Triage and Risk Concept: Application Proposal for Pre-Hospital Emergencies in a Psychiatric Ambulance in the City of Buenos Aires

The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.

The Application of Information Systems to Improve Ambulance Response Times in the UK

Emergency ambulance services in the UK are tasked with providing pre-hospital patient care and clinical services with a target response time between call connect to on-scene attendance.In 2017,NHS England introduced four new response time categories based on patient needs.The most challenging is to be on-scene for a life-threatening situation within seven minutes of the call being connected when such calls are random in terms of time and place throughout a large territory.Recent evidence indicates emergency ambulance services regularly fall short of achieving the target ambulance response times set by the National Health Service(NHS).To achieve these targets,they need to undertake transformational change and apply statistical,operations research and artificial intelligence techniques in the form of five separate modules covering demand forecasting,plus locate,allocate,dispatch,monitoring and re-deployment of resources.These modules should be linked in real-time employing a data warehouse to minimise computational data and generate accurate,meaningful and timely decisions ensuring patients receive an appropriate and timely response.A simulation covering a limited geographical area,time and operational data concluded that this form of integration of the five modules provides accurate and timely data upon which to make decisions that effectively improve ambulance response times.

由“ambulance”所联想到的

在美国几乎所有的人都有“family doctor／家庭(特约)医生”，人们通常是按“family doctor”的医嘱就医．或到药店买所需药品。然而，当人们在旅行或外出时，突然出现高烧、呼吸困难或因某种事故负伤了，已不可能同“family doctor”联系，这时应马上向旅馆工作人员或行人请求帮助呼叫“ambulance”：

Perception of Effects of Shiftwork Questionnaire (PESQ) among Ambulance Service Staff in Saudi Arabia: An Exploratory Factor Analysis

Objective: Despite efforts in describing the impact of shiftwork on the performance of health care workers, the perception of ambulance service staff is largely unexplored. This study attempted to develop the Perception of Effects of Shiftwork Questionnaire (PESQ) using a factor analysis approach to determine the underlying dimensions. Methods: A 16-item Likert scale research instrument, designed to gather information about the perceived effects of shiftwork on the respondents’ health, social relationships, and career quality, was floated to 375 ambulance services personnel in Saudi Arabia during March and April 2021. Results: Based on factor analysis, the questionnaire has three dimensions with varying reliability, namely “perceived effects on social relationship” (α = 0.815), perceived effects on health (α = 0.787) and “perceived effects on career quality” (α = 0.602). Over-all, the research instrument had an acceptable internal consistency (α = 0.829). Conclusion: The three-dimension model was analyzed simultaneously using parallel analysis and confirms that the three-factor model is the most ideal for the research instrument. Further research, however, is recommended to improve the internal consistency of the items which measure the perceived effects on career quality.

Air temperature was associated with ambulance transports in Osaka area, Japan

We investigated the link between ambulance transports and meteorological parameters of summer by using daily data in Osaka area, Japan. Daily observations for ambulance transports (from July 1 to September 30, 2009) were obtained from Fire Department Service in Osaka. Data of meteorological parameters in Osaka area, Japan (from July 1 to September 30, 2009) were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports was analyzed. A total of 49,526 ambulance transports were observed from July 1 to September 30, 2009 in Osaka, Japan. Ambulance transports were significantly correlated with mean air temperature (r = 0.298), the highest air temperature (r = 0.347), the lowest air temperature (r = 0.209) and daylight hours (r = 0.301). The higher air temperature was associated with higher ambulance transports of summer in Osaka area, Japan.

The relation between ambulance transports due to heat stroke and air temperature using daily data in Okayama prefecture, Japan

The aim of this study was to investigate the link between ambulance transports due to heat stroke and air temperature by using daily data of ambulance transports in Okayama prefecture, Japan. Daily observations for ambulance transports due to heat stroke from July to September in 2010 in Okayama prefecture, Japan were obtained from Fire and Disaster Management Agency in Japan. Data of meteorological parameters in Okayama prefecture, Japan were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports due to heat stroke was analyzed. A total of 1133 ambulance transports due to heat stroke were observed in from July to September of 2010 in Okayama prefecture, Japan. Ambulance transports due to heat stroke was significantly correlated with air temperature. In addition, number of subjects with ambulance transports due to heat stroke over 34°C in the highest air temperature was 21.2 ± 9.8 per day. Higher air temperature was closely associated with higher ambulance transports due to heat stroke by using daily data in Okayama, prefecture, Japan.

