Facilitators of and barriers to emergency medical service use by acute ischemic stroke patients: A retrospective survey

Objective: The objective of the study was to identify facilitators and barriers to emergency medical service use among acute ischemic stroke patients in Korea.Methods: This paper presents a secondary analysis of a retrospective survey that collected data from questionnaires and medical records.Among 233 acute ischemic stroke patients enrolled in a large-scale study,160 patients who had arrived at a hospital within 72 h after symptom onset were included in the data analysis.Results: Users of emergency medical services needed a shorter time than non-users to arrive at hospital (140 min vs.625 min.,p =0.001) and were more likely to arrive at hospital within 3 h of symptom onset (51.9% vs.31.5%,p =0.013).For those who first contacted emergency medical service,the facilitators of emergency medical service use were the presence of hemiparesis (p =0.003),bilateral paralysis (p =0.040),and loss of balance (p =0.021).The predominant barrier was the failure to recognize the urgency of symptoms (p 0.006).Conclusions: The use of emergency medical services reduced prehospital delay and increased the likelihood of patient arrival at hospital within 3 h.Given that experiencing typical stroke symptoms was a facilitator of emergency medical service use yet failure to recognize the urgency of symptoms was a barrier,public awareness should be raised as regards stroke symptoms and the benefits of using emergency medical services.

Self-Reported Use of Personal Protective Equipment during the SARS-CoV-2 Pandemic in Emergency Medical Service Employees in Germany—A Survey

Background: Multicentric prospective cohort investigation survey conducted between 1st of March and 1st of April 2021on SARS-CoV-2 occupational risk for German Emergency Medical Services (EMS) personnel. Study Objectives: Primary: The objective is to take stock of the use and availability of Personal Protective Equipment (PPE) in German EMS, both at managerial and employee level, during the SARS-CoV-2 pandemic. Secondary: Generate additional data on individual perceptions of risk of infection and occurrence of infections at respective places of service. Methods: Multicentric prospective cohort investigation survey conducted online at two levels of German EMS personnel—EMS managers and EMS employees, both medical and paramedical—with questions adapted slightly to fit the respective study population. Results: A total of 34 responses were received in the managerial group;a total of 2389 responses were received in the group of employees. Self-reported PPE adherence of EMS employees for confirmed SARS-CoV-2 positive patients: use of gloves (99.8%), FFP2 or FFP3 masks (99.8%), gowns or coveralls (99.1%), goggles (89.7%), face shields (24.0%), surgical masks (0.0%). Self-reported PPE adherence of EMS employees for suspected SARS-CoV-2 positive patients: gloves (98.8%), FFP2 or FFP3 masks (total: 99.4%), gowns or coveralls (total: 95.9%), goggles (85.6%), face shields (19.2%), surgical masks (0.2%). Conclusions: Findings included an overall improved self-reported adherence to PPE compared to studies that were conducted before the pandemic. Self-reported general adherence to PPE recommendations when attending to confirmed SARS-CoV-2 positive patients was good, with the exception of goggles. Self-reported adherence to PPE recommendations dropped when attending to suspected SARS-CoV-2 positive patients.

The impact of prehospital blood sampling on the emergency department process of patients with chest pain:a pragmatic non-randomized controlled trial

BACKGROUND:In patients with chest pain who arrive at the emergency department(ED)by ambulance,venous access is frequently established prehospital,and could be utilized to sample blood.Prehospital blood sampling may save time in the diagnostic process.In this study,the association of prehospital blood draw with blood sample arrival times,troponin turnaround times,and ED length of stay(LOS),number of blood sample mix-ups and blood sample quality were assessed.METHODS:The study was conducted from October 1,2019 to February 29,2020.In patients who were transported to the ED with acute chest pain with low suspicion for acute coronary syndrome(ACS),outcomes were compared between cases,in whom prehospital blood draw was performed,and controls,in whom blood was drawn at the ED.Regression analyses were used to assess the association of prehospital blood draw with the time intervals.RESULTS:Prehospital blood draw was performed in 100 patients.In 406 patients,blood draw was performed at the ED.Prehospital blood draw was independently associated with shorter blood sample arrival times,shorter troponin turnaround times and decreased LOS(P<0.001).No differences in the number of blood sample mix-ups and quality were observed(P>0.05).CONCLUSION:For patients with acute chest pain with low suspicion for ACS,prehospital blood sampling is associated with shorter time intervals,while there were no significant differences between the two groups in the validity of the blood samples.

