratory behavior of ambulation and rearings in a new environment. These results indicate that through H1R, histamine is involved in circadian rhythm of locomotor activity and exploratory behavior as a neurotransmitter. PMID:8917588

Dynamic balance control during stair negotiation for older adults and people with Parkinson disease.

PubMed

Conway, Zachary J; Blackmore, Tim; Silburn, Peter A; Cole, Michael H

2018-06-01

It is well understood that stability during ambulation is reliant upon appropriate control of the trunk segment, but research shows that the rhythmicity of this segment is significantly reduced for people with Parkinson's disease (PD). Given the increased risk associated with stair ambulation, this study investigated whether people with PD demonstrate poorer trunk control during stair ambulation compared with age-matched controls. Trunk accelerations were recorded for twelve PD patients and age-matched controls during stair ascent and descent. Accelerations were used to derive measures of harmonic ratios and root mean square (RMS) acceleration to provide insight into the rhythmicity and amplitude of segmental motion. Compared with what is typically seen during level-ground walking, gait rhythmicity during stair negotiation was markedly reduced for older adults and people with PD. Furthermore, both groups exhibited significantly poorer trunk movements during stair descent compared to stair ascent, suggesting that both populations may face a greater risk of falling during this task. As stair negotiation is a common activity of daily life, the increased risk associated with this task should be considered when working with populations that have an increased risk of falling. Copyright © 2018 Elsevier B.V. All rights reserved.

Exploratory study of factors associated with adverse clinical features in patients presenting with non-fatal drug overdose/self-poisoning to the ambulance service.

PubMed

Gwini, Stella May; Shaw, Deborah; Iqbal, Mohammad; Spaight, Anne; Siriwardena, Aloysius Niroshan

2011-10-01

To investigate the factors associated with adverse clinical features presented by drug overdose/self-poisoning patients and the treatments provided. Historical patient records collected over 3 months from ambulance crews attending non-fatal overdoses/self-poisoning incidents were reviewed. Logistic regression was used to investigate predictors of adverse clinical features (reduced consciousness, obstructed airway, hypotension or bradycardia, hypoglycaemia) and treatment. Of 22,728 calls attended to over 3 months, 585 (rate 26/1000 calls) were classified as overdose or self-poisoning. In the 585 patients identified, paracetamol-containing drugs were most commonly involved (31.5%). At least one adverse clinical feature occurred in 103 (17.7%) patients, with higher odds in men and opiate overdose or illegal drugs. Older patients and patients with reduced consciousness were more likely to receive oxygen. The latter also had a greater chance of receiving saline. Non-fatal overdose/self-poisoning accounted for 2.6% of patients attended by an ambulance. Gender, illegal drugs or opiates were important predictors of adverse clinical features. The treatments most often provided to patients were oxygen and saline.

Skeletal maturation in children with cerebral palsy and its relationship with motor functioning.

PubMed

van Eck, Mirjam; Dallmeijer, Annet J; Voorman, Jeanine M; Becher, Jules G

2008-07-01

The objective of this study was to describe skeletal maturation in relation to chronological age in children with cerebral palsy (CP) aged 9 to 16 years, and to analyze the relationship between skeletal maturation and motor functioning. The skeletal age of 100 children with CP (37 females, 63 males; age 9, 11, or 13 y; 73 ambulant, 27 non-ambulant) was determined over a period of 3 years based on X-rays of the hand (Greulich and Pyle technique). Motor functioning was measured with the Gross Motor Function Measure-66. The skeletal age of females with CP was significantly higher than their chronological age, but this did not apply to males. Longitudinal analysis showed no difference in the course of skeletal age in relation to chronological age over a 3-year period for sex or for level of ambulation. No association was found between changes in skeletal age and changes in gross motor function over the 3-year period. Skeletal age during (pre-)puberty in females with CP is advanced in relation to chronological age. No evidence was found that children with CP are at risk for deterioration in gross motor function as a result of skeletal maturation during puberty.

Optimizing the location of ambulances in Tijuana, Mexico.

PubMed

Dibene, Juan Carlos; Maldonado, Yazmin; Vera, Carlos; de Oliveira, Mauricio; Trujillo, Leonardo; Schütze, Oliver

2017-01-01

In this work we report on modeling the demand for Emergency Medical Services (EMS) in Tijuana, Baja California, Mexico, followed by the optimization of the location of the ambulances for the Red Cross of Tijuana (RCT), which is by far the largest provider of EMS services in the region. We used data from more than 10,000 emergency calls surveyed during the year 2013 to model and classify the demand for EMS in different scenarios that provide different perspectives on the demand throughout the city, considering such factors as the time of day, work and off-days. A modification of the Double Standard Model (DSM) is proposed and solved to determine a common robust solution to the ambulance location problem that simultaneously satisfies all specified constraints in all demand scenarios selecting from a set of almost 1000 possible base locations. The resulting optimization problems are solved using integer linear programming and the solutions are compared with the locations currently used by the Red Cross. Results show that demand coverage and response times can be substantially improved by relocating the current bases without the need for additional resources. Copyright © 2016 Elsevier Ltd. All rights reserved.

Virtual reality-based training improves community ambulation in individuals with stroke: a randomized controlled trial.

PubMed

Yang, Yea-Ru; Tsai, Meng-Pin; Chuang, Tien-Yow; Sung, Wen-Hsu; Wang, Ray-Yau

2008-08-01

This is a single blind randomized controlled trial to examine the effect of virtual reality-based training on the community ambulation in individuals with stroke. Twenty subjects with stroke were assigned randomly to either the control group (n=9) or the experimental group (n=11). Subjects in the control group received the treadmill training. Subjects in the experimental group underwent the virtual reality-based treadmill training. Walking speed, community walking time, walking ability questionnaire (WAQ), and activities-specific balance confidence (ABC) scale were evaluated. Subjects in the experimental group improved significantly in walking speed, community walking time, and WAQ score at posttraining and 1-month follow-up periods. Their ABC score also significantly increased at posttraining but did not maintain at follow-up period. Regarding the between-group comparisons, the experimental group improved significantly more than control group in walking speed (P=0.03) and community walking time (P=0.04) at posttraining period and in WAQ score (P=0.03) at follow-up period. Our results support the perceived benefits of gait training programs that incorporate virtual reality to augment the community ambulation of individuals with stroke.

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India.

PubMed

Singh, Samiksha; Doyle, Pat; Campbell, Oona Mr; Oakley, Laura; Rao, Gv Ramana; Murthy, Gvs

2017-06-09

To estimate the proportion of interfacility transfers (IFTs) transported by '108' ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of '108' services for pregnant women in India. A cross-sectional analysis of '108' ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called '108'. Proportion of all pregnancies and institutional deliveries in the population who were transported by '108', both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. The '108' ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that '108' transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by '108' for IFTs-lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all '108' IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states. Only 6% institutional deliveries made use of the '108' ambulance for IFTs in India. The vast majority did not have any complication or emergency. The '108' service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events.

PubMed

Quigg, Zara; McGee, Ciara; Hughes, Karen; Russell, Simon; Bellis, Mark A

2017-06-01

The aim of this study was to explore the potential of ambulance call-out data in understanding violence to inform about prevention activity. This cross-sectional (2013-2015) study examined the nature, extent and characteristics of violence-related ambulance call-outs (n=15 687) across North West England and relationships with temporal, celebratory and sporting events. The majority of call-outs were for men, with a mean age of 33 years. Most call-outs were to deprived (64.4%) and urban (65.4%) areas and occurred at night (18:00-5:59; 75.2%). Three-quarters (77.3%) were recorded as assault/sexual assault and 22.7% stab/gunshot/penetrating trauma. Significant differences in call-out characteristics were identified between the two violence types. Generalised linear modelling found that call-outs significantly increased on weekends, New Year's Eve and weekday bank holiday eves (except for stab/gunshot/penetrating trauma). No significant associations between all violence call-outs, the two violence categories and sporting or celebration events were identified. Two-thirds (66.1%) of the call-outs were transferred to another health service for further assessment and/or treatment. The odds of being transferred were significantly higher among men (adjusted OR (AOR) 1.5, 95%CI 1.4 to 1.6), those aged 13-24 years (AOR 1.2, 95%CI 1.0 to 1.4), call-outs for stab/gunshot/penetrating trauma (AOR 1.4, 95%CI 1.3 to 1.5) and call-outs on Fridays/Saturdays (AOR 1.1, 95%CI 1.0 to 1.2) and lower for call-outs on New Year's Eve (AOR 0.6, 95%CI 0.4 to 0.9). Ambulance call-out data can provide a wealth of information to understand violence and subsequently inform about violence prevention and response activity. Ambulance services and staff could play a key role in preventing violence through sharing data and identifying and supporting victims. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Multiple triangulation and collaborative research using qualitative methods to explore decision making in pre-hospital emergency care.

PubMed

Johnson, Maxine; O'Hara, Rachel; Hirst, Enid; Weyman, Andrew; Turner, Janette; Mason, Suzanne; Quinn, Tom; Shewan, Jane; Siriwardena, A Niroshan

2017-01-24

Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas. Combining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.

Improvement in the pre-hospital care of recreational drug users through the development of club specific ambulance referral guidelines

PubMed Central

Wood, David M; Greene, Shaun L; Alldus, Graham; Huggett, Denise; Nicolaou, Michelle; Chapman, Kerry; Moore, Fionna; Heather, Kim; Drake, Nicola; Dargan, Paul I

2008-01-01

Background Previously developed 'club guidelines' developed for club owners and promoters have tended to focus more on the legislative aspects of clubs, rather than the medical management of unwell clubbers within club environments. Despite this lack of guidance on the management of unwell clubbers, a significant proportion of clubs have 'club medic' rooms for managing these individuals. However, due to the lack of specific guidance on the training of staff working in these rooms and guidelines on when an ambulance should be called for an unwell clubber, there have been instances previously where clubbers have been inappropriately managed within the club environment, and often referred to hospital only after significant physiological derangement has occurred, thereby leading to an increased risk of morbidity and mortality. Methods We identified owners and promoters of local club venues within the catchment area of our Emergency Department and working jointly with them and other key stakeholders, in particular the London Ambulance Service and Metropolitan Police, identified strategies to improve pre-hospital care for clubbers who become unwell as a result of recreational drug use. These included developing guidelines detailing indications for ambulance transfer to hospital for clubbers with recreational drug toxicity and the training of club medic staff to use the guidelines Results Following the initial development of a pilot set of guidelines, an audit of their use identified training needed relating to the assessment of unwell clubbers with recreational drug toxicity and revisions required to the pilot version of the guidelines. After training related to the revised guidelines, all the club medic staff were confident in their ability to assess unwell clubbers with recreational drug toxicity, the use of the guidelines and also when to call an ambulance. Conclusion Working with key stakeholders in the local community, we have developed guidelines that can be used to improve the pre-hospital care of clubber unwell with recreational drug toxicity, and demonstrated that individuals with a variety of medical knowledge can be trained to use these guidelines. Wider dissemination of these guidelines, both regionally, nationally and potentially internationally, may help to reduce the pre-hospital morbidity and mortality associated with recreational drug toxicity encountered in club environments. PMID:18538005

Operation of a brain-computer interface walking simulator for individuals with spinal cord injury

PubMed Central

2013-01-01

Background Spinal cord injury (SCI) can leave the affected individuals with paraparesis or paraplegia, thus rendering them unable to ambulate. Since there are currently no restorative treatments for this population, novel approaches such as brain-controlled prostheses have been sought. Our recent studies show that a brain-computer interface (BCI) can be used to control ambulation within a virtual reality environment (VRE), suggesting that a BCI-controlled lower extremity prosthesis for ambulation may be feasible. However, the operability of our BCI has not yet been tested in a SCI population. Methods Five participants with paraplegia or tetraplegia due to SCI underwent a 10-min training session in which they alternated between kinesthetic motor imagery (KMI) of idling and walking while their electroencephalogram (EEG) were recorded. Participants then performed a goal-oriented online task, where they utilized KMI to control the linear ambulation of an avatar while making 10 sequential stops at designated points within the VRE. Multiple online trials were performed in a single day, and this procedure was repeated across 5 experimental days. Results Classification accuracy of idling and walking was estimated offline and ranged from 60.5% (p = 0.0176) to 92.3% (p = 1.36×10−20) across participants and days. Offline analysis revealed that the activation of mid-frontal areas mostly in the μ and low β bands was the most consistent feature for differentiating between idling and walking KMI. In the online task, participants achieved an average performance of 7.4±2.3 successful stops in 273±51 sec. These performances were purposeful, i.e. significantly different from the random walk Monte Carlo simulations (p<0.01), and all but one participant achieved purposeful control within the first day of the experiments. Finally, all participants were able to maintain purposeful control throughout the study, and their online performances improved over time. Conclusions The results of this study demonstrate that SCI participants can purposefully operate a self-paced BCI walking simulator to complete a goal-oriented ambulation task. The operation of the proposed BCI system requires short training, is intuitive, and robust against participant-to-participant and day-to-day neurophysiological variations. These findings indicate that BCI-controlled lower extremity prostheses for gait rehabilitation or restoration after SCI may be feasible in the future. PMID:23866985

Improvement in the pre-hospital care of recreational drug users through the development of club specific ambulance referral guidelines.

PubMed

Wood, David M; Greene, Shaun L; Alldus, Graham; Huggett, Denise; Nicolaou, Michelle; Chapman, Kerry; Moore, Fionna; Heather, Kim; Drake, Nicola; Dargan, Paul I

2008-06-06

Previously developed 'club guidelines' developed for club owners and promoters have tended to focus more on the legislative aspects of clubs, rather than the medical management of unwell clubbers within club environments. Despite this lack of guidance on the management of unwell clubbers, a significant proportion of clubs have 'club medic' rooms for managing these individuals. However, due to the lack of specific guidance on the training of staff working in these rooms and guidelines on when an ambulance should be called for an unwell clubber, there have been instances previously where clubbers have been inappropriately managed within the club environment, and often referred to hospital only after significant physiological derangement has occurred, thereby leading to an increased risk of morbidity and mortality. We identified owners and promoters of local club venues within the catchment area of our Emergency Department and working jointly with them and other key stakeholders, in particular the London Ambulance Service and Metropolitan Police, identified strategies to improve pre-hospital care for clubbers who become unwell as a result of recreational drug use. These included developing guidelines detailing indications for ambulance transfer to hospital for clubbers with recreational drug toxicity and the training of club medic staff to use the guidelines Following the initial development of a pilot set of guidelines, an audit of their use identified training needed relating to the assessment of unwell clubbers with recreational drug toxicity and revisions required to the pilot version of the guidelines. After training related to the revised guidelines, all the club medic staff were confident in their ability to assess unwell clubbers with recreational drug toxicity, the use of the guidelines and also when to call an ambulance. Working with key stakeholders in the local community, we have developed guidelines that can be used to improve the pre-hospital care of clubber unwell with recreational drug toxicity, and demonstrated that individuals with a variety of medical knowledge can be trained to use these guidelines. Wider dissemination of these guidelines, both regionally, nationally and potentially internationally, may help to reduce the pre-hospital morbidity and mortality associated with recreational drug toxicity encountered in club environments.

Interfacility transfer of pregnant women using publicly funded emergency call centre-based ambulance services: a cross-sectional analysis of service logs from five states in India

PubMed Central

Doyle, Pat; Campbell, Oona MR; Oakley, Laura; Rao, GV Ramana; Murthy, GVS

2017-01-01

Objective To estimate the proportion of interfacility transfers (IFTs) transported by ‘108’ ambulances and to compare the characteristics of the IFTs and non-IFTs to understand the pattern of use of ‘108’ services for pregnant women in India. Design A cross-sectional analysis of ‘108’ ambulance records from five states for the period April 2013 to March 2014. Data were obtained from the call centre database for the pregnant women, who called ‘108’. Main outcomes Proportion of all pregnancies and institutional deliveries in the population who were transported by ‘108’, both overall and for IFT. Characteristics of the women transported; obstetric emergencies, the distances travelled and the time taken for both IFT and non-IFT. Results The ‘108’ ambulances transported 6 08 559 pregnant women, of whom 34 993 were IFTs (5.8%) in the five states. We estimated that ‘108’ transferred 16.5% of all pregnancies and 20.8% of institutional deliveries. Only 1.2% of all institutional deliveries in the population were transported by ‘108’ for IFTs—lowest 0.6% in Gujarat and highest 3.0% in Himachal Pradesh. Of all ‘108’ IFTs, only 8.4% had any pregnancy complication. For all states combined, on adjusted analysis, IFTs were more likely than non-IFTs to be for older and younger women or from urban areas, and less likely to be for women from high-priority districts, from backward or scheduled castes, or women below the poverty line. Obstetric emergencies were more than twice as likely to be IFTs as pregnant women without obstetric emergencies (OR=2.18, 95% CI 2.09 to 2.27). There was considerable variation across states. Conclusion Only 6% institutional deliveries made use of the ‘108’ ambulance for IFTs in India. The vast majority did not have any complication or emergency. The ‘108’ service may need to consider strategies to prioritise the transfer of women with obstetric emergency and those requiring IFT, over uncomplicated non-IFT. PMID:28601830

Ambulation Increases Decompression Sickness in Spacewalk Simulations

NASA Technical Reports Server (NTRS)

Pollock, N. W.; Natoli, M. J.; Conkin, J.; Wessel, J. H., III; Gernhardt, M. L.

2014-01-01

Musculoskeletal activity has the potential to both improve and compromise decompression safety. Exercise enhances inert gas elimination during oxygen breathing prior to decompression (prebreathe), but it may also promote bubble nuclei formation (nucleation), which can lead to gas phase separation and bubble growth and increase the risk of decompression sickness (DCS). The timing, pattern and intensity of musculoskeletal activity and the level of tissue supersaturation may be critical to the net effect. Understanding the relationships is important to evaluate exercise prebreathe protocols and quantify decompression risk in gravity and microgravity environments. Data gathered during NASA's Prebreathe Reduction Program (PRP) studies combined oxygen prebreathe and exercise followed by low pressure (4.3 psi; altitude equivalent of 30,300 ft [9,235 m]) microgravity simulation to produce two protocols used by astronauts preparing for extravehicular activity. Both the Phase II/CEVIS (cycle ergometer vibration isolation system) and ISLE (in-suit light exercise) trials eliminated ambulation to more closely simulate the microgravity environment. The CEVIS results (35 male, 10 female) serve as control data for this NASA/Duke study to investigate the influence of ambulation exercise on bubble formation and the subsequent risk of DCS. METHODS Four experiments will replicate the CEVIS exercise-enhanced oxygen prebreathe protocol, each with a different exception. The first of these is currently underway. Experiment 1 - Subjects complete controlled ambulation (walking in place with fixed cadence and step height) during both preflight and at 4.3 psi instead of remaining nonambulatory throughout. Experiment 2 - Subjects remain non-ambulatory during the preflight period and ambulatory at 4.3 psi. Experiment 3 - Subjects ambulate during the preflight period and remain non-ambulatory at 4.3 psi. Experiment 4 - The order of heavy and light exercise employed in the CEVIS protocol is reversed, with the light exercise occurring first (subjects remain non-ambulatory throughout). Decompression stress is assessed with non-invasive ultrasound during each of 14 epochs of a 4 hour simulated spacewalk at 4.3 psi; aural Doppler is used to monitor bubbles (Spencer grade 0-IV scale) passing through the pulmonary artery, and two-dimensional echocardiographic imaging is used to look for left ventricular gas emboli (LVGE; the presence of which is a test termination criterion). Venous blood is collected at baseline and twice following repressurization to determine if the decompression stress is correlated with microparticles (cell fragments) accumulation. The plan is to test 25-50 subjects in each experiment. Fisher Exact Tests (one-tailed) are used to compare test and control groups. Trials are suspended when the DCS or grade IV VGE observations reach 70% confidence of DCS risk >15% and grade IV VGE risk >20%. RESULTS Experiment 1 was concluded with 20 complete trials (15 male, 5 female) since the statistical outcome would not change with five additional trials. The observed DCS was significantly greater in Experiment 1 than in CEVIS trials (4/20 [20%] vs. 0/45 [0%], respectively, p=0.007), as was the frequency of peak grade IV VGE (6/21 [29%; including one additional subject that presented grade IV VGE but whose trial was ended before completion when LVGE were observed] vs. 3/45 [7%], respectively, p=0.024). Experiment 3 trials are now underway, with 11 trials completed (10 male, 1 female). Preliminary results indicate no difference in observed DCS between Experiment 3 and CEVIS trials (1/11 [9%] vs. 0/45 [0%], respectively, p=0.196), or between Experiment 3 and Experiment 1 trials (p=0.405). The frequency of peak grade IV VGE in Experiment 3 (2/11 [18%]) did not differ from CEVIS or Experiment 1 trials (p=0.251 and p=0.425, respectively). Microparticle patterns are widely variable and still under analysis. DISCUSSION The results of the Experiment 1 trials support the thesis that decompression stress is increased by ambulation exercise, given the higher incidence of DCS and grade IV VGE when compared to the non-ambulatory PRP CEVIS trials. Experiment 3 trials are incomplete, but suggest that the effect of ambulation during ground level preflight oxygen breathing alone, when subjects are undersaturated with inert gas, may not differ in risk from ambulation at both preflight and spacesuit pressures, the latter when subjects are supersaturated with inert gas. Further trials are needed to confirm the relative effects of ambulation in undersaturated vs. supersaturated states and to determine whether light exercise facilitates the removal of heavy exercise-induced nucleation (Experiment 4).

