Current situation of emergency medical service system for patients with acute myocardial infarction in Hebei Province and its influence on treatment and prognosis / 中华急诊医学杂志

Objective:To investigate the current situation of emergency medical service (EMS) system and its effect on treatment of the acute stage and short- and long-term prognosis in patients with acute myocardial infarction in Hebei province.Methods:Totally 2 961 patients with acute myocardial infarction who were admitted to major tertiary and some representative secondary hospitals in Hebei province from January 2016 to December 2016 were collected. According to the pattern of arriving hospital, all the patients were divided into the EMS group and self-transport group. The general conditions, time from onset to treatment, treatment methods, in-hospital mortality rate and 3-year mortality rate were compared between the two groups.Results:Of the included 2 961 patients, 33.13% of them were transported through EMS and 66.87% of them by private transport. Patients with a history of hypertension and ST-segment elevation myocardial infarction were more likely to choose EMS, and the difference was statistically significant ( P<0.05). Moreover, patients in the EMS group were more likely to go to tertiary hospitals for treatment (88.58% vs 85.76%, P=0.033). The time from onset to treatment of the EMS group was significantly shorter than that of the self-transport group (160 min vs 185 min, P<0.01), and the proportion of patients in the EMS group from onset-to-door time in <3 h and 3-6 h was higher than that of the self-transport group (55.76% vs 49.14%, 21.41% vs 19.09%, P<0.01). Compared with the self-transport group, the EMS group has a higher rate of reperfusion therapy (67.48% vs 61.67%, P=0.002). Patients in the EMS group had a higher in-hospital mortality rate in the acute stage (7.03% vs 4.44%, P=0.003), but its 3-year mortality rate was lower than that of the self-transport group (17.31% vs 20.77%, P<0.05). Conclusions:EMS can shorten symptom-onset-to-arrival time, increase the rate of reperfusion therapy and improve long-term prognosis of patients with acute myocardial infarction.

Trends and challenges of emergency and acute care in Chinese mainland: 2005-2017 / 世界急诊医学杂志（英文）

@#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 pre-hospital 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 findings and comparison with the USA could offer experiences and lessons to EMSS development worldwide, especially for developing countries.

Preliminary study on application of drones in a county emergency medical service system / 中华急诊医学杂志

Objective@#To explore the feasibility and advantage of the drones in a county emergency medical service system.@*Methods@#The study was conducted in Changxing County, Zhejiang Province from January to September 2018. The Changxing County People's Hospital and the health centers within its radius of 25 km were included in the study. Three types of indicators were obtained by using commercial drones to transfer simulated first-aid medical supplies from health centers to county people's hospitals: (1)The flight time of the drone; (2) The road traffic time measured by Baidu map and Tencent map software of the above-mentioned route at midnight; (3) The road traffic time measured by Amap software of these routes at 0: 00, 8: 00, 10:00, 12:00, 14:00, 16:00, 18:00, 20:00. The road traffic time at different time points measured by map softwares and drones flight time were compared. Wilcoxon symbolic rank test was used for statistical analysis, and P value of < 0.05 was considered statistically significant.@*Results@#(1) A total of 10 health centers were involved in this study, the air straight-line distance between them and the county people's hospital was (10.97±3.59) km, and the road traffic distance was (13.61±4.95) km. (2) The flight time of drone was (16.35±5.15) min, less than road traffic time measured by Amap, Baidu and Tencent map software, which were (21.40±5.15) min, (22.50±6.11) min, (22.00±5.23) min, respectively (P< 0.01). (3)The road traffic time measured by Amap software was longer than that of drones from 0:00 to 20:00 (P< 0.01), with the maximum time of (27.80±6.12) min at 18:00, and the minimum time of (21.40±5.15) min at midnight. Drones could save up 14.07 min at most and 2.8 min at least, with an average save of (7.98±1.32) min.@*Conclusions@#Drone might be used to transfer first aid medical supplies between health centers in a county area, which is faster than road transportation. It has a better application prospect and is worth to further study.

Construction of Pre-hospital and In-hospital Emergency Medical Service System Based on 5G Communication Technology / 中华急诊医学杂志

