Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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To describe the characteristics of older people who fall and call an emergency ambulance, and the operational and clinical impact of the ambulance responses they receive. ⋯ In this population, ambulance services appear to provide timely responses to older people who have fallen, and "long-lies" are relatively uncommon. More than one-quarter of patients were not transported to an emergency department, and repeat use of ambulance resources appears to be common. Opportunities exist to explore alternate pathways and models of care that maximize outcomes for nontransport patients as well as improving operational efficiency of the ambulance service.
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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. ⋯ 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.
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Post-resuscitation care of cardiac arrest patients at specialized centers may improve outcome after out-of-hospital cardiac arrest (OOHCA). This study describes experience with regionalized care of resuscitated patients. ⋯ We found higher rates of neurologically intact survival from OOHCA in our system after regionalization of post-resuscitation care as compared to historical data.
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To assess principal investigators' and study coordinators' views and experiences regarding community consultation in a multicenter trial of prehospital treatment for status epilepticus conducted under an exception from informed consent for research in emergency settings. ⋯ Coordinators and investigators in this trial viewed community consultation efforts as successful but reported real challenges generating public interest. Individuals with the condition under study were found to be more engaged and supportive of the trial. Respondents endorsed numerous potential goals of the community consultation process and often combined methods to achieve these goals.