BMC Emergency Medicine最新文献

Introduction: Implementing innovative educational methods is crucial for enhancing emergency technicians' knowledge and skills in providing fundamental care for trauma patients. This study aims to assess the impact of a scenario-based pre-hospital trauma management (PHTM) course on the knowledge and skill level of emergency medical system (EMS) students in Iran.

Methods: This semi-experimental, single-group pre-test-post-test study involved 25 emergency medical students participated in the PHTM training course. The students underwent two days of training (6 h per day) in a simulated, scenario-based environment across 5 stations, using realistic patients. The PHTM course knowledge assessment tool and a standard clinical skills checklist were used to collect data before and after the intervention.

Results: The results revealed that EMS students had an average level of trauma knowledge and clinical skills before the PHTM course, which significant improved to a desirable level after the intervention(P = 0.0001). The average skill level increased from 57.44 before the intervention to 122.24 afterward. The results also demonstrated that the interventions significantly improved students' skill levels in various PHTM domains, including trauma patient assessment, spinal motion restriction for sitting and lying positions, immobilization of injured long bones and joints, application of a traction splint, bleeding control and shock treatment, airway management, and ventilation/endotracheal intubation skills(P = 0.0001).

Conclusion: The findings of this study indicate that scenario-based and simulated training methods, as applied in the PHTM workshop, are effective in improving emergency medical students' knowledge and clinical skills for managing trauma patients.

Background: Anemia affects up to 25% of emergency department (ED) patients. Restrictive red blood cell (RBC) transfusion strategies are recommended for stable patients, but ED transfusion practices often remain liberal. Benefits of ED transfusion remains unclear.

Objective: To evaluate the impact of ED transfusion on death-adjusted in-hospital length of stay (LOS) in stable anemic patients requiring hospitalization.

Methods: This single-center retrospective propensity-matched study included patients ≥ 18 years admitted to the ED of Nîmes University Hospital in 2022 with hemoglobin levels between 70 and 90 g.L^- 1. Patients with hemorrhagic shock or requiring emergent hemostatic procedures were excluded. Propensity score matching was conducted on variables including age, comorbidities, hemoglobin levels, and diastolic blood pressure. Primary outcome was adjusted in-hospital LOS. Secondary outcomes included ED LOS and RBC transfusion volumes.

Results: Among 564 patients, 118 (21%) were propensity-matched: 59 (50%) ED-transfused, 59 (50%) non-ED-transfused. Adjusted in-hospital LOS 13 [8-32] for ED-transfused patients and 12 [6-24] days for non-ED-transfused patients (median difference = 0; 95%CI: -10-7; p = 0.52). Median difference in ED LOS was 7:13 (95%CI: 1:00-11:25; p < 0.001) between ED transfused and non-ED-transfused patients. Median difference in number of RBC transfused during in hospital stay was 2 (95%CI: 1-3); p < 0.01) between ED transfused and non-ED-transfused patients.

Conclusion: In stable anemic patients with 70 to 90 g.L^- 1 hemoglobin level, ED transfusion did not reduce adjusted in-hospital LOS but prolonged ED LOS. Identifying patients who may safely defer transfusion could improve ED efficiency and safety.

Background: Emergency endotracheal intubation is a critical skill for managing airway emergencies in the emergency department (ED). Accurate prediction of difficult laryngoscopy is essential for improving first-attempt success, minimizing complications, optimizing resource utilization, and enhancing patient outcomes. Traditional methods, such as the LEMON criteria, have limited predictive accuracy. Machine learning (ML) offers advanced predictive capabilities by analyzing large datasets and identifying complex variable interactions. This study aimed to develop and validate the performance of ML models for predicting difficult laryngoscopy in the ED, comparing it with a conventional regression model.