Objective@#To explore a new platform for pre-hospital and in-hospital emergency medical services based on a new generation of 5G communication technology, providing a basis for further improving the level of emergency medical services.@*Methods@#This study was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2017 to April 2019. Based on the latest requirements of emergency medical services at home and abroad, the cross-enterprise and multi-disciplinary technical forces were organized to build platform. Firstly, to determine the process of pre-hospital and in-hospital emergency medical services, various modules and technical routes were constructed under 5G conditions and individual technologies were tested one by one. Then they were gradually integrated into two platforms of ambulance and hospital emergency. Finally, the simulation test is carried out under the support of the whole 5G network.@*Results@#The pre-hospital and in-hospital emergency medical service platform based on 5G technology comprises of 5G ambulance, 5G panoramic VR real-time display system, 5G remote ultrasonic examination system, medical drone system, and 5G emergency command platform. 5G ambulance contains medical equipments such as multi-function monitor, ventilator, defibrillation monitor, portable B-ultrasound, high-definition remote video interactive system based on 5G network, VR immersive real-time panoramic experience system, and GPS positioning system. 5G panoramic VR real-time display system includes VR panoramic camera and VR glasses. The wearer with VR glasses can view the real-time situation on the ambulance, which makes a preliminary judgment on the patient's condition and provides rescue guidance. 5G remote ultrasonic examination system integrates robot technology, real-time remote control technology, and ultrasonic imaging technology. The specialist can control the movement of the ultrasonic probe set on the 5G ambulance by manipulating the mechanical arm. The patient's image and color super-picture can also be simultaneously returned to the specialist. The medical drone system enables the medical resources to be allocated in the shortest possible time through the 5G networked drones, so as to eliminate the delay caused by traffic congestion. 5G emergency command platform can integrate, transmit, and display data from multiple sources and forms through web pages in assistance of AI and internet of things.@*Conclusions@#The new platform for pre-hospital and in-hospital emergency medical services based on 5G technology can realize more fluent information exchange in pre-hospital and in-hospital, and realize the functions that are difficult to achieve under the previous network conditions.

Preliminary study on application of drones in a county emergency medical service system / 中华急诊医学杂志

Objective To explore the feasibility and advantage of the drones in a county emergency medical service system.Methods The study was conducted in Changxing County,Zhejiang Province from January to September 2018.The Changxing County People's Hospital and the health centers within its radius of 25 km were included in the study.Three types of indicators were obtained by using commercial drones to transfer simulated first-aid medical supplies from health centers to county people's hospitals:(1)The flight time of the drone;(2) The road traffic time measured by Baidu map and Tencent map software of the above-mentioned route at midnight;(3) The road traffic time measured by Amap software of these routes at 0:00,8:00,10:00,12:00,14:00,16:00,18:00,20:00.The road traffic time at different time points measured by map softwares and drones flight time were compared.Wilcoxon symbolic rank test was used for statistical analysis,and P value of ＜ 0.05 was considered statistically significant.Results (1) A total of 10 health centers were involved in this study,the air straight-line distance between them and the county people's hospital was (10.97±3.59) km,and the road traffic distance was (13.61±4.95) km.(2) The flight time of drone was (16.35±5.15) min,less than road traffic time measured by Amap,Baidu and Tencent map software,which were (21.40±5.15) min,(22.50±6.11) min,(22.00±5.23) min,respectively (P＜ 0.01).(3)The road traffic time measured by Amap software was longer than that of drones from 0:00 to 20:00 (P＜ 0.01),with the maximum time of (27.80±6.12) min at 18:00,and the minimum time of (21.40±5.15) min at midnight.Drones could save up 14.07 min at most and 2.8 min at least,with an average save of (7.98±1.32) min.Conclusions Drone might be used to transfer first aid medical supplies between health centers in a county area,which is faster than road transportation.It has a better application prospect and is worth to further study.

Construction of Pre-hospital and In-hospital Emergency Medical Service System Based on 5G Communication Technology / 中华急诊医学杂志

Objective To explore a new platform for pre-hospital and in-hospital emergency medical services based on a new generation of 5G communication technology,providing a basis for further improving the level of emergency medical services.Methods This study was conducted at the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2017 to April 2019.Based on the latest requirements of emergency medical services at home and abroad,the cross-enterprise and multi-disciplinary technical forces were organized to build platform.Firstly,to determine the process of pre-hospital and in-hospital emergency medical services,various modules and technical routes were constructed under 5G conditions and individual technologies were tested one by one.Then they were gradually integrated into two platforms of ambulance and hospital emergency.Finally,the simulation test is carried out under the support of the whole 5G network.Results The pre-hospital and in-hospital emergency medical service platform based on 5G technology comprises of 5G ambulance,5G panoramic VR real-time display system,5G remote ultrasonic examination system,medical drone system,and 5G emergency command platform.5G ambulance contains medical equipments such as multi-function monitor,ventilator,defibrillation monitor,portable B-ultrasound,high-definition remote video interactive system based on 5G network,VR immersive real-time panoramic experience system,and GPS positioning system.5G panoramic VR real-time display system includes VR panoramic camera and VR glasses.The wearer with VR glasses can view the real-time situation on the ambulance,which makes a preliminary judgment on the patient's condition and provides rescue guidance.5G remote ultrasonic examination system integrates robot technology,real-time remote control technology,and ultrasonic imaging technology.The specialist can control the movement of the ultrasonic probe set on the 5G ambulance by manipulating the mechanical arm.The patient's image and color super-picture can also be simultaneously returned to the specialist.The medical drone system enables the medical resources to be allocated in the shortest possible time through the 5G networked drones,so as to eliminate the delay caused by traffic congestion.5G emergency command platform can integrate,transmit,and display data from multiple sources and forms through web pages in assistance of AI and intemet of things.Conclusions The new platform for pre-hospital and in-hospital emergency medical services based on 5G technology can realize more fluent information exchange in pre-hospital and in-hospital,and realize the functions that are difficult to achieve under the previous network conditions.