PubMed

Aléx, Jonas; Gyllencreutz, Lina

2018-02-05

Trauma care at an accident site is of great importance for patient survival. The purpose of the study was to observe the compliance of ambulance nurses with the Prehospital Trauma Life Support (PHTLS) concept of trauma care in a simulation situation. The material consisted of video recordings in trauma simulation and an observation protocol was designed to analyze the video material. The result showed weaknesses in systematic exam and an ineffective use of time at the scene of injury. Development of observation protocols in trauma simulation can ensure the quality of ambulance nurses' compliance with established concepts. Our pilot study shows that insufficiencies in systematic care lead to an ineffective treatment for trauma patients which in turn may increase the risk of complications and mortality.

Model application for rapid detection of the exact location when calling an ambulance using OGC Open GeoSMS Standards

NASA Astrophysics Data System (ADS)

Sukic, Enes; Stoimenov, Leonid

2016-02-01

The web has penetrated just about every sphere of human interest and using information from the web has become ubiquitous among different categories of users. Medicine has long being using the benefits of modern technologies and without them it cannot function. This paper offers a proposal of use and mutual collaboration of several modern technologies within facilitating the location and communication between persons in need of emergency medical assistance and the emergency head offices, i.e., the ambulance. The main advantage of the proposed model is the technical possibility of implementation and use of these technologies in developing countries and low implementation cost.

Use of a forensic technique to identify blood contamination of emergency department and ambulance trauma equipment.

PubMed

Lee, J B; Levy, M; Walker, A

2006-01-01

Using a Kastle-Meyer (KM) technique, the following equipment from the emergency departments of six UK hospitals (four trusts) and three regional ambulance services was tested for blood contamination: extrication ("spinal") boards, cervical collars, straps, box splints, head blocks, and headboards. Only equipment ready for patient use was tested. Over half of trauma equipment (57%) tested positive for blood, including 15% of equipment that was visibly stained with blood. There have been no recorded cases of infection from contaminated trauma equipment but our study has identified the potential risk. Disposable covers for boards, disposable straps, and disposable radiolucent head blocks which are currently available provide a solution but have resource implications.

Cost-benefit analysis of ambulance and rescue helicopters in Norway: reflections on assigning a monetary value to saving a human life.

PubMed

Elvik, Rune

2002-01-01

This paper reports the results of a cost-benefit analysis undertaken in 1996 for a public commission set up to plan the future operation of state-owned ambulance and rescue helicopters in Norway. The analysis indicates that the benefits of ambulance missions flown by helicopters exceeds the costs by a factor of almost six. To do this analysis it was necessary to assign a monetary value to human life. Traditionally this has not been done in medicine, and may be widely regarded as inconsistent with medical ethics. The results of the cost-benefit analysis serve as the starting point to a more general discussion surrounding the economic value of activities designed to reduce human mortality. It is concluded that human preferences for the provision of health care or other life-saving interventions are probably too complex to be adequately represented by means of a single monetary value expressing the benefits of life-saving. The task of developing an inclusive framework for a normative approach to priority setting in injury prevention is daunting, and may be insoluble. It is important to assess the extent to which current value-of-life estimates depend on study methods and social context.

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation

PubMed Central

Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y.; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

2017-01-01

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients’ biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient’s biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios. PMID:28117724

Ubiquitous Emergency Medical Service System Based on Wireless Biosensors, Traffic Information, and Wireless Communication Technologies: Development and Evaluation.

PubMed

Tan, Tan-Hsu; Gochoo, Munkhjargal; Chen, Yung-Fu; Hu, Jin-Jia; Chiang, John Y; Chang, Ching-Su; Lee, Ming-Huei; Hsu, Yung-Nian; Hsu, Jiin-Chyr

2017-01-21

This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time. In the proposed system, patient's biosignals and real-time video, acquired by wireless biosensors and a webcam, can be simultaneously transmitted to an emergency room for pre-hospital treatment via WiMax/3.5 G networks. Performances of WiMax and 3.5 G, in terms of initialization time, data rate, and average end-to-end delay are evaluated and compared. A driver can choose the route of the shortest time among the suggested routes by Google Maps after inspecting the current traffic conditions based on real-time CCTV camera streams and traffic information. The destination address can be inputted vocally for easiness and safety in driving. A series of field test results validates the feasibility of the proposed system for application in real-life scenarios.

Changes in travel-related carbon emissions associated with modernization of services for patients with acute myocardial infarction: a case study.

PubMed

Zander, Alexis; Niggebrugge, Aphrodite; Pencheon, David; Lyratzopoulos, Georgios

2011-06-01

Little attention has been paid on the carbon footprint of different healthcare service models. We examined this question for service models for patients with acute ST elevation myocardial infarction (STEMI). We estimated carbon emissions associated with ambulance (patient) transport under a primary percutaneous coronary intervention (pPCI) care model based in tertiary centres, compared with historical emissions under a thrombolysis model based in general hospitals. We used geographical information on 41,449 hospitalizations, and published UK government fuel to carbon emissions conversion factors. The average ambulance journey required for transporting a STEMI patient to its closest care point was 13.0 km under the thrombolysis model and 42.2 km under the pPCI model, producing 3.46 and 11.2 kg of CO(2) emissions, respectively. Thus, introducing pPCI will more than triple ambulance journey associated carbon emissions (by a factor of 3.24). This ratio was robust to sensitivity analysis varying assumptions on conversion factor values; and the number of patients treated. Introducing pPCI to manage STEMI patients results in substantial carbon emissions increase. Environmental profiling of service modernization projects could motivate carbon control strategies, and care pathways design that will reduce patient transport need. Healthcare planners should consider the environmental legacy of quality improvement initiatives.

Body weight-supported bedside treadmill training facilitates ambulation in ICU patients: An interventional proof of concept study.

PubMed

Sommers, Juultje; Wieferink, Denise C; Dongelmans, Dave A; Nollet, Frans; Engelbert, Raoul H H; van der Schaaf, Marike

2017-10-01

Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore the feasibility of Body Weight-Supported Treadmill Training (BWSTT) in critically ill patients in the ICU. A custom build bedside Body Weight-Supported Treadmill was used and evaluated in medical and surgical patients in the ICU. Feasibility was evaluated according to eligibility, successful number of BWSTT, number of staff needed, adverse events, number of patients that could not have walked without BWSTT, patient satisfaction and anxiety. Twenty participants, underwent 54 sessions BWSTT. Two staff members executed the BWSTT and no adverse events occurred. Medical equipment did not have to be disconnected during all treatment sessions. In 74% of the sessions, the participants would not have been able to walk without the BWSTT. Patient satisfaction with BWSTT was high and anxiety low. This proof of concept study demonstrated that BWSTT is safe, reduces staff resource, and facilitates the first time to ambulation in critically ill patients with severe muscle weakness in the ICU. Copyright © 2017 Elsevier Inc. All rights reserved.

Bi-objective approach for placing ground and air ambulance base and helipad locations in order to optimize EMS response.

PubMed

Shahriari, Milad; Bozorgi-Amiri, Ali; Tavakoli, Shayan; Yousefi-Babadi, Abolghasem

2017-12-01

Shortening the travel time of patient transfer has clinical implications for many conditions such as cardiac arrest, trauma, stroke and STEMI. As resources are often limited precise calculations are needed. In this paper we consider the location problem for both ground and aerial emergency medical services. Given the uncertainty of when patients are in need of prompt medical attention we consider these demand points to be uncertain. We consider various ways in which ground and helicopter ambulances can work together to make the whole process go faster. We develop a mathematical model that minimizes travel time and maximizes service level. We use a compromising programming method to solve this bi-objective mathematical model. For numerical experiments we apply our model to a case study in Lorestan, Iran, using geographical and population data, and the location of the actual hospital based in the capital of the province. Results show that low-accessibility locations are the main focus of the proposed problem and with mathematical modeling access to a hospital is vastly improved. We also found out that once the budget reaches a certain point which suffices for building certain ambulance bases more investments does not necessarily result in less travel time. Copyright © 2017 Elsevier Inc. All rights reserved.

Assessment of canes used by older adults in senior living communities.

PubMed

Liu, Hao Howe; Eaves, Joshua; Wang, Wen; Womack, Jill; Bullock, Paige

2011-01-01

The purpose of this cross-sectional study is to provide basic but essential information about how older cane users obtain their canes and how they use these canes for their daily mobility, since there is still lack of information on these areas. Ninety-three older (≥65 years old) subjects who use canes for daily activities were recruited from four assisted living facilities and five retirement centers for this cross-sectional study. The assessment involved interviewing cane users with a questionnaire, examining their canes, and investigating how these canes were used by their owners during ambulation. The commonly used canes are (from most to least): adjustable single-tip, un-adjustable (wooden), small quad, and large quad. Five major problems from data analysis were identified: lack of medical consultation for device selection/use, incorrect cane height/maintenance, placement of cane in improper hand, inability to maintain the proper reciprocal gait pattern, and improper posture during ambulation. Only forward-leaning posture during ambulation might be associated with increased falls among the older cane users. Knowledge of these problems could assist health professionals to implement appropriate interventions in clinical settings and to provide community service to address all problems related to cane use. Published by Elsevier Ireland Ltd.

[Statements of general practitioners on cooperation with specialists and a future health care system].

PubMed

Heintze, Christoph; Matysiak-Klose, Dorothea; Howorka, Antje; Kröhn, Thorsten; Braun, Vittoria

2004-08-15

Ideas of general practitioners (GPs) could be of value for the restructuring of the German ambulant health care system. The way managed care is seen by GPs is of particular interest. The aim of this study was to record opinions of GPs, working in Berlin, in regard to several aspects of their daily work. 14 female and 16 male GPs from Berlin participated in a qualitative survey. These 30 GPs were interviewed about their attitude toward cooperation with specialized colleagues and their opinions on a future medical care system. The interviews performed were summarized, structured and analyzed according to the qualitative content analysis by Mayring. From the GPs' point of view, ambulant cooperation is facilitated by knowing specialized colleagues, by staying in close contact to them via telephone and by being able to arrange short-term appointments with these specialists. A closer cooperation with specialists in a network as well as an advanced use of digital information systems for accessing patients' data were considered to be vital elements for a future health care system. An important reason for choosing the cooperation with specialists is to find quick comprehensive treatment strategies for patients. It may be concluded that ambulant managed care of patients could be optimized with the creation of medical networks.

Exploring implicit preventive strategies in prehospital emergency workers: a novel approach for preventing back problems.

PubMed

Arial, Marc; Benoît, Damien; Wild, Pascal

2014-07-01

Back problems are a major occupational health issue for prehospital emergency care professionals. The goals of this article are to: 1) provide descriptive data about the prevalence and the severity of lower back and upper back disorders in EMTs and paramedics; 2) identify some individual and collective strategies used by EMTs and paramedics to protect their health as they perform prehospital emergency missions; 3) assess the possible effectiveness of strategies in preventing back problems by exploring associations between the use of strategies and the presence and severity of symptoms. The method includes a questionnaire survey (sample n = 334; paramedics and emergency medical technicians) and ergonomics work practice analysis involving shadowing ambulance crews in 12 medical emergency services (over 400 h). A majority of ambulance professionals had experienced back pain in the twelve-month period before the survey. Work practice analysis revealed strategies and tricks of the trade used by ambulance professionals to reduce the chances of back strain while working. Multiple regression analyses showed that self-reported use of such strategies was associated with fewer back symptoms. Preventive strategies should be integrated into specialised training programs for prehospital medical emergency professionals. This approach could also be used in other work settings. Copyright © 2014 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Voluntary ambulation using voluntary upper limb muscle activity and Hybrid Assistive Limb® (HAL®) in a patient with complete paraplegia due to chronic spinal cord injury: A case report.

PubMed

Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Saotome, Kousaku; Ueno, Tomoyuki; Abe, Tetsuya; Marushima, Aiki; Watanabe, Hiroki; Endo, Ayumu; Tsurumi, Kazue; Ishimoto, Ryu; Matsushita, Akira; Koda, Masao; Matsumura, Akira; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

2018-01-19

We sought to describe our experience with the Hybrid Assistive Limb® (HAL®) for active knee extension and voluntary ambulation with remaining muscle activity in a patient with complete paraplegia after spinal cord injury. A 30-year-old man with complete paraplegia used the HAL® for 1 month (10 sessions) using his remaining muscle activity, including hip flexor and upper limb activity. Electromyography was used to evaluate muscle activity of the gluteus maximus, tensor fascia lata, quadriceps femoris, and hamstring muscles in synchronization with the Vicon motion capture system. A HAL® session included a knee extension session with the hip flexor and voluntary gait with upper limb activity. After using the HAL® for one month, the patient's manual muscle hip flexor scores improved from 1/5 to 2/5 for the right and from 2/5 to 3/5 for the left knee, and from 0/5 to 1/5 for the extension of both knees. Knee extension sessions with HAL®, and hip flexor and upper-limb-triggered HAL® ambulation seem a safe and feasible option in a patient with complete paraplegia due to spinal cord injury.

Integrated locating of helicopter stations and helipads for wounded transfer under demand location uncertainty.

PubMed

Bozorgi-Amiri, Ali; Tavakoli, Shayan; Mirzaeipour, Hossein; Rabbani, Masoud

2017-03-01

Health emergency medical service (HEMS) plays an important role in reducing injuries by providing advanced medical care in the shortest time and reducing the transfer time to advanced treatment centers. In the regions without ground relief coverage, it would be faster to transfer emergency patients to the hospital by a helicopter. In this paper, an integer nonlinear programming model is presented for the integrated locating of helicopter stations and helipads by considering uncertainty in demand points. We assume three transfer modes: (1) direct transfer by an ambulance, (2) transfer by an ambulance to a helicopter station and then to the hospital by a helicopter, (3) transfer by an ambulance to a predetermined point and then to the hospital by a helicopter. We also assume that demands occur in a square-shaped area, in which each side follows a uniform distribution. It is also assumed that demands in an area decrease errors in the distances between each two cities. The purpose of this model is to minimize the transfer time from demand points to the hospital by considering different modes. The proposed model is examined in terms of validity and applicability in Lorestan Province and a sensitivity analysis is also conducted on the total allocated budget. Copyright © 2016 Elsevier Inc. All rights reserved.

Benefits of microprocessor-controlled prosthetic knees to limited community ambulators: systematic review.

PubMed

Kannenberg, Andreas; Zacharias, Britta; Pröbsting, Eva

2014-01-01

The benefits of microprocessor-controlled prosthetic knees (MPKs) have been well established in community ambulators (Medicare Functional Classification Level [MFCL]-3) with a transfemoral amputation (TFA). A systematic review of the literature was performed to analyze whether limited community ambulators (MFCL-2) may also benefit from using an MPK in safety, performance-based function and mobility, and perceived function and satisfaction. We searched 10 scientific databases for clinical trials with MPKs and identified six publications with 57 subjects with TFA and MFCL-2 mobility grade. Using the criteria of a Cochrane Review on prosthetic components, we rated methodological quality moderate in four publications and low in two publications. MPK use may significantly reduce uncontrolled falls by up to 80% as well as significantly improve indicators of fall risk. Performance-based outcome measures suggest that persons with MFCL-2 mobility grade may be able to walk about 14% to 25% faster on level ground, be around 20% quicker on uneven surfaces, and descend a slope almost 30% faster when using an MPK. The results of this systematic review suggest that trial fittings may be used to determine whether or not individuals with TFA and MFCL-2 mobility grade benefit from MPK use. Criteria for patient selection and assessment of trial fitting success or failure are proposed.

Is a drain tube necessary for minimally invasive lumbar spine fusion surgery?

PubMed

Hung, Pei-I; Chang, Ming-Chau; Chou, Po-Hsin; Lin, Hsi-Hsien; Wang, Shih-Tien; Liu, Chien-Lin

2017-03-01

This study aimed to evaluate if closed suction wound drainage is necessary in minimally invasive surgery of transforaminal lumbar interbody fusion (MIS TLIF). This is a prospective randomized clinical study. Fifty-six patients who underwent MIS TLIF were randomly divided into groups A (with a closed suction wound drainage) and B (without tube drainage). Surgical duration, intraoperative blood loss, timing of ambulation, length of hospital stay and complications were recorded. Patients were followed up for an average of 25.3 months. Clinical outcome was assessed using the Oswestry disability index and visual analogue scale (VAS). Fusion rate was classified with the Bridwell grading system, based on plain radiograph. Both groups had similar patient demographics. The use of drains had no significant influence on perioperative parameters including operative time, estimated blood loss, length of stay and complications. Patients in group B started ambulation 1 day earlier than patients in group A (p < 0.001). Clinical outcomes were comparable between group A and group B. A drain tube can lead to pain, anxiety and discomfort during the postoperative period. We conclude that drain tubes are not necessary for MIS TLIF. Patients without drains had the benefit of earlier ambulation than those with drains.

Trauma care in Scotland: effect of rurality on ambulance travel times and level of destination healthcare facility.

PubMed

Yeap, E E; Morrison, J J; Apodaca, A N; Egan, G; Jansen, J O

2014-06-01

The aim of this study was to determine the effect of rurality on the level of destination healthcare facility and ambulance response times for trauma patients in Scotland. We used a retrospective analysis of pre-hospital data routinely collected by the Scottish Ambulance Service from 2009-2010. Incident locations were categorised by rurality, using the Scottish urban/rural classification. The level of destination healthcare facility was coded as either a teaching hospital, large general hospital, general hospital, or other type of facility. A total of 64,377 incidents met the inclusion criteria. The majority of incidents occurred in urban areas, which mostly resulted in admission to teaching hospitals. Incidents from other areas resulted in admission to a lower-level facility. The majority of incidents originating in very remote small towns and very remote rural areas were treated in a general hospital. Median call-out times and travel times increased with the degree of rurality, although with some exceptions. Trauma is relatively rare in rural areas, but patients injured in remote locations are doubly disadvantaged by prolonged pre-hospital times and admission to a hospital that may not be adequately equipped to deal with their injuries. These problems may be overcome by the regionalisation of trauma care, and enhanced retrieval capability.

Rehabilitation of children and infants with osteogenesis imperfecta. A program for ambulation.

PubMed

Gerber, L H; Binder, H; Weintrob, J; Grange, D K; Shapiro, J; Fromherz, W; Berry, R; Conway, A; Nason, S; Marini, J

1990-02-01

Management of children and infants with osteogenesis imperfecta (OI) poses difficult decisions for pediatricians, orthopedists, and physiatrists. These children are frequently frail with disabling bone and joint deformities and fractures. In an eight-year cumulative management of 12 children with OI, a comprehensive program included strengthening exercises to the pelvic girdle and lower extremity muscles, in addition to pool exercises and molded seating to support upright posture. Long leg braces were fitted when the children were able to sit unsupported. All 12 were fitted with braces; nine were functional ambulators, and three were home ambulators. Six children required femoral plating or rodding, two of whom subsequently had the metal removed. Lower extremity fractures averaged one and one-half per year prior to bracing for nine children who had fractures. There was 0.83 fracture per year for the ten children who had fractures after bracing. The degree of femoral bowing increased in four, decreased in four, and remained unchanged in four, while the degree of tibial bowing increased in two, decreased in nine, and remained unchanged in one during the observation period. A comprehensive rehabilitation program and long leg bracing with surgical operations on the femur result in a high level of functional activity for children with OI with an acceptable level of risk for fracture.

Evaluating Cellular Instrumentation on Rural Handpumps to Improve Service Delivery-A Longitudinal Study in Rural Rwanda.

PubMed

Nagel, Corey; Beach, Jack; Iribagiza, Chantal; Thomas, Evan A

2015-12-15

In rural sub-Saharan Africa, where handpumps are common, 10-67% are nonfunctional at any one time, and many never get repaired. Increased reliability requires improved monitoring and responsiveness of maintenance providers. In 2014, 181 cellular enabled water pump use sensors were installed in three provinces of Rwanda. In three arms, the nominal maintenance model was compared against a "best practice" circuit rider model, and an "ambulance" service model. In only the ambulance model was the sensor data available to the implementer, and used to dispatch technicians. The study ran for seven months in 2014-2015. In the study period, the nominal maintenance group had a median time to successful repair of approximately 152 days, with a mean per-pump functionality of about 68%. In the circuit rider group, the median time to successful repair was nearly 57 days, with a per-pump functionality mean of nearly 73%. In the ambulance service group, the successful repair interval was nearly 21 days with a functionality mean of nearly 91%. An indicative cost analysis suggests that the cost per functional pump per year is approximately similar between the three models. However, the benefits of reliable water service may justify greater focus on servicing models over installation models.