Methods: A retrospective cohort study was conducted on 4,370 adult patients who underwent intubation in the ED at Thammasat University Hospital. Difficult laryngoscopy was defined as a Cormack-Lehane grade III or IV. Patients were divided into development (training, 70%) and validation (testing, 30%) cohorts. Predictors of difficult laryngoscopy were identified using multivariable stepwise backward elimination logistic regression and were used to develop ML models, including Logistic Regression, Decision Tree, Random Forest, and XGBoost. Model performance was evaluated using the area under the receiver operating characteristic curve (AuROC), accuracy, precision, recall, and F1-score. Validation was performed on the validation cohort to confirm model accuracy.

Results: Nine significant predictors were identified: male sex, trauma, absence of neuromuscular blocking agents, large incisors, large tongue, limited mouth opening, short thyrohyoid distance, obstructed airway, and poor neck mobility. The Random Forest model demonstrated the highest predictive performance, with an AuROC of 0.82 (95% CI: 0.78-0.85), accuracy of 0.89, recall of 0.89, and F1-score of 0.87, outperforming conventional regression (AuROC 0.76, 95% CI: 0.73-0.78) and other ML models. DeLong's test confirmed a statistically significant difference in AuROC between the two models (p = 0.002). The Decision Tree showed limited performance due to overfitting, while XGBoost demonstrated strong precision. No significant differences were found when comparing the two models with conventional regression (p = 0.498 and 0.496, respectively).

Conclusion: The Random Forest model provides the most robust prediction of difficult laryngoscopy, outperforming both conventional and other ML methods. While ML models improve predictive accuracy, logistic regression remains a practical option in resource-limited settings. Integrating ML into clinical workflows could enhance decision-making, resource allocation, and patient safety in emergency airway management. Future research should prioritize external validation and real-world implementation.

Background/aim: Disasters are becoming more frequent globally. In the past years, Saudi Arabia has been exposed to various disasters. Public awareness of disasters and disaster preparedness/response are deemed important to reduce risks, injury, or even death from disasters. This study was conducted to determine the level of knowledge, beliefs, and performance of female high school students in relation to disaster preparedness.

Method: From November to December 2016, a cross-sectional study was conducted among 579 female high school students enrolled in five public schools in Riyadh, Saudi Arabia. Participants were distributed a self-administered questionnaire on disaster experiences, knowledge of disaster, attitudes and beliefs, and health belief model components.

Results: The students' level of knowledge was high (48.7%), while their level of performance in disaster preventive behaviours was average (28.5%). The students' total preparedness for disasters was also average (30%). Their beliefs regarding the risk of catastrophe were low (45.1%).

Conclusion: The findings of this study reveal a significant gap between knowledge and action. The students' disbelief in the occurrence of disasters and the importance of preparation has led to a lack of readiness. This underscores the critical need for increased education and emphasis on disaster response and preparedness among female high school students.

Background: Overcrowding is a common issue in emergency departments worldwide. One condition associated with overcrowding is the Emergency Department Length of Stay(EDLOS). Prolonged EDLOS is linked to increased hospitalization costs, worsening clinical outcomes, and deterioration in patient-reported outcomes. Consequently, there is a need to reduce EDLOS, and the scientific literature reports multiple strategies aimed at this goal. Therefore, the objective of this study was to determine strategies statistically significant in reducing the EDLOS.

Method: A systematic search was conducted in PubMed, Scopus, the Latin American and Caribbean Health Sciences Literature (LILACS) database, and Google Scholar from January 2000 to January 2024. Studies that included patient care strategies in emergency departments to reduce EDLOS, in adults or pediatric populations, and observational or experimental studies were included. The quality of the studies was assessed using the Cochrane Collaboration's Risk of Bias tool for Interventional Studies, and the certainty of the evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation criteria. A mean difference analysis in minutes was performed using a random-effects model.

Results: A total of 3410 studies were identified using the search strategy with a total of 245,404 patients were analyzed. Three types of strategies were identified with results in reducing EDLOS. Interventions performed by physicians in the triage area (liaison, supervision, and advanced triage) showed a significant reduction of -21.87 min (95% CI -28.35; -15.38). The second intervention was the use of Point-of-Care Testing, which showed a reduction of -41.98 min (95% CI -98.13; 14.15). The third intervention was the creation of fast-track strategies, which documented a reduction of -21.81 min (95% CI -41.79; -1.83). Most of the studies were of the before-and-after type. The certainty of the evidence for the first intervention was moderate, while for the other two groups, it was considered low.