The higher air temperature was closely associated with higher ambulance transports due to heat stroke in elderly Japanese

To investigate the link between higher air temperature and ambulance transports due to heat stroke, especially in elderly subjects, using daily data in Sai-tama prefecture in August, 2010, Japan. We obtained daily data of air temperature in Saitama prefecture in August, 2010, Japan from Japan Meteorological Agency. Number of ambulance transports due to heat stroke was also used by Saitama prefecture official website. The effect of high air temperature on am-bulance transports due to heat stroke was evaluated. A total of 1688 ambulance transports due to heat stroke was observed in Saitama prefecture in August, 2010, Japan. Seven hundred and twenty one subjects (42.7%) were over the age of 65. Mean air temperature, the highest air temperature and day light hours were significantly associated with ambulance transports due to heat stroke in total subjects (mean air temperature: r = 0.749, p < 0.0001) and the over the age of 7. In addition, by separate analysis as classified by age groups, the correlation coefficient between ambulance transports due to heat stroke and mean air temperature was the highest in subjects with over 65. However, the lowest air temperature was not cor-related with ambulance transports due to heat stroke. Higher air temperature was closely associated with higher ambulance transports due to heat stroke using daily data in Saitama prefecture in August, 2010, Ja-pan, especially in elderly subjects.

A GIS-Based Decision Support System for Reducing Air Ambulance Response Times: A Case Study on Public Schools in Jeddah City

In injuries reducing ambulance response time (time from injury to hospital arrival) is an important factor for saving people’s lives. Helicopter emergency medical services can reduce out-of-hospital transport times because of their high speed and their ability to travel in straight paths?unlike ground ambulance which are restricted to road network paths, as well as the ability toaccess rural or remote area injuries that are difficult to reach by ground ambulance. GIS technology aids air ambulance movement planning to reduce out-of-hospital response time based on mathematical and geographic models to support decision making which is necessary from out-of-hospital care providers. The goal of this study is to use GIS to develop an efficient DSS to outline where air ambulance can reduce response times, by using spatial analysis tools to create Euclidean distance and direction zones around receiving hospitals. The study concludes that GIS technology can be used to develop an efficient DSS to outline where air ambulance can reduce response times, by creating surfaces of Euclidean allocation, direction, and distance that can be used to improve initial response times for the civil defense air rescue and air ambulance services.

Higher Temperatures Were Closely Associated with Higher Ambulance Transports in Takamatsu Area,Japan

The link between high temperatures and ambulance transports in Takamatsu area, Japan was investigated. Monthly observations for ambulance transports (2004-2008) were obtained from Fire Department Service in Takamatsu. Data of temperatures in Takamatsu area, Japan (2004-2008) were used by Japan Meteorological Agency. Effect of high temperatures on ambulance transports was analyzed. By using data from July to September, there were not clear differences of mean temperatures and ambulance transports among years. Ambulance transports were significantly correlated with parameters of temperatures. Correlation coefficient rate between ambulance transports and the mean temperature of maximum temperatures in a month was highest among parameters (r = 0.738, p = 0.0017). In addition, ambulance transports were also significantly correlated with the number of days over the level of 32?C in a month (r = 0.782, p = 0.0006). Higher temperatures were closely associated with higher ambulance transports in Takamatsu area, Japan.

Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands

Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.

Feasibility of using ultrasound in ambulances in Saudi Arabia

BACKGROUND In developed countries,the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies,and this of course does not apply to Arab countries,as there are no current studies to support this.Therefore,this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIM To measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODS A cross-sectional study of five different groups of participants including radiation technologists,emergency physicians,paramedics,Red Crescent managers and the public.Email and social media were used to deliver a questionnaire to these groups.The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTS Each group had some knowledge on ultrasound and its benefits.More than 50%in each study group supported the availability of ultrasound in ambulances.Additionally,60%of emergency physicians reported that they had difficulties in venous access,checking the presence of internal bleeding,recognizing pregnancy in trauma cases,and inserting endotracheal tubes,and the majority of them confirmed the effective role of ultrasound in achieving such tasks.Almost all paramedics(93.33%),physicians(98.89%),and Saudi Red Crescent managers(96.3%)emphasized the importance of communication between ambulance staff and emergency departments.Moreover,most physicians(77.78%),and technologists(82.73%)supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSION Most of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.

