Simulação realítsica como estratégia de treinamento para equipe de saúde

Objetivo: Avaliar a simulação realística como estratégia de capacitação de técnicos de enfermagem e condutores de ambulância na avaliação primária dos traumas. Método: Estudo quase experimental, tipo antes e depois, abordagem quantitativa, desenvolvido entre dezembro de 2021 a março de 2022. A população constitui-se de 98 profissionais de 14 municípios que compõem o Complexo Regulador do Serviço de Atendimento Móvel de Urgência, da região norte do Estado do Paraná. Foi aplicado um teste de conhecimento, com 10 questões, antes e depois da simulação. Os dados foram avaliados em relação à medida central e dispersão. Os acertos, no pré e pós-teste, foram comparados por percentual. A média e desvio padrão dos acertos foram avaliados empregando o teste de Shapiro-Wilk para identificação da distribuição normal, ou não, dos dados. Também foi realizado o teste de Wilcoxon para identificação de diferença entre as médias de acertos entre os momentos de pesquisa. Empregou-se o índice de significância de 0,050. Resultados: Das perguntas propostas, aquelas sobre cinemática do trauma, estágios da avaliação primária da vítima, planejamento do atendimento e imobilização da vítima de trauma, atendimento na avaliação e presença de choque atingiram 90% das respostas corretas esperadas após o treinamento. As perguntas sobre avaliação primária do paciente e manejo das vias aéreas também produziram resultados significativos. Conclusão: A assimilação de conhecimento através da simulação realística promoveu um incremento importante de acertos das questões.

Objetivo: Evaluar la simulación realista como estrategia de formación de técnicos de enfermería y conductores de ambulancias en la valoración primaria del trauma. Método: Estudio cuasiexperimental, tipo antes y después, enfoque cuantitativo, desarrollado entre diciembre de 2021 y marzo de 2022. La población está compuesta por 98 profesionales de 14 municipios que componen el Complejo Regulador del Servicio de Atención Móvil de Emergencia de la región norte del Estado de Paraná. Se aplicó una prueba de conocimientos, con 10 preguntas, antes y después de la simulación. Los datos fueron evaluados en relación con la medida central y dispersión. Las respuestas correctas, en el pre y postest, fueron comparadas por porcentaje. La media y la desviación estándar de las respuestas correctas se evaluaron mediante la prueba de Shapiro-Wilk para identificar la distribución normal o no de los datos. También se realizó la prueba de Wilcoxon para identificar la diferencia entre las medias de aciertos entre los momentos de la investigación. Se utilizó un índice de significación de 0.050. Resultados: De las preguntas propuestas, aquellas sobre cinemática del trauma, etapas de la valoración primaria de la víctima, planificación del cuidado e inmovilización de la víctima del trauma, atención en la valoración y presencia de shock alcanzaron el 90 % de respuestas correctas esperadas después el entrenamiento. Las preguntas sobre evaluación primaria del paciente y control de la vía aérea también arrojaron resultados significativos. Conclusión: La asimilación de conocimientos a través de la simulación realista promovió un aumento importante en las respuestas correctas a las preguntas

Objective: To assess realistic simulation as a training strategy for nursing technicians and ambulance drivers in the primary assessment of trauma cases. Method: A quasi-experimental study, before-and-after design, with a quantitative approach, conducted between December 2021 and March 2022. The study population consisted of 98 professionals from 14 municipalities within the Northern region of the State of Paraná, who are part of the Regulatory Complex of the Mobile Emergency Care Service. A knowledge test consisting of 10 questions was administered before and after the simulation. Data were analyzed in terms of central tendency and dispersion. Pre-test and post-test correct answers were compared as percentages. The mean and standard deviation of correct answers were assessed using the Shapiro-Wilk test to determine whether the data followed a normal distribution. The Wilcoxon test was also employed to identify differences in mean correct answers between the research phases, with a significance level of 0.050. Results: Among the proposed questions, those related to trauma kinematics, stages of primary victim assessment, treatment planning, victim immobilization, assessment during care, and recognition of shock achieved a 90% correct response rate after the training. Questions about primary patient assessment and airway management also yielded significant results. Conclusion: The assimilation of knowledge through realistic simulation led to a significant improvement in correct answer rates for the questions