Medical services for sports injuries and illnesses in the Beijing 2022 Olympic Winter Games

BACKGROUND:Beijing 2022 Olympic Winter Games was the second Games held amid the COVID-19 pandemic.To a certain extent,it has altered the way sporting activities operate.There is a lack of knowledge on injury risk and illness occurrence in elite winter sport athletes amid the COVID-19 pandemic.This study aimed to describe the incidence of injuries and illnesses sustained during the XXIV Olympic Winter Games in Beijing from February 4 to 20,2022.METHODS:We recorded the daily number of injuries and illnesses among athletes reported by Beijing 2022 medical staff in the polyclinic,medical venues,and ambulance.We calculated injury and illness incidence as the number of injuries or illnesses occurring during competition or training,respectively,with incidence presented as injuries/illnesses per 100 athlete-days.RESULTS:In total,2,897 athletes from 91 nations experienced injury or illness.Beijing 2022 medical staff reported 326 injuries and 80 illnesses,equaling 11.3 injuries and 2.8 illnesses per 100 athletes over the 17-day period.Altogether,11%of the athletes incurred at least one injury and nearly 3%incurred at least one illness.The number of injured athletes was highest in the skating sports(n=104),followed by alpine skiing(n=53),ice track(n=37),freestyle skiing(n=36),and ice hockey(n=35),and was the lowest in the Nordic skiing disciplines(n=20).Of the 326 injuries,14(4.3%)led to an estimated absence from training or competition of more than 1 week.A total of 52 injured athletes were transferred to hospitals for further care.The number of athletes with illness(n=80)was the highest for skating(n=33)and Nordic skiing(n=22).A total of 50 illnesses(62.5%)were admitted to the department of dentistry/ophthalmology/otolaryngology,and the most common cause of illness was other causes,including preexisting illness and medicine(n=52,65%).CONCLUSION:Overall,11%of athletes incurred at least one injury during the Games,which is similar to the findings during the Olympic Winter Games in 2014 and 2018.Regarding illness,2%of athletes were affected,which is approximately one-third of the number affected in the 2018 Olympic Winter Games.

Association of post-traumatic stress disorder and work performance: A survey from an emergency medical service, Karachi, Pakistan

BACKGROUND: The purpose of the study was to explore the association between posttraumatic stress disorder(PTSD) and work performance of emergency medical services personnel in Karachi, Pakistan.METHODS: Emergency medical service personnel were screened for potential PTSD using Impact of Event Scale-Revised(IES-R). Work performance was assessed on the basis of fi ve variables: number of late arrivals to work, number of days absent, number of days sick, adherence to protocol, and patient satisfaction over a period of 3 months. In order to model outcomes like the number of late arrivals to work, days absent and days late, negative binomial regression was applied, whereas logistic regression was applied for adherence to protocol and linear for patient satisfaction scores.RESULTS: Mean scores of PTSD were 24.0±12.2. No association was found between PTSD and work performance measures: number of late arrivals to work(RRadj 0.99; 0.98–1.00), days absent(RRadj 0.98; 0.96–0.99), days sick(RRadj 0.99; 0.98–1.00), adherence to protocol(ORadj 1.01; 0.99–1.04) and patient satisfaction(β 0.001%–0.03%) after adjusting for years of formal schooling, living status, coping mechanism, social support, working hours, years of experience and anxiety or depression.CONCLUSION: No statistically significant association was found between PTSD and work performance amongst EMS personnel in Karachi, Pakistan.

