A Scale of Parental Anxiety about Pediatric Emergency Medical Care Services of Japan: Development, Reliability, Validity, Generalizability and Usefulness

Aim: The purpose of this study was to develop a scale, “parental anxiety about pediatric emergency medical care services” (PAPEMCS), and to evaluate its psychometric properties. Methods: Participants were 14,510 parents with children 6 years old or younger in Kagawa Prefecture. Using each half of the participants, exploratory factor analysis was performed to generate items and factors for the PAPEMCS, and confirmatory factor analysis (CFA) was used to establish the construct validity. The generalizability of the PAPEMCS was evaluated by congruence tests and multigroup CFA. The usefulness of the PAPEMCS was established by the relationship between the PAPEMCS and non-urgent usage of pediatric emergency medical care services (PEMCS). Results: The PAPEMCS compromised 4 factors: “anxiety about quality of PEMCS”, “anxiety about PEMCS system”, “anxiety about public support”, and “anxiety about private support”. All reliability estimates (polychoric ordinal alpha coefficients, item-rest correlations), the item discrimination, 5 fit indices for CFA, the convergent validity (indicator reliabilities, composite reliabilities, average variance extracteds), and the discriminant validity fulfilled the acceptability thresholds. All generalizability estimates fulfilled the predetermined levels of acceptability (Tucker’s congruence coefficients, congruence tests, strict factorial invariance). The usefulness of the PAPEMCS was established by the higher scores of the PAPEMCS being related to non-urgent usage of PEMCS. Conclusions: The PAPEMCS demonstrated satisfactory reliability, validity, generalizability and usefulness. The PAPEMCS is useful to quantify the contents and extent of parental anxiety about PEMCS, and to clarify the mechanisms of non-urgent PEMCS usage.

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.

Factors Influencing the Emergency Medical Service Response Time for Cardiovascular Disease in Guangzhou, China

While emergency medical service (EMS) response time (ERT) is a major factor associated with the survival of patients with cardiovascular disease (CVD), relatively few studies have explored the factors associated with ERT. This study aimed to assess the current status of ERT and to identify the factors affecting ERT in patients with CVD in China. Between January 1, 2011 and December 31, 2015, EMS responses to CVD incidents in Guangzhou, China, were examined. The primary outcome was ERT, defined as the time from receipt of an emergency call to the arrival of paramedics on the scene. Factors associated with ERT were evaluated by multivariable logistic regression. A total of 44 383 CVD incidents were analysed. The median ERT was 12.58 min (interquartile range=9.98-15.67). Among the risk factors, distance (OR=13.73, 95% CI=11.76- 16.04), level of hospital (OR=1.57, 95% CI=1.40-1.75), and site of the incident (OR=1.53, 95% CI=1.38-1.69) were the top three significant factors affecting the ERT. Our results suggest that greater attention should be given to factors affecting the ERT. It is essential to make continuous efforts to promote the development of effective interventions to reduce the response time.

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.

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.BACKGROUND：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. In 2011, 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.

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.

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.

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.

Mental Wellbeing Monitoring in a Sample of Emergency Medical Service Personnel

Background: There have been concerns regarding the mental wellbeing of emergency medical service staff, particularly when faced with multiple trauma exposures. This study aimed to describe a cross-sectional view of the mental wellbeing status of emergency medical service workers, as well as to comment on the usefulness of an electronic survey tool to reach staff that is distributed across large geographical areas. Methods: The data presented here are drawn from an anonymous, voluntary, electronic survey, made available via the internet, to emergency medical service workers in the Western Cape province of South Africa. This paper reports on four domain expressions of mental wellbeing, namely disordered mood, problematic substance use, post-traumatic stress disorder, and domestic discord. Results: Elevated rates were reported by this sample, across all four distress domains, i.e. mood disorder = 12.3%;problematic substance use = 14.9%;post-traumatic stress disorder = 11.9%;and domestic discord = 11.9%. These rates were generally similar to data from comparable emergency worker groups, and much higher than local population estimates. Conclusions: The data support earlier findings that emergency medical work is associated with increased risk for symptoms of psychological distress, which present a strong case for regular organizational monitoring of employees’ mental wellbeing. In this regard, a brief, internet delivered, survey-type tool showed promise for screening employees, in order to guide further streaming of distressed individuals towards appropriate support services. Further work is required to develop clear mechanisms for referral and intervention in order to optimize a confidential and supportive monitoring program.

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.

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.

基于EMSS的混合式教学在急危重症护理学课程中的应用

目的探讨基于急救医疗服务体系(EMSS)的混合式教学在急危重症护理学课程教学中的应用效果。方法选取医学院2019级护理专业32名本科生为试验组,对其实施基于EMSS的混合式教学;选取2018级护理专业30名本科生为对照组,对其实施以面对面课堂讲授为主、线上教学为辅的传统教学。比较两组理论与操作考核成绩、临床急救能力,并调查试验组对教学的评价。结果试验组理论成绩、操作考核成绩及护士临床急救能力自评量表中的知识储备、应急处置能力、沟通协调能力、个人素质维度得分均高于对照组(P<0.05)。结论基于EMSS的混合式教学可提升学生操作技能及临床急救能力,有助于学生构建临床急救思维体系。

基于急救医疗服务体系框架的案例情景教学提升护生急危重症护理职业素质的教学设计与实践

目的探讨在急危重症护理课程教学中提高护生急危重症护理职业素质的教学方法。方法选取224名护理专业大专生为研究对象,实施基于急救医疗服务体系(EMSS)框架的案例情景教学,即“依托案例—情景设计、线上线下—以点带面”,对护生进行职业素质培养。结果护生对本次教学改革效果较满意。结论在急危重症护理课程教学中,实施基于EMSS框架的案例情景教学,有利于培养护生急危重症护理职业素质。