Effect of Kangaroo Mother Care Transport in Preventing Moderate Hypothermia in Low Birth Weight Babies During Transportion to Home After Discharge: A Randomized Controlled Trial

Background: Transport of neonates is often neglected, which results in high mortality of neonates during transport. Objective: To determine the effectiveness of kangaroo mother care (KMC) in terms of hypothermia prevention during transport from hospital to home for low birth weight neonates. Study design: Randomized controlled trial. Participants: A total of 152 low birth weight neonates being discharged from the neonatal intensive care unit of our hospital between March, 2021 and August, 2022. Intervention: Neonates in the study group (n=76) received KMC during transport from the hospital to home, while the control group (n=76) did not receive KMC during transport. Axillary temperature was recorded in both groups at the time of discharge, every 5 minutes during transport, and on reaching home. Outcomes: Hypothermia episodes in neonates while receiving KMC compared to neonates not receiving KMC. Results: Primary endpoint of the study was moderate hypothermia. During transport, 23 (30.3%) neonates in the control group experienced moderate hypothermia during transport, which was statistically significant [0% vs 30.3%; P<0.001]. From 10 minutes of transport till the neonates reached home, the mean (SD) temperature in the study group was significantly higher than in the control group [ 36.8 (0.23) °C vs 36.6 (0.3) °C; P<0.001] at time 15 minutes. Similar results were noted in preterm neonates [36.7 (0.25) °C vs 36.5 (0.29) °C; P<0.001] at time 15 minutes. The number of hypothermia episodes was more in the control group than in the study group during most of the transport time [7.6% vs 43.2%; P<0.001] at time 15 minutes. Conclusions: Low birth weight neonates receiving KMC showed optimal thermoregulation, whereas a high incidence of moderate hypothermia was seen among neonates receiving conventional care during transport.

Knowledge about COVID-19 Infection and Stress Levels among Ambulance Drivers during COVID-19 Pandemic — A Cross Sectional Study

Introduction : The medical personnel especially have to deal with both the Biological and Psychological consequences originating from the influence of virus. Emergency Care Units equipped with ambulance service always should be at the fore front to face all emerging untoward incidents. Ambulance Drivers often disregard their physical health and mental stress in order to fulfil the duties entrusted on them. Methodology : Cross-sectional questionnaire based on-line survey was conducted. Ambulance drivers were North and South India were taken as study subjects. Knowledge based questions and mental stress were assessed using Perceived Stress level Scale (PSS). The questionnaires were translated toTamil, Kannada, Telugu, Malayalam and Hindi languages. Chi-square test was done to find the association between variables. Results : Among the 101 respondents, 84.2% were having good knowledge about the pandemic. Statistically significant association between number of patients transported per day and the knowledge levels of Ambulance drivers was found (p =0.048)(Chi-square value=15.65). Drivers in Government sector were having more knowledge compared to private sector (p =0.038)(Chi square value=6.53). The perceived mental stress was found to increase with a greater number of patients being transported per day, which was statistically significant (p =0.001)(Chi-square value= 30.42). Conclusion : Knowledge regarding COVID-19 virus was adequate among the Ambulance Drivers. Knowledge was found to be more among drivers who work in Government medical establishments. Mental stress was more among drivers who transported more than 5 patients per day.