Recognition of simulated cyanosis by color-vision-normal and color-vision-deficient subjects.

PubMed

Dain, Stephen J

2014-04-01

There are anecdotal reports that the recognition of cyanosis is difficult for some color-deficient observers. The chromaticity changes of blood with oxygenation in vitro lie close to the dichromatic confusion lines. The chromaticity changes of lips and nail beds measured in vivo are also generally aligned in the same way. Experiments involving visual assessment of cyanosis in vivo are fraught with technical and ethical difficulties A single lower face image of a healthy individual was digitally altered to produce levels of simulated cyanosis. The color change is essentially one of saturation. Some images with other color changes were also included to ensure that there was no propensity to identify those as cyanosed. The images were assessed for reality by a panel of four instructors from the NSW Ambulance Service training section. The images were displayed singly and the observer was required to identify if the person was cyanosed or not. Color normal subjects comprised 32 experienced ambulance officers and 27 new recruits. Twenty-seven color deficient subjects (non-NSW Ambulance Service) were examined. The recruits were less accurate and slower at identifying the cyanosed images and the color vision deficient were less accurate and slower still. The identification of cyanosis is a skill that improves with training and is adversely affected in color deficient observers.

Task-specific gross motor skills training for ambulant school-aged children with cerebral palsy: a systematic review.

PubMed

Toovey, Rachel; Bernie, Charmaine; Harvey, Adrienne R; McGinley, Jennifer L; Spittle, Alicia J

2017-01-01

The primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome. Systematic review. Relevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs. Thirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, p<0.001; Life-HABITS satisfaction SMD=1.29, 95% CI 0.40 to 2.18, p=0.001), while no difference or negative effects were found for gross motor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome. Limited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions. PROSPERO ID42016036727.

Emergency automatic signalling system using time scheduling

NASA Astrophysics Data System (ADS)

Rayavel, P.; Surenderanath, S.; Rathnavel, P.; Prakash, G.

2018-04-01

It is difficult to handle traffic congestion and maintain roads during traffic mainly in India. As the people migrate from rural to urban and sub-urban areas, it becomes still more critical. Presently Roadways is a standout amongst the most vital transportation. At the point when a car crash happens, crisis vehicles, for example, ambulances and fire trucks must rush to the mischance scene. There emerges a situation where a portion of the crisis vehicles may cause another car crash. Therefore it becomes still more difficult for emergency vehicle to reach the destination within a predicted time. To avoid that kind of problem we have come out with an effective idea which can reduce the potential in the traffic system. The traffic system is been modified using a wireless technology and high speed micro controller to provide smooth and clear flow of traffic for ambulance to reach the destination on time. This is achieved by using RFID Tag at the ambulance and RFID Reader at the traffic system i.e., traffic signal. This mainly deals with identifying the emergency vehicle and providing a green signal to traffic signal at time of traffic jam. — By assigning priorities to various traffic movements, we can control the traffic jam. In some moments like ambulance emergency, high delegates arrive people facing lot of trouble. To overcome this problem in this paper we propose a time priority based traffic system achieved by using RFID transmitter at the emergency vehicle and RFID receiver at the traffic system i.e., traffic signal. The signal from the emergency vehicle is sent to traffic system which after detecting it sends it to microcontroller which controls the traffic signal. If any emergency vehicle is detected the system goes to emergency system mode where signal switch to green and if it is not detected normal system mode.

Resuscitation from out-of-hospital cardiac arrest: is survival dependent on who is available at the scene?

PubMed Central

Soo, L; Gray, D; Young, T; Huff, N; Skene, A; Hampton, J

1999-01-01

Objective—To determine whether survival from out-of-hospital cardiac arrest is influenced by the on-scene availability of different grades of ambulance personnel and other health professionals.
Design—Population based, retrospective, observational study.
Setting—County of Nottinghamshire with a population of one million.
Subjects—All 2094 patients who had resuscitation attempted by Nottinghamshire Ambulance Service crew from 1991 to 1994; study of 1547 patients whose arrest were of cardiac aetiology.
Main outcome measures—Survival to hospital admission and survival to hospital discharge.
Results—Overall survival from out-of-hospital cardiac arrest remains poor: 221 patients (14.3%) survived to reach hospital alive and only 94 (6.1%) survived to be discharged from hospital. Multivariate logistic regression analysis showed that the chances of those resuscitated by technician crew reaching hospital alive were poor but were greater when paramedic crew were either called to assist technicians or dealt with the arrest themselves (odds ratio 6.9 (95% confidence interval 3.92 to 26.61)). Compared to technician crew, survival to hospital discharge was only significantly improved with paramedic crew (3.55 (1.62 to 7.79)) and further improved when paramedics were assisted by either a health professional (9.91 (3.12 to 26.61)) or a medical practitioner (20.88 (6.72 to 64.94)).
Conclusions—Survival from out-of-hospital cardiac arrest remains poor despite attendance at the scene of the arrest by ambulance crew and other health professionals. Patients resuscitated by a paramedic from out-of-hospital cardiac arrest caused by cardiac disease were more likely to survive to hospital discharge than when resuscitation was provided by an ambulance technician. Resuscitation by a paramedic assisted by a medical practitioner offers a patient the best chances of surviving the event.

 Keywords: out-of-hospital;  cardiac arrest;  paramedic;  technician PMID:10220544

OXYGEN UPTAKE BEFORE AND AFTER THE ONSET OF CLAUDICATION DURING A 6-MINUTE WALK TEST

PubMed Central

Gardner, Andrew W.; Ritti-Dias, Raphael M.; Stoner, Julie A.; Montgomery, Polly S.; Khurana, Aman; Blevins, Steve M.

2011-01-01

Purposes To compare oxygen uptake before and after the onset of claudication in subjects with peripheral artery disease (PAD) during a 6-minute walk test, and to identify predictors of the change in oxygen uptake following the onset of claudication pain Methods Fifty subjects with PAD were studied, in which 33 experienced claudication (Pain Group) during a 6-minute walk test, and 17 were pain-free during this test (Pain-Free Group). Oxygen uptake and ambulatory cadence were primary outcomes obtained during the 6-minute walk test. Results The Pain Group experienced onset of claudication pain at 179 ± 45 meters (mean ± standard deviation) and continued to walk to achieve a 6-minute walk distance of 393 ± 74 meters, which was similar (p = 0.74) to the Pain-Free Group (401 ± 76 meters). Oxygen uptake increased (p < 0.0001) after the onset of pain in the Pain Group, and this change was greater (p = 0.025) than the increase in oxygen uptake from the second to fifth minute of walking in the Pain-Free Group. Furthermore, ambulatory cadence decreased after the onset of pain in the Pain Group (p = 0.0003). The change in oxygen uptake was associated with metabolic syndrome (p = 0.0023), 6-minute walk distance (p = 0.0037), age, (p = 0.0041), and the oxygen uptake during the second minute of the test (p = 0.012). Conclusion Claudication increases oxygen uptake of self-paced, over-ground ambulation despite a decrease in cadence. The pain-mediated increase in oxygen uptake was blunted in subjects with metabolic syndrome, suggesting that they have an impaired ability to increase oxygen uptake during ambulation. The clinical significance is that claudication increases metabolic cost of ambulation, thereby increasing the relative intensity of exercise and reducing the tolerance to sustain ambulation. PMID:21890308

Can routinely collected ambulance data about assaults contribute to reduction in community violence?

PubMed

Ariel, Barak; Weinborn, Cristobal; Boyle, Adrian

2015-04-01

The 'law of spatiotemporal concentrations of events' introduced major preventative shifts in policing communities. 'Hotspots' are at the forefront of these developments yet somewhat understudied in emergency medicine. Furthermore, little is known about interagency 'data-crossover', despite some developments through the Cardiff Model. Can police-ED interagency data-sharing be used to reduce community-violence using a hotspots methodology? 12-month (2012) descriptive study and analysis of spatiotemporal clusters of police and emergency calls for service using hotspots methodology and assessing the degree of incident overlap. 3775 violent crime incidents and 775 assault incidents analysed using spatiotemporal clustering with k-means++ algorithm and Spearman's rho. Spatiotemporal location of calls for services to the police and the ambulance service are equally highly concentrated in a small number of geographical areas, primarily within intra-agency hotspots (33% and 53%, respectively) but across agencies' hotspots as well (25% and 15%, respectively). Datasets are statistically correlated with one another at the 0.57 and 0.34 levels, with 50% overlap when adjusted for the number of hotspots. At least one in every two police hotspots does not have an ambulance hotspot overlapping with it, suggesting half of assault spatiotemporal concentrations are unknown to the police. Data further suggest that more severely injured patients, as estimated by transfer to hospital, tend to be injured in the places with the highest number of police-recorded crimes. A hotspots approach to sharing data circumvents the problem of disclosing person-identifiable data between different agencies. Practically, at least half of ambulance hotspots are unknown to the police; if causal, it suggests that data sharing leads to both reduced community violence by way of prevention (such as through anticipatory patrols or problem-oriented policing), particularly of more severe assaults, and improved efficiency of resource deployment. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Prognostic Factors Associated with Recovery of Ambulation and Urinary Continence in Dogs with Acute Lumbosacral Spinal Cord Injury.

PubMed

Shaw, T A; De Risio, L; Laws, E J; Rose, J H; Harcourt-Brown, T R; Granger, N

2017-05-01

Limited information is available about prognostic factors for recovery after spinal cord injury (SCI) to the L4-S3 segments. Previous research suggests that L4-S3 SCI does not have a worse prognosis than T3-L3 SCI. To elucidate prognostic factors for regaining urinary continence and ambulation in dogs with L4-S3 SCI and compare prognosis to T3-L3 SCI. A retrospective study on 61 nonambulatory dogs with L4-S3 SCI, matched to dogs with T3-L3 SCI, compared 3 weeks after onset. Prognostic factors explored using logistic regression and used for matching: nonchondrodystrophic dogs >15 kg versus dogs that were chondrodystrophic or <15 kg; compressive versus noncompressive lesions; presence versus absence of conscious pain perception (CPP); and lower vs upper motor neuron (LMN/UMN) incontinence. Fewer L4-S3 dogs regained continence compared to T3-L3 dogs (64 vs 85%, P = .0033), but no difference existed for regaining ambulation (66 vs 75%, P = .1306). In L4-S3 SCI dogs, fewer dogs regained continence with loss of CPP (P < .001), LMN incontinence (P = .004), and noncompressive lesions (P = .006). Negative prognostic factors for regaining ambulation included absent CPP (P < .001) and large nonchondrodystrophic breed (P = .022). Dogs with L4-S3 SCI have a poorer short-term prognosis than do dogs with T3-L3 SCI. Dogs with L4-S3 SCI had a poor prognosis with loss of CPP, or noncompressive lesions combined with LMN incontinence. Small-breed or chondrodystrophic dogs with retained CPP, compressive lesions, and UMN incontinence had an excellent prognosis. These findings may help guide decision-making in L4-S3 SCI. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

PubMed Central

Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.

2016-01-01

Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

Impact of helicopter transport and hospital level on mortality of polytrauma patients.

PubMed

Biewener, Achim; Aschenbrenner, Ulf; Rammelt, Stefan; Grass, René; Zwipp, Hans

2004-01-01

Despite numerous studies analyzing this topic, specific advantages of helicopter transport of blunt polytrauma patients as compared with ground ambulances have not yet been identified unequivocally. Four possible pathways in 403 polytrauma patients (Injury Severity Score [ISS] > 16) who were in reach of the helicopter emergency medical service (HEMS) Dresden were analyzed as follows: HEMS-UNI group (n = 140), transfer by HEMS into a university hospital; AMB-REG group (n = 102), transfer by ground ambulance into a regional (Level II or III) hospital; AMB-UNI group (n = 70), transfer by ground ambulance into the university hospital; and INTER group (n = 91), transfer by ground ambulance into a regional hospital, followed by transfer to the university hospital. Scores used were the ISS and the TRISS. Tests used for statistical analysis included chi2 and Fisher's tests. Statistical significance was set at p > 0.05. Age, gender, and mean ISS (range, 33.3-35.6) revealed extensive homogeneity of the groups. Mortality of the AMB-REG group was almost doubled (41.2%) compared with HEMS-UNI (22.1%) patients (p = 0.002). The AMB-UNI group displayed the lowest mortality (15.7%, p = not significant). TRISS analysis (PRE-Chart) revealed identical outcome for AMB-UNI and HEMS-UNI patients. Rescue time averaged 90 +/- 29 minutes for HEMS-UNI patients, 68 +/- 25 minutes for AMB-UNI patients, and 69 +/- 26 minutes for the AMB-REG group. Primary transfer by HEMS into a Level I trauma center reduces mortality markedly. In principle, this benefit can be attributed to superior preclinical therapy, primary admission to a Level I trauma center, or both. However, the identical probability of survival of the AMB-UNI and HEMS-UNI groups in this and comparable studies does not confirm generally better survival rates on account of a more aggressive on-site approach.

Task-specific gross motor skills training for ambulant school-aged children with cerebral palsy: a systematic review

PubMed Central

Bernie, Charmaine; Harvey, Adrienne R; McGinley, Jennifer L; Spittle, Alicia J

2017-01-01

Objectives The primary objective is to systematically evaluate the evidence for the effectiveness of task-specific training (TST) of gross motor skills for improving activity and/or participation outcomes in ambulant school-aged children with cerebral palsy (CP). The secondary objective is to identify motor learning strategies reported within TST and assess relationship to outcome. Design Systematic review. Method Relevant databases were searched for studies including: children with CP (mean age >4 years and >60% of the sample ambulant); TST targeting gross motor skills and activity (skill performance, gross motor function and functional skills) and/or participation-related outcomes. Quality of included studies was assessed using standardised tools for risk of bias, study design and quality of evidence across outcomes. Continuous data were summarised for each study using standardised mean difference (SMD) and 95% CIs. Results Thirteen studies met inclusion criteria: eight randomised controlled trials (RCTs), three comparative studies, one repeated-measures study and one single-subject design study. Risk of bias was moderate across studies. Components of TST varied and were often poorly reported. Within-group effects of TST were positive across all outcomes of interest in 11 studies. In RCTs, between-group effects were conflicting for skill performance and functional skills, positive for participation-related outcomes (one study: Life-HABITS performance SMD=1.19, 95% CI 0.3 to 2.07, p<0.001; Life-HABITS satisfaction SMD=1.29, 95% CI 0.40 to 2.18, p=0.001), while no difference or negative effects were found for gross motor function. The quality of evidence was low-to-moderate overall. Variability and poor reporting of motor learning strategies limited assessment of relationship to outcome. Conclusions Limited evidence for TST for gross motor skills in ambulant children with CP exists for improving activity and participation-related outcomes and recommendations for use over other interventions are limited by poor study methodology and heterogeneous interventions. Registration PROSPERO ID42016036727 PMID:29637118

Severity of urban cycling injuries and the relationship with personal, trip, route and crash characteristics: analyses using four severity metrics

PubMed Central

Cripton, Peter A; Shen, Hui; Brubacher, Jeff R; Chipman, Mary; Friedman, Steven M; Harris, M Anne; Winters, Meghan; Reynolds, Conor C O; Cusimano, Michael D; Babul, Shelina; Teschke, Kay

2015-01-01

Objective To examine the relationship between cycling injury severity and personal, trip, route and crash characteristics. Methods Data from a previous study of injury risk, conducted in Toronto and Vancouver, Canada, were used to classify injury severity using four metrics: (1) did not continue trip by bike; (2) transported to hospital by ambulance; (3) admitted to hospital; and (4) Canadian Triage and Acuity Scale (CTAS). Multiple logistic regression was used to examine associations with personal, trip, route and crash characteristics. Results Of 683 adults injured while cycling, 528 did not continue their trip by bike, 251 were transported by ambulance and 60 were admitted to hospital for further treatment. Treatment urgencies included 75 as CTAS=1 or 2 (most medically urgent), 284 as CTAS=3, and 320 as CTAS=4 or 5 (least medically urgent). Older age and collision with a motor vehicle were consistently associated with increased severity in all four metrics and statistically significant in three each (both variables with ambulance transport and CTAS; age with hospital admission; and motor vehicle collision with did not continue by bike). Other factors were consistently associated with more severe injuries, but statistically significant in one metric each: downhill grades; higher motor vehicle speeds; sidewalks (these significant for ambulance transport); multiuse paths and local streets (both significant for hospital admission). Conclusions In two of Canada's largest cities, about one-third of the bicycle crashes were collisions with motor vehicles and the resulting injuries were more severe than in other crash circumstances, underscoring the importance of separating cyclists from motor vehicle traffic. Our results also suggest that bicycling injury severity and injury risk would be reduced on facilities that minimise slopes, have lower vehicle speeds, and that are designed for bicycling rather than shared with pedestrians. PMID:25564148

A specialist, second-tier response to out-of-hospital cardiac arrest: setting up TOPCAT2.

PubMed

Clarke, Scott; Lyon, Richard M; Short, Steven; Crookston, Colin; Clegg, Gareth R

2014-05-01

Out-of-hospital cardiac arrest (OHCA) is the most common, immediately life-threatening, medical emergency faced by ambulance crews. Survival from OHCA is largely dependent on quality of prehospital resuscitation. Non-technical skills, including resuscitation team leadership, communication and clinical decision-making are important in providing high quality prehospital resuscitation. We describe a pilot study (TOPCAT2, TC2) to establish a second tier, expert paramedic response to OHCA in Edinburgh, Scotland. Eight paramedics were selected to undergo advanced training in resuscitation and non-technical skills. Simulation and video feedback was used during training. The designated TC2 paramedic manned a regular ambulance service response car and attended emergency calls in the usual manner. Emergency medical dispatch centre dispatchers were instructed to call the TC2 paramedic directly on receipt of a possible OHCA call. Call and dispatch timings, quality of cardiopulmonary resuscitation and return-of-spontaneous circulation were all measured prospectively. Establishing a specialist, second-tier paramedic response was feasible. There was no overall impact on ambulance response times. From the first 40 activations, the TC2 paramedic was activated in a median of 3.2 min (IQR 1.6-5.8) and on-scene in a median of 10.8 min (8.0-17.9). Bimonthly team debrief, case review and training sessions were successfully established. OHCA attended by TC2 showed an additional trend towards improved outcome with a rate of return of spontaneous circulation of 22.5%, compared with a national average of 16%. Establishing a specialist, second-tier response to OHCA is feasible, without impacting on overall ambulance response times. Improving non-technical skills, including prehospital resuscitation team leadership, has the potential to save lives and further research on the impact of the TOPCAT2 pilot programme is warranted. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Ambulance smartphone tool for field triage of ruptured aortic aneurysms (FILTR): study protocol for a prospective observational validation of diagnostic accuracy.

PubMed

Lewis, Thomas L; Fothergill, Rachael T; Karthikesalingam, Alan

2016-10-24

Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre. Prospective multicentre observational study assessing the diagnostic accuracy of a prehospital smartphone triage tool for detection of rAAA. The study will be conducted across London in conjunction with London Ambulance Service (LAS). A logistic score predicting the risk of rAAA by assessing ten key parameters was developed and retrospectively validated through logistic regression analysis of ambulance records and Hospital Episode Statistics data for 2200 patients from 2005 to 2010. The triage tool is integrated into a secure mobile app for major smartphone platforms. Key parameters collected from the app will be retrospectively matched with final hospital discharge diagnosis for each patient encounter. The primary outcome is to assess the sensitivity, specificity and positive predictive value of the rAAA triage tool logistic score in prospective use as a mob app for prehospital ambulance clinicians. Data collection started in November 2014 and the study will recruit a minimum of 1150 non-consecutive patients over a time period of 2 years. Full ethical approval has been gained for this study. The results of this study will be disseminated in peer-reviewed publications, and international/national presentations. CPMS 16459; pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate.

