Prehospital Emergency Care最新文献

Objectives: Patients receiving extracorporeal membranous oxygenation (ECMO) support often have fragile conditions that make them susceptible to physiological deterioration during interhospital transport (IHT). This study aimed to assess the safety of IHT for ECMO-supported patients, utilizing a dedicated critical care transport team.

Methods: A retrospective analysis was conducted on patients who underwent IHT while receiving ECMO support in a metropolitan city between January 2016 and April 2024. The primary outcome was the occurrence of abnormal physiologic parameters during IHT, including hypotension (mean arterial pressure <65 mmHg), desaturation (pulse oximetry <90%), tachycardia (heart rate >120/min), and bradycardia (heart rate <50/min).

Results: A total of 151 patients were included in the study, with 96 (59.6%) on Veno-arterial (VA)-ECMO and 55 (40.4%) on veno-venous (VV)-ECMO. Of these, 37.1% had experienced cardiac arrest prior to ECMO initiation. The median transport time from departure at the referring hospital to arrival at the receiving hospital was 25 minutes (interquartile range, 19-37 minutes). Several adverse events occurred during transport, including ECMO console shutdown in 8.9% of cases (n = 10 spontaneous shutdowns, n = 3 due to human error), all of which were appropriately managed by the trained transport team. Physiological parameters remained stable between the start and end of IHT, with a significant reduction in the prevalence of tachycardia (p < 0.01).

Conclusions: Interhospital transport for ECMO-supported patients by a dedicated critical care transport team is safe. These findings support the implementation of specialized transport systems to facilitate the safe transfer of critically ill patients receiving ECMO support.

Objectives: Chest pain is the most common reason for 9-1-1 calls in the United States. Triage of these patients to a local hospital vs tertiary care facility can be challenging. Our objective was to determine whether a cardiovascular telehealth program that connects rural paramedics with emergency physicians could avoid interfacility transfers in patients with chest pain.

Methods: We conducted a pilot prospective cohort study of adult patients with chest pain who underwent prehospital telehealth evaluation in a single emergency medical services (EMS) system (2/2021-11/2023). A paramedic completed a structured assessment of each patient, then connected with an emergency physician to complete a telehealth call. The physician reviewed the patient's electrocardgram (ECG), discussed the case with the paramedic, and met with the patient to determine risk for emergent conditions. Transport destination was guided by the following framework: local clinic (during operating hours) for stable low-risk patients, local community hospital for stable moderate-risk patients, and tertiary care center for high-risk patients, an ischemic ECG, or instability. The primary outcome was avoided interfacility transfers. Secondary outcomes included transport destination, avoided emergency department (ED) visits, and patient satisfaction assessed with the Short Assessment of Patient Satisfaction (SAPS) score.

Results: During the study, 112 patients were accrued, of which 45.5% (51/112) were female and 9.8% (11/112) were non-white with a mean age of 60 ± 17 years. Among these patients, 67.8% (76/112) were triaged to the local hospital, 19.6% (22/112) to a tertiary care center, 2.7% (3/112) to the clinic, and 9.8% (11/112) refused transport. Telehealth triage resulted in in 9 out of 112 patients (8.0%; 95% CI 5.0-13.0%) adjudicated as likely to have avoided subsequent interfacility transfer and avoided ED visits in 2 out of 112 patients (1.8%, 95% CI 0.0-4.3%). Mean SAPS score was 23.4 (±2.8), consistent with strong overall satisfaction with telehealth calls.

Conclusions: Among rural patients with chest pain, an EMS telehealth program was associated with avoided interfacility transfers and strong patient satisfaction.

Objectives: This study aims to characterize the national prehospital trends in primary supraglottic airway use in non-cardiac arrest patients with various methods, including rapid sequence airway (RSA), defined as administration of a sedative and paralytic to facilitate supraglottic airway (SGA) placement. We compared this SGA-first practice to other methods of prehospital airway management.

Methods: This was a retrospective analysis of a national emergency medical services (EMS) database containing 9-1-1 calls over a five-year period. Only ALS-level calls were included. We compared the incidence of SGA- and tracheal-intubation-first attempts by paramedics. We excluded interfacility transfers, patients in or near cardiac arrest, and surgical airways before intubation.

Results: There were 355,511 encounters with endotracheal tube (ETT) or SGA placement, of which 316,392 patients were excluded, most commonly for cardiac arrest and peri-cardiac arrest, leaving 36,058 (92%) managed with tracheal intubation first and 3,061 (8%) managed with a SGA first. Trauma was the primary reason for encounter for approximately 28% of both groups. SGA-first approaches increased over the five-year period from 3.5% to 8.7% of invasive airway attempts. The type of SGA changed substantially over the study period, with use of the iGel increasing (42% to 82%), and the King LTSD decreasing (50% to 14%). Neuromuscular blocking agents were used in 74% of encounters.

Conclusions: Among prehospital patients not in cardiac arrest, supraglottic airway devices comprise 8% of initial advanced airway management, with increasing use over time. Placement is usually facilitated by use of a sedative and neuromuscular blocking agent.