The construction of the systemic emergency protocol in pediatrics / 中国小儿急救医学

Through introducing the current situation of systemic pediatric emergency protocol,including five-level triage system,pediatric critical rescue protocol,pediatric trauma life support,emergency observation and guidelines for the pediatric intrahospital transport,we reviewed the issues of pediatric emergency to put forward recommendations.

The current situation of construction and development of pediatric emergency and critical care system in China / 中国小儿急救医学

Through analyzing the children's pre-hospital transport,emergency medicine,intensive care medicine,nursing,professional training and research,we reviewed the current status of construction and issues of pediatric emergency and critical care system,then put forward recommendations of its development.

Overview of the Shenzhen Emergency Medical Service Call Pattern / 世界急诊医学杂志（英文）

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. In 2011, the Shenzhen 120 EMS center received 153160 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 post-trauma 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.

Application of u-Health to Emergency Medical Service System

Recent advances in information and telecommunication technology make u-health strategies possible in Emergency Medical Services (EMS) system. The u-Health can offer advanced life support, medical oversight to the emergency medical technician, quality improvement in EMS, and hazard management. The aim of this study is to provide comprehensive review, and to discuss the role and problems of the u-Health used in EMS system. The efficient operation of EMS system is contingent upon the quality management of both the working systems and underlying communication infrastructures of u-health. The u-Health services for EMS requires assessment skill, IT technology and organization of all systems. The u-Health raises the level of a medical control and treatment to a much higher degree in pre-hospital setting and also tends to decrease mortality. By utilizing u-Health system, the patient's data collected from ambulances transfer simultaneously to a central emergency medical information center (EMIC) and hospitals. Medical director delivers medical oversight to the paramedics in the ambulance, and also transmits the information to a doctor at ER before arriving to the hospital. The transmitted data contains the patient's information, vital signs (blood pressure, pulse rate, respiration rate, and temperature), ECG, pulse oxymetry, a moving picture and information at the point of care administration. For a successful integration of u-Health to EMS system, information technologies, assessment technologies, telecommunications, and legal remedy are needed. Especially, advance in assessment technologies offer the possibility of small size, but also of intelligent, active devices that are wireless and non-invasive or minimally-invasive. u-Health will benefit the patients by advanced life support in pre-hospital and emergency department settings. It will help decrease the cost associated with the hospital, mortality, and morbidity.

The study on response time of Beijing 120 EMSS / 中华急诊医学杂志

Objective To survey the status quo on response time of Emergency Medical Service System (EMSS)in Beijing and analyze the influence,factors in order to explore the existent problems upon EMSS of Beijing for 2008 Beijing Olympic game Methods The quantitative and aualitative mehods were used.The data derived from the record of Beijing Emergency Medical Center on the second half of 2005 was described and analyzed.Results At present,the median of response times in Beijing 120 Emss is 16.5 min,with 14.3 min for Quartile range.The cumulate proportion was 2.28% for less than 5 min,whereas 19.20% for over 30 min. there were statistically significant differences in term of the areas and stations respectively.Conclusion The response time of Beijing EMSS is too long,and it is not to be compared to the developed eoumtries itn terms of swift reponse,we should explore and amalyze the influence factors from various angles and make effort to resolve it.

Time for Change: The State of Emergency Medical Services in South Korea

Trauma is the leading cause of death among people younger than 40 years of age in South Korea. This demographic represents the productive members of Korean society, yet little is being done to correct this growing problem. The preventable death rate in Korea is estimated to be approximately 60%, which is unacceptable given Korea's growing economy and available resources.

Prehospital Ambulance Run Report: How Much Collected and Contents are Completed?