Conclusion: The presence of a physician in the triage team demonstrated a reduction in patient EDLOS, although with high heterogeneity among the analyzed studies. Similarly, the use of fast-track strategies is also significantly useful in reducing EDLOS, while POCT reduces EDLOS but not significantly.

Introduction: Several prehospital trauma triage tools have been recently developed, but no standardized tools currently exist to identify trauma patients at risk of requiring resuscitative interventions (RIs) within the first 24 h post-injury and to prioritize their transport to high-level trauma facilities.

Methods: This prognostic study employed a retrospective cohort design to evaluate the predictive performance of the Triage Revised Score (T-RTS), Glasgow Coma Scale, Age, and Systolic Blood Pressure Score (GAP), Mechanism, Glasgow Coma Scale, Age, and Systolic Blood Pressure Score (MGAP), National Early Warning Score 2 (NEWS-2), Shock Index (SI), and Reverse Shock Index multiplied by Glasgow Coma Scale (rSIG) in predicting the need for RIs within 24 h. Data was retrieved from the electronic medical records of Ramathibodi Hospital, and the study included patients aged ≥ 15 years who were categorized as high-risk or life-threatening and subsequently transported to the emergency department. We used Area Under the Receiver Operating Characteristic (AUROC) curve and calibration plots to assess the performance of prehospital trauma triage tools.

Results: There were 440 traumatic injury patients enrolled in the study, with 44 (10%) receiving RIs. T-RTS, GAP, MGAP, and NEWS-2 demonstrate good discriminative and predictive performance for RIs within 24 h after an injury (AUROC of 0.969, 0.949, 0.971, and 0.929, respectively, with the O:E ratio of 1). With the predefined standard cut-off values, the GAP score of less than 19 results in the highest accuracy for ruling out patients who do not need RIs (Specificity = 94.4% and NPV = 94.1%, p-value < 0.001).

Conclusions: Several commonly used prehospital trauma triage tools demonstrate good predictive abilities for identifying the need for RIs. Among these, the GAP score with a threshold value of 19 serves as an optimal tool for identifying patients who require transfer to high-level trauma facilities.

Background: EMS providers are often the only emergency workers with medical knowledge at the scene of chemical hazards and are exposed to severe risks. They should always be prepared to face chemical hazards to be able to provide an effective response to them. Therefore, this study identified the dimensions and components of emergency medical services system preparedness in chemical hazards.

Methods: We searched the relevant electronic databases, including ProQuest, Embase, PubMed, Web of Science, and Scopus. The search included articles in English published up to November 2, 2023. In addition, organizational websites, including WHO, CDC, OSHA, NIOSH, FEMA, IFRC, NFPA, OECD, and OPCW, were searched to find gray literature. Studies were selected using the PRISMA checklist, and thematic analysis was used to analyze the findings.

Results: Finally, of 8193 selected records, 16 papers were included in the final analysis. Using thematic analysis, two main themes, 15 categories, and 57 subcategories were revealed. The categories for management measures included Plans and guidelines, Communication and coordination, Risk management, Management of physical spaces and Sources of funding, and for technical measures were recognition of chemical release, incident scene management, personal protection, casualty management, ambulance equipment and drugs, decontamination, psychological support, supporting units, Chemical, Biological, Radiological, Nuclear, and Explosives (CBRNE) ambulances, and training.

Conclusions: Due to the importance and extent of the effects of chemical hazards, EMS systems need to develop their preparedness using more specific approaches to provide medical services in chemical hazards. EMS systems should provide medical equipment and antidotes, chemical ambulances, chemical protective equipment, and necessary physical spaces with appropriate financing. Also, preparedness and response plans should be prepared and practiced regularly based on previous lessons learned and with the cooperation and participation of other organizations involved in chemical disasters.