PubMed

Snooks, Helen A; Anthony, Rebecca; Chatters, Robin; Dale, Jeremy; Fothergill, Rachael; Gaze, Sarah; Halter, Mary; Humphreys, Ioan; Koniotou, Marina; Logan, Phillipa; Lyons, Ronan; Mason, Suzanne; Nicholl, Jon; Peconi, Julie; Phillips, Ceri; Phillips, Judith; Porter, Alison; Siriwardena, A Niroshan; Smith, Graham; Toghill, Alun; Wani, Mushtaq; Watkins, Alan; Whitfield, Richard; Wilson, Lynsey; Russell, Ian T

2017-03-01

Emergency calls are frequently made to ambulance services for older people who have fallen, but ambulance crews often leave patients at the scene without any ongoing care. We evaluated a new clinical protocol which allowed paramedics to assess older people who had fallen and, if appropriate, refer them to community-based falls services. To compare outcomes, processes and costs of care between intervention and control groups; and to understand factors which facilitate or hinder use. Cluster randomised controlled trial. Participating paramedics at three ambulance services in England and Wales were based at stations randomised to intervention or control arms. Participants were aged 65 years and over, attended by a study paramedic for a fall-related emergency service call, and resident in the trial catchment areas. Intervention paramedics received a clinical protocol with referral pathway, training and support to change practice. Control paramedics continued practice as normal. The primary outcome comprised subsequent emergency health-care contacts (emergency admissions, emergency department attendances, emergency service calls) or death at 1 month and 6 months. Secondary outcomes included pathway of care, ambulance service operational indicators, self-reported outcomes and costs of care. Those assessing outcomes remained blinded to group allocation. Across sites, 3073 eligible patients attended by 105 paramedics from 14 ambulance stations were randomly allocated to the intervention group, and 2841 eligible patients attended by 110 paramedics from 11 stations were randomly allocated to the control group. After excluding dissenting and unmatched patients, 2391 intervention group patients and 2264 control group patients were included in primary outcome analyses. We did not find an effect on our overall primary outcome at 1 month or 6 months. However, further emergency service calls were reduced at both 1 month and 6 months; a smaller proportion of patients had made further emergency service calls at 1 month (18.5% vs. 21.8%) and the rate per patient-day at risk at 6 months was lower in the intervention group (0.013 vs. 0.017). Rate of conveyance to emergency department at index incident was similar between groups. Eight per cent of trial eligible patients in the intervention arm were referred to falls services by attending paramedics, compared with 1% in the control arm. The proportion of patients left at scene without further care was lower in the intervention group than in the control group (22.6% vs. 30.3%). We found no differences in duration of episode of care or job cycle. No adverse events were reported. Mean cost of the intervention was £17.30 per patient. There were no significant differences in mean resource utilisation, utilities at 1 month or 6 months or quality-adjusted life-years. In total, 58 patients, 25 paramedics and 31 stakeholders participated in focus groups or interviews. Patients were very satisfied with assessments carried out by paramedics. Paramedics reported that the intervention had increased their confidence to leave patients at home, but barriers to referral included patients' social situations and autonomy. Findings indicate that this new pathway may be introduced by ambulance services at modest cost, without risk of harm and with some reductions in further emergency calls. However, we did not find evidence of improved health outcomes or reductions in overall NHS emergency workload. Further research is necessary to understand issues in implementation, the costs and benefits of e-trials and the performance of the modified Falls Efficacy Scale. Current Controlled Trials ISRCTN60481756 and PROSPERO CRD42013006418. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment ; Vol. 21, No. 13. See the NIHR Journals Library website for further project information.

A Detection Device for the Signs of Human Life in Accident

NASA Astrophysics Data System (ADS)

Ning, Li; Ruilan, Zhang; Jian, Liu; Ruirui, Cheng; Yuhong, Diao

2017-12-01

A detection device for the signs of human life in accidents is a device used in emergency situations, such as the crash site. the scene of natural disasters, the battlefield ruins. it designed to detect the life signs of the distress under the injured ambulance vital signs devices. The device can on human vital signs, including pulse, respiration physiological signals to make rapid and accurate response. After some calculations, and after contrast to normal human physiological parameters given warning signals, in order for them to make timely ambulance judgment. In this case the device is required to do gymnastics convenience, ease of movement, power and detection of small flexible easy realization. This device has the maximum protection of the wounded safety significance.

Use of a forensic technique to identify blood contamination of emergency department and ambulance trauma equipment

PubMed Central

Lee, J B; Levy, M; Walker, A

2006-01-01

Using a Kastle‐Meyer (KM) technique, the following equipment from the emergency departments of six UK hospitals (four trusts) and three regional ambulance services was tested for blood contamination: extrication (“spinal”) boards, cervical collars, straps, box splints, head blocks, and headboards. Only equipment ready for patient use was tested. Over half of trauma equipment (57%) tested positive for blood, including 15% of equipment that was visibly stained with blood. There have been no recorded cases of infection from contaminated trauma equipment but our study has identified the potential risk. Disposable covers for boards, disposable straps, and disposable radiolucent head blocks which are currently available provide a solution but have resource implications PMID:16373813

Hemodynamics during an ambulance flight.

PubMed

Ehlers, Ulrike Elisabeth; Seiler, Olivier

2012-01-01

Transportation of patients may present challenges, especially if they need intensive care, require mechanical ventilation, or are hemodynamically unstable. In the reported case study, Picco-based measurements were used to track hemodynamic changes in a patient throughout the duration of a transfer, which included an air ambulance transport. If air medical transport is indicated, several additional physical and chemical considerations require awareness during the trip, planning, and pretransport patient preparation: first, that decreasing atmospheric pressure leads to reduced blood oxygenation, and second, that intracorporeal volume shifts may occur during takeoff and landing. To our knowledge, our findings represent the first measurements with a Picco system during interhospital patient transport that included an air medical flight. Copyright © 2012 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Work-related well-being

PubMed Central

Soh, Melinda; Zarola, Antonio; Palaiou, Kat; Furnham, Adrian

2016-01-01

This study aimed to investigate the different dimensions of well-being (namely, work engagement, job satisfaction, and psychological stress) and possible predictors such as personality and perceived organizational support. A cross-sectional survey design was used, with a sample of 490 ambulance personnel in the United Kingdom. Significant correlations were found between the dimensions of job satisfaction, engagement, and stress. The results also supported a hierarchical model with job satisfaction, stress, and engagement loading onto one higher order factor of work well-being. Emotional stability and perceived organizational support were identified as significant predictors of well-being. The findings suggest the importance of measuring the work-related well-being of ambulance personnel holistically and present perceived organizational support as a possible area for interventions to improve well-being. PMID:28070386

Clinician-Focused Overview of Bionic Exoskeleton Use After Spinal Cord Injury.

PubMed

Palermo, Anne E; Maher, Jennifer L; Baunsgaard, Carsten Bach; Nash, Mark S

2017-01-01

Spinal cord injury (SCI) resulting in paralysis of lower limbs and trunk restricts daily upright activity, work capacity, and ambulation ability, putting persons with an injury at greater risk of developing a myriad of secondary medical issues. Time spent in the upright posture has been shown to decrease the risk of these complications in SCI. Unfortunately, the majority of ambulation assistive technologies are limited by inefficiencies such as high energy demand, lengthy donning and doffing time, and poor gait pattern precluding widespread use. These limitations spurred the development of bionic exoskeletons. These devices are currently being used in rehabilitation settings for gait retraining, and some have been approved for home use. This overview will address the current state of available devices and their utility.

[Postoperative management of patients with BMI > 40 kg / m2].

PubMed

Kaffarnik, M; Utzolino, S

2009-02-01

Bariatric surgery, especially in the morbidly obese, can be associated with serious postoperative problems. Apart from surgical complications requiring reoperation, pre-existing disease can worsen during the postoperative period. Bariatric patients require particular therapeutic approaches such as adapted fluid and pain management, management of obstructive sleep apnoea-hypopnea, early ambulation and measures for preventing pressure ulcers. Another challenging issue is the early identification and management of postoperative intraabdominal sepsis (IAS) before the onset of organ dysfunction. Early and frequent ambulation is thought to reduce risk of pressure ulcers, deep vein thrombosis, resedation, pain, pneumonia and atelectasis. To prevent spine injury of health care workers it is necessary to provide appropriate support with special beds, lifting and transfer devices.

The feasibility of using a portable xenon delivery device to permit earlier xenon ventilation with therapeutic cooling of neonates during ambulance retrieval.

PubMed

Dingley, John; Liu, Xun; Gill, Hannah; Smit, Elisa; Sabir, Hemmen; Tooley, James; Chakkarapani, Ela; Windsor, David; Thoresen, Marianne

2015-06-01

Therapeutic hypothermia is the standard of care after perinatal asphyxia. Preclinical studies show 50% xenon improves outcome, if started early. During a 32-patient study randomized between hypothermia only and hypothermia with xenon, 5 neonates were given xenon during retrieval using a closed-circuit incubator-mounted system. Without xenon availability during retrieval, 50% of eligible infants exceeded the 5-hour treatment window. With the transportable system, 100% were recruited. Xenon delivery lasted 55 to 120 minutes, using 174 mL/h (117.5-193.2) (median [interquartile range]), after circuit priming (1300 mL). Xenon delivery during ambulance retrieval was feasible, reduced starting delays, and used very little gas.

Ambulant photodynamic therapy of superficial malignomas with 5-ALA in combination with folic acid and use of noncoherent light.

PubMed

Jindra, R H; Kubin, A; Kolbabek, H; Alth, G; Dobrowsky, W

1999-01-01

This study reports our first results of ambulant photodynamic treatment with 5-aminolevulinic acid (5-ALA) in combination with folic acid and subsequent illumination with a noncoherent light source. The compound was topically applied to avoid total body skin sensitivity which occurs in the case of systemic administration. If no therapeutic response could be proved, we added folic acid to 5-ALA for a further treatment attempt. Illumination was performed by broad band red thermic light to also excitate reaction products with absorption bands located near to that of the sensitizer. As a result, we observed a response in all cases, however, in some cases only after the addition of folic acid.

Cardiac arrest at high elevation with a favorable outcome.

PubMed

Yanagawa, Youichi; Omori, Kazuhiko; Takeuchi, Ikuto; Jitsuiki, Kei; Yoshizawa, Toshihiko; Ishikawa, Kouhei; Kando, Yumi; Fukata, Mutsumu; Ohsaka, Hiromichi

2017-04-01

A 36-year-old man started to climb Mount Fuji (3776m above sea level: ASL), from the Gotemba new fifth station (2400m ASL). He had no significant medical history, and this was his first attempt to climb such a high mountain. He began feeling chest discomfort but continued to climb. When he reached the ninth station of the mountain (3600mASL), he lost consciousness. One individual immediately provided basic life support using an automated external defibrillator (AED) that was located in the station. After electroshocks, he regained consciousness. He was transported to the fifth station, where an ambulance could approach, in a large crawler. When the medical staff, who were transported via helicopter and ambulance, examined him near the fifth station, he still complained of chest discomfort. A single spray of nitroglycerin and aspirin (200mg) was administered. He was transported to the Cardiac Care Unit via ambulance and helicopter under escort by a physician. A chest computed tomography angiogram indicated triple-vessel disease. He was discharged without any neurological deficits after undergoing bypass surgery. In high mountains that can be easily accessed by amateur climbers who may have cardiac disease, the placement of AED devices and the establishment of the chain of survival from the scene to the intensive care unit are essential for obtaining a favorable outcome when a climber suffers cardiac arrest. Copyright © 2016 Elsevier Inc. All rights reserved.

Evaluation of a training program for persons with SCI paraplegia using the Parastep 1 ambulation system: part 4. Effect on physical self-concept and depression.

PubMed

Guest, R S; Klose, K J; Needham-Shropshire, B M; Jacobs, P L

1997-08-01

To determine whether persons with spinal cord injury (SCI) paraplegia who participated in an electrical stimulation walking program experienced changes in measures of physical self-concept and depression. Before-after trial. Human SCI applied research laboratory. Volunteer sample of 12 men and 3 women with SCI paraplegia, mean age 28.75 +/- 6.6yrs and mean duration of injury 3.8 +/- 3.2yrs. Thirty-two FNS ambulation training sessions using a commercially available system (Parastep 1). The hybrid system consists of a microprocessor-controlled stimulator and a modified walking frame with finger-operated switches that permit the user to control the stimulation parameters and activate the stepping. The Tennessee Self-Concept Scale (TSCS) and the Beck Depression Inventory (BDI) were administered before and after training. Only the Physical Self subscale of the TSCS was analyzed. After training, individual interviews were performed to assess participants' subjective reactions to the training program. A repeated measures analysis of variance indicated that desired directional and statistically significant changes occurred on the Physical Self subscale of the TSCS (F(1,14) = 8.54, p < .011) and on the BDI (F(1,14) = 5.42, p < .035). Subsequent to the ambulation training program there were statistically significant increases in physical self-concept scores and decreases in depression scores.

Locomotor-respiratory coupling during axillary crutch ambulation.

PubMed

Hurst, C A; Kirby, R L; MacLeod, D A

2001-11-01

To test the hypotheses that locomotor-respiratory coupling occurs in humans using axillary crutches in a swing-through ambulation pattern and that expiration occurs during crutch-stance phase during locomotor-respiratory coupling. Eighteen able-bodied persons were trained in one-footed swing-through gait with axillary crutches. Then, as subjects walked at "somewhat hard" speeds (Borg) on a motorized treadmill for 5 min, we recorded signals from a crutch pressure switch and a mouthpiece-mounted thermocouple. Coupling was defined as being present when the onset of inspiration varied by < or = 5% with respect to the onset of the crutch gait cycle for a minimum of 10 consecutive gait cycles and when there was no drift on a raster plot of the respiratory phases relative to the onset of the gait cycle. Ten (56%) of the 18 subjects exhibited locomotor-respiratory coupling on 1-4 occasions each, with episodes lasting 11.3-148 sec. In 17 (89%) of the 19 episodes of 1:1 locomotor-respiratory coupling, expiration occurred during the crutch-stance phase of the gait cycle and inspiration occurred during crutch swing. Transient 1:1 locomotor-respiratory coupling occurs in many able-bodied subjects ambulating with axillary crutches and a swing-through gait. Expiration is most often associated with the crutch-stance phase of the gait cycle. This study may have implications for training axillary crutch users.

Differentiating frailty in older people using the Swedish ambulance service: a retrospective audit.

PubMed

Vicente, Veronica; Ekebergh, Margaretha; Castren, Maaret; Sjöstrand, Fredrik; Svensson, Leif; Sundström, Birgitta Wireklint

2012-10-01

The elderly population in Sweden is increasing. This will lead to an increased need for healthcare resources and put extra demands on healthcare professionals. Consequently, ambulance personnel will be faced with the challenge of meeting extra demands from increasing numbers of older people with complex and atypical clinical presentations. Therefore we highlight that great problems exist for ambulance personnel to understand and meet these patients' care needs. Using a caring science approach, we apply the patient's perspective, and the aim of this study is to identify and illuminate the conditions that affect elderly people assessed with the assessment category "general affected health condition". Thus, we have analyzed the characteristics belonging to this specific condition. The method is a retrospective audit, involving a qualitative content analysis of a total of 88 emergency service records. The conclusion is that by using caring science, the concept of frailty which is based on a comprehensive understanding of human life can clarify the state of "general affected health condition", as either illness or ill-health. This offers a new assessment category and outlines care and treatment that strengthen and support the health and wellbeing of the individual elderly person. Furthermore, the concept of frailty ought to be included in "The International Statistical Classification of Diseases and Related Health Problems" (ICD-10). Copyright © 2011 Elsevier Ltd. All rights reserved.

A model of survival following pre-hospital cardiac arrest based on the Victorian Ambulance Cardiac Arrest Register.

PubMed

Fridman, Masha; Barnes, Vanessa; Whyman, Andrew; Currell, Alex; Bernard, Stephen; Walker, Tony; Smith, Karen L

2007-11-01

This study describes the epidemiology of sudden cardiac arrest patients in Victoria, Australia, as captured via the Victorian Ambulance Cardiac Arrest Register (VACAR). We used the VACAR data to construct a new model of out-of-hospital cardiac arrest (OHCA), which was specified in accordance with observed trends. All cases of cardiac arrest in Victoria that were attended by Victorian ambulance services during the period of 2002-2005. Overall survival to hospital discharge was 3.8% among 18,827 cases of OHCA. Survival was 15.7% among 1726 bystander witnessed, adult cardiac arrests of presumed cardiac aetiology, presenting in ventricular fibrillation or ventricular tachycardia (VF/VT), where resuscitation was attempted. In multivariate logistic regression analysis, bystander CPR, cardiac arrest (CA) location, response time, age and sex were predictors of VF/VT, which, in turn, was a strong predictor of survival. The same factors that affected VF/VT made an additional contribution to survival. However, for bystander CPR, CA location and response time this additional contribution was limited to VF/VT patients only. There was no detectable association between survival and age younger than 60 years or response time over 15min. The new model accounts for relationships among predictors of survival. These relationships indicate that interventions such as reduced response times and bystander CPR act in multiple ways to improve survival.

Outcome of patients identified as dead (beyond resuscitation) at the point of the emergency call.

PubMed

Harvey, L; Woollard, M

2004-05-01

Currently, an emergency ambulance is dispatched to all cardiac arrest victims. This study aimed to determine the outcome of patients with a dispatch code of 09B01 ("obvious death") and considers the appropriateness of dispatching a non-emergency response. Dispatch records, patient report forms, and hospital records were reviewed to determine patient outcome. Within the one year study period 141 emergency calls were coded as 09B01. Records were obtained for 59 of these cases (42%). Ambulance crews diagnosed 54 as beyond resuscitation (91.5%, 95% CI 79.5% to 96.2%). Three received resuscitation attempts (5.1%, 95% CI 1.1% to 14.2%): two were subsequently pronounced dead at scene and one on arrival at hospital. Two patients were not in cardiac arrest (3.4%, 95% CI 0.4% to 11.7%): one was a transiently unconscious assault victim, and one had a hand injury after a road accident. Three patients coded as 09B01 were transported to hospital for treatment other than confirmation of death (5.1%, 95% CI 1.1% to 14.2%). Not all patients coded 09B01 by dispatchers are assessed as "dead beyond resuscitation" by attending ambulance crews. Although poor data recovery and a small sample size limited the study, its findings suggest that it is inappropriate to allocate a non-emergency response to 09B01 (obvious death) calls.

Online adaptive neural control of a robotic lower limb prosthesis

NASA Astrophysics Data System (ADS)

Spanias, J. A.; Simon, A. M.; Finucane, S. B.; Perreault, E. J.; Hargrove, L. J.

2018-02-01

Objective. The purpose of this study was to develop and evaluate an adaptive intent recognition algorithm that continuously learns to incorporate a lower limb amputee’s neural information (acquired via electromyography (EMG)) as they ambulate with a robotic leg prosthesis. Approach. We present a powered lower limb prosthesis that was configured to acquire the user’s neural information and kinetic/kinematic information from embedded mechanical sensors, and identify and respond to the user’s intent. We conducted an experiment with eight transfemoral amputees over multiple days. EMG and mechanical sensor data were collected while subjects using a powered knee/ankle prosthesis completed various ambulation activities such as walking on level ground, stairs, and ramps. Our adaptive intent recognition algorithm automatically transitioned the prosthesis into the different locomotion modes and continuously updated the user’s model of neural data during ambulation. Main results. Our proposed algorithm accurately and consistently identified the user’s intent over multiple days, despite changing neural signals. The algorithm incorporated 96.31% [0.91%] (mean, [standard error]) of neural information across multiple experimental sessions, and outperformed non-adaptive versions of our algorithm—with a 6.66% [3.16%] relative decrease in error rate. Significance. This study demonstrates that our adaptive intent recognition algorithm enables incorporation of neural information over long periods of use, allowing assistive robotic devices to accurately respond to the user’s intent with low error rates.

[Nurses and social care workers in emergency teams in Norway].

PubMed

Hilpüsch, Frank; Parschat, Petra; Fenes, Sissel; Aaraas, Ivar J; Gilbert, Mads

2011-01-07

The Norwegian counties Troms and Finnmark are dominated by large areas with widespread habitation and rather long response times for ambulances and doctors. We wished to investigate the extent to which the municipal preparedness in these counties use employees from the municipal nursing and social care services and if these are part of local emergency teams. In the autumn of 2008, we sent a questionnaire to the district medical officers and the leaders for municipal nursing and social care services in all 44 municipalities in Troms and Finnmark. The answers were analyzed manually. 41 municipalities responded. In 34 of these the municipal nurses and social care workers practice emergency medicine procedures. The content in these training sessions is much more comprehensive than that in a typical first aid course. In three of four municipalities ambulance personnel do not participate in this training. In 31 municipalities the inhabitants contact nurses and social care workers directly if they are acutely ill. In only 10 of the municipalities the nurses and social care workers are organized in local teams including a doctor and an ambulance. In the districts, nursing and social care services are a resource in an emergency medicine context. The potential within these professions can be exploited better and be an important supplement in emergencies. In emergencies, cooperation across disciplines requires a clear organizational and economical structure, local basis and leadership.

Lack of relation between drug-seeking behavior in an addiction model and the expression of behavioral sensitization in response to ethanol challenge in mice.

PubMed

Ribeiro, A F; Pigatto, G; Goeldner, F O; Lopes, J F; de Lacerda, R B

2008-01-01

Drug-induced sensitization has been associated with enhanced self-administration and may contribute to addiction. The possible association between sensitization and voluntary ethanol consumption using an addiction model was investigated. Mice (n = 60) were individually housed with ad libitum access to food and had free choice between ethanol (5% and 10%) and water in a four-phase paradigm: free choice (12 weeks), withdrawal (2 weeks), re-exposure (2 weeks), and quinine-adulteration (2 weeks). Control mice (n = 10) had access to water. Mice were characterized as addicted (n = 10, ethanol preference without reducing intake with adulterated ethanol), heavy (n = 22, ethanol preference but reduced intake with adulterated ethanol), and light (n = 21, water preference). Oral ethanol then was withdrawn, and 24 h later mice received a 2 g/kg ethanol (i.p.) challenge dose or saline, and ambulation was evaluated 10 min later. Half of the classified mice received daily 2 g/kg ethanol injections for 14 days, and ambulation was assessed 10 min after the last dose. Acute ethanol increased ambulation in all groups compared to the control group, and chronic ethanol induced sensitization, showing no difference among ethanol-treated mice. The data suggest that independent neural mechanisms are responsible for the development of addiction and sensitization.

