The best prehospital transport strategy for patients with suspected stroke due to possible large vessel occlusion varies by jurisdiction and available resources. A foundational problem is the lack of a definitive diagnosis at the scene. Rural stroke presentations provide the most problematic triage destination decision-making. In Alberta, Canada, the implementation and 5-year experience with a rural field consultation approach to provide service to rural patients with acute stroke is described.

The protocols established through the rural field consultation system and the subsequent transport patterns for suspected stroke patients during the first 5 years of implementation are presented. Outcomes are reported using home time and data are summarized using descriptive statistics.

From April 2017 to March 2022, 721 patients met the definition for a rural field consultation, and 601 patients were included in the analysis. Most patients (n = 541, 90%) were transported by ground ambulance. Intravenous thrombolysis was provided for 65 (10.8%) of patients, and 106 (17.6%) underwent endovascular thrombectomy. The median time from first medical contact to arterial access was 3.2 h (range 1.3–7.6) in the direct transfers, compared to 6.5 h (range 4.6–7.9) in patients arriving indirectly to the comprehensive stroke center (CSC). Only a small proportion of patients (n = 5, 0.8%) were routed suboptimally to a primary stroke center and then to a CSC where they underwent endovascular therapy.

The rural field consultation system was associated with shortened delays to recanalization and demonstrated that it is feasible to improve access to acute stroke care for rural patients.

This study explores the impact of heatwaves on emergency calls for assistance resulting in service attendance in the Australian state of Queensland for the period from January 1, 2010 through December 31, 2019. The study uses data from the Queensland Ambulance Service (QAS), a state-wide prehospital health system for emergency health care.

A retrospective case series using de-identified data from QAS explored spatial and demographic characteristics of patients attended by ambulance and the reason for attendance. All individuals for which there was an emergency call to “000” that resulted in ambulance attendance in Queensland across the ten years were captured. Demand for ambulance services during heatwave and non-heatwave periods were compared. Incidence rate ratio (IRR) and 95% confidence intervals (CI) were constructed exploring ambulance usage patterns during heatwaves and by rurality, climate zone, age groups, sex, and reasons for attendance.

Compared with non-heatwave days, ambulance attendance across Queensland increased by 9.3% during heatwave days. The impact of heatwaves on ambulance demand differed by climate zone (high humidity summer with warm winter; hot dry summer with warm winter; warm humid summer with mild winter). Attendances related to heat exposure, dehydration, alcohol/drug use, and sepsis increased substantially during heatwaves.

Heatwaves are a driver of increased ambulance demand in Queensland. The data raise questions about climatic conditions and heat tolerance, and how future cascading and compounding heat disasters may influence work practices and demands on the ambulance service. Understanding the implications of heatwaves in the prehospital setting is important to inform community, service, and system preparedness.

Blast injuries can occur by a multitude of mechanisms, including improvised explosive devices (IEDs), military munitions, and accidental detonation of chemical or petroleum stores. These injuries disproportionately affect people in low- and middle-income countries (LMICs), where there are often fewer resources to manage complex injuries and mass-casualty events.

The aim of this systematic review is to describe the literature on the acute facility-based management of blast injuries in LMICs to aid hospitals and organizations preparing to respond to conflict- and non-conflict-related blast events.

A search of Ovid MEDLINE, Scopus, Global Index Medicus, Web of Science, CINAHL, and Cochrane databases was used to identify relevant citations from January 1998 through July 2024. This systematic review was conducted in adherence with PRISMA guidelines. Data were extracted and analyzed descriptively. A meta-analysis calculated the pooled proportions of mortality, hospital admission, intensive care unit (ICU) admission, intubation and mechanical ventilation, and emergency surgery.

Reviewers screened 3,731 titles and abstracts and 173 full texts. Seventy-five articles from 22 countries were included for analysis. Only 14.7% of included articles came from low-income countries (LICs). Sixty percent of studies were conducted in tertiary care hospitals. The mean proportion of patients who were admitted was 52.1% (95% CI, 0.376 to 0.664). Among all in-patients, 20.0% (95% CI, 0.124 to 0.288) were admitted to an ICU. Overall, 38.0% (95% CI, 0.256 to 0.513) of in-patients underwent emergency surgery and 13.8% (95% CI, 0.023 to 0.315) were intubated. Pooled in-patient mortality was 9.5% (95% CI, 0.046 to 0.156) and total hospital mortality (including emergency department [ED] mortality) was 7.4% (95% CI, 0.034 to 0.124). There were no significant differences in mortality when stratified by country income level or hospital setting.