Lower air temperature is associated with higher ambulance transports in Sakata area, Yamagata prefecture, Japan

To investigate the link between low air temperature and ambulance transports in Japan. Data on climate parameters i.e. air temperature, humidity and daylight hours in Sakata area, Yamagata prefecture, Japan, which is northern part (Tohoku) in Japan, was obtained from Japan Meteorological Agency. Monthly data on ambulance transports due to acute disease from 2005 to 2011 was also directly obtained from Sakata area official website, Japan. The relations between air temperature and ambulance transports were evaluated by ecological study. Ambulance transports per day were 10.1 ± 1.0 and mean air temperature was 13.0 ± 8.4 (°C). Ambulance transports per day were weakly and negatively correlated with mean air temperature, mean of the highest air temperature, mean of the lowest air temperature, the highest air temperature and daylight hours. It was also weakly and positively correlated with mean humidity. However, the relation between ambulance transports and mean air temperature was well estimated by quadratic curve (r = 0.633,

Do the Right Patients use the Ambulance Service in South-Eastern Finland?-A Prospective Descriptive Study of Ambulance Dispatching in Relation to the Ambulance Staff’s Assessment of Patients’Needs in a Subset in the South East of Finland

Background: Several Emergency Medical Systems use a criteria-based prioritization system for ambulance response. The emergency medical priority dispatching of ambulances was introduced in the 1980s. In a system of this kind, the operators at the medical emergency dispatch centers have to assess the patients’ symptoms and the need for ambulance response. The prioritization of the ambulance response is based on the seriousness of the patient’s symptoms, his/her current condition and, in the case of trauma, the trauma mechanism. The priority system is supposed to optimize the use of the ambulance service and to match and meet the patients’ needs with an adequate response from the ambulances. The aim of this study was to describe the dispatching and utilization of the ambulance service in a part of Finland. Results: There was a substantial divergence between the initial priority assigned and the patients’ medical status at the scene. The ambulance staff confirmed the need for ambulance transport for 65% of all the patients who were assigned an ambulance by the dispatch center. Conclusions: Using a criteria-based dispatch protocol, the dispatch operator works with a wider safety margin in the priority assessments for ambulance response than was actually confirmed by the ambulance personnel at the scene. In this sample, there may be some overuse of the ambulance service. According to the assessments made by the ambulance staff, 35% of the patients did not require ambulance transport. The emergency system has to accept and work with safety margins. At the same time, there must be a balance between a safety margin and a waste of limited resources.

Effect of Temperature on Emergency Ambulance Call-Outs for Cardiovascular Causes:A Scoping Review

Climate change has increased interest in the effects of the thermal environment on cardiovascular health.Most studies have focused on mortality data.However,pre-hospital care data are better able to evaluate these effects,as they can register the full spectrum of the disease in real time.This scoping review aims to synthesize the epidemiological evidence regarding the effects of the thermal environment on cardiovascular morbidity in the pre-hospital setting,evaluated through ambulance calls.A staged literature search was performed using the PubMed database for the period between 1st January 2000 and 30th March 2023,using the MeSH terms“Weather”AND“Emergency Medical Services”.A total of 987 publications were identified that examined the correlation between the thermal environment and ambulance call-outs for cardiovascular causes.The studies were mostly ecological time series,with significant variability in the methodological aspects employed.An increase in the number of ambulance call-outs has been observed in association with low temperatures,both for overall cardiovascular pathologies and for certain pathological subtypes.For high temperatures,no effect has been observed in overall call-outs,although an increase has been observed during heat waves.The demand for ambulances for cardiac arrests is increased by both low and high temperatures and during heat waves.Ambulance call-outs for cardiovascular causes increase with low temperatures and heat waves,with no significant increase in the overall demand associated with high temperatures.Ambulance call-outs for cardiac arrests are the only subtype that is increased by high temperatures.