Priming With 1-Hz Repetitive Transcranial Magnetic Stimulation Over Contralesional Leg Motor Cortex Does Not Increase the Rate of Regaining Ambulation Within 3 Months of Stroke: A Randomized Controlled Trial.

PubMed

Huang, Ying-Zu; Lin, Li-Fong; Chang, Kwang-Hwa; Hu, Chaur-Jong; Liou, Tsan-Hon; Lin, Yen-Nung

2018-05-01

The potential benefits of repetitive transcranial magnetic stimulation (rTMS), applied either alone or as a combination treatment, on recovery of lower limbs after stroke have been insufficiently studied. The aim of the study was to evaluate the effect of priming with 1-Hz repetitive transcranial magnetic stimulation over contralesional leg motor area with a double-cone coil before physical therapy on regaining ambulation. Thirty-eight subacute stroke patients with significant leg disabilities were randomly assigned into the experimental group or control group to receive a 15-min real or sham 1-Hz repetitive transcranial magnetic stimulation, respectively, over the contralesional motor cortex representing the quadriceps muscle followed by 45-min physical therapy for 15 sessions for 3 wks. Functional measures, motor evoked potentials, and quality of life were assessed. There was no significant difference between experimental group and control group regarding the recovery in ambulation, balance, motor functions, and activity of daily living. No significant difference was found in other functional measures and the quality of life. Only the control group displayed significantly increased cortical excitability of the contralesional hemisphere after the intervention. The present study found that insufficient evidence that contralesional priming with 1-Hz repetitive transcranial magnetic stimulation improves ambulatory and other motor functions among patients with a severe leg dysfunction in subacute stroke.

Dissociation of frontal-midline delta-theta and posterior alpha oscillations: A mobile EEG study.

PubMed

Liang, Mingli; Starrett, Michael J; Ekstrom, Arne D

2018-04-22

Numerous reports have demonstrated low-frequency oscillations during navigation using invasive recordings in the hippocampus of both rats and human patients. Given evidence, in some cases, of low-frequency synchronization between midline cortex and hippocampus, it is also possible that low-frequency movement-related oscillations manifest in healthy human neocortex. However, this possibility remains largely unexplored, in part due to the difficulties of coupling free ambulation and effective scalp EEG recordings. In the current study, participants freely ambulated on an omnidirectional treadmill and explored an immersive virtual reality city rendered on a head-mounted display while undergoing simultaneous wireless scalp EEG recordings. We found that frontal-midline (FM) delta-theta (2-7.21 Hz) oscillations increased during movement compared to standing still periods, consistent with a role in navigation. In contrast, posterior alpha (8.32-12.76 Hz) oscillations were suppressed in the presence of visual input, independent of movement. Our findings suggest that FM delta-theta and posterior alpha oscillations arise at independent frequencies, under complementary behavioral conditions, and, at least for FM delta-theta oscillations, at independent recordings sites. Together, our findings support a double dissociation between movement-related FM delta-theta and resting-related posterior alpha oscillations. Our study thus provides novel evidence that FM delta-theta oscillations arise, in part, from real-world ambulation, and are functionally independent from posterior alpha oscillations. © 2018 Society for Psychophysiological Research.

[Baron Dominique-Jean Larrey: the founder of urological traumatology].

PubMed

Hatzinger, M; Ameijenda, C; Lent, V; Sohn, M

2012-12-01

Dominique-Jean Larrey (1766-1842) was Surgeon-in-Chief of the Grande Army under Napoleon Bonaparte (1769-1821) and personal physician of the Emperor. Against the opposition of the traditionalists he introduced the "ambulances volantes", the so-called flying ambulances. The aim was the medical treatment of the injured soldiers immediately on the battlefield. This revolutionary treatment led to a benefit not only for the own soldiers, but also for the wounded enemies. His innovation in the field of immediate assistance of wounded persons, together with Larreys' outstanding medical competence, saved thousands of soldiers lives on the battlefield of the Napoleonic wars. His memories concerning the military campaigns, have been even up to the 20th century one of the standard works of modern military surgery. He had as well great interest in urolological injuries of the urinary system and their conservative and operative care. Up to these days, his work shows a surprising actuality and perfect anatomic understanding. In a time without anaesthetics, antibiotics and under primitive circumstances, Larrey and his collegues accomplished surgical feats. Larreys flying ambulances were copied by many different countries. The American Mobile Army Surgical Hospital (M.A.S.H) is clearly based on his thoughts and ideals. In our opinion he is the father of the modern war surgery as well the urological traumatology. Georg Thieme Verlag KG Stuttgart · New York.

Use of ambulance dispatch data as an early warning system for communitywide influenzalike illness, New York City.

PubMed

Mostashari, Farzad; Fine, Annie; Das, Debjani; Adams, John; Layton, Marcelle

2003-06-01

In 1998, the New York City Department of Health and the Mayor's Office of Emergency Management began monitoring the volume of ambulance dispatch calls as a surveillance tool for biologic terrorism. We adapted statistical techniques designed to measure excess influenza mortality and applied them to outbreak detection using ambulance dispatch data. Since 1999, we have been performing serial daily regressions to determine the alarm threshold for the current day. In this article, we evaluate this approach by simulating a series of 2,200 daily regressions. In the influenza detection implementation of this model, there were 71 (3.2%) alarms at the 99% level. Of these alarms, 64 (90%) occurred shortly before or during a period of peak influenza in each of six influenza seasons. In the bioterrorism detection implementation of this methodology, after accounting for current influenza activity, there were 24 (1.1%) alarms at the 99% level. Two occurred during a large snowstorm, 1 is unexplained, and 21 occurred shortly before or during a period of peak influenza activity in each of six influenza seasons. Our findings suggest that this surveillance system is sensitive to communitywide respiratory outbreaks with relatively few false alarms. More work needs to be done to evaluate the sensitivity of this approach for detecting nonrespiratory illness and more localized outbreaks.

Criteria-based audit to improve a district referral system in Malawi: a pilot study.

PubMed

Kongnyuy, Eugene J; Mlava, Grace; van den Broek, Nynke

2008-09-22

To study the feasibility of using criteria-based audit to improve a district referral system. A criteria-based audit was used to assess the Salima District referral system in Malawi. A retrospective review of 60 obstetric emergencies referred from 12 health centres was conducted and compared with prior established standards for optimal referral of emergencies. Recommendations were made and implemented. Three months later, a re-audit was conducted (62 cases). There were significant improvements in 4 out of 7 standards: adequate resuscitation before referral (33.3% vs 88.7%; p = 0.001); delay of less than 2 hours from the time the ambulance is called to when the ambulance brought the patient to the hospital (42.8% vs 88.3%; p = 0.014); clinician attends to patient within 30 minutes of arrival to hospital (30.8% vs 92.6%; p = 0.001) and feedback given to the referring health centres (1.7% vs 91.9%; p <0.001). The rest of the three standards showed a high level of attainment (>95%) in both the initial audit and the re-audit: referred patients accompanied by a referral form; ambulances are available at all times and the district hospital is informed through short-wave radio by the health centre when a patient is referred. Criteria-based audit can improve the ability of a district referral system to handle obstetric emergencies in countries with limited resources.

Pharmacokinetics and safety of single doses of drisapersen in non-ambulant subjects with Duchenne muscular dystrophy: Results of a double-blind randomized clinical trial

PubMed Central

Flanigan, Kevin M.; Voit, Thomas; Rosales, Xiomara Q.; Servais, Laurent; Kraus, John E.; Wardell, Claire; Morgan, Allison; Dorricott, Susie; Nakielny, Joanna; Quarcoo, Naashika; Liefaard, Lia; Drury, Tom; Campion, Giles; Wright, Padraig

2014-01-01

Duchenne muscular dystrophy (DMD) is a progressive, lethal neuromuscular disorder caused by the absence of dystrophin protein due to mutations of the dystrophin gene. Drisapersen is a 2′-O-methyl-phosphorothioate oligonucleotide designed to skip exon 51 in dystrophin pre-mRNA to restore the reading frame of the mRNA. This study assessed safety, tolerability, and pharmacokinetics of drisapersen after a single subcutaneous administration in non-ambulatory subjects. Eligible subjects were non-ambulant boys aged ≥9 years, in wheelchairs for ≥1 to ≤4 years, with a diagnosis of DMD resulting from a mutation correctable by drisapersen treatment. Four dose cohorts were planned (3, 6, 9 and 12 mg/kg), but study objectives were met with the 9 mg/kg dose. Less than proportional increase in exposure was demonstrated over the 3–9 mg/kg dose range, though post hoc analysis showed dose proportionality was more feasible over the 3–6 mg/kg range. Single doses of drisapersen at 3 and 6 mg/kg did not result in significant safety or tolerability concerns; however, at the 9 mg/kg dose, pyrexia and transient elevations in inflammatory parameters were seen. The maximum tolerated dose of 6 mg/kg drisapersen was identified for further characterization in multiple dose studies in the non-ambulant DMD population. PMID:24321374

An Assessment of Psychological Need in Emergency Medical Staff in the Northern Health and Social Care Trust Area.

PubMed

Aisling, McAleese; Aisling, Diamond; David, Curran

2016-05-01

Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107). The General Health Questionnaire (GHQ-12, Goldberg, 1972, 1978), Secondary Traumatic Stress Scale (STSS, Bride, 2004) and an assessment of need questionnaire were completed and explored using mixed method analysis. Results showed elevated levels of psychological distress within each profession except ambulance service clinical support officers (CSOs). Elevated levels of secondary trauma symptomatology were also found; the highest were within some nursing grades and junior doctors. Decreased enjoyment in job over time was significantly associated with higher scores. Analysis of qualitative data identified sources of stress to include low morale. A total of 65% of participants thought that work related stressors had negatively affected their mental health. Participants explored what they felt could decrease psychological distress including improved resources and psychoeducation. There were elevated levels of distress and secondary traumatic stress within this population as well as an expressed level of need, on both systemic and support levels.

40 CFR 202.12 - Applicability.

Code of Federal Regulations, 2013 CFR

2013-07-01

... operating under such conditions, including the sound produced by auxiliary equipment mounted on such motor... such as fire engines, ambulances, police vans, and rescue vans, when responding to emergency calls; or...

40 CFR 202.12 - Applicability.

Code of Federal Regulations, 2012 CFR

2012-07-01

... operating under such conditions, including the sound produced by auxiliary equipment mounted on such motor... such as fire engines, ambulances, police vans, and rescue vans, when responding to emergency calls; or...

40 CFR 202.12 - Applicability.

Code of Federal Regulations, 2014 CFR

2014-07-01

... operating under such conditions, including the sound produced by auxiliary equipment mounted on such motor... such as fire engines, ambulances, police vans, and rescue vans, when responding to emergency calls; or...

40 CFR 202.12 - Applicability.

Code of Federal Regulations, 2011 CFR

2011-07-01

... operating under such conditions, including the sound produced by auxiliary equipment mounted on such motor... such as fire engines, ambulances, police vans, and rescue vans, when responding to emergency calls; or...

Isochrones as Indicators of the Influence of Traffic in Public Health: A Visual Simulation Application in Ávila, Spain

PubMed Central

Otamendi, F. Javier; García-Heredia, David

2015-01-01

It is well known that excessive rescue times after traffic accidents negatively affect the health of those injured. There is a need to quantitatively measure the impact of unexpected events like ambulance availability, weather, floating population and congestion in those rescue times. A family of indicators based on isochrones is disguised and proposed to understand the risk of the whole population as the probability of not being assisted on time. Indicators of health risk for local towns are also defined. The indicators are calculated using a simulation model and visualized in web format. The framework of analysis is validated using Ávila (Spain) and the problem of the optimal deployment of ambulances as a test-bench. PMID:26473894

Hazards of air travel for the obese: Miss Pickwick and the Boeing 747.

PubMed

Toff, N J

1993-10-01

A morbidity obese woman took a touring holiday which included two long flights and a stay at altitude. At the end of the second week of her holiday she was admitted to hospital in respiratory and cardiac failure. When she was better she travelled home by a combination of air ambulance and scheduled flights with a medical escort. This extreme case illustrates some of the physiological and physical challenges of air travel to the obese passenger, which may precipitate respiratory and cardiac decompensation in susceptible individuals. When advising these patients, consultation with the airline medical department is recommended, and preflight testing by altitude simulation may be helpful. If medical transport is required, there may be particular problems in lifting and accommodating these patients on board normal air ambulance aircraft.

Association between ambulance diversion and survival among patients with acute myocardial infarction.

PubMed

Shen, Yu-Chu; Hsia, Renee Y

2011-06-15

Ambulance diversion, a practice in which emergency departments (EDs) are temporarily closed to ambulance traffic, might be problematic for patients experiencing time-sensitive conditions, such as acute myocardial infarction (AMI). However, there is little empirical evidence to show whether diversion is associated with worse patient outcomes. To analyze whether temporary ED closure on the day a patient experiences AMI, as measured by ambulance diversion hours of the nearest ED, is associated with increased mortality rates among patients with AMI. DESIGN, STUDY, AND PARTICIPANTS: A case-crossover design of 13,860 Medicare patients with AMI from 508 zip codes within 4 California counties (Los Angeles, San Francisco, San Mateo, and Santa Clara) whose admission date was between 2000 and 2005. Data included 100% Medicare claims data that covered admissions between 2000 and 2005, linked with date of death until 2006, and daily ambulance diversion logs from the same 4 counties. Among the hospital universe, 149 EDs were identified as the nearest ED to these patients. The percentage of patients with AMI who died within 7 days, 30 days, 90 days, 9 months, and 1 year from admission (when their nearest ED was not on diversion and when that same ED was exposed to <6, 6 to <12, and ≥12 hours of diversion out of 24 hours on the day of admission). Between 2000 and 2006, the mean (SD) daily diversion duration was 7.9 (6.1) hours. Based on analysis of 11,625 patients admitted to the ED between 2000 and 2005, and whose nearest ED had at least 3 diversion exposure levels (3541, 3357, 2667, and 2060 patients for no exposure, exposure to <6, 6 to <12, and ≥12 hours of diversion, respectively), there were no statistically significant differences in mortality rates between no diversion and exposure to less than 12 hours of diversion. Exposure to 12 or more hours of diversion was associated with higher 30-day mortality vs no diversion status (unadjusted mortality rate, 392 patients [19%] vs 545 patients [15%]; regression adjusted difference, 3.24 percentage points; 95% confidence interval [CI], 0.60-5.88); higher 90-day mortality (537 patients [26%] vs 762 patients [22%]; 2.89 percentage points; 95% CI, 0.13-5.64); higher 9-month mortality (680 patients [33%] vs 980 patients [28%]; 2.93 percentage points; 95% CI, 0.15-5.71); and higher 1-year mortality (731 patients [35%] vs 1034 patients [29%]; 3.04 percentage points; 95% CI, 0.33-5.75). Among Medicare patients with AMI in 4 populous California counties, exposure to at least 12 hours of diversion by the nearest ED was associated with increased 30-day, 90-day, 9-month, and 1-year mortality.

Air Ambulance Services Clarification Act

THOMAS, 112th Congress

Sen. Snowe, Olympia J. [R-ME

2012-04-26

Senate - 04/26/2012 Read twice and referred to the Committee on Commerce, Science, and Transportation. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury.

PubMed

Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Abe, Tetsuya; Ueno, Tomoyuki; Soma, Yuichiro; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

2017-01-01

Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20-67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60-90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI.

Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

PubMed Central

Shimizu, Yukiyo; Kadone, Hideki; Kubota, Shigeki; Suzuki, Kenji; Abe, Tetsuya; Ueno, Tomoyuki; Soma, Yuichiro; Sankai, Yoshiyuki; Hada, Yasushi; Yamazaki, Masashi

2017-01-01

Patients with complete paraplegia after spinal cord injury (SCI) are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL) in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman) were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67) years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS) grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG) was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad) in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs) score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention. These findings suggest that upper-limb-triggered HAL ambulation is a safe and feasible option for rehabilitation in patients with complete quadri/paraplegia caused by chronic SCI. PMID:29209163

The role of general practitioners in the pre hospital setting, as experienced by emergency medicine technicians: a qualitative study

PubMed Central

2014-01-01

Background Together with the ambulances staffed with emergency medical technicians (EMTs), general practitioners (GPs) on call are the primary resources for handling emergencies outside hospitals in Norway. The benefit of the GP accompanying the ambulance to pre-hospital calls is a matter of controversy in Norway. The purpose of the present study was to gain better insight into the EMT’s experiences with the role of the GPs in the care for critically ill patients in the pre-hospital setting. Methods We conducted four focus group interviews with EMTs at four different ambulance stations in Norway. Three of the stations were located at least 2 hours driving distance from the nearest hospital. The interviews were transcribed and analyzed using systematic text condensation. Results The EMTs described increasing confidence in emergency medicine during the last few years. However, they felt the need for GP participation in the ambulance when responding to a critically ill patient. The presence of GPs made the EMTs feel more confident, especially in unclear and difficult cases that did not fit into EMT guidelines. The main contributions of the GPs were described as diagnosis and decision-making. Bringing the physician to the patient shortened transportation time to the hospital and important medication could be started earlier. Several examples of sub-optimal treatment in the absence of the GP were given. The EMTs described discomfort with GPs not responding to the calls. They also experienced GPs responding to calls that did not function in the pre-hospital emergency setting. The EMTs reported a need for professional requirements for GPs taking part in out-of-hours work and mandatory interdisciplinary training on a regular basis. Conclusions EMTs want GPs to be present in challenging pre-hospital emergency settings. The presence of GPs is perceived as improving patient care. However, professional requirements are needed for GPs taking part in out-of-hours work, and the informants suggested a formalized area for training between EMTs and GPs on call. PMID:25145390

16 CFR 1101.32 - Reasonable steps to assure information is accurate.

Code of Federal Regulations, 2012 CFR

2012-01-01

..., an electrical engineer, or an attending physician) conducts an investigation or an inspection which... fire marshal, a fire investigator, an electrical engineer, an ambulance attendant, or an attending...

16 CFR 1101.32 - Reasonable steps to assure information is accurate.

Code of Federal Regulations, 2011 CFR

2011-01-01

..., an electrical engineer, or an attending physician) conducts an investigation or an inspection which... fire marshal, a fire investigator, an electrical engineer, an ambulance attendant, or an attending...

16 CFR 1101.32 - Reasonable steps to assure information is accurate.

Code of Federal Regulations, 2014 CFR

2014-01-01

..., an electrical engineer, or an attending physician) conducts an investigation or an inspection which... fire marshal, a fire investigator, an electrical engineer, an ambulance attendant, or an attending...

16 CFR 1101.32 - Reasonable steps to assure information is accurate.

Code of Federal Regulations, 2010 CFR

2010-01-01

..., an electrical engineer, or an attending physician) conducts an investigation or an inspection which... fire marshal, a fire investigator, an electrical engineer, an ambulance attendant, or an attending...

21 CFR 880.6910 - Wheeled stretcher.

Code of Federal Regulations, 2010 CFR

2010-04-01

... platform mounted on a wheeled frame that is designed to transport patients in a horizontal position. The... frame may be fixed or collapsible for use in an ambulance. (b) Classification. Class II (special...

A Myoelectric Hand Splint

ERIC Educational Resources Information Center

Silverstein, Frances; And Others

1974-01-01

Development of a myoelectrically controlled hand splint permitting ambulating mobility of the user is discussed. The role of occupational therapy in the research and design of the device and the training of the patient are emphasized. (Authors)

16 CFR § 1101.32 - Reasonable steps to assure information is accurate.

Code of Federal Regulations, 2013 CFR

2013-01-01

..., an electrical engineer, or an attending physician) conducts an investigation or an inspection which... fire marshal, a fire investigator, an electrical engineer, an ambulance attendant, or an attending...

Real-Time Human Ambulation, Activity, and Physiological Monitoring: Taxonomy of Issues, Techniques, Applications, Challenges and Limitations

PubMed Central

Khusainov, Rinat; Azzi, Djamel; Achumba, Ifeyinwa E.; Bersch, Sebastian D.