Challenges and opportunities to improve efficiency and quality of prehospital emergency care using an mHealth platform: Qualitative study in Rwanda

Introduction: Prompt, high-quality pre-hospital emergency medical services (EMS) can significantly reduce morbidity and mortality. The goal of this study was to identify factors that compromise efficiency and quality of pre-hospital emergency care in Rwanda, and explore the opportunities for a mobile health (mHealth) tool to address these challenges. Methods: In-depth interviews were conducted with 21 individuals representing four stakeholder groups: EMS dispatch staff, ambulance staff, hospital staff, and policymakers. A semi-structured interview guide explored participants' perspectives on all aspects of the pre-hospital emergency care continuum, from receiving a call at dispatch to hospital handover. Participants were asked how the current system could be improved, and the potential utility of an mHealth tool to address existing challenges. Interviews were audio-recorded, and transcripts were thematically analyzed using NVivo. Results: Stakeholders identified factors that compromise the efficiency and quality of care across the prehospital emergency care continuum: triage at dispatch, dispatching the ambulance, locating the emergency, coordinating patient care at scene, preparing the receiving hospital, and patient handover to the hospital. They identified four areas where an mHealth tool could improve care: efficient location of the emergency, streamline communication for decision making, documentation with real-time communication, and routine data for quality improvement. While stakeholders identified advantages of an mHealth tool, they also mentioned challenges that would need to be addressed, namely: limited internet bandwidth, capacity to maintain and update software, and risks of data security breaches that could lead to stolen or lost data. Conclusion: Despite the success of Rwanda's EMS system, this study highlights factors across the care continuum that could compromise quality and efficiency of prehospital emergency care. Mobile health tools hold great promise to address these challenges, but contextual issues need to be considered to ensure sustainability of use.

Uso de simulación de eventos discretos y algoritmos genéticos para estimar los recursos necesarios para responder oportunamente en el sistema de emergencias médicas en Bogotá / Use of discrete event simulation and genetic algorithms to estimate the necessary resources to respond in a timely manner in the Medical Emergency System in Bogotá

INTRODUCCIÓN: Bogotá cuenta con un sistema de emergencias médicas de ambulancias públicas y privadas que responden a incidentes de salud. No se conoce, sin embargo, su suficiencia en cantidad, tipo y ubicación de recursos demandados. OBJETIVOS: A partir de los datos del sistema de emergencias médicas de Bogotá, Colombia, se buscó primero caracterizar la respuesta pre hospitalaria en paro cardiaco. Luego, con el modelo se buscó determinar cuál sería el menor número de recursos necesarios para responder antes de ocho minutos, teniendo en cuenta su ubicación, número y tipo. MÉTODOS: Se obtuvo una base de datos de incidentes reportados en registros administrativos de la autoridad sanitaria distrital de Bogotá (de 2014 a 2017). A partir de esa información, se diseñó un modelo híbrido basado en la simulación de eventos discretos y algoritmos genéticos para establecer la cantidad, tipo y ubicación geográfica de recursos, conforme a frecuencias y tipología de los eventos. RESULTADOS: De la base de datos, Bogotá presentó 938 671 envíos de ambulancias en el período. El 47,4% de prioridad alta, 18,9% media y 33,74% baja. El 92% de estos correspondieron a 15 de 43 códigos de emergencias médicas. Los tiempos de respuesta registrados fueron mayores a lo esperado, especialmente en paro cardiaco extra hospitalario (mediana de 19 minutos). En el modelo planteado, el mejor escenario requirió al menos 281 ambulancias, medicalizadas y básicas en proporción de 3:1 respectivamente para responder en tiempos adecuados. CONCLUSIONES: Los resultados sugieren la necesidad de incrementar los recursos que responden a estos incidentes para acercar estos tiempos de respuesta a las necesidades de nuestra población.