Influence of ambulance use on early reperfusion therapies for acute myocardial infarction

Background Ambulance use expedites the definitive treatment of acute myocardial infarction （AMI）. The aim of this study was to evaluate the effect of ambulance use on the administration of early reperfusion therapies for patients with AMI in Beijing, China. Methods Data were prospectively collected from 498 patients with ST-elevation myocardial infarction （STEMI） who were admitted within 12 hours of symptom onset to 19 hospitals in Beijing between November 1,2005 and December 31, 2006. The baseline characteristics of and the initial management of the ambulance users and the non-ambulance users were compared. Results Only 186 （37.3%） patients used an ambulance as transportation to the hospital. Ambulance users were, on average, older and at relatively higher risk on presentation than the non-ambulance users. After adjustment for patient and hospital characteristics, ambulance use was associated with a greater early reperfusion rate, mainly because of a greater incidence of primary percutaneous coronary intervention. In addition, ambulance users had a significantly shorter median door-to-balloon （120 compared with 145 minutes, P 〈0.001） and symptom onset-to-balloon （223 compared with 300 minutes, P 〈0.001） time than non-ambulance users. Conclusions Ambulances are underused by AMI patients in Beijing. Ambulance use may lead to more frequent and faster receipt of early reperfusion therapies. New public health strategies should be developed to facilitate an increased use of ambulances by AMI patients.

Factors influencing ambulance use in patients with ST-elevation myocardial infarction in Beijing, China

Background Emergency medical service plays a key role in the early recognition and treatment of ST-elevation myocardial infarction （STEMI）, but studies indicate that the patients experiencing STEMI symptoms often fail to call an ambulance as recommended. This study aimed to examine the current ambulance transport frequency and ascertain predictors and reasons for not choosing ambulance transportation by the patients with STEMI in Beijing. Methods A prospective, cross-sectional survey was conducted from January 1,2006 through until June 30, 2007 in two tertiary hospitals in Beijing and included consecutive patients with STEMI admitted within 24 hours of onset of symptoms. Data were collected by structured interviews and medical records review. Results Of the 572 patients, only 172 （30.1%） used an ambulance, and the remaining 400 （69.9%） presented by self-transport. Multivariate analysis showed that age 〈65 years （OR： 1.220; 95% CI： 1.001-2.043）, lower education level （OR： 1.582; 95% CI： 1.003-2.512）, presence of pre-infarction angina （OR： 1.595; 95% CI： 1.086-2.347）, and attribution of symptoms to non-cardiac origin （OR： 1.519; 95% CI： 1.011-2.284） were independent predictors for not using an ambulance. However, history of coronary artery disease （CAD）, dyspnea, perceiving symptoms to be serious, and knowing the meaning of cardiopulmonary resuscitation appeared to be independent predictors of ambulance use. The main reasons for not using an ambulance were convenience and quickness of self-transport and the decreased severity of symptoms. Conclusions A large proportion of patients in Beijing do not call for an ambulance after onset of STEMI symptoms. Several factors including demographics, previous CAD, symptoms and cognitive factors of patients are associated with the ambulance use. The public should be educated that an ambulance is not merely a transportation modality and that it also provides rapid diagnosis and treatment.

Association of heat exposure and emergency ambulance calls: A multi-city study

Evidence of the impact of ambient temperatures on emergency ambulance calls (EACs) in developing countries contributes to the improvement and complete understanding of the acute health effects of temperatures. This study aimed to examine the impacts and burden of heat on EACs in China, quantify the contributions of regional modifiers, and identify the vulnerable populations. A semi-parametric generalized additive model with a Poisson distribution was used to analyze the city-specific impacts of the daily maximum temperature (Tmax) on EACs in June–August in 2014–2017. Stratified analyses by sex and age were performed to identify the vulnerable sub-populations. Meta-analysis was undertaken to illustrate the pooled associations. Further subgroup analysis, stratified by climate, latitude, and per capita disposable income (PCDI), and meta-regression analysis were conducted to explore the regional heterogeneity and quantify the contributions of possible modifiers. The city- and region-specific attributable fractions of EACs attributable to heat were calculated. Strong associations were observed between the daily Tmax and total EACs in all cities. A total of 11.7% (95% confidence interval (CI): 11.2%–12.3%) of EACs were attributed to high temperatures in ten Chinese cities, and the central region with a low level of PCDI had the highest attributable fraction of 17.8% (95% CI: 17.2%–18.4%). People living in the central region with lower PCDI, and those aged 18–44 and 0–6 years were more vulnerable to heat than the others. The combined effects of PCDI, temperature, and latitude contributed 88.6% of the regional heterogeneity. The results complemented the understanding of the burden of EACs attributable to heat in developing countries and the quantitative contribution of regional modifiers.