“5S”管理法在院前老年创伤性骨折患者与120急救中心联动管理中的应用效果评价

选取2022年1—12月某三级甲等老年综合医院急诊科出诊的50名参加院前老年创伤性骨折患者急救的医护人员作为研究对象,其中2022年1—6月为干预前,2022年7—12月为干预后。干预前运用常规院前老年创伤性骨折患者急救模式;干预后在常规院前老年创伤性骨折患者救治模式的基础上,护理管理者运用“5S”管理法对急诊护理人员进行培训后,分别从接收到120中心指令任务派遣、老年创伤性骨折现场急救处置、安全转运、院前与院内衔接对院前老年创伤性骨折患者的救治流程进行优化和规范化,形成统一标准,以探讨“5S”管理法在老年创伤性骨折患者与120急救中心联动管理中的应用效果评价。

中国航空医疗救护的发展与建议

航空医疗救护是航空应急救援在医疗领域的应用。利用航空器提供紧急医疗服务,为危急重症患者提供生命和健康支持,特别是在突发事件的重大伤情中,可以为患者争取黄金救援时间。基于现有文献、政府文件、调查访谈、会议交流、公开数据等开展研究,梳理中国航空医疗救护的发展历程、重要事件、经验教训、问题与对策发现,中国航空医疗救护虽有长足发展,但仍与民众需求相距较远。研究表明,中国航空医疗救护的应用场景以院间转运为主,运行模式多样,参与救护的力量多元,救护机构围绕资金、技术、战略、政策、管理等要素存在竞争。中国航空医疗救护水平与部分发达国家差距较大,存在体系不完善、程序复杂、力量薄弱、资金不足等问题。为此,建议在领导机构、经费来源、政策支持、技术资源保障等方面加强建设,在突发事件的应急救援中增加航空医疗救护能力,在医疗紧急救护中增加航空急救和转运能力。

基于智慧教室+SimMan 3G模型人中医临床技能教学方法

中医临床技能教学是新时代高层次中医药人才培养的重要环节。以中医临床医生岗位胜任力为导向,以培养应用型医学人才为目标,践行“以学生为本”的教育理念,通过创新教学方法、丰富教学内容、提升教学效率以实现临床技能教育教学改革。此文以综合急救虚拟仿真实训教学为例,探讨“智慧教室+SimMan 3G模型人”的中医临床技能教学方法的优势效果。

院前急救在高危胸痛患者救治中的应用效果分析

目的探索院前急救方案在高危胸痛急救过程中的应用效果。方法将2021年6月至2023年6月由漳州市急救中心收治的90例高危胸痛患者,采用随机数字表法分为观察组与对照组,每组各45例。观察组采取院前急救服务,对照组采取常规急救,对比两组患者的抢救时间、不良结局及临床疗效。结果观察组发病到急诊时间、发病到病情确诊时间、平均住院时间均显著短于对照组(P值均<0.001)。观察组并发症发生率为24.44%,死亡率为8.89%,对照组的并发症发生率为48.89%,死亡率为33.33%,观察组的并发症发生率及死亡率均显著低于对照组(P<0.005)。观察组的临床有效率为97.78%,显著高于对照组的82.22%,差异有统计学意义(P=0.014)。结论院前急救服务可有效缩短高危胸痛患者急救时间,降低不良结局的发生率,提高抢救的有效率。

跨文化护理在大型体育赛事医疗急救保障中的实践与思考

总结杭州亚运会跨文化工作在急救保障中的护理管理经验:强化多元文化知识培训,开展急救保障应急演练,创建国际化医疗环境,编制医疗保障手册,简化运动员医疗保障理赔流程等措施,为赛事运行提供优质高效的医疗保障服务,提升就医满意度。建议进一步提高医护人员英文口语及医学专业英语水平,充分发挥中医专科护理特色,助力多元文化交流。

多情景震后城市应急医疗救援网络结构特征研究

城市应急医疗服务设施系统在震时发挥重要的医疗救援作用,是驱动城市防灾韧性的重要因素。为了保障强震后的城市应急医疗救援,强化网络关键节点、优化网络空间布局。基于建筑物、应急医疗设施和道路网络等城市系统的模拟仿真,构建不同地震灾害强度下城市应急医疗救援的供需场景。该文采用复杂网络技术构建城市应急医疗救援网络模型,分析多情景震后网络社团结构与特征参数。以某城市应急医疗服务设施系统为例进行实例分析,表征多情景地震灾害对应急医疗救援网络结构的具体影响,为优化城市应急医疗救援网络的结构鲁棒性和网络抗毁性提供决策支撑。

合肥地区老年高血压急症患者对EMSS资源利用现状调查

目的通过对合肥地区高血压急症老年患者利用急诊医疗服务体系调查,为进一步规范EMSS资源管理和建设,优化资源配置提供科学依据。方法对2005年3月-2010年3月间在我院就诊的281例高血压急症患者的发病及EMSS资源利用情况进行回顾性调查。结果 EMSS资源利用率60～80岁老年患者为56.79%,80岁及以上患者为68.29%;城区居民为60.22%,农村居民为49.00%。就诊时症状非特异和伴有急慢性合并症60～79岁患者分别为121和130例,80岁以上患者65和68例,城区居民111和118例,农村居民为75和80例。结论 EMSS资源利用率显示,城区居民高于农村、80岁及以上患者利用率高,且30 d再住院率和病死率亦显著增多。入院病人以农村居民、80岁以上、非特异症状、合并急、慢性合并症患者较为多见。