Overview of the Shenzhen Emergency Medical Service Call Pattern

BACKGROUND:In Shenzhen,the Emergency Medical Service(EMS) system has been in service since 1997.This study aims to examine the operation of Shenzhen 120 EMS center and to identify the reasons of calling EMS.METHODS:In this retrospective quantitative descriptive study,the data from the Shenzhen 120 EMS registry in 2011 were analyzed.RESULTS:Shenzhen 120 EMS center is a communication command center.When the number of 120 are dialed,it is forwarded to the closest appropriate hospital for ambulance dispatch.In2011,the Shenzhen 120 EMS center received 153 160 ambulance calls,with an average of 420 calls per day.Calling emergency services was mainly due to traffic accidents.Trauma and other acute diseases constituted a majority of ambulance transports.The adult patients aged 15-60 years are the principal users of EMS.There are no recognized 'paramedic' doctors and nurses.The pre-hospital emergency service is under the operation of emergency departments of hospitals.Shenzhen at present does not have specialized pre-hospital training for doctors and nurses in posttrauma management.Moreover,specialized pre-hospital training,financial support,and public health education on proper use of EMS should be emphasized.CONCLUSION:The Shenzhen 120 EMS center has its own epidemiology characteristics.Traumatic injury and traffic accident are the main reasons for calling ambulance service.In-depth study emphasizing the distribution and characteristics of trauma patients is crucial to the future development of EMS.

Is routine pregnancy test necessary in women of reproductive age admitted to the emergency department?

BACKGROUND:This study aimed to determine the necessity of pregnancy test in women of reproductive age admitted to emergency department(ED) in routine practice.METHODS:We retrospectively reviewed the records of patients who presented to the ED between January 1,2006 and December 31,2010 and received a pregnancy test.RESULTS:The median age of 1 586 patients enrolled into the study was 27 years.Of these patients,19.55%had a positive result of pregnancy test.The most common complaint at admission was abdominal pain in 60.15%of the patients,and pregnancy test was prescribed.15.83%of the patients with abdominal pain had a positive result of pregnancy test.Of the patients,30.64%had nausea-vomiting at admission,and 11.52%had a positive result of pregnancy test.When other complaints were considered,the most commonly observed complaints were non-specific symptoms such as dizziness,malaise and respiratory problems.Of the patients,70.93%were not remembering the date of last menstruation,and 9.51%showed a positive result of pregnancy test.Urinary tract infection(UTI) was commonly diagnosed with an incidence of 17.65%,which was followed by nonspecific abdominal pain(NSAP)(16.77%) and gastrointestinal disorders such as gastritis and peptic ulcer(6.87%).Of the patients,88.40%were discharged from ED,and 11.60%were hospitalized.CONCLUSION:Pregnancy test should be given to women of reproductive age as a routine practice in ED in developing countries like Turkey.

Trends and challenges of emergency and acute care in Chinese mainland:2005–2017

BACKGROUND:Emergency medical service system(EMSS)is essential in providing acute care services for health conditions.However,trends of emergency and acute care in China haven’t been studied systematically.METHODS:Relevant literature was carefully reviewed,including original and review articles,letters,government reports,yearbooks,both in Chinese and in English.Data on the number of emergency visits,physicians and beds in emergency departments(EDs),and the workforce of prehospital emergency care were summarized and analyzed from China Health and Family Planning Statistical Yearbooks(2006–2018).RESULTS:Over the past decade,the number of ED visits tripled from 51.9 million to 166.5 million;and utilization of pre-hospital emergency care increased from 3.2 million to 6.8 million.In response to rapid increases in demand,the number of licensed emergency physicians raised from 20,058 to 59,409;the beds’number increased from 10,783 to 42,367.For pre-hospital emergency care,the volume of health workforce increased from 3,687 to 8,671,with a 109%increase in the number of physicians from 1,774 to 3,712.However,overcrowding,the long length of stay in EDs,poor work environment,and work exhaustion were still the critical challenges faced by China’s EMSS.CONCLUSIONS:The number of emergency visits has grown with continual capability enhancement during the past decade.However,overcrowding,the long length of stay in EDs,poor work environment,and work exhaustion still need to be solved by China’s EMSS.These fi ndings and comparison with the USA could offer experiences and lessons to EMSS development worldwide,especially for developing countries.