Simulation modeling and optimization for ambulance allocation considering spatiotemporal stochastic demand

To ensure a timely response to emergencies,governments are obliged to implement effective ambulance allocation plans.In practice,an emergency medical service(EMS)system works in an uncertain environment,with stochastic demand,response-times,and travel-times.This uncertainty significantly affects ambulance allocation planning.How-ever,few studies in this field adequately consider the effect of spatiotemporal uncertainty in demand,because it is difficult to measure it quantitatively.As a result,few analytic models capture the dynamic nature of an EMS system and,thus,the allocation plans they generate are not efficient in practice.Therefore,this study proposes a simulation-based optimization method for ambulance allocation.A simulation model is constructed to mimic the operational processes of an EMS system,and to evaluate the performance of an ambulance allocation plan in an uncertain environment.Gaussian mixture model clus-tering is used to derive the uncertain spatial demand.Then,the simulation generates emergency demand based on the obtained spatial distribution.A Gaussian-process-based search algorithm is used together with the simulation model to identify optimal solutions.To validate the proposed method,a case study is conducted using data on emergency patients in the Shanghai Songjiang District.Compared with the current plan adopted in Songjiang,the experimental results demonstrate that the delay time and frequency of the EMS system can be reduced significantly by employing the proposed methods.Further-more,nearly 41%of the allocation cost can be saved.

Impact of subtropical climate on frequency of ambulance use for trauma patients in a coastal area of China

Purpose： To explore the impact of subtropical maritime monsoon climate on the frequency of ambulance use for trauma patients in a coastal region in China. Method： Statistical analysis of data on ambulance use from the 120 Emergency Command Center in Shantou City, Guangdong Province, from January to December 2012 as well as daily meteorological data from a Shantou observatory was performed to determine how climatic factors （seasons, time, and weather） affect the frequency of ambulance use for trauma patients. Results： The daily ambulance use for trauma patients differed between spring and summer or autumn （p 〈 0.05）, between sunny and rainy days （p 〈 0.05）, and between cloudy and lightly or moderately rainy days （p 〈 0.05）. We found a linear correlation between daily maximum temperature and daily ambulance use for trauma patients （R^2 0.103, p 〈 0.05）. In addition, there was significant difference in ambulance use between good and bad weather （p 〈 0.05）. Conclusion： Frequency of ambulance use for trauma patients is affected by the subtropical maritime monsoon climate in the coastal region. Better weather contributes to increased daily frequency of ambulance use, which is the highest in autumn and lowest in spring.

Time of arrival and in-hospital evaluation processes among patients with acute ischemic stroke at Yozgat City Hospital in Turkey: A retrospective study

Objective: To reveal the factors leading to delay in the evaluation processes of patients with suspected acute ischemic stroke at Yozgat City Hospital in Turkey and suggest potential solutions. Methods: Patients who visited the emergency service of Yozgat City Hospital between 1 April 2017 and 1 July 2017 and those hospitalized with a diagnosis of ischemic stroke, were included in this retrospective study. The clinical information of the patients was collected via hospital files and telephone interviews. In addition, the potential association between arrival time and the clinical parameters was investigated. Results: A total of 87 patients were included. The median arrival time to emergency service was 5 (IQR=9) h. Forty-four percent of patients arrived within the first 4.5 h from symptom onset. However, intravenous thrombolytic treatment was performed in only 7% of the patients. The median time from arrival to neuroimaging performing was 20.0 (IQR=34) min. Fifty-one percent of patients were screened within the first 20 min from arrival to emergency service. There was no association between arrival time and transfer method of the patients. Conclusions: The main problem regarding acute stroke care in our region may be inefficient use of emergency ambulance. This study provides basis for measures to shorten the arrival time.