2013-01-01

Automated methods of real-time, unobtrusive, human ambulation, activity, and wellness monitoring and data analysis using various algorithmic techniques have been subjects of intense research. The general aim is to devise effective means of addressing the demands of assisted living, rehabilitation, and clinical observation and assessment through sensor-based monitoring. The research studies have resulted in a large amount of literature. This paper presents a holistic articulation of the research studies and offers comprehensive insights along four main axes: distribution of existing studies; monitoring device framework and sensor types; data collection, processing and analysis; and applications, limitations and challenges. The aim is to present a systematic and most complete study of literature in the area in order to identify research gaps and prioritize future research directions. PMID:24072027

Using a business rule management system to improve disposition of traumatized patients.

PubMed

Neuhaus, Philipp; Noack, Oliver; Majchrzak, Tim; Uckert, Frank

2010-01-01

We propose a business rule management system that is used to optimize the dispatchment on a mass casualty incident. Using geospatial information from available ambulances and rescue helicopters, a business rule engine calculates an optimized transportation plan for injured persons. It automatically considers special needs like ambulances equipped for baby transportation or special decontamination equipment, e.g. to deal with an accident in a chemical factory. The rules used in the system are not hardcoded; thus, it is possible to redefine them on the fly without changing the program's source code. It is possible to load and save a rule set in case of a catastrophe. Furthermore, it is possible to automatically recalculate an already planned operation if it becomes clear that the rescue vehicles assigned are needed by a person with life-threatening injuries.

The breakdown of an emergency system following a gas explosion in Osaka and the subsequent resolution of problems.

PubMed

Ishida, T; Ohta, M; Sugimoto, T

1985-01-01

Osaka, a modern urban metropolis in Japan, experienced a tragic gas explosion in 1970 when the dispatch room of the City Fire Department was in the process of being moved to a new building. Many unforseen problems arose during this disaster: eg, there was an overall lack of leadership, confusion of communication, a need for triage, and lack of control of mass media. The Osaka Medical Association organized a committee to resolve these problems. Their conclusions and recommendations were that a control headquarters be established at the scene of disaster, the number of ambulances and EMTs be increased, disaster tags be utilized, a special radio frequency be created, and a computer-aided command and control system for fire fighting and ambulance services be introduced. These recommendations have all been followed.

Occupational accidents among ambulance drivers in the emergency relief.

PubMed

Takeda, Elisabete; do Carmo Cruz Robazzi, Maria Lúcia

2007-01-01

We analyzed the occurrence of occupational accidents (OA) among ambulance drivers in Emergency Relief (ER), with a view to disclosing the types of events and their causes. A quantitative-qualitative study was carried out through the interview of 22 workers in a city in São Paulo, Brazil. The subjects were male, between 36 and 40 years old (40.9%), married (81.82%), with uncompleted primary education (40.9%), individual (90.9%) and family (54.55%) income between two and four Brazilian minimum wages, not performing any other paid occupation (45.45%). The majority of the OA were typical, due to an excess of exercises and vigorous and repeated movements (42.11%) and aggression through body strength and other means (26.33%). The OA occurs mainly because drivers carry out tasks that do not suit their professional formation.

Comparison of nonmicroprocessor knee mechanism versus C-Leg on Prosthesis Evaluation Questionnaire, stumbles, falls, walking tests, stair descent, and knee preference.

PubMed

Kahle, Jason T; Highsmith, M Jason; Hubbard, Sandra L

2008-01-01

This study compared subjects' performance with a nonmicroprocessor knee mechanism (NMKM) versus a C-Leg on nine clinically repeatable evaluative measures. We recorded data on subjects' performance while they used an accommodated NMKM and, following a 90-day accommodation period, the C-Leg in a convenience sample of 19 transfemoral (TF) amputees (mean age 51 +/- 19) from an outpatient prosthetic clinic. We found that use of the C-Leg improved function in all outcomes: (1) Prosthesis Evaluation Questionnaire scores increased 20% (p = 0.007), (2) stumbles decreased 59% (p = 0.006), (3) falls decreased 64% (p = 0.03), (4) 75 m self-selected walking speed on even terrain improved 15% (p = 0.03), (5) 75 m fastest possible walking speed (FPWS) on even terrain improved 12% (p = 0.005), (6) 38 m FPWS on uneven terrain improved 21% (p < 0.001), (7) 6 m FPWS on even terrain improved 17% (p = 0.001), (8) Montreal Rehabilitation Performance Profile Performance Composite Scores for stair descent increased for 12 subjects, and (9) the C-Leg was preferred over the NMKM by 14 subjects. Four limited community ambulators (Medicare Functional Classification Level [MFCL] K2) increased their ambulatory functional level to unlimited community ambulation (MFCL K3). Objective evaluative clinical measures are vital for justifying the medical necessity of knee mechanisms for TF amputees. Use of the C-Leg improves performance and quality of life and can increase MFCL and community ambulation level.

The Effectiveness Evaluation of Helicopter Ambulance Transport among Neurotrauma Patients in Korea

PubMed Central

Park, Kyoung Duck; Seo, Sook Jin; Oh, Chang Hyun; Kim, Se Hyuk

2014-01-01

Objective Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. Methods This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. Results Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). Conclusion In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method. PMID:25289124

The Effectiveness Evaluation of Helicopter Ambulance Transport among Neurotrauma Patients in Korea.

PubMed

Park, Kyoung Duck; Seo, Sook Jin; Oh, Chang Hyun; Kim, Se Hyuk; Cho, Jin Mo

2014-07-01

Helicopter ambulance transport (HAT) is a highly resource-intensive facility that is a well-established part of the trauma transport system in many developed countries. Here, we review the benefit of HAT for neurosurgical patients in Korea. This retrospective study followed neurotrauma patients who were transferred by HAT to a single emergency trauma center over a period of 2 years. The clinical benefits of HAT were measured according to the necessity of emergency surgical intervention and the differences in the time taken to transport patients by ground ambulance transport (GAT) and HAT. Ninety-nine patients were transferred to a single university hospital using HAT, of whom 32 were taken to the neurosurgery department. Of these 32 patients, 10 (31.3%) needed neurosurgical intervention, 14 (43.8%) needed non-neurosurgical intervention, 3 (9.4%) required both, and 11 (34.4%) did not require any intervention. The transfer time was faster using HAT than the estimated time needed for GAT, although for a relatively close distance (<50 km) without ground obstacles (mountain or sea) HAT did not improve transfer time. The cost comparison showed that HAT was more expensive than GAT (3,292,000 vs. 84,000 KRW, p<0.001). In this Korean-based study, we found that HAT has a clinical benefit for neurotrauma cases involving a transfer from a distant site or an isolated area. A more precise triage for using HAT should be considered to prevent overuse of this expensive transport method.

Prehospital emergency care nurses' strategies while caring for patients with limited Swedish - English proficiency.

PubMed

Alm Pfrunder, A; Falk, A; Vicente, V; Lindström, V

2018-04-20

To explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish-English proficiency. Communication difficulties due to lack of mutual language is a challenge in health care systems around the world. Little is known about nurses' strategies while caring for patients with whom they do not share a mutual language in an unstructured, unplanned prehospital emergency environment, the ambulance service. A qualitative study design based on interviews was used and a purposeful sample and snowball technique was used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish-English proficiency. Eleven nurses were interviewed, and the main strategy they used was adapting to the patients' need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department since they had not found a secure way of assessing and caring for the patients in the ambulance. The nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Transcription regulation of gene expression in rat brown adipose tissue in response to unloading or 2G loading during growing period

NASA Astrophysics Data System (ADS)

Watanabe, S.; Hitomi, Y.; Kawano, F.; Ohira, Y.; Kizaki, T.; Nakano, N.; Sakurai, T.; Izawa, T.; Suzuki, K.; Sudoh, M.; Roy, R. R.; Ohno, H.

2007-05-01

The effects were investigated of long-term unloading and macrogravity on the expression of 15 genes at the mRNA levels in brown adipose tissue (BAT) from rat pups, particularly focusing on uncoupling protein (UCP) family, nitric oxide synthase (NOS) isoenzymes, and antioxidant enzymes. The animals in the unloaded group (a simulation model of spaceflight) were hindlimb-unloaded by tail suspension between postnatal day 4 and month 3, followed by 2-mo ambulation recovery. Moreover, centrifugation at 2G (an imitation of the hypergravity effects) was performed during the same period as the unloading, also followed by 2-mo ambulation recovery (adaptation to 1G from 2G). Compared with the age-matched control group, significantly lower expression levels of mRNA for UCP2, iNOS, and Cu,Zn-superoxide dismutase (Cu, Zn-SOD) in BAT were observed immediately after unloading, but not immediately after exposure to 2G. During 2-mo ambulation recovery from both extreme conditions, the expression of mRNA for Mn-SOD was enhanced, suggesting an increase in oxidative stress. These findings suggest that both micro- and macrogravity may have some influence upon the function of BAT, and that changes in the BAT function may be involved in the mechanisms subserving adaptation to such extreme conditions by what humans have to be faced with during the spaceflight and return to 1G.

Developing an analytical tool for evaluating EMS system design changes and their impact on cardiac arrest outcomes: combining geographic information systems with register data on survival rates

PubMed Central

2013-01-01

Background Out-of-hospital cardiac arrest (OHCA) is a frequent and acute medical condition that requires immediate care. We estimate survival rates from OHCA in the area of Stockholm, through developing an analytical tool for evaluating Emergency Medical Services (EMS) system design changes. The study also is an attempt to validate the proposed model used to generate the outcome measures for the study. Methods and results This was done by combining a geographic information systems (GIS) simulation of driving times with register data on survival rates. The emergency resources comprised ambulance alone and ambulance plus fire services. The simulation model predicted a baseline survival rate of 3.9 per cent, and reducing the ambulance response time by one minute increased survival to 4.6 per cent. Adding the fire services as first responders (dual dispatch) increased survival to 6.2 per cent from the baseline level. The model predictions were validated using empirical data. Conclusion We have presented an analytical tool that easily can be generalized to other regions or countries. The model can be used to predict outcomes of cardiac arrest prior to investment in EMS design changes that affect the alarm process, e.g. (1) static changes such as trimming the emergency call handling time or (2) dynamic changes such as location of emergency resources or which resources should carry a defibrillator. PMID:23415045

Achieving femoral artery hemostasis after cardiac catheterization: a comparison of methods.

PubMed

Schickel, S I; Adkisson, P; Miracle, V; Cronin, S N

1999-11-01

Cardiac catheterization is a common procedure that involves the introduction of a small sheath (5F-8F) into the femoral artery for insertion of other diagnostic catheters. After cardiac catheterization, local compression of the femoral artery is required to prevent bleeding and to achieve hemostasis. Traditional methods of achieving hemostasis require significant time and close supervision by medical personnel and can contribute to patients' discomfort. VasoSeal is a recently developed device that delivers absorbable collagen into the supra-arterial space to promote hemostasis. To compare outcomes between patients receiving a collagen plug and patients in whom a traditional method of achieving hemostasis was used after diagnostic cardiac catheterization. An outcomes tracking tool was used to analyze the medical records of 95 patients in whom a traditional method was used (traditional group) and 81 patients in whom VasoSeal was used (device group) to achieve hemostasis. Complications at the femoral access site, patients' satisfaction, and times to hemostasis, ambulation, and discharge were compared. Hematomas of 6-cm diameter occurred in 5.3% of the traditional group; no complications occurred in the device group. The device group also achieved hemostasis faster and had earlier ambulation (P < .001). Patients in the device group were discharged a mean of 5 hours sooner than patients in the traditional group (P < .05). No significant differences were found in patients' satisfaction. VasoSeal is a safe and effective method of achieving hemostasis after cardiac catheterization that can hasten time to hemostasis, ambulation, and discharge.

Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

PubMed

Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

2015-02-27

We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of T<1.5 °C and T≥12.5 °C by 8% (RR=1.08; CI 1.04-1.12). An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T≥17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.

Inhaled methoxyflurane as a prehospital analgesic in children.

PubMed

Babl, Franz E; Jamison, Sarah R; Spicer, Maureen; Bernard, Stephen

2006-08-01

Despite widespread use of methoxyflurane as an inhaled analgesic by ambulance services in Australia there are no published data as to its use pattern, efficacy and safety in the prehospital setting. We set out to characterize methoxyflurane use in children in the prehospital setting. An observational case series was conducted over an 8 month period. Children who received methoxyflurane while being transported to a tertiary children's hospital by ambulance were enrolled. We analysed indications for use, verbal numerical pain scores, adverse events and depth of sedation based on paramedic, patient, parent and ED staff surveys and review of ambulance care records. During the study period 105 patients were enrolled with an age range of 15 months to 17 years (median age 11 years). Methoxyflurane was mainly used for extremity injuries (82%). Paramedic pain scores dropped from a mean of 7.9 (95% confidence interval [CI] 7.5-8.3) prior to methoxyflurane use to 4.5 (95% CI 3.9-5.0) at 2-5 min and to 3.2 (95% CI 2.8-3.7) at 10 min. There were no serious adverse events (one-sided 97.5% CI 0-3%). Mild adverse events occurred in 38 patients (36.2%; 95% CI 27.0-46.1%). Five of 15 (33.3%) patients under 5 years of age were deeply sedated. In the present paediatric case series methoxyflurane appears to be an efficacious analgesic with a low adverse events profile. In young children in particular it can briefly lead to deep sedation.

A low-cost, tablet-based option for prehospital neurologic assessment: The iTREAT Study.

PubMed

Chapman Smith, Sherita N; Govindarajan, Prasanthi; Padrick, Matthew M; Lippman, Jason M; McMurry, Timothy L; Resler, Brian L; Keenan, Kevin; Gunnell, Brian S; Mehndiratta, Prachi; Chee, Christina Y; Cahill, Elizabeth A; Dietiker, Cameron; Cattell-Gordon, David C; Smith, Wade S; Perina, Debra G; Solenski, Nina J; Worrall, Bradford B; Southerland, Andrew M

2016-07-05

In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations. We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval). We conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to -0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92-0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites. Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms. © 2016 American Academy of Neurology.

Medical Telemetry

NASA Technical Reports Server (NTRS)

1978-01-01

Telemetry is the process whereby physiological or other data is acquired by instruments, translated into radio signals and j sent to a receiving station where the signals are decoded and recorded. Extensively used in I space operations, it is finding new Earth applications, among them transmission of medical data between emergency vehicles and hospitals. For example, transmission of an electrocardiogram from an ambulance to a hospital enables a physician to read the telemetered EKG and advise ambulance attendants on emergency procedures. Central Medical Emergency Dispatch (CMED) operates as a regional emergency medical communications center for Cleveland, Ohio and Cuyahoga County. The CMED system includes radio and telephone communications from hospital-to-hospital and from ambulance-to-hospital, but for improved emergency life support CMED sought to add a county-wide telemetry capability. The problem was that there were only eight radio frequencies available for telemetry and there were more than 30 potential users in Cleveland alone. NASA's Lewis Research Center volunteered its expert assistance. The Center's engineers studied the systems of other telemetry using cities, surveyed area hospitals to assure compatibility of telemetry equipment, and advised what types of equipment would be needed in emergency vehicles and at the various hospitals. The Lewis plan suggested that CMED be designated the central coordinating agency for the Cuyahoga County system, monitoring all telemetry frequencies and, when requested, assigning one not in use or one to be used at a sufficient distance that it would create no interference problem.

[Mobile CT: technical aspects of prehospital stroke imaging before intravenous thrombolysis].

PubMed

Gierhake, D; Weber, J E; Villringer, K; Ebinger, M; Audebert, H J; Fiebach, J B

2013-01-01

To reduce the time from symptom onset to treatment with tissue plasminogen activator (tPA) in ischemic stroke, an ambulance was equipped with a CT scanner. We analyzed process and image quality of CT scanning during the pilot study regarding image quality and safety issues. The pilot study of a stroke emergency mobile unit (STEMO) ran over a period of 12 weeks on 5 weekdays from 7a.m. to 6:30 p.m. A teleradiological service for the justifying indication and reporting was established. The radiographer was responsible for the performance of the CT scan on the ambulance. 64 cranial CT scans and 1 intracranial CT angiography were performed. We compared times from ambulance alarm to treatment decision (time of last brain scan) with a cohort of 50 consecutive tPA treatments before implementation of STEMO. 62 (95%) of the 65 scans performed had sufficient quality for reading. Technical quality was not optimal in 45 cases (69%) mainly caused by suboptimal positioning of patient or eye lens protection. Motion artefacts were observed in 8 exams (12%). No safety issues occurred for team or patients. 23 patients were treated with thrombolysis. Time from alarm to last CT scan was 18 minutes shorter than in the tPA cohort before STEMO implementation. A teleradiological support for primary stroke imaging by CT on-site is feasible, quality-wise of diagnostic value and has not raised safety issues. © Georg Thieme Verlag KG Stuttgart · New York.

A 12-month audit of laryngeal mask airway (LMA) use in a South Australian ambulance service.

PubMed

Hein, Cindy; Owen, Harry; Plummer, John

2008-11-01

The aim of the study was to provide an accurate account of current practice of laryngeal mask airway (LMA) use within SA Ambulance Service (SAAS) and identify issues that could lead to constructive training for paramedics and improve clinical care and patient safety. A clinical audit of LMA use within SAAS was registered with the Director of Clinical Governance at Flinders Medical Centre in South Australia. Data were collected prospectively in a state wide all inclusive study over 12 months (February 2006 to January 2007). The primary outcome variable we determined was successful insertion after one or two attempts. Secondary outcome measures were overall success rate and reasons for failure. Insertion of an LMA was attempted by 179 paramedical staff in 164 patients. Success after one or two attempts was obtained in 65% of patients (107/164). Overall success rate (any number of attempts) was 74% (121/164), of those 45% were on the first attempt, 20% on the second attempt and the remainder (9%) required three or more attempts to achieve successful insertion. Reported failures were ascribed to patient anatomy (13), technique (9), airway soiling (7), device (6), trismus (1), high Glasgow Coma Score (1), trauma (1) or unknown (5). This clinical audit provides a comprehensive account of LMA use within SA Ambulance Service. Although the current practice was found to be acceptable, these results are below those of comparable groups and should be improved upon.

A low-cost, tablet-based option for prehospital neurologic assessment

PubMed Central

Chapman Smith, Sherita N.; Govindarajan, Prasanthi; Padrick, Matthew M.; Lippman, Jason M.; McMurry, Timothy L.; Resler, Brian L.; Keenan, Kevin; Gunnell, Brian S.; Mehndiratta, Prachi; Chee, Christina Y.; Cahill, Elizabeth A.; Dietiker, Cameron; Cattell-Gordon, David C.; Smith, Wade S.; Perina, Debra G.; Solenski, Nina J.; Worrall, Bradford B.

2016-01-01

Objectives: In this 2-center study, we assessed the technical feasibility and reliability of a low cost, tablet-based mobile telestroke option for ambulance transport and hypothesized that the NIH Stroke Scale (NIHSS) could be performed with similar reliability between remote and bedside examinations. Methods: We piloted our mobile telemedicine system in 2 geographic regions, central Virginia and the San Francisco Bay Area, utilizing commercial cellular networks for videoconferencing transmission. Standardized patients portrayed scripted stroke scenarios during ambulance transport and were evaluated by independent raters comparing bedside to remote mobile telestroke assessments. We used a mixed-effects regression model to determine intraclass correlation of the NIHSS between bedside and remote examinations (95% confidence interval). Results: We conducted 27 ambulance runs at both sites and successfully completed the NIHSS for all prehospital assessments without prohibitive technical interruption. The mean difference between bedside (face-to-face) and remote (video) NIHSS scores was 0.25 (1.00 to −0.50). Overall, correlation of the NIHSS between bedside and mobile telestroke assessments was 0.96 (0.92–0.98). In the mixed-effects regression model, there were no statistically significant differences accounting for method of evaluation or differences between sites. Conclusions: Utilizing a low-cost, tablet-based platform and commercial cellular networks, we can reliably perform prehospital neurologic assessments in both rural and urban settings. Further research is needed to establish the reliability and validity of prehospital mobile telestroke assessment in live patients presenting with acute neurologic symptoms. PMID:27281534

An Assessment of Psychological Need in Emergency Medical Staff in the Northern Health and Social Care Trust Area

PubMed Central

Aisling, Diamond; David, Curran

2016-01-01

Setting Psychological stress is increasingly recognised within emergency medicine, given the environmental and clinical stressors associated with the specialism. The current study assessed whether psychological distress is experienced by emergency medical staff and if so, what is the expressed need within this population? Participants Participants included ambulance personnel, nursing staff, doctors and ancillary support staff within two Accident and Emergency (A&E) departments and twelve ambulance bases within one Trust locality in NI (N = 107). Primary and secondary outcome measures The General Health Questionnaire (GHQ-12, Goldberg, 1972, 1978), Secondary Traumatic Stress Scale (STSS, Bride, 2004) and an assessment of need questionnaire were completed and explored using mixed method analysis. Results Results showed elevated levels of psychological distress within each profession except ambulance service clinical support officers (CSOs). Elevated levels of secondary trauma symptomatology were also found; the highest were within some nursing grades and junior doctors. Decreased enjoyment in job over time was significantly associated with higher scores. Analysis of qualitative data identified sources of stress to include low morale. A total of 65% of participants thought that work related stressors had negatively affected their mental health. Participants explored what they felt could decrease psychological distress including improved resources and psychoeducation. Conclusion There were elevated levels of distress and secondary traumatic stress within this population as well as an expressed level of need, on both systemic and support levels. PMID:27601762

42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

Code of Federal Regulations, 2010 CFR

2010-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special... connection with covered inpatient hospital services; and (2) They meet the conditions set forth in paragraphs...