Objectives: On November 28, 2017, the fire at the Guadeloupe University Hospital created an exceptional health care crisis, due to the loss of critical care units, operating rooms, and emergency department at the island's main hospital. Large-scale air medical evacuations were organized to the University Hospital of Martinique, another nearby French island. This unprecedented event posed unique challenges in terms of feasibility and risks inherent to these emergency medical evacuations of critically ill patients.

Methods: It was a retrospective, observational, monocentric study, including all patients with initial medical care provided in Guadeloupe archipelago, Saint-Martin and Saint-Barthelemy islands and which required medical evacuation to the Martinique University Hospital during the following 6 wk after fire at the Guadeloupe University Hospital.

Results: During the study period, 93 patients were included which corresponds to 2.2 patients transferred per day, with a highest transfers occurred during the first week (n = 30). Median age was 52 [22-64] years-old, and 54 were male (58.1%). All transfers were conducted by air 58 patients were admitted in ICU (62.3%) and diseases were mainly cardiovascular (n = 18, 19.4%), neurosurgery (n = 16, 17.2%) and pediatric (n = 15, 16.1%). Nine patients (9.7%) experienced complications or clinical deterioration during air transfer. Median length of hospital stay was 11 [7-17] days. Seven patients died during hospitalization (7.5%) and 81 patients (87.1%) returned in home territories after care in Martinique.

Conclusions: This event demonstrates the feasibility of conducting multiple air medical evacuations during a health crisis in a French overseas territory, with the appropriate medical and logistical resources for the safety and quality of care for evacuated patients.

Objectives: To explore the long-term effect of intelligent first-aid training based on virtual reality (VR) technology on cardiopulmonary resuscitation (CPR) skill proficiency.

Methods: The convenience sampling method was used to select a total of 100 non-medical volunteers from Nanchang, China, and this cohort was randomized to either the VR training group (VR group) or the traditional simulation scenario training group (traditional group). Relevant data were collected for comparative analysis. Participants were evaluated by measuring mean chest compression depth, chest compression pauses time, the proportion of compressions with correct compression depth, mean chest compression rate, and mean ventilation volume.

Results: After initial training, the two groups of participants showed similar results in terms of chest compression depth and chest compression rate. There were significant differences in chest compression pauses time, proportion of compressions with correct compression depth, and ventilation volume (p < 0.001). Long-term follow-up (12 months) after training showed that both groups of participants showed differences in the above indicators (p < 0.001). After training, the VR group had higher pass proportions for mean chest compression rate (p = 0.047) and mean ventilation volume (p = 0.043) than the traditional group. After training, the VR group had higher pass proportion for mean chest compression depth (p < 0.001), mean chest compression rate (p < 0.001), and mean ventilation volume (p < 0.001) than the traditional group.

Conclusions: Training with VR can significantly improve CPR knowledge and skill levels and help learners master and maintain high-quality CPR skills.

Objectives: To examine the impact of migration across the United States southern land border on the mental health of emergency medical services (EMS) clinicians in the border region.

Methods: We conducted 67 in-depth interviews with fire-based EMS clinicians in three communities. Interviews took place from June 23 to 27, 2024. We conducted thematic analysis using inductive, latent coding in NVivo 14© software.

Results: Primary themes identified were that EMS clinicians were emotionally impacted by helping migrants, that calls to provide care to migrants often led EMS clinicians to feel overwhelmed, and that EMS clinicians have developed support systems and coping mechanisms for the mental health impacts of their job.

Conclusions: Given the complex environment of the border region and the uniqueness of migrant-related emergency calls, EMS clinicians in the border region need greater mental health support.

Objectives: Motorcycle helmets save lives and reduce serious injury after motorcycle collisions (MCC). In 2022, 18 states had laws requiring helmet use by motorcyclists aged ≥21 years. Our objective was to compare helmet use and head trauma in emergency medical services (EMS) patients involved in MCC in states with and without helmet use laws.

Methods: We conducted an analysis of the 2022 ImageTrend Collaborate national EMS dataset. We included 9-1-1 responses where the patient was a motorcyclist in a transport accident (ICD-10 V20-V29) and aged ≥21 years. Patient demographics, incident urbanicity, helmet use, presence of state helmet use law, patient disposition, Glasgow Coma Scale (GCS) score, and trauma team activations were examined. Our primary outcome of interest was EMS documentation of helmet use (yes/no). Our secondary outcome was the presence of a head injury. We examined EMS-documented head injury, defined using clinician impressions and chief complaint anatomical location. Chi-square tests were used to assess differences in proportions, and a multivariable logistic regression model was used to estimate odds of moderate/severe head injury adjusted for covariates of interest.

Results: A total of 15,891 patient encounters were included, 10,738 (67.6%) occurred in states without helmet use laws. States without helmet use laws had higher proportions of unhelmeted patients (56.8% vs 24.2%, p < 0.001), encounters in non-metro/rural areas (19.7% vs 13.3%, p < 0.001), and GCS-defined moderate/severe head injuries (4.6% vs 2.3%, p < 0.001). In a multivariable model that included 10-yr age groups, sex, race, urbanicity, and documented helmet use, the adjusted odds of moderate/severe head injury were lower for females (0.47, 95%CI, 0.35-0.65) and Black patients (0.47, 95%CI 0.32-0.70), and were higher for incidents in nonmetro/rural areas (1.58, 95%CI 1.28-1.95) and when EMS had not documented helmet use (3.17, 95%CI 2.56-3.92).

