Duration of mission time in prehospital emergency medicine: effects of emergency severity and physicians level of education

Schuster, Martín; Pints, Matthias; Fiege, Marko

doi:10.1136/emj.2009.074211

Cited by 23 publications

(18 citation statements)

References 18 publications

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“…Most dispatches occurred during daytime, especially in the afternoon. A German study reported a similar pattern, although their peak proportion of missions per hour was before noon 25. The summer is a busy period, probably because of more outdoor‐related activity, and the frequency of competing missions increased in these periods.…”

Section: Discussionmentioning

confidence: 71%

Helicopter‐based emergency medical services for a sparsely populated region: A study of 42,500 dispatches

Østerås

Brattebø

Heltne

2015

Acta Anaesthesiol Scand

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BackgroundThe Helicopter Emergency Medical Service (HEMS) in Norway is operated day and night, despite challenging geography and weather. In Western Norway, three ambulance helicopters, with a rapid response car as an alternative, cover close to 1 million inhabitants in an area of 45,000 km2. Our objective was to assess patterns of emergency medical problems and treatments in HEMS in a geographically large, but sparsely populated region.MethodsData from all HEMS dispatches during 2004–2013 were assessed retrospectively. Information was analyzed with respect to patient treatment and characteristics, in addition to variations in services use during the day, week, and seasons.ResultsA total of 42,456 dispatches were analyzed. One third of the patients encountered were severely ill or injured, and two thirds of these received advanced treatment. Median activation time and on‐scene time in primary helicopter missions were 5 and 11 min, respectively. Most patients (95%) were reached within 45 min by helicopter or rapid response car. Patterns of use did not change. More than one third of all dispatches were declined or aborted, mostly due to no longer medical indication, bad weather conditions, or competing missions.ConclusionOne third of the patients encountered were severely ill or injured, and more than two thirds of these received advanced treatment. HEMS use did not change over the 10‐year period, however HEMS use peaked during daytime, weekends, and the summer. More than one third of all dispatches were declined or aborted.

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Section: Discussionmentioning

confidence: 71%

Helicopter‐based emergency medical services for a sparsely populated region: A study of 42,500 dispatches

Østerås

Brattebø

Heltne

2015

Acta Anaesthesiol Scand

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“…However, these findings support the thesis that telemedically supported prehospital diagnosis and therapy on the whole is a safe procedure, although the process was completely new for the participating physicians as well as for the paramedics. In comparison with ground- or helicopter-based EMS physician operations [23], this concept allows for a spatially unrestricted emergency concept with fewer resources. At this point it has to be mentioned that, to our knowledge, most studies with 12-lead-ECG transmission represent rather small sample sizes.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

Brokmann¹,

Conrad²,

Rossaint³

et al. 2016

J Med Internet Res

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BackgroundPrehospital treatment of acute coronary syndrome (ACS) in German emergency medical services (EMSs) is reserved for EMS physicians due to legal issues.ObjectiveThe objective of this prospective, interventional, multicenter trial was to evaluate the quality of telemedically-delegated therapy and the possible complications in patients with ACS.MethodsAfter approval by the ethics committee and trial registration, a one-year study phase was started in August 2012 with 5 ambulances, telemedically equipped and staffed with paramedics, in 4 German EMS districts. The paramedics could contact an EMS-physician–staffed telemedicine center. After initiation of an audio connection, real-time data transmission was automatically established. If required, 12-lead electrocardiogram (ECG) and still pictures could be sent. Video was streamed from inside each ambulance. All drugs, including opioids, were delegated to the paramedics based on standardized, predefined algorithms. To compare telemedically-delegated medication and treatment in ACS cases with regular EMS missions, a matched pair analysis with historical controls was performed.ResultsTeleconsultation was performed on 150 patients having a cardiovascular emergency. In 39 cases, teleconsultation was started due to suspected ACS. No case had a medical complication. Correct handling of 12-lead ECG was performed equally between the groups (study group, n=38 vs control group, n=39, P>.99). There were no differences in correct handling of intravenous administration of acetylsalicylic acid, heparin, or morphine between both the groups (study group vs control group): acetylsalicylic acid, n=31 vs n=33, P=.73; unfractionated heparin, n=34 vs n=33, P>.99; morphine, n=29 vs n=27, P=.50. The correct handling of oxygen administration was significantly higher in the study group (n=29 vs n=18, P=.007).ConclusionsTelemedical delegation of guideline conform medication and therapy by paramedics in patients with ACS and was found to be feasible and safe. The quality of guideline-adherent therapy was not significantly different in both the groups except for the correct administration of oxygen, which was significantly higher in the study group.Trial RegistrationClinicaltrials.gov NCT01644006; http://clinicaltrials.gov/ct2/show/NCT01644006 (Archived by WebCite at http://www.webcitation.org/6mPam3eDy).

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“…These factors include prehospital strategies,42 level of training of ambulance crews,43 and hospital capacity 44. Future studies should address the influence of these factors.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2016

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ObjectivesIn 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 settingA cross-sectional study of an ambulance records database in Nara prefecture, Japan.CasesA 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 measuresThe time from call to hospital arrival, defined as the time interval from receipt of an emergency call to ambulance arrival at a hospital.ResultsThe 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.ConclusionsThe 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.

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Duration of mission time in prehospital emergency medicine: effects of emergency severity and physicians level of education

Abstract: The effect of education on treatment process and outcome in prehospital emergency care should merit further research, especially to ensure that junior emergency physicians are properly trained before they work in prehospital emergency medicine.

Cited by 23 publications

References 18 publications

Helicopter‐based emergency medical services for a sparsely populated region: A study of 42,500 dispatches

Helicopter‐based emergency medical services for a sparsely populated region: A study of 42,500 dispatches

Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional, Multicenter Trial

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

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