Satisfaction at Work and Suffering in Professional Psychic Service Mobile Service Emergency (SAMU)

Background: This study aimed to evaluate the level of professional satisfaction, to identify the presence of psychic suffering and their correlations in Emergency Medical Services professionals. Methods: The study is of the exploratory, census, descriptive, transversal type, with quantitative approach. It used three instruments: A sociodemographic questionnaire;the Professional Satisfaction Index—PSI;and the Self Report Questionnaire—SRQ-20. 200 professionals took part in the research (doctors, nurses, nursing technicians and conductors). Results: The data show that the majority of professionals are aged between 40 and 49 years old and that the largest quantity of women belong to the group of nurses. As to the PSI, the majority of professionals pointed out remuneration as the most important for satisfaction. In the overall satisfaction result, the physicians were those who had the highest level of satisfaction. Regarding the SRQ-20 scores, the group of nursing technicians and nurses had the highest prevalence for psychic suffering, with 44.56% and 43.48%. In the statistical analyses between each of the components of the professional satisfaction with the SRQ-20 scores, we verified statistically significant correlations when adopting (p Conclusions: It was concluded that the discontent of workers with remuneration and managerial issues are predominant for total dissatisfaction with work and dissatisfaction exerts a strong influence on the presence of suffering in these professionals.

Effects of a closed-loop system against SARS-CoV-2 at the Beijing 2022 Olympic Winter Games:a descriptive and modeling study

BACKGROUND:To assess the efficacy of the epidemic prevention measures of the“closed-loop”system adopted by the Beijing 2022 Olympic Winter Games(BOWG).METHODS:We retrospectively collected and analyzed information,including age,sex,nationality,vaccination status,date of diagnosis,and date of entry,from 280 SARS-CoV-2-positive individuals identified during the BOWG.A susceptibility-exposed-infectious-remove model was employed to evaluate the effectiveness of epidemic prevention strategies on controlling the spread of SARS-CoV-2 under different scenarios during the BOWG.RESULTS:Regarding SARS-CoV-2-positive cases,97.9%were imported,and 96.4%were asymptomatic.The median age was 37 years(range:29–47 years),and 73.9%were male,with the majority of cases being broadcasters and European attendees.Regarding vaccination status,93.5%were fully vaccinated,and six cases were considered to have been infected in the closed-loop system during the BOWG.Assuming that the BOWG adopted a semi-closed-loop management system,the cumulative number of confirmed cases would be 1,137 for quick quarantine measures(3 d later)implemented and 5,530 for delayed quarantine measures(9 d later)implemented.This modeling revealed that stringent pandemic prevention measures and closed-loop management effectively controlled the spread of SARS-CoV-2 during the BOWG.CONCLUSION:Imported cases are considered the main risk factor for SARS-CoV-2 transmission during mass gatherings,but a comprehensive closed-loop system could minimize transmission among attendees and general personnel.

Unmanned aerial vehicle based intelligent triage system in mass-casualty incidents using 5G and artificial intelligence

BACKGROUND:Rapid on-site triage is critical after mass-casualty incidents(MCIs)and other mass injury events.Unmanned aerial vehicles(UAVs)have been used in MCIs to search and rescue wounded individuals,but they mainly depend on the UAV operator’s experience.We used UAVs and artificial intelligence(AI)to provide a new technique for the triage of MCIs and more efficient solutions for emergency rescue.METHODS:This was a preliminary experimental study.We developed an intelligent triage system based on two AI algorithms,namely OpenPose and YOLO.Volunteers were recruited to simulate the MCI scene and triage,combined with UAV and Fifth Generation(5G)Mobile Communication Technology real-time transmission technique,to achieve triage in the simulated MCI scene.RESULTS:Seven postures were designed and recognized to achieve brief but meaningful triage in MCIs.Eight volunteers participated in the MCI simulation scenario.The results of simulation scenarios showed that the proposed method was feasible in tasks of triage for MCIs.CONCLUSION:The proposed technique may provide an alternative technique for the triage of MCIs and is an innovative method in emergency rescue.