Findings from this systematic review can be used to guide preparedness and resource allocation for acute care facilities. Pooled proportions for mortality and other outcomes described in the meta-analysis offer a metric by which future researchers can assess the impact of blast events. Under-representation of LICs and non-tertiary care medical facilities and significant heterogeneity in data reporting among published studies limited the analysis.

Few empirical studies have examined the collective impact of and interplay between individual factors on collaborative outcomes during major infectious disease outbreaks and the direct and interactive effects of these factors and their underlying mechanisms. Therefore, this study investigates the effects and underlying mechanisms of emergency preparedness, support and assurance, task difficulty, organizational command, medical treatment, and epidemic prevention and protection on collaborative outcomes during major infectious disease outbreaks.

A structured questionnaire was distributed to medical personnel with experience in responding to major infectious disease outbreaks. SPSS software was used to perform the statistical analysis. Structural equation modeling was conducted using AMOS 24.0 to analyze the complex relationships among the study variables.

Organizational command, medical treatment, and epidemic prevention and protection had significant and positive impacts on collaborative outcomes. Emergency preparedness and supportive measures positively impacted collaborative outcomes during health crises and were mediated through organizational command, medical treatment, and epidemic prevention and protection.

The results underscore the critical roles of organizational command, medical treatment, and epidemic prevention and protection in achieving positive collaborative outcomes during health crises, with emergency preparedness and supportive measures enhancing these outcomes through the same key factors.

Vital signs are an essential component of the prehospital assessment of patients encountered in an emergency response system and during mass-casualty disaster events. Limited data exist to define meaningful vital sign ranges to predict need for advanced care.

The aim of this study was to identify vital sign ranges that were maximally predictive of requiring a life-saving intervention (LSI) among adults cared for by Emergency Medical Services (EMS).

A retrospective study of adult prehospital encounters that resulted in hospital transport by an Advanced Life Support (ALS) provider in the 2022 National EMS Information System (NEMSIS) dataset was performed. The outcome was performance of an LSI, a composite measure incorporating critical airway, medication, and procedural interventions, categorized into eleven groups: tachydysrhythmia, cardiac arrest, airway, seizure/sedation, toxicologic, bradycardia, airway foreign body removal, vasoactive medication, hemorrhage control, needle decompression, and hypoglycemia. Cut point selection was performed in a training partition (75%) to identify ranges for heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), oxygen saturation, and Glasgow Coma Scale (GCS) by using an approach intended to prioritize specificity, keeping sensitivity constrained to at least 25%.

Of 18,259,766 included encounters (median age 63 years; 51.8% male), 6.3% had at least one LSI, with the most common being airway interventions (2.2%). Optimal ranges for vital signs included 47-129 beats/minute for HR, 8-30 breaths/minute for RR, 96-180mmHg for SBP, >93% for oxygen saturation, and >13 for GCS. In the test partition, an abnormal vital sign had a sensitivity of 75.1%, specificity of 66.6%, and positive predictive value (PPV) of 12.5%. A multivariable model encompassing all vital signs demonstrated an area under the receiver operator characteristic curve (AUROC) of 0.78 (95% confidence interval [CI], 0.78-0.78). Vital signs were of greater accuracy (AUROC) in identifying encounters needing airway management (0.85), needle decompression (0.84), and tachydysrhythmia (0.84) and were lower for hemorrhage control (0.52), hypoglycemia management (0.68), and foreign body removal (0.69).

Optimal ranges for adult vital signs in the prehospital setting were statistically derived. These may be useful in prehospital protocols and medical alert systems or may be incorporated within prediction models to identify those with critical illness and/or injury for patients with out-of-hospital emergencies.

This study aimed to examine the regional impact of COVID-19 on severe trauma patients in South Korea.

This study utilized Community-based Severe Trauma Survey data from the Korea Disease Control and Prevention Agency. The average treatment effect (ATE) of COVID-19 on severe trauma patients by region was determined using doubly robust estimation (DR). Subgroup analysis was conducted for the greater Seoul area, metropolitan cities in rural areas, and rural areas.

Significant differences were observed in the general characteristics of participants before and after the COVID-19 outbreak, particularly in the mechanisms of injury and types of hospitals to which they were transported. DR revealed that the probability of death among severe trauma patients was higher in metropolitan cities in rural areas than in other regions.

The greater impact of COVID-19 on severe trauma patients in metropolitan cities in rural areas is attributed to their higher population density and the inability of emergency medical systems to manage the spread of COVID-19. Therefore, future national policies related to emergency medical care should focus on enhancing the capacity for managing infectious diseases in large-scale metropolitan cities.

Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers’ first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.

This study’s aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.

This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 (n = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at P < .05.

Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; P < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; P = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; P < .001) and 2021 (n = 87; 70.7%; P < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; P = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; P = .0072).

Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency’s decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers’ proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.

To maintain procedural proficiency and certification according to the standards set by The Joint Commission—which accredits health care centers in the United States—thrombectomy-capable stroke centers (TSCs) must achieve a minimum annual procedural volume. The addition of thrombectomy-capable centers in a regional stroke care system has the potential to increase access but also to decrease patient presentations and procedural volume at nearby centers. This study sought to characterize the impact of certifying additional thrombectomy-capable centers on procedural volume by center in a large, urban Emergency Medical Services (EMS) system.

Data were collected from each designated thrombectomy-capable center in Los Angeles (LA) County from January 1, 2018 through June 30, 2022, during which a net total of five thrombectomy-capable centers were newly designated in the County. Per center volume for ischemic stroke presentations, intravenous (IV) thrombolysis administrations (IV tissue plasminogen activator [tPA]), and thrombectomy were tabulated by six-month interval. Median last-known-well-to-procedure times by LA County Public Health service planning area (SPA) were calculated. The effect of the number of designated centers on procedural volumes per center and median last-known-well-to-procedure times were analyzed via a linear mixed effects model with a log link function.

Procedural volume, ischemic stroke presentation volume, and last-known-well-to-procedure times had high variability over the time period studied. Nonetheless, the median values for each metric in this EMS system remained largely stable over the study period. There was no statistically significant association between the number of thrombectomy-capable centers and per center procedural volumes or times-to-procedure.

The designation of additional thrombectomy-capable centers in a regional stroke care system was not significantly associated with the volume of procedures by center or times-to-procedure, suggesting that additional centers may increase patient access to time-sensitive interventions without diluting patient presentations at existing centers.

The aim of this study was to systematically review evidence that supports best practice post-crash response emergency care.

The research questions to achieve the study objective were developed using the Patient, Intervention, Control, Outcome standard following which a systematic literature review (SLR) of research related to prehospital post-road-crash was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

A total of 89 papers were included in the analysis, presented according to the PRISMA guidelines.

This research explored and identified key insights related to emergency care post-road-crash response. The findings showed that interservice coordination and shared understanding of roles was recommended. Application of traditional practice of the “Golden Hour” has been explored and contested as a standard for all care. Notwithstanding this, timeliness of provision of care remains important to certain patient groups suffering certain injury types and is supported as part of a trauma system approach for patient care.

More than 50% of patients with dementia visit the emergency department (ED) each year. Patients with dementia experience frequently unrelieved symptoms that can benefit from palliative care. Response to palliative care needs in the ED can be quite challenging and access to palliative care is generally scarce. The aim of this scoping review is to assess ED use and responsiveness to palliative care needs of patients with dementia in their last year of life.

A scoping literature review following the Joanna Briggs Institute methodology. Electronic search of the literature was undertaken in Medline (PubMed), Web of Science, Scopus, Scielo, and APA PsycInfo, last updated on 19 February 2024.

Twenty-four studies were identified and confirmed that patients with dementia frequently resort to the ED near the end of life, frequently more than once in their last year of life. Eight studies directly addressed palliative care needs, suggesting significant rates of palliative care needs among patients with dementia and in comparison, to other oncological or non-oncological conditions. Infections and neuropsychiatric symptoms were the main reasons of admission to the ED. Access to palliative care was confirmed to be low.

This scoping review indicates that patients with dementia frequently resource to the ED in their last year of life with unmet palliative care needs. Although scarce access to palliative care and the existence of important barriers in the ED, palliative care intervention in this setting can be seen as an opportunity to attend palliative care needs and referral to palliative care services.

The project aimed to characterize the exposure to seismic hazard in the emergency area of a high-complexity hospital in Cali, Colombia.

The occupancy of the emergency area was analyzed over 6 months, determining the value of material elements exposed to the seismic hazard. Four phases were executed: search for pre-existing information, occupancy analysis, evaluation of exposed assets, and results analysis. The information was analyzed using a Geographic Information System (GIS), which allowed the visualization of demographic behavior in different locations and times.

The results confirmed that the seismic hazard is high, exacerbated by local geomechanical characteristics. It was observed that the average occupancy of most studied areas exceeded capacity. The value of the exposed assets was estimated at COP 3 221 008 640 (USD 959 844.76), the demolition value at COP 10 582 770 000 (USD 3 153 613.49), and the reconstruction value at COP 30 293 640 275 (USD 9 027 356.03). In the worst-case scenario, the losses were equivalent to 12.4% of the hospital’s annual budget.