Background: The 72-h emergency department (ED) revisit rate is a key quality indicator. While some revisits stem from medical errors or inadequate initial treatment, others are due to disease progression or a lack of accessible care. The development of a risk assessment tool could identify high-risk patients and improve resource management.

Methods: This study was conducted via an electronic health records system at a tertiary center in Taiwan. We derived a risk model via logistic regression and bootstrapping methods using a retrospective cohort of adults who underwent 72-h ED revisits between January 2019 and December 2020. The study population was divided into development (2019: 1224) and validation datasets (2020: 985). The primary outcome was high-risk return, defined as intensive care unit (ICU) admission or in-hospital mortality after 72-h ED return.

Results: On the basis of the odds ratio, eight variables were independently associated with high-risk ED returns and subsequently included in the HANDLE-24 score (hypertension; symptoms of acute coronary syndrome; dysnatremia; dyspnea; liver disease; triage level escalation; and revisits within 24 h). The area under the receiver operating characteristic curve was 0.816 (95% CI: 0.760-0.871, p < 0.001) in the development dataset and 0.804 (0.750-0.858) in the validation dataset. Patients can be divided into three risk categories on the basis of the HANDLE-24 score: low [0-8.5], moderate [9-11.5] and high [12-22] risk groups. The ability of our risk score to predict the rates of hospital admission, ICU admission and in-hospital mortality was significant according to the Cochran‒Armitage trend test.

Conclusion: The HANDLE-24 score represents a simple tool that allows early risk stratification and suggests more aggressive therapeutic strategies for patients experiencing ED revisits. The risk of adverse outcomes in ED adults after revisiting can be swiftly assessed via easily available information.

Background: The literature has identified numerous factors that contribute to workplace violence, ranging from environmental stressors to interpersonal conflict. However, a gap remains in our understanding of the specific factors associated with physical violence, particularly concerning its frequency and perceived significance.

Methods: A summative content analysis was conducted via the electronic survey platform Porsline in Iran for data collection. In April 2024, EMTs working in urban, road, and air bases in western Iran participated in the study. In total, 358 EMTs were selected via convenience sampling. They provided open-ended responses to the following question: "What do you believe are the most significant factors contributing to physical violence in your workplace?"

Results: The analysis resulted in a comprehensive list of 1,407 descriptions, organized into 20 subcategories and further consolidated into ten main categories. The category with the highest frequency was "legal and policy deficiencies," with a frequency of 3103, and the category with the lowest frequency was "workplace culture and professional satisfaction," with 579. The categories based on frequency and significance included "legal and policy deficiencies," "cultural and societal barriers," "insufficient training and practical skills," "shortcomings in organizational safety and support," "interpersonal and operational pressures," "organizational culture and workforce dynamics," "barriers to effective prehospital care," "resource and infrastructure limitation," "challenges in interagency coordination and support," and "workplace culture and professional satisfaction."

Conclusion: Legal reforms addressing legal inadequacies, enhancing organizational support systems, and implementing targeted training programs to mitigate conflicts are essential for fostering a safer working environment. By addressing these pressing issues, healthcare facilities can enhance emergency care, safeguard the well-being of emergency responders, and increase the quality of emergency medical services for communities.

Aim: This study explores HICGs' experience of disaster response during a terrorist-induced major incident major incident.

Design: A qualitative descriptive design with individual semi-structured interviews was used.

Methods: This was a qualitative study based on seven individual interviews. Participants were members of hospital incident command groups during a terror attack. The interviews were transcribed verbatim and analyzed using deductive content analysis. The SRQR checklist was used to report the findings.

Results: The data created from the interviews identified barriers and facilitators for hospital response as well as aligned with previously established categories: Expectations, prior experience, and uncertainty affect hospital incident command group response during a Major Incident and three categories, (I) Gaining situational awareness (containing two subcategories), (II) Transitioning to management (containing three subcategories) and (III) Experiences of hospital incident command group response (containing two subcategories). In addition, the results suggest that an exaggerated response may have led to unanticipated adverse events.

Clinical trial number: Not applicable.