Articles: emergency-medical-services.
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JNMA J Nepal Med Assoc · Jun 2024
Pre-hospital care, pre-hospital delay, and in-hospital delay in patients with traumatic brain injury in getting neurosurgical care in a tertiary care center: A Cross-Sectional study.
Timely institution of pre-hospital therapies aimed at damage control and the appropriately timed decision of transfer to higher centers for definitive neurosurgical management are crucial in determining the outcome of patients following traumatic brain injury. This study aimed to evaluate the factors determining pre-hospital care and delay in patients with traumatic brain injury. ⋯ Our study highlights the challenges in pre-hospital care and delays in reaching for neurosurgical care in patients with traumatic brain injury. Falls, road accidents, and physical assaults were the leading causes.
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Objectives: Cognitive load refers to the working memory resources required during a task. When the load is too high or too low this has implications for an individual's task performance. In the context of paramedicine and emergency medical services (EMS) broadly, high cognitive load could potentially put patient and personnel safety at risk. ⋯ Cognitive load influences clinical task performance and has a bi-directional relationship with emotion. However, the literature is mixed regarding physiological responses to cognitive load, and how they are best measured. These findings highlight potential intervention points where cognitive load can be managed or reduced to improve working conditions for EMS clinicians and safety for their patients.
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This study sought to evaluate performance indicators to assist a static-based 9-1-1 agency in defining its response efficiency. ⋯ These findings suggest a way to evaluate the efficiency of static-based ambulance deployment and potentially identify strategies for redeployment.
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With the establishment and growth of the Emergency Medical Services (EMS) subspecialty, significant attention has been focused on clinical activities performed by EMS physicians in the out-of-hospital environment. An EMS fellowship includes special operations education to develop preparedness for responding to field situations requiring physician expertise. With only a thousand Board Certified EMS physicians in North America, EMS physicians may not be available 24 h per day to respond to field emergencies. ⋯ The Los Angeles County EMS Agency implemented a policy in 1992 to establish Hospital Emergency Response Teams (HERT) as a regional resource to provide time-critical, specialized prehospital services within an EMS system. Activation of the HERT is rare, most frequently prompted by need for field amputation to enable extrication. We describe one such incident of a field intervention by HERT and detail the staffing, training, and equipment considerations within our large regional EMS system.
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Multicenter Study
Healthcare professional views about a prehospital redirection pathway for stroke thrombectomy: a multiphase deductive qualitative study.
Mechanical thrombectomy for stroke is highly effective but time-critical. Delays are common because many patients require transfer between local hospitals and regional centres. A two-stage prehospital redirection pathway consisting of a simple ambulance screen followed by regional centre assessment to select patients for direct admission could optimise access. However, implementation might be challenged by the limited number of thrombectomy providers, a lack of prehospital diagnostic tests for selecting patients and whether finite resources can accommodate longer ambulance journeys plus greater central admissions. We undertook a three-phase, multiregional, qualitative study to obtain health professional views on the acceptability and feasibility of a new pathway. ⋯ Positive views from health professionals were expressed about the concept of a proposed pathway while raising key content and implementation challenges and useful 'real-world' issues for consideration.