The data allow the hospital to take preventive measures and educate the staff to identify and mitigate critical areas. It also contributes to the knowledge of the approximate value of economic losses and the impact of potential human losses.

Disasters pose significant challenges globally, affecting millions of people annually. In Saudi Arabia, floods constitute a prevalent natural disaster, underscoring the necessity for effective disaster preparedness among Emergency Medical Services (EMS) workers. Despite their critical role in disaster response, research on disaster preparedness among EMS workers in Saudi Arabia is limited.

The study aimed to explore the disaster preparedness among EMS workers in Saudi Arabia. This study applied an explanatory sequential mixed-methods design to explore disaster preparedness among EMS workers in Saudi Arabia, focusing on the qualitative phase. Semi-structured interviews were conducted with 15 EMS workers from National Guard Health Affairs (NGHA) and Ministry of Health (MOH) facilities in Riyadh, Dammam, and Jeddah. Thematic analysis was conducted following Braun and Clarke’s six-step process, ensuring data rigor through Schwandt, et al’s criteria for trustworthiness.

The demographic characteristics of participants revealed a predominantly young, male workforce with varying levels of experience and educational backgrounds. Thematic analysis identified three key themes: (1) Newly/developed profession, highlighting the challenges faced by young EMS workers in acquiring disaster preparedness; (2) Access to opportunities and workplace resources (government versus military), indicating discrepancies in disaster preparedness support between government and military hospitals; and (3) Workplace policies and procedures, highlighting the need for clearer disaster policies, training opportunities, and role clarity among EMS workers.

The study underscores the importance of addressing the unique challenges faced by EMS workers in Saudi Arabia to enhance disaster preparedness. Recommendations include targeted support for young EMS professionals, standardization of disaster training across health care facilities, and improved communication of disaster policies and procedures. These findings have implications for policy and practice in disaster management and EMS training in Saudi Arabia.

Humanitarian mine action (HMA) stakeholders have an organized presence with well-resourced medical capability in many conflict and post-conflict settings. Humanitarian mine action has the potential to positively augment local trauma care capacity for civilian casualties of explosive ordnance (EO) and explosive weapons (EWs). Yet at present, few strategies exist for coordinated engagement between HMA and the health sector to support emergency care system strengthening to improve outcomes among EO/EW casualties.

A scoping literature review was conducted to identify records that described trauma care interventions pertinent to civilian casualties of EO/EW in resource-constrained settings using structured searches of indexed databases and grey literature. A 2017 World Health Organization (WHO) review on trauma systems components in low- and middle-income countries (LMICs) was updated with additional eligible reports describing trauma care interventions in LMICs or among civilian casualties of EO/EWs after 2001.

A total of 14,195 non-duplicative records were retrieved, of which 48 reports met eligibility criteria. Seventy-four reports from the 2017 WHO review and 16 reports identified from reference lists yielded 138 reports describing interventions in 47 countries. Intervention efficacy was assessed using heterogenous measures ranging from trainee satisfaction to patient outcomes; only 39 reported mortality differences. Interventions that could feasibly be supported by HMA stakeholders were synthesized into a bundle of opportunities for HMA engagement designated links in a Civilian Casualty Care Chain (C-CCC).

This review identified trauma care interventions with the potential to reduce mortality and disability among civilian EO/EW casualties that could be feasibly supported by HMA stakeholders. In partnership with local and multi-lateral health authorities, HMA can leverage their medical capabilities and expertise to strengthen emergency care capacity to improve trauma outcomes in settings affected by EO/EWs.

Terrorist attacks on the aviation sector represent a significant security challenge due to the high-profile status of airports and aircraft. These attacks not only jeopardize global security but also have severe public health repercussions, leading to widespread casualties and psychological distress.

This study conducted a comprehensive retrospective analysis using data from the Global Terrorism Database to explore the patterns, frequencies, and impacts of terrorist attacks on the aviation sector worldwide. The analysis spanned incidents from 1970 to 2020, focusing on attack types, affected regions, and the direct and indirect health consequences arising from these incidents.

Over the 50-year period, the study identified 1183 terrorist attacks targeting the aviation sector. Bombings and explosions emerged as the most common and deadliest forms of attack, responsible for the majority of fatalities and injuries. The data also highlighted significant regional disparities, with certain areas experiencing higher frequencies of attacks and more severe outcomes. Notably, North America bore a disproportionately high number of fatalities, primarily due to the events of September 11, 2001.

The findings emphasize the ongoing and evolving threat of terrorism in the aviation industry, underscoring the critical need for a proactive and comprehensive approach to security and public health preparedness. Future strategies should prioritize the integration of advanced technological solutions, enhanced international cooperation, and thorough public health planning to mitigate the impact of terrorist attacks on aviation effectively.