Conclusions: In this retrospective cross-sectional study, a higher proportion of patients involved in MCCs in states without helmet laws were not wearing helmets at the time of injury, and unhelemted patients had increased likelihood of sustaining a head injury. EMS agencies in states without helmet laws should prepare their systems and clinicians for an increased incidence of head injuries after MCCs.

Objectives: Paramedic services face increasing challenges due to delays in patient transfer of care (TOC) at emergency departments (EDs). Prolonged TOC times directly impact paramedic services' ability to provide emergency response, though the patient and clinical factors contributing to these delays remain unclear. We examined TOC times for all transports to the ED and analyzed factors associated with prolonged TOC.

Methods: We conducted a retrospective cohort study using paramedic call data from Toronto Paramedic Services from September 1, 2022, to July 31, 2024. We included all paramedic-transported patient records to EDs following a 9-1-1 call, excluding inter-facility transfers and records with missing TOC timestamps. The TOC times were categorized into four intervals: 0-29, 30-59, 60-89, and ≥ 90 min. We conducted a cohort and subgroup analysis of patients aged 60 years or older using multivariable binary logistic regression models to identify factors independently associated with TOC times exceeding 60 min, using odds ratios (OR) with 95% confidence intervals (CI).

Results: A total of 418,196 patients were transported to EDs, of which 214,612 were 60 years or older. Overall, mean TOC was 39.9 min (SD 54.2). Patients aged 0-17 years had the lowest proportion in longer TOC intervals (5% for 60-89 mins; 2% for ≥ 90 mins), while patients 75 years or older had the highest (9%; 9% respectively). A TOC of at least 60 min was independently associated with older age (60 to 74 years OR 1.19, 1.15-1.22; 75 years or greater OR 1.27, 1.23-1.30), medical complexity (seven to eight diagnoses OR 1.15, 1.10-1.20; nine or greater diagnoses OR 1.29, 1.23-1.36), polypharmacy and specific presenting complaints (altered level of consciousness, respiratory distress, general weakness, head trauma). Medical acuity and receiving a paramedic intervention were not associated with prolonged TOC. Similar findings were determined in the subgroup analysis of older adults.

Conclusions: Prolonged TOC times disproportionately affect older or clinically complex patients, regardless of their acuity or need for paramedic intervention. Our findings highlight the importance for paramedic services, hospitals, and stakeholders to develop targeted care models and collaborations to reduce prolonged TOC.

Objectives: To compare the effects of powered and manual stretchers on participants' perceived comfort and measured acceleration during lifting and loading operations.

Methods: This non-randomized, laboratory-based crossover study involved forty-one participants (thirty-one firefighters and ten third-year paramedic students) who served as simulated patients experiencing lifting, lowering, loading, and unloading maneuvers using manual and powered stretchers. Four stretcher types were evaluated: one powered stretcher (Power-PRO^™ XT) and three manual stretchers (Matsunaga GT, Exchange 4070, Scad Mate), with each group using the manual stretcher they routinely operated. Linear acceleration data were collected using a nine-axis inertial measurement unit placed at the participants' anterior waist. Root mean square (RMS) and peak accelerations along the X-, Y-, and Z-axes were calculated. Participants completed a twenty-three-item comfort questionnaire based on the Semantic Differential method. Due to non-normal data distribution, nonparametric statistical tests were employed for analysis.

Results: The lifting/lowering and loading/unloading movements showed that the powered stretcher significantly reduced the RMS values, maximum accelerations, and minimum accelerations in the vertical axis (Z-axis) compared to manual stretchers. Specifically, the powered stretcher demonstrated lower RMS acceleration (0.29 m/s² vs. 0.73 m/s², p < 0.001), maximum acceleration (1.60 m/s² vs. 2.90 m/s², p < 0.001), and minimum acceleration (-1.48 m/s² vs. -3.30 m/s², p < 0.001) in the vertical direction compared to other manual stretchers. Similar results were observed in the comparison of participant loading/unloading movements. However, no significant differences were observed between the powered and Exchange stretchers in X-axis minimum acceleration, Y-axis maximum and minimum accelerations, or Z-axis maximum acceleration. Similarly, Y-axis minimum accelerations did not significantly differ between the powered stretcher and Matsunaga GT or Scad Mate stretchers. After loading and unloading movements, the questionnaire results showed that the powered stretcher was rated significantly higher on comfort-related items including "comfortable," "secure," "like," "smooth," and "relaxing."

Conclusions: In a controlled, laboratory-based setting, simulated use of manual and powered stretchers showed that powered stretchers significantly minimize patient discomfort and vibrations. This study underscores the potential for enhancing patient safety and quality of care. In conclusion, the powered stretcher is a promising tool for improving the quality and safety of patient transportation in prehospital settings.