Prehospital system delay in patients with ST-segment elevation myocardial infarction in Singapore

BACKGROUND: Timely reperfusion in ST-segment elevation myocardial infarction(STEMI)improves outcomes. System delay is that between first medical contact and reperfusion therapy,comprising prehospital and hospital components. This study aimed to characterize prehospital system delay in Singapore.METHODS: A retrospective chart review was performed for 462 consecutive STEMI patients presenting to a tertiary hospital from December 2006 to April 2008. Patients with cardiac arrest secondarily presented were excluded. For those who received emergency medical services(EMS),ambulance records were reviewed. Time intervals in the hospital were collected prospectively. The patients were divided into two equal groups of high/low prehospital system delay using visual binning technique.RESULTS: Of 462 patients, 76 received EMS and 52 of the 76 patients were analyzed. The median system delay was 125.5 minutes and the median prehospital system delay was 33.5minutes(interquartile range [IQR]=27.0, 42.0). Delay between call-received-by-ambulance and ambulance-dispatched was 2.48 minutes(IQR=1.47, 16.55); between ambulance-dispatch and arrival-at-patient-location was 8.07 minutes(IQR=1.30, 22.13); between arrival-at- and departurefrom-patient-location was 13.12 minutes(IQR=3.12, 32.2); and between leaving-patient-location to ED-registration was 9.90 minutes(IQR=1.62, 32.92). Comparing patients with prehospital system delay of less than 35.5 minutes versus more showed that the median delay between ambulancedispatch and arrival-at-patient-location was shorter(5.75 vs. 9.37 minutes, P<0.01). The median delay between arrival-at-patient-location and leaving-patient-location was also shorter(10.78 vs.14.37 minutes, P<0.01).CONCLUSION: Prehospital system delay in our patients was suboptimal. This is the first attempt at characterizing prehospital system delay in Singapore and forms the basis for improving efficiency of STEMI care.

Prehospital road traffic injuries among the elderly in Beijing, China： data from the Beijing Emergency Medical Center, 2004-2010

Background Road traffic injuries （RTIs） are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing＇s geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries. Methods In a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using ;~2 tests and Logistic regression analysis. Results The annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 （P 〈0.001）. The mean age was （72.92＋5.67） years, and 911 （53.40%） of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car （85.64%） and pedestrian victim injuries （79.19%）. Our statistical analysis found three factors for injury severity： abdominal injuries （P 〈0.001）, number of injury sites （P=0.027）, and head injuries （P=0.034）. The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the sevedty of RTIs also decreased. Conclusions This study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

Improving hospital-based trauma care for road traffic injuries in Malawi

BACKGROUND: The mortality rate from road traffic injuries has increased in sub-Saharan Africa as the number of motor vehicles increase. This study examined the capacity of hospitals along Malawi's main north-south highway to provide emergency trauma care.METHODS: Structured interviews and checklists were used to evaluate the infrastructure, personnel, supplies, and equipment at all four of Malawi's central hospitals, ten district hospitals, and one mission hospital in 2014. Most of these facilities are along the main north-south highway that spans the country.RESULTS: Between July 2013 and March 2014, more than 9 200 road traffic injuries(RTIs) and 100 RTI deaths were recorded by the participating hospitals. All of the hospitals reported staff shortages, especially during nights and weekends. Few clinicians had completed formal training in emergency trauma management, and healthcare workers reported gaps in knowledge and skills, especially at district hospitals. Most central hospitals had access to the critical supplies and medications necessary for trauma care, but district hospitals lacked some of the supplies and equipment needed for diagnosis, treatment, and personal protection.CONCLUSION: The mortality and disability burden from road traffi c injuries in Malawi(and other low-income countries in sub-Saharan Africa) can be reduced by ensuring that every central and district hospital has a dedicated trauma unit with qualified staff who have completed primary trauma care courses and have access to the equipment necessary to save lives.

Focused research in emergency medical systems in Asia: a necessity for trauma system advancement

Since trauma is a growing health problem worldwide,emergency trauma care including emergency medical services(EMS)is becoming an integral part of the healthcare system.The optimal EMS which will improve access to trauma care,will be different in each country because of different healthcare systems,trauma etiology,and economic situations.To adopt models that have succeeded in developed countries is not always appropriate.In order to identify the optimal EMS model in developing countries,comparing the systems among many countries in detail and examining their advantages and disadvantages would be necessary.Therefore,this article tries to identify important elements of EMS to achieve mature EMS systems based on comparisons of 7 Asian countries,and discusses the need to conduct more detailed and extensive comparisons.