PURPOSE: The prehospital ambulance run report function's as a legal and billing document, a unit of database for emergency medical service system quality improvement and community resources allocation. We examined how much ambulance run report is collected, contents are checked and whether there is a hospital-wise difference. METHODS: Prehospital run report of patients who visited the emergency department of Severance hospital, YongDong Severance hospital and Ilsan hospital by ambulance during the month of August in 2003 were collected. The items in run report were grouped according to relevancy in 11categories including 6 essential cetegories. The scores of each item was calculated as follows; 1 point if completed, 0 point if not checked and 0.5 point if incomplete. The categorical score, total score and essential score was consisted of corresponding scores. RESULTS: There was 1,339 (13.5%) 119 ambulance transportation in 9,946 total visit and 783 (58.5%) reports were collected with no statistical difference among hospitals. Overall score completed 100 point scale was in total 54.43 in total score, 70.61 in essential score. In essential categories, transportation category score (78.26) was higher than EMS information (73.04), rand & signature category (72.73) and patient condition & care category (45.20) scores. Among hospitals, YongDong Severance hospital showed significantly higher total and essential score than others. In essential categories, YongDong Severance hospital in EMS information, patient condition & care, rank & signature categories and Ilsan hospital in transportation category had higher score than others with significant differences. CONCLUSION: In this study, the collection rate and completion score of prehospital 119 run report were disappointedly low and differed among hospitals. To improve present status, we prepare urgent need redesign of run report, was of uniform data set and proper education of emergency medical personnel.

Prospective Analysis on the Emergency Transport Systems in Pusan Area

PURPOSE: Overcrowding of emergency departments remains an unsolved international issue and has led to not a few unfavorable consequences. For a solution of this, appropriate patient triage and selection of appropriate hospitals to which to be transported will be essential. METHODS: The authors performed a prospective analysis of 690 patients transported via emergency transport services to the Emergency Department of Pusan National University Hospital between May 1, 2000 and June 30, 2000. RESULTS: Five hundred five cases (73.2%) were considered as appropriate transport, but 185 (26.8%) were not. In 300 cases (43.5%), the hospitals to which the patients were transported had been decided by the patient's family members, in 283 cases (41.0%) by medical professionals, in 70 cases (10.1%) by EMS personnels, and in 37 cases (5.4%) by the patients themselves. In the selection of the hospital to be transported to, patients and family members took the patient's medical condition into consideration less seriously than the other groups, but they had the greatest influence on the decision. CONCLUSION: The patients and their family members turned out to be unsuitable for the selection of the hospital to be transported to, but they actually had the greatest influence on the selection. The EMS personnels had limited influence on the selection, and they were lacking in ability to select appropriate hospital with the consideration of the patient's condition. For now there's no active regional ambulance destination policy or decision scheme. For the optimization of emergency transport activity, every effort should be made to enhance the role and ability of EMS personnels in patient triage and selection of transported hospital and to develope well-functioning ambulance destination policies as soon as possible.

A One-Click Paging System in the ED via the Internet

BACKGROUND: The time lag and the difficulty associated with calling clinicians of other departments are major concern in the emergency department(ED). We tried to design a new paging system which was faster, easier, and more accurate. METHOD: We made a web page comprised of paging numbers and then connected a personal computer in the ED to the internet through a dial-up modem, via a web-paging service, and could page persons wearing public pagers. RESULTS: We found that using the internet for paging was faster and more accurate than the hand-operated way. Calls were placed via the internet with only one click of the mouse. CONCLUSION: The One-click paging system is useful for hospital telecommunication. In this way, the internet can be applied to the entire emergency medical service system.

An Analysis on the Patient Transported via 119 System

An analysis was performed to evaluate the problems in Emegency Medical Service System(EMSS) through the review of the 119 transport chart of 1,229 patients who visited to emergency center of Chonnam University Hospital via 119 system during the period from January 1998 to December 1998. The results were obtained as follows: 1) 1,229(4.9%) of the 25,253 patients were transported to emergency center via 119 system. Among 1.229 patients, male were 691(56%) and female 538(44%), and nontraumatic patients were 946(77%) and traumatic patients 283(23%). The peak age was 5th to 6th decades. 2) Mean arrival time to scene(ambulance response time) was 4.8 +/-.8minutes and mean arrival time to hospital 19.6 +/-0.1minutes. In the distribution of the requested place for ambulance, 73% was house and 23% was field. 3) In the severity of patients, 154(12.5%) patients were classified into emergent, 442(36%) into urgent, and 633(51.5%) into non-emergent. Among 1,229 patients, number of patients admitted were 419cases(34.1%), operated 85(6.9%), discharged in emergency department 536(43.6%), dead 70(5.7%), and transferred 119(9.7%), respectively. 4) The assessment of prehospital treatment by Emergency Medical Technician(EMT) revealed that checking the vital sign was only 49.5%, and prehospital care was limited to airway management, O2 inhalation and immobilization. There was no case of the notification to medical institute or the consultation to doctor. These results show that over the half of patients transported to level III emergency center via 119 system were classified into non-emergent and the prehospital management of the patient by EMT was not adequate. This study suggests the need of more simple and objective triage guideline for patient transport, the improvement of prehospital care system, and reconstruction of the computerized communication system.