The mortality and morbidity due to road traffic crashes (RTCs) are increasing drastically world-wide. Poor prehospital care management contributes to dismal patient outcomes, especially in low- and middle-income countries (LMICs). This study aimed to assess the knowledge, attitude, and self-reported practice (KAP) of providing first aid for RTC victims by commercial motorcyclists. In addition, it determined the relationship between sociodemographic characteristics and the level of KAP, then the predicting factors of outcome variables.

A cross-sectional study of 200 randomly selected commercial motorcyclists was conducted in May 2021. A chi-square test and multivariate analysis were used to analyze data.

The findings showed that most participants had a poor knowledge level (87.5 %), positive attitudes (74.5%), and poor self-reported practice (51.5%). Previous first-aid training and knowing an emergency call number for the police were predictors of good knowledge (AOR = 3.7064; 95% CI, 1.379-9.956 and AOR = 6.132; 95% CI,1.735-21.669, respectively). Previous first-aid training was also a predictor of positive attitudes (AOR = 3.087; 95% CI, 1.033-9.225). Moreover, the likelihood of having an excellent self-reported practice was less among participants under 40 years of age (AOR = 0.404; 95% CI, 0.182-0.897) and those who cared for up to five victims (AOR = 0.523; 95% CI, 0.282-0.969). Contrary, previous first-aid training (AOR = 2.410; 95% CI, 1.056-5.499) and educational level from high school and above increased the odds of having good self-reported practice (AOR = 2.533; 95% CI, 1.260-5.092).

Considering the study findings, training should be provided to improve the knowledge and skills of commercial motorcyclists since they are among the primary road users in Rwanda and involved in RTCs.

Over 2.7 million people have an opioid use disorder (OUD). Opioid-related deaths have steadily increased over the last decade. Although emergency department (ED)-based medication for OUD (MOUD) has been successful in initiating treatment for patients, there still is a need for improved access. This study describes the development of a prehospital MOUD program.

An interdisciplinary team expanded a MOUD program into the prehospital setting through the local city fire department Quick Response Team (QRT) to identify patients appropriate for MOUD treatment. The QRT consisted of a paramedic, social worker, and police officer. This team visited eligible patients (i.e., history of an opioid overdose and received prehospital care the previous week). The implementation team developed a prehospital MOUD protocol and a two-hour training course for QRT personnel. Implementation also required a signed contract between local hospitals and the fire department. A drug license was necessary for the QRT vehicle to carry buprenorphine/naloxone, and a process to restock the vehicle was created. Pamphlets were created to provide to patients. A clinical algorithm was created for substance use disorder (SUD) care coordinators to provide a transition of care for patients. Metrics to evaluate the program included the number of patients seen, the number enrolled in an MOUD program, and the number of naloxone kits dispensed. Data were entered into iPads designated for the QRT and uploaded into the Research Electronic Data Capture (REDCap) program.

Over the six-month pilot, the QRT made 348 visits. Of these, the QRT successfully contacted 83 individuals, and no individuals elected to be evaluated for new MOUD treatment. Nine fatal opioid overdoses occurred during the study period. A total of 55 naloxone kits were distributed, and all patients received MOUD information pamphlets.

A prehospital MOUD program can be established to expand access to early treatment and continuity of care for patients with OUD. The program was well-received by the local city fire department and QRT. There is a plan to expand the prehospital MOUD program to other local fire departments with QRTs.

Mass Casualty Incidents (MCIs) involving high-speed passenger ferries (HSPFs) may result in the dual-wave phenomenon, in which the emergency department (ED) is overwhelmed by an initial wave of minor injuries, followed by a second wave of more seriously injured victims. This study aimed to characterize the time pattern of ED presentation of victims in such accidents in Hong Kong.

All HSPF MCIs from 2005 to 2015 were reviewed retrospectively, with the time interval from accident to ED registration determined for each victim. Multivariable linear regression was used to identify independent factors associated with the time of ED presentation after the accidents.

Eight MCIs involving 492 victims were identified. Victims with an Injury Severity Score (ISS) ≥ 9 had a significantly shorter median time interval compared to those with minor injuries. An ISS ≥ 9 and evacuation by emergency service vessels were associated with a shorter delay in ED arrival, whereas ship sinking, accident at nighttime, and a longer linear distance between the accident and receiving ED were associated with a longer delay.

The dual-wave phenomenon was not present in HSPF MCIs. Early communication is the key to ensure early resource mobilisation and a well-timed response.