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.

Impact of regional differences in stroke symptom awareness and low-income status on seeking emergency medical service in China

Background:Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service(EMS).This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China.Methods:A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally.Four status of awareness and annual income were identified:unaware and low-income,unaware-only,low-income-only,and aware and regular income.The outcomes were whether they intended to call EMS or not.The regional distribution of each status and their associations with not calling EMS were presented.Results:The status of unaware and low-income,unaware-only,and low-income-only accounted for 6.3%(11,806/187,673),11.9%(22,241/187,673),and 21.5%(40,289/187,673)of the total sample,respectively.Not calling EMS was significantly associated with the status of unaware and low-income(odds ratio[OR]:3.21,95%confidence interval[Cl]:3.07-3.35),unaware-only(OR:2.38,95%Cl:2.31-2.46),and low-income-only(OR:1.67,95%Cl:1.63-1.71),compared with the aware and regular income status.The Midwest regions had higher percentages of people in the unaware and low-income status;the East,South,and Central had higher percentages of unaware-only status;the North and Northeast regions had a higher percentage of low-income-only status,compared with other regions.Conclusion:The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.

Studyt on the Emergency Medical Service Evaluation and Improvement

The Emergency Medical Service（ EMS） system in China from service supply chain perspective is analyzed. Firstly,it reviews service supply chain researches in emergency medical service,and it is found that waiting time,safety,service integration and communication before the emergency surgery are the four indicators to measure the quality of emergency medical service. Secondly,the information barrier-inconsistent information flow-is prominent,which is between emergency in hospital and pre-hospital,after analyzing three different types of flows on service, information and logistics. Besides, comparing with Joint Commission International accreditation（ JCI） standards for hospitals in USA,the requirements of service integration and communication in Chinese hospital accreditation are much lower. In the end,a Smart First Aid Information Center（ SFAIC） model for first aid service is proposed. This model can be used to enhance information exchanges more effectively between first aid in-and pre-hospital. Moreover,it also shortens pre-surgery time and betters the communication and coordination between service sections. To put it in a nutshell,the improved medical service process can greatly increase emergency medical service quality.

Trends and characteristics in pre-hospital emergency care in Beijing from 2008 to 2017

Background: We aimed to describe and analyze the pre-hospital emergency medical service (EMS) in Beijing and provide information for the government and medical institutions to optimize EMS.Methods: We collected all pre-hospital emergency data in Beijing from 2008 to 2017. The chief complaint in each case was classified according to the Medical Priority Dispatch System (MPDS). The sites’ administrative districts were determined through geo-encoding of addresses and then classified into four functional regions. We analyzed the demand for EMS, emergency response times (ERT), and disease spectrum for Beijing as a whole, and for each functional region.Results: A total of 4,192,870 pre-hospital EMS cases met the inclusion criteria, with a significant increase (P < 0.001) of 51.60% from 2008 to 2017. EMS demand was positively associated with population (r= 0.946,P < 0.001). The pre-hospital EMS demand rate was 1907.05 in 2008 and 2172.23 in 2017 per 100,000, with no significant change (P = 0.57). ERT increased significantly (P = 0.001), from 19.18 min in 2008 to 24.51 min in 2016. According to MPDS classifications, the demand for pre-hospital care increased for 14 diseases, remained stable for 19, and decreased for only 1 disease. Cases of injury-related disease increased significantly from approximately 90,000 in 2017, accounting for 20% of all pre-hospital EMS cases, and the demand rate decreased in the core region but increased in the sub-urban regions. Cases of heart problems and stroke/transient ischemic attack also increased significantly in the four functional regions, with the highest demand rate in the Core Functional Region.Conclusions: More resources and effort should be devoted to pre-hospital EMS according to the increased pre-hospital EMS demand and prolonged ERT in Beijing over our 10-year study period. Changes in disease spectrum and differences between functional regions should also be considered.