42 CFR 424.124 - Conditions for payment for physician services and ambulance services.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM CONDITIONS FOR MEDICARE PAYMENT Special... connection with covered inpatient hospital services; and (2) They meet the conditions set forth in paragraphs...

Prehospital airway management on rescue helicopters in the United Kingdom.

PubMed

Schmid, M; Mang, H; Ey, K; Schüttler, J

2009-06-01

Adequate equipment is one prerequisite for advanced, out of hospital, airway management. There are no data on current availability of airway equipment on UK rescue helicopters. An internet search revealed all UK rescue helicopters, and a questionnaire was sent to the bases asking for available airway management items. We identified 27 helicopter bases and 26 (96%) sent the questionnaire back. Twenty-four bases (92%) had at least one supraglottic airway device; 16 (62%) helicopters had material for establishing a surgical airway (e.g. a cricothyroidotomy set); 88% of the helicopters had CO(2) detection; 25 (96%) helicopters carried automatic ventilators; among these, four (15%) had sophisticated ventilators and seven (27%) helicopters carried special face masks suitable for non-invasive ventilation. We found a wide variation in the advanced airway management equipment that was carried routinely on air ambulances. Current guidelines for airway management are not met by all UK air ambulances.

Peripheral Nerve Blocks Causing Increased Risk for Fall and Difficulty in Ambulation for the Hip and Knee Joint Replacement Patient.

PubMed

Crumley Aybar, Bonnie L; Gillespie, Michael J; Gipson, Sean F; Mullaney, Caitlin E; Tommasino-Storz, Melissa

2016-12-01

A systematic review of the literature was completed by the Evidence-Based Practice Group for the Patient population, Intervention/Issue, Comparison Intervention, Outcomes, Timing (PICOT) question: "Does the use of a peripheral nerve block increase the risk for falls and difficulty ambulation in patients after lower extremity surgery through postoperative day 2?" A search of multiple databases using specified key terms resulted in 258 articles for total knee arthroplasty or total hip arthroplasty. These were reduced to 13 with exclusion criteria and became primary evidence. Numbers Needed to Harm and Numbers Needed to Treat (NNT) were calculated. Numbers Needed to Harm supported the PICOT question. Further research of postoperative falls and nursing interventions to reduce or prevent falls is suggested before creation of a Clinical Practice Guideline. Copyright © 2016 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.

High-velocity facial gunshot wounds: multidisciplinary care from prehospital to discharge

PubMed Central

Sinnott, J D; Morris, G; Medland, P J; Porter, K

2016-01-01

A case is presented in which a high velocity rifle (shotgun) was fired into the inferior part of a patient's face in an attempted suicide causing widespread trauma to the inferior and left side of the patient's face. He presented to his general practitioner where an ambulance was called. The patient is followed from prehospital care (air ambulance) to resuscitation in accident and emergency and through the first stages of reconstructive surgery. The article focuses on the multidisciplinary approach to the patient's prehospital care and initial resuscitation at a major trauma centre. CT reconstruction images of the patient's skull allow visualisation of the extent of bone damage at presentation. Medical photography allows visualisation of the extent of the initial damage and shows how reconstructive surgery was undertaken early and in progressive stages. A literature review was performed allowing discussion of the current evidence and best practice in the management of facial gunshot wounds. PMID:26823355

[Laser treatment for retinopathy of prematurity in neonatal intensive care units. Premature Eye Rescue Program].

PubMed

Maka, Erika; Imre, László; Somogyvári, Zsolt; Németh, János

2015-02-01

Retinopathy of prematurity is a leading cause of childhood blindness around the world. The Department of Ophthalmology at the Semmelweis University and the Peter Cerny Neonatal Emergency and Ambulance Service started an innovative Premature Eye Rescue Program to reduce the non-essential transport of premature babies suffering from retinopathy of prematurity. During the first 5 years 186 eyes of 93 premature babies were treated at the bedside with stage 3 retinopathy of prematurity in the primary hospitals. In this first 5-years period the authors reduced the number of transports of premature babies for laser treatment; 93 children avoided the unnecessary transport, saving altogether a distance of 21,930 kilometers for children, as well as the ambulance service. The Premature Eye Rescue Program offers a good and effective alternative for treatment of retinopathy in the primary hospitals. The authors propose the national extension of this program.

[Medical technology: the leading trend in the conversion of an enterprise].

PubMed

Grodetskiĭ, V P; Kuznetsov, V I

1996-01-01

The Izhevsky motozavod (Aksion Public stock company) is one of the Russia's largest production associations (PA), which manufactures a wide range of products for various purposes, including those for implementation of space programmes. Medical engineering is close to space instrument making as it required special technologies, high quality and reliability for its manufacture. The development and introduction of medical equipment into production of the Izhevsky motozavod PA are under way along several basic lines: electrocardiographic equipment and defibrillators, devices for maternity and child care, ambulances, reanimobiles, etc. The most interesting produce, such as one-channel EK1 TTSSP-01 (for emergency care) and EK1T-04 electrocardiographs, DKI-H-04 defibrillator, Oksipuls-01 pulsoximeter, a DLTB-01 unit for diagnosis and treatment of tubal sterility in females, a KPH-01 unit for neonatal resuscitation, an ambulance, a Nadezhda reanimobile, etc. are briefly described.

Pre-hospital identification and post-recovery challenges of intoxication with synthetic cannabinoid containing legal high products such as 'Exodus Damnation'.

PubMed

Fitzpatrick, David; O'Meara, Patrick; Cunningham, Andrew

2016-11-01

This short report describes the case of a young adult male who had smoked a synthetic cannabinoid legal high product called 'Exodus Damnation'. The patient's presentation was atypical from that described in the literature, with hypotension and hypoxaemia. Of note was the rapid recovery after pre-hospital intervention with high-flow oxygen therapy and intravenous fluids. The patient refused on-going care, despite repeated advice to attend the Emergency Department. The distinct lack of specialist support and referral to drug treatment for this patient population, with whom ambulance services are coming into contact with increasing frequency, is reported. For those patients with the capacity to refuse on-going care, ambulance services may be in an opportune position to actively promote referral to support services for these vulnerable individuals. © The Author(s) 2016.

Biofeedback device for patients on axillary crutches.

PubMed

Ang, E J; Goh, J C; Bose, K; Toh, S L; Choo, A

1989-08-01

The axillary crutch is commonly prescribed as an ambulatory aid to patients with temporal or permanent disability in the lower extremity. When fitting the axillary crutch, it is important that the user be instructed not to bear excessive weight on the axillary bar. Excessive weight bearing on the axillary bar can result in a sevenfold increase in the reaction force under the armpit. This force may be a contributory factor to crutch paralysis or thrombosis of the axillobrachial artery. In order to prevent this occurrence an electronic biofeedback device was designed and developed for use in the training of 3-point swing-through axillary crutch ambulation. It detects excessive weight bearing on the axillary bar during crutch ambulation and produces an audible signal which prompts the patient to make necessary adjustment to relieve load bearing on the axillary bar. The design and development of the biofeedback device is discussed in this paper.

Preoperative teaching and hysterectomy outcomes.

PubMed

Oetker-Black, Sharon L; Jones, Susan; Estok, Patricia; Ryan, Marian; Gale, Nancy; Parker, Carla

2003-06-01

This study used a theoretical model to determine whether an efficacy-enhancing teaching protocol was effective in improving immediate postoperative behaviors and selected short- and long-term health outcomes in women who underwent abdominal hysterectomies. The model used was the self-efficacy theory of Albert Bandura, PhD. One hundred eight patients in a 486-bed teaching hospital in the Midwest who underwent hysterectomies participated. The participation rate was 85%, and the attrition rate was 17% during the six-month study. The major finding was that participants in the efficacy-enhancing teaching group ambulated significantly longer than participants in the usual care group. This is an important finding because the most prevalent postoperative complications after hysterectomy are atelectasis, pneumonia, paralytic ileus, and deep vein thrombosis, and postoperative ambulation has been shown to decrease or prevent all of these complications. This finding could affect the overall health status of women undergoing hysterectomies.

Use of a unipedal standing test to assess the ambulation reacquisition time during the early postoperative stage after hip fracture in elderly Japanese: prospective study.

PubMed

Murata, Koichi; Sugitani, Shigeki; Yoshioka, Hiroki; Noguchi, Takashi; Aoto, Toshiyuki; Nakamura, Takashi

2010-01-01

The aim of this study was to predict the ambulation reacquisition time after hip fracture in elderly people using the unipedal standing test during the early postoperative stage. Patients with an intertrochanteric fracture treated with internal fixation (n = 35) and patients with a femoral neck fracture treated with hemiarthroplasty (n = 22) were included. A unipedal standing test using the nonoperated leg was performed on days 3 and 7 after the operation. Among the patients with an intertrochanteric fracture, those with a positive result on the unipedal standing test on postoperative day (POD) 3 attained gait with parallel guide bars (BG) and walker-assisted gait (WG) significantly earlier than did patients with a negative result on the unipedal standing test. Patients with a positive result on the unipedal standing test on POD 7 attained BG, WG, and cane-assisted gait (CG) significantly earlier than did patients with a negative test. Among patients with a femoral neck fracture, those with a positive unipedal standing test result on POD 3 attained BG, WG, and CG significantly earlier than did patients with a negative test. Those with a positive test result on POD 7 attained BG, WG, and CG significantly earlier than did patients with a negative test. The unipedal standing test given during the early postoperative stage is a good test for predicting the ambulation reacquisition time. Moreover, it gives information that can help determine the need for subacute rehabilitation and about discharge planning and health service provision.

Comparing population and incident data for optimal air ambulance base locations in Norway.

PubMed

Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Uleberg, Oddvar; Aardal, Karen; van Essen, J Theresia

2018-05-24

Helicopter emergency medical services are important in many health care systems. Norway has a nationwide physician manned air ambulance service servicing a country with large geographical variations in population density and incident frequencies. The aim of the study was to compare optimal air ambulance base locations using both population and incident data. We used municipality population and incident data for Norway from 2015. The 428 municipalities had a median (5-95 percentile) of 4675 (940-36,264) inhabitants and 10 (2-38) incidents. Optimal helicopter base locations were estimated using the Maximal Covering Location Problem (MCLP) optimization model, exploring the number and location of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, in green field scenarios and conditioned on the existing base structure. The existing bases covered 96.90% of the population and 91.86% of the incidents for time threshold 45 min. Correlation between municipality population and incident frequencies was -0.0027, and optimal base locations varied markedly between the two data types, particularly when lowering the target time. The optimal solution using population density data put focus on the greater Oslo area, where one third of Norwegians live, while using incident data put focus on low population high incident areas, such as northern Norway and winter sport resorts. Using population density data as a proxy for incident frequency is not recommended, as the two data types lead to different optimal base locations. Lowering the target time increases the sensitivity to choice of data.

Knee strength retention and analgesia with continuous perineural fentanyl infusion after total knee replacement: randomized controlled trial.

PubMed

Mangar, Devanand; Karlnoski, Rachel A; Sprenker, Collin J; Downes, Katheryne L; Taffe, Narrene; Wainwright, Robert; Gustke, Kenneth; Bernasek, Thomas L; Camporesi, Enrico

2014-04-01

Despite providing adequate pain relief, a femoral nerve block can induce postoperative muscle weakness after total knee arthoplasty (TKA). Fentanyl has been shown to have peripheral effects but has not been used as a perineural infusate alone after TKA. Sixty patients scheduled for TKA were randomized to one of three blinded groups: a continuous 24 h infusion of either fentanyl 3 μg/ml, ropivacaine 0.1%, or 0.9% normal saline through a femoral nerve sheath catheter at 10 ml/h. The main outcome was maximum voluntary isometric contraction (MVIC) in the quadriceps femoris (knee extension), measured by a handheld dynamometer (Nm/kg). Other variables assessed were preoperative and postoperative visual analog scale (VAS) scores, hamstrings MVIC (knee flexion), active range of motion of the operative knee, distance ambulated, incidence of knee buckling, supplemental morphine usage, postoperative side effects, and serum fentanyl levels. Quadriceps MVIC values were significantly greater in the fentanyl group compared to the group that received ropivacaine (median values, 0.08 vs. 0.03 Nm/kg; p = 0.028). The incidence of postoperative knee buckling upon ambulation was higher in the ropivacaine group compared to the fentanyl group, although not statistically significant (40% vs. 15 %, respectively; p = 0.077). VAS scores while ambulating were not significantly different between the fentanyl group and the ropivacaine group (p = 0.270). Postoperative morphine consumption, nausea and vomiting, and resting VAS scores were similar among the three groups. A continuous perineural infusion of fentanyl produced greater strength retention than ropivacaine post-TKA.

Effectiveness of acute geriatric units in the real world: the case of short-term mortality among seniors hospitalized for pneumonia.

PubMed

Ding, Yew Yoong; Abisheganaden, John; Chong, Wai Fung; Heng, Bee Hoon; Lim, Tow Keang

2013-01-01

We sought to compare the effectiveness of acute geriatric units with usual medical care in reducing short-term mortality among seniors hospitalized for pneumonia in the real world. In a retrospective cohort study, we merged chart and administrative data of seniors aged 65 years and older admitted to acute geriatric units and other medical units for pneumonia at three hospitals over 1 year. The outcome was 30-day mortality. Hierarchical logistic regression modeling was carried out to estimate the treatment effect of acute geriatric units for all seniors, those aged 80 years and older, and those with premorbid ambulation impairment, after adjusting for demographic and clinical characteristics, and accounting for clustering around hospitals. Among 2721 seniors, 30-day mortality was 25.5%. For those admitted to acute geriatric and other medical units, this was 24.2% and 25.8%, respectively. Using hierarchical logistic regression modeling, treatment in acute geriatric units was not associated with significant mortality reduction among all seniors (OR 0.72, 95% CI 0.52-1.00). However, significant mortality reduction was observed in the subgroups of those aged 80 years and older (OR 0.73, 95% CI 0.54-0.99), and with premorbid ambulation impairment (OR 0.65, 95% CI 0.46-0.93). Acute geriatric units reduced short-term mortality among seniors hospitalized for pneumonia who were aged 80 years and older or had premorbid ambulation impairment. Further research is required to determine if this beneficial effect extends to seniors hospitalized for other acute medical disorders. © 2012 Japan Geriatrics Society.

[A million football fans in a city of 120,000 inhabitants--a nightmare for emergency medicine and disaster management? Euro 2008 and the "Orange wonder of Berne"].

PubMed

Martinolli, L; Tanyeli, E; Hasler, R M; Burkhardt, P; Bähler, H; Neff, F; Rupp, P; Zimmermann, H; Exadaktylos, A K

2011-01-01

The 2008 European Football Championship 2008 (Euro 08) is the largest sporting event ever organized in Switzerland. One million visitors came to the city of Berne during the event and the local airport in Bern/Belp registered 261 extra flights. For each football game there were 33,000 fans in the stadium and 100,000 fans in the public viewing zones.The ambulance corps and the Department of Emergency Medicine (ED) at Inselspital, University Hospital Berne, were responsible for basic medical care and emergency medical management. Injuries and illnesses were analyzed by a standardized score (NACA score). The preparation strategy as well as costs and patient numbers are presented in detail.A total of 30 additional ambulance vehicles were used, 4,723 additional working days (one-third medical professionals) were accumulated, 662 ambulance calls were registered and 240 persons needed medical care (62% Swiss, 28% Dutch and 10% other nationalities). Among those needing treatment 51 were treated in 1 of the 4 city hospitals. No injuries with NACA grades VI and VII occurred (NACA I: 4, NACA II: 17, NACA III: 16, NACA IV: 10 and NACA V: 4 patients). The city of Berne compensated the Inselspital Bern with a total of 112,603 Euros for extra medical care costs. The largest amount was spent on security measures (50,300 Euros) and medical staff (medical doctors 22,600 Euros, nurses 29,000 Euros). Because of the poor weather and the exemplary behavior of the fans, the course of events was rather peaceful.

Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data

PubMed Central

2015-01-01

Background Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Methods Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. Results A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Conclusion Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging. PMID:26692453

Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data.

PubMed

Khan, Irum; Khan, Nadeem; Naeem, Rubaba; Kerai, Salima; Allen, Kate; Zia, Nukhba; Shahbaz, Sana; Afridi, Shiraz; Siddiqui, Emaduddin; Khan, Uzma; Hyder, Adnan A; Razzak, Junaid A

2015-01-01

Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging.

Managing emergency department overcrowding via ambulance diversion: a discrete event simulation model.

PubMed

Lin, Chih-Hao; Kao, Chung-Yao; Huang, Chong-Ye

2015-01-01

Ambulance diversion (AD) is considered one of the possible solutions to relieve emergency department (ED) overcrowding. Study of the effectiveness of various AD strategies is prerequisite for policy-making. Our aim is to develop a tool that quantitatively evaluates the effectiveness of various AD strategies. A simulation model and a computer simulation program were developed. Three sets of simulations were executed to evaluate AD initiating criteria, patient-blocking rules, and AD intervals, respectively. The crowdedness index, the patient waiting time for service, and the percentage of adverse patients were assessed to determine the effect of various AD policies. Simulation results suggest that, in a certain setting, the best timing for implementing AD is when the crowdedness index reaches the critical value, 1.0 - an indicator that ED is operating at its maximal capacity. The strategy to divert all patients transported by ambulance is more effective than to divert either high-acuity patients only or low-acuity patients only. Given a total allowable AD duration, implementing AD multiple times with short intervals generally has better effect than having a single AD with maximal allowable duration. An input-throughput-output simulation model is proposed for simulating ED operation. Effectiveness of several AD strategies on relieving ED overcrowding was assessed via computer simulations based on this model. By appropriate parameter settings, the model can represent medical resource providers of different scales. It is also feasible to expand the simulations to evaluate the effect of AD strategies on a community basis. The results may offer insights for making effective AD policies. Copyright © 2012. Published by Elsevier B.V.

Timing of urinary catheter removal after uncomplicated total abdominal hysterectomy: a prospective randomized trial.

PubMed

Ahmed, Magdy R; Sayed Ahmed, Waleed A; Atwa, Khaled A; Metwally, Lobna

2014-05-01

To assess whether immediate (0h), intermediate (after 6h) or delayed (after 24h) removal of an indwelling urinary catheter after uncomplicated abdominal hysterectomy can affect the rate of re-catheterization due to urinary retention, rate of urinary tract infection, ambulation time and length of hospital stay. Prospective randomized controlled trial conducted at Suez Canal University Hospital, Egypt. Two hundred and twenty-one women underwent total abdominal hysterectomy for benign gynecological diseases and were randomly allocated into three groups. Women in group A (73 patients) had their urinary catheter removed immediately after surgery. Group B (81 patients) had the catheter removed 6h post-operatively while in group C (67 patients) the catheter was removed after 24h. The main outcome measures were the frequency of urinary retention, urinary tract infections, ambulation time and length of hospital stay. There was a significantly higher number of urinary retention episodes requiring re-catheterization in the immediate removal group compared to the intermediate and delayed removal groups (16.4% versus 2.5% and 0% respectively). Delayed urinary catheter removal was associated with a higher incidence of urinary tract infections (15%), delayed ambulation time (10.3h) and longer hospital stay (5.6 days) compared to the early (1.4%, 4.1h and 3.2 days respectively) and intermediate (3.7%, 6.8h and 3.4 days respectively) removal groups. Removal of the urinary catheter 6h postoperatively appears to be more advantageous than early or late removal in cases of uncomplicated total abdominal hysterectomy. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The effects of locomotor training in children with spinal cord injury: a systematic review.

PubMed

Donenberg, Jennifer Glenna; Fetters, Linda; Johnson, Robert

2018-06-19

Discuss the effectiveness of locomotor training (LT) in children following spinal cord injury (SCI). This intervention was assessed following an exhaustive search of the literature using the Preferred Reporting Items for Systematic Reviews and Meta- Analyses: The PRISMA Statement as a guideline. Six databases were searched including PubMed, PEDro, CINAHL, Cochrane, PsycINFO, and Web of Knowledge in January 2016 and November 2016, without date restrictions. Inclusion criteria were: studies in English and peer-reviewed and journal articles with a primary intervention of LT in children following SCI. Twelve articles, reporting eleven studies, were included. A systematic review assessing locomotor training in children with SCI published in April 2016 was also included. Participants were ages 15 months to 18 years old. Forms of LT included body-weight supported treadmill or over ground training, functional electrical stimulation, robotics, and virtual reality. Protocols differed in set-up and delivery mode, with improvements seen in ambulation for all 41 participants following LT. Children might benefit from LT to develop or restore ambulation following SCI. Age, completeness, and level of injury remain the most important prognostic factors to consider with this intervention. Additional benefits include improved bowel/ bladder management and control, bone density, cardiovascular endurance, and overall quality of life. Looking beyond the effects LT has just on ambulation is crucial because it can offer benefits to all children sustaining a SCI, even if restoration or development of walking is not the primary goal. Further rigorous research is required to determine the overall effectiveness of LT.