INTRODUCTION: Bogotá has a Medical Emergency System of public and private ambulances that respond to health incidents. However, its sufficiency in quantity, type and location of the resources demanded is not known. OBJECTIVE: Based on the data from the Medical Emergency System of Bogotá, Colombia, we first sought to characterize the prehospital response in cardiac arrest and determine with the model which is the least number of resources necessary to respond within eight minutes, taking into account their location, number, and type. METHODS: A database of incidents reported in administrative records of the district health authority of Bogotá (2014 to 2017) was obtained. Based on this information, a hybrid model based on discrete event simulation and genetic algorithms was designed to establish the amount, type and geographic location of resources according to the frequencies and typology of the events. RESULTS: From the database, Bogotá presented 938 671 ambulances dispatches in the period. 47.4% high priority, 18.9% medium and 33.74% low. 92% of these corresponded to 15 of 43 medical emergency codes. The response times recorded were longer than expected, especially in out-of-hospital cardiac arrest (median 19 minutes). In the proposed model, the best scenario required at least 281 ambulances, medicalized and basic in a 3:1 ratio, respectively, to respond in adequate time. CONCLUSIONS: Results suggest the need for an increase in the resources that respond to these incidents to bring these response times to the needs of our population.

Accessibility to urgent and emergency care services in low-density territories: the case of Baixo Alentejo, Portugal / Acessibilidade à rede de serviços de urgência em territórios de baixa densidade: o caso do Baixo Alentejo, Portugal

Abstract Access to health care is a sensitive issue in low population density territories, as these areas tend to have a lower level of service provision. One dimension of access is accessibility. This paper focuses on measuring the accessibility to urgent and emergency care services in the Portuguese region of Baixo Alentejo, a territory characterized by low population density. Data for the calculation of accessibility is the road network, and the methodology considers the application of a two-level network analyst method: time-distance by own mean (car or taxi) to the urgent care services and the time distance to emergency services as a way to get assistance and to go to urgent care services. While urgent care accessibility meets the requirements stipulated in the Integrated Medical Emergency System's current legislative framework, the simulation of different scenarios of potential accessibility shows intra-regional disparities. Some territories have a low level of accessibility. Older adults, the poorly educated, and low-income population, also have the lowest levels of accessibility, which translates into dually disadvantageous situation since the potential users of emergency services are most likely to belong to this group of citizens.

Resumo Em territórios de baixa densidade populacional, o acesso aos cuidados de saúde é uma questão delicada, pois essas áreas tendem a ter um nível mais baixo de prestação de serviços. Uma dimensão do acesso é a medição da acessibilidade. Este artigo tem como propósito medir a acessibilidade aos serviços de urgência e aos meios de emergência médica na região portuguesa do Baixo Alentejo, território caracterizado por uma baixa densidade populacional. A metodologia considera o método network analyst aplicado à rede viária, em dois níveis: o cálculo da distância-tempo aos serviços de urgência usando modo próprio (carro ou táxi); e o cálculo da distância-tempo recorrendo aos meios de socorro e emergência como forma de aceder aos serviços de urgência. Embora se considere que a acessibilidade às urgências atende ao atual quadro legislativo do Sistema Integrado de Emergência Médica, a simulação de diferentes cenários no Baixo Alentejo mostra a existência de disparidades intra-regionais no que se refere à acessibilidade aos serviços de urgência. Verifica-se que é a população idosa, de baixa instrução e residente em zonas com baixa densidade populacional quem apresenta menores índices de acessibilidade, o que traduz uma situação duplamente desvantajosa, uma vez que estes são os maiores utilizadores destes serviços.

The utility of physician-staffed helicopters for managing individuals who experience severe isolated head trauma / Journal of Rural Medicine

Objective: The authors retrospectively investigated prognostic factors for severe isolated head trauma in patients evacuated by a physician-staffed helicopter emergency medical service (HEMS) or ground ambulance using data from the Japan Trauma Data Bank (JTDB).Patients and Methods: This study was a retrospective analysis of data housed in the JTDB database. The study period was from January 2004 to May 2019. Subjects were divided into two groups according to the method of transportation: helicopter (i.e., HEMS), which included patients transported by a physician-staffed helicopter; and ambulance, which included patients transported by ground ambulance.Results: A total of 41,358 patients were enrolled in the study, including 2,029 in the helicopter group and 39,329 in the ambulance group. The ratio of males, median head Abbreviated Injury Scale and Injury Severity Scale (ISS) scores were significantly greater in the helicopter group than in the ambulance group, while the average age, median Glasgow Coma