An analysis of inter-healthcare facility transfer of neonates within the eThekwini Health District of KwaZulu-Natal, South Africa.

PubMed

Ashokcoomar, Pradeep; Naidoo, Raveen

2016-04-19

To investigate delays in the transfer of neonates between healthcare facilities and to detect any adverse events encountered during neonatal transfer. A prospective study was conducted from December 2011 to January 2012. A quantitative, non-experimental design was used to undertake a descriptive analysis of 120 inter-healthcare facility transfers of neonates within the eThekwini Health District (Durban) of KwaZulu-Natal Province, South Africa. Data collection was via questionnaire. Data collection was restricted to the Emergency Medical Services (EMSs) of eThekwini Health District, which is the local public ambulance provider. All transfers were undertaken by road ambulances: 83 (62.2%) by frontline ambulances; 35 (29.2%) by the obstetric unit; and 2 (1.7%) by the planned patient transport vehicles. Twenty-nine (24.2%) transfers involved critically ill neonates. The mean (standard deviation (SD)) time to complete an inter-healthcare facility transfer was 3 h 49 min (1 h 57 min) (range 0 h 55 min - 10 h 34 min). Problems with transfer equipment were common due to poor resource allocation, malfunctioning equipment, inappropriate equipment for the type of transfer and dirty or unsterile equipment. The study identified 10 (8.3%) physiologically related adverse events, which included 1 (0.8%) death plus a further 18 (15.0%) equipment-related adverse events. EMS is involved in transporting a significant number of intensive care and non-intensive care neonates between healthcare facilities. This study has identified numerous factors affecting the efficiency of inter-facility transfer of neonates and highlights a number of areas requiring improvement.

Research of an emergency medical system for mass casualty incidents in Shanghai, China: a system dynamics model.

PubMed

Yu, Wenya; Lv, Yipeng; Hu, Chaoqun; Liu, Xu; Chen, Haiping; Xue, Chen; Zhang, Lulu

2018-01-01

Emergency medical system for mass casualty incidents (EMS-MCIs) is a global issue. However, China lacks such studies extremely, which cannot meet the requirement of rapid decision-support system. This study aims to realize modeling EMS-MCIs in Shanghai, to improve mass casualty incident (MCI) rescue efficiency in China, and to provide a possible method of making rapid rescue decisions during MCIs. This study established a system dynamics (SD) model of EMS-MCIs using the Vensim DSS program. Intervention scenarios were designed as adjusting scales of MCIs, allocation of ambulances, allocation of emergency medical staff, and efficiency of organization and command. Mortality increased with the increasing scale of MCIs, medical rescue capability of hospitals was relatively good, but the efficiency of organization and command was poor, and the prehospital time was too long. Mortality declined significantly when increasing ambulances and improving the efficiency of organization and command; triage and on-site first-aid time were shortened if increasing the availability of emergency medical staff. The effect was the most evident when 2,000 people were involved in MCIs; however, the influence was very small under the scale of 5,000 people. The keys to decrease the mortality of MCIs were shortening the prehospital time and improving the efficiency of organization and command. For small-scale MCIs, improving the utilization rate of health resources was important in decreasing the mortality. For large-scale MCIs, increasing the number of ambulances and emergency medical professionals was the core to decrease prehospital time and mortality. For super-large-scale MCIs, increasing health resources was the premise.

Postoperated hip fracture rehabilitation effectiveness and efficiency in a community hospital.

PubMed

Tan, Adrian K H; Taiju, Rangpa; Menon, Edward B; Koh, Gerald C H

2014-04-01

This study aims to determine the inpatient rehabilitation effectiveness (REs) and rehabilitation efficiency (REy) of hip fracture in a Singapore community hospital (CH), its association with socio-demographic variables, medical comorbidities and admission Shah-modified Barthel Index (BI) score as well as change in independent ambulation from discharge to 4 months later. A retrospective cohort study using data manually extracted from medical records of all patients who had hip fracture within 90 days and admitted to a CH after the operation for rehabilitation. Multiple linear regressions are used to identify independent predictors of REs and REy. The mean REs was 40.4% (95% Confidence Interval (CI), 36.7 to 44.0). The independent predictors of poorer REs on multivariate analysis were older age, Malay (vs non-Malay) patients, fewer numbers of rehabilitative therapy sessions and dementia. The mean REy was 0.41 units per day [CI, 0.36 to 0.46]. The independent predictors of poorer REy on multivariate analysis were higher admission BI and being non-hypertensive patient. The prevalence of independent ambulation improved from 78.9% at the discharge to 88.3% 4 months later. CH inpatient rehabilitative therapy showed REs 40.4% and REy of 0.41 units per day and the optimum number of rehabilitative therapy session was from 28 to 41 in terms of rehabilitation effectiveness and the maximum rehabilitation efficiency was seen in those doing 14 to 27 sessions of rehabilitative therapy. The study also showed improvement in BI at discharge and improvement in the independent ambulation 4 months after discharge from the CH.

Exposure and posttraumatic stress symptoms among first responders working in proximity to the terror sites in Norway on July 22, 2011 - a cross-sectional study.

PubMed

Skogstad, Laila; Fjetland, Anja M; Ekeberg, Øivind

2015-02-24

Norway experienced two terror attacks on July 22, 2011. A car bomb exploded in the Oslo government district killing eight people. Shortly after, 69 adolescents gathered at a political youth camp were shot and killed at Utøya Island. First responders were exposed to multiple risk factors for the development of posttraumatic stress symptoms (PTSS). This cross-sectional study investigated the degree of perceived peritraumatic strain among police officers, fire-fighters, and ambulance personnel, as well as the prevalence and predictors of PTSS. A questionnaire was completed by 89 ambulance personnel, 73 fire-fighters, and 76 police officers working close to the terror sites, 8-11 months after the event. PTSS were assessed using the PTSD Check List (PCL-S). Merging all groups, 68% reported to have witnessed injured/dead people, but only 5.7% reported this as very/extremely strainful. The PCL-S scores were low and not significantly different among the three professions (Median = 19-20, range 17-64). The prevalence of possible PTSD (cut-off > 50) was 1.3 %, and 2 % had scores indicating sub-threshold PTSD. Dissociation predicted higher PTSS-level in all groups (β 1.6-5.1), witnessing injured/dead among ambulance personnel (β 2.5) and feeling overwhelmed among police officers (β 1.2). First responders were exposed to deaths, injuries, and destruction, but few reported this as highly stressful. The prevalence of possible PTSD was low in all occupational groups, and symptoms of dissociation were found to be the most important predictor.

Taking to bed. Rapid functional decline in an independently mobile older population living in an intermediate-care facility.

PubMed

Clark, L P; Dion, D M; Barker, W H

1990-09-01

The objective of this study was to determine the incidence and selected clinical outcomes of taking to bed among a population of independently ambulating older individuals. It was designed as a retrospective case series and was conducted in the intermediate-care facility of a not-for-profit, teaching nursing home. Our study group was composed of individuals over 65 years of age who became bed bound. Thirty-six taking-to-bed episodes occurred in 36 individuals during one calendar year, giving an incidence of 13 per 1,000 resident-months (95% CI, 4 to 23 per 1,000). Twelve of the 36 died within 3 months, and 17 within 6 months, but almost all who survived regained ambulation. Survival was significantly shorter for the five without localizing symptoms (P less than .05). Orthopedic, neurologic, psychiatric, and iatrogenic conditions were most commonly identified as concurrent medical events. Almost half who took to bed had multiple concurrent medical events, and these residents were more likely to present without localizing symptoms (P less than .05). Twenty-one (58%) of the episodes occurred after a fall. The incidence of taking to bed in this population indicates that clinicians caring for older persons should be alert to its occurrence. The dramatic decline in mobility deserves careful assessment because it initiated a period of relatively rapid change in the health careers of the individuals we studied: almost half died within 6 months, but nearly all who survived regained ambulation. Those without localizing symptoms may have more complex interacting medical problems and a worse prognosis.

Is emergency department crowding associated with increased “bounceback” admissions?

PubMed Central

Hsia, Renee Y.; Asch, Steven M.; Weiss, Robert E.; Zingmond, David; Gabayan, Gelareh; Liang, Li-Jung; Han, Weijuan; McCreath, Heather; Sun, Benjamin C.

2013-01-01

Objective Emergency department (ED) crowding is linked with poor quality of care and worse outcomes, including higher mortality. With the growing emphasis on hospital performance measures, there is additional concern whether inadequate care during crowded periods increases a patient’s likelihood of subsequent inpatient admission. We sought to determine if ED crowding during the index visit was associated with these “bounceback” admissions. Methods We used comprehensive, non-public, statewide ED and inpatient discharge data from the California Office of Statewide Health Planning and Development from 2007 to identify index outpatient ED visits and bounceback admissions within seven days. We further used ambulance diversion data collected from California local emergency medical services agencies to identify crowded days using intra-hospital daily diversion hour quartiles. Using a hierarchical logistic regression model, we then determined if patients visiting on crowded days were more likely to have a subsequent bounceback admission. Results We analyzed 3,368,527 index visits across 202 hospitals, of which 596,471 (17.7%) observations were on crowded days. We found no association between ED crowding and bounceback admissions. This lack of relationship persisted in both a discrete (high/low) model (OR 1.01, 95% CI 0.99, 1.02) and a secondary model using ambulance diversion hours as a continuous predictor (OR 1.00, 95% CI 1.00, 1.00). Conclusions Crowding as measured by ambulance diversion does not have an association with hospitalization within 7 days of an ED visit discharge. Therefore, bounceback admission may be a poor measure of delayed or worsened quality of care due to crowding. PMID:24036997

Region-Specific Responses of Adductor Longus Muscle to Gravitational Load-Dependent Activity in Wistar Hannover Rats

PubMed Central

Ohira, Takashi; Terada, Masahiro; Kawano, Fuminori; Nakai, Naoya; Ogura, Akihiko; Ohira, Yoshinobu

2011-01-01

Response of adductor longus (AL) muscle to gravitational unloading and reloading was studied. Male Wistar Hannover rats (5-wk old) were hindlimb-unloaded for 16 days with or without 16-day ambulation recovery. The electromyogram (EMG) activity in AL decreased after acute unloading, but that in the rostral region was even elevated during continuous unloading. The EMG levels in the caudal region gradually increased up to 6th day, but decreased again. Approximately 97% of fibers in the caudal region were pure type I at the beginning of experiment. Mean percentage of type I fibers in the rostral region was 61% and that of type I+II and II fiber was 14 and 25%, respectively. The percent type I fibers decreased and de novo appearance of type I+II was noted after unloading. But the fiber phenotype in caudal, not rostral and middle, region was normalized after 16-day ambulation. Pronounced atrophy after unloading and re-growth following ambulation was noted in type I fibers of the caudal region. Sarcomere length in the caudal region was passively shortened during unloading, but that in the rostral region was unchanged or even stretched slightly. Growth-associated increase of myonuclear number seen in the caudal region of control rats was inhibited by unloading. Number of mitotic active satellite cells decreased after unloading only in the caudal region. It was indicated that the responses of fiber properties in AL to unloading and reloading were closely related to the region-specific neural and mechanical activities, being the caudal region more responsive. PMID:21731645

Stroke education program of act FAST for junior high school students and their parents.

PubMed

Amano, Tatsuo; Yokota, Chiaki; Sakamoto, Yuki; Shigehatake, Yuya; Inoue, Yasuteru; Ishigami, Akiko; Hagihara, Takaaki; Tomii, Yasuhiro; Miyashita, Fumio; Toyoda, Kazunori; Minematsu, Kazuo

2014-01-01

We produced a stroke education program using the FAST (facial droop, arm weakness, speech disturbance, time to call an ambulance) mnemonic. The aim of this study is to examine efficacy of our education program for junior high school students and their parents. One hundred ninety students of 3 junior high schools (aged 12-13 years) and their parents were enrolled. Students received a 45-minute lesson of stroke enlightenment using the FAST mnemonic. Enlightenment items, such as a magnet poster, were distributed. Parents were educated indirectly from their child. Surveys of stroke knowledge were examined at baseline, immediately after the lesson, and at 3 months after the lesson. For the students, correct answers at 3 months were significantly higher than those at baseline in questions of facial palsy (98% versus 33%), speech disturbance (98% versus 54%), numbness on one side (64% versus 42%), weakness on one side (80% versus 51%), calling an ambulance (88% versus 60%), alcohol drinking (85% versus 65%), smoking (70% versus 43%), dyslipidemia (58% versus 46%), hyperglycemia (59% versus 48%), and obesity (47% versus 23%). At 3 months, the parents answered more correctly questions of facial palsy (93% versus 66%), calling an ambulance (95% versus 88%), and alcohol drinking (65% versus 51%) than at baseline. At 3 months, 96% of students and 78% of parents answered the FAST mnemonic correctly. Our stroke education program improved stroke knowledge, especially the FAST message, for junior high school students and their parents. Copyright © 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.

Mobile phone use for contacting emergency services in life-threatening circumstances.

PubMed

Wu, Olivia; Briggs, Andrew; Kemp, Tom; Gray, Alastair; MacIntyre, Kate; Rowley, Jack; Willett, Keith

2012-03-01

The potential health benefits of mobile phone use have not been widely studied, except for telemedicine-type applications. This study seeks to determine whether initial contact with emergency services via a mobile phone in life-threatening situations is associated with potential health benefits when compared to contact via a landline. A record-linkage study was carried out in which data from all emergency dispatches for immediately life-threatening events from a United Kingdom county ambulance service were linked to the Patient Admission System at two major local hospitals. Mortality (at the scene, at the emergency department [ED], and during hospitalization); transfer to the ED; admission (inpatient care, and intensive care unit); and length of stay were analyzed for calls classified as Code Red (immediately life-threatening) by initial exposure (mobile phone vs. landline), while controlling for potential confounding variables. Of 354,199 ambulances dispatched to attend emergency incidents, 66% transported patients to the hospital while 2% stood down due to death at the scene. Mobile phone compared to landline reporting of emergencies resulted in significant reductions in the risk of death at the scene (odds ratio [OR] 0.77), but not for death in the ED or during inpatient admission. The risk of being transferred to the ED and subsequent inpatient admission were significantly lower with reporting from mobile phones compared to landline (OR 0.93 and OR 0.82, respectively). In this study, evidence of statistical association was demonstrated between the use of mobile phones to alert ambulance services in life-threatening situations and improved outcomes for patients. Copyright © 2012 Elsevier Inc. All rights reserved.

[Treatment of liver cirrhosis - actually possibility of ambulant internist].

PubMed

Ehrmann, Jiří; Aiglová, Květa; Konečný, Michal; Procházka, Vlastimil; Vrzalová, Drahomíra

There are 40 000-60 000 patients with cirrhosis in the Czech Republic. 2 000 die of this disease yearly. This group of patients needs a complex treatment and it is mostly an internist cooperating with other specialists. The most important for an ambulant internist is to diagnose the disease as soon as possible and start with treatment of chronic liver disease that could lead to a cirrhosis. It means especially chronic viral hepatitis, alcoholic or non-alcoholic steatosis/steatohepatitis, auto-immune liver damage and metabolic disease. The next step is to diagnose the cirrhosis in time when it is in no manifest stage. The third step is to diagnose and treat the liver decompensation. It means consequences of the portal hypertension, it is ascit, esophageal or gastric varices, hepatorenal syndrome. Next there are consequences of the metabolic insufficiency, it is icterus, coagulopathy and hepatic encephalopathy. It is necessary to diagnose and cure cholestasis from the very first extrahepatic causes. For a successful treatment of the hepatocellular carcinoma originated almost exclusively in the grounds of the cirrhosis must be early diagnosed. The ambulant internist respective hepatologist must diagnose the stage of the cirrhosis and decide when a hospitalization is necessary. Also a close cooperation with other specialists is urgent if it is about a liver transplantation. The treatment of successive stages of the cirrhosis is a topic of the showed educational article. compensated/decompensated liver cirrhosis - diet/nutrition in liver cirrhosis - etiology and diagnose of liver cirrhosis - treatment of liver insufficiency/failure - treatment of portal hypertension and its complications.

HOW I DID IT....THE CEO OF ATHENAHEALTH on ON THE ROLE OF ANGER IN STARTING NEW BUSINESSES.

PubMed

Bush, Jonathan

2015-12-01

As a boy, Bush watched Emergency! on television and was captivated by the romance and seeming magic of saving lives. As an adult, he found the reality of medicine to be very different: There wasn't much humanity in the way health care was actually delivered. Believing that he'd be daunted by the course work required for a medical degree, he decided to take an entrepreneurial route to improving the system. His first sense of the opportunity came while he was driving an ambulance in New Orleans one summer during college. Some patients with chronic disease who couldn't afford their medicines would repeatedly call the ambulance to take them to a hospital where they could be stabilized. What if the ambulance itself were outfitted with treatments for the five most common chronic diseases and carried EMTs who were trained to use them? Those patients could be treated in place, at a radically lower cost than what the hospital would charge. That idea didn't work out, and Bush moved on to think about a network of maternity clinics. He and Todd Park drew up a business plan at Harvard Business School--one that was "unbelievably complicated to execute and very risky." But in the process of pursuing it, they created websites for the paperwork with rules that prevented mistakes. That was the seed for athenahealth, which today supports electronic medical records and a suite of practice management and care coordination services, leaving doctors free to spend more time with their patients.

Crew Configuration, Ingress/Egress Procedures, and In-Flight Caregiving Capacity in a Space Ambulance Based on the Boeing X-37B

NASA Astrophysics Data System (ADS)

Halberg, Ephriam Etan

This study proposes that a Boeing X-37B space plane, its dimensions and performance characteristics estimated from publicly available documents, diagrams, and photographs, could be internally redesigned as a medical evacuation (ambulance) vehicle for the International Space Station. As of 2017, there is currently no spacecraft designed to accommodate a contingency medical evacuation wherein a crew member aboard the ISS is injured or ailing and must be returned to Earth for immediate medical attention. The X-37B is an unmanned vehicle with a history of success in both sub-orbital testing and all four of its long-duration orbital missions to date. Research conducted at UC Davis suggests that it is possible to retain the outer mold line of the X-37B while expanding the internal payload compartment to a volume sufficient for a crew of three--pilot, crew medical officer, and injured crew member--throughout ISS un-dock and atmospheric entry, descent, and landing. In addition to crew life support systems, this re-purposed X-37B, hereafter referred to as the X-37SA (Space Ambulance), includes medical equipment for stabilization of a patient in-transit. This study suggests an optimal, ergonomic crew configuration and berthing port location, procedures for microgravity ingress and 1G egress, a minimum medical equipment list and location within the crew cabin for the medical care and monitoring equipment. Conceptual crew configuration, ingress/egress procedures, and patient/equipment access are validated via physical simulation in a full-scale mockup of the proposed X-37SA crew cabin.

Combining afferent stimulation and mirror therapy for rehabilitating motor function, motor control, ambulation, and daily functions after stroke.

PubMed

Lin, Keh-chung; Huang, Pai-chuan; Chen, Yu-ting; Wu, Ching-yi; Huang, Wen-ling

2014-02-01

Mirror therapy (MT) and mesh glove (MG) afferent stimulation may be effective in reducing motor impairment after stroke. A hybrid intervention of MT combined with MG (MT + MG) may broaden aspects of treatment benefits. To demonstrate the comparative effects of MG + MT, MT, and a control treatment (CT) on the outcomes of motor impairments, manual dexterity, ambulation function, motor control, and daily function. Forty-three chronic stroke patients with mild to moderate upper extremity impairment were randomly assigned to receive MT + MG, MT, or CT for 1.5 hours/day, 5 days/week for 4 weeks. Outcome measures were the Fugl-Meyer Assessment (FMA) and muscle tone measured by Myoton-3 for motor impairment and the Box and Block Test (BBT) and 10-Meter Walk Test (10 MWT) for motor function. Secondary outcomes included kinematic parameters for motor control and the Motor Activity Log and ABILHAND Questionnaire for daily function. FMA total scores were significantly higher and synergistic shoulder abduction during reach was less in the MT + MG and MT groups compared with the CT group. Performance on the BBT and the 10 MWT (velocity and stride length in self-paced task and velocity in as-quickly-as-possible task) were improved after MT + MG compared with MT. MT + MG improved manual dexterity and ambulation. MT + MG and MT reduced motor impairment and synergistic shoulder abduction more than CT. Future studies may integrate functional task practice into treatments to enhance functional outcomes in patients with various levels of motor severity. The long-term effects of MG + MT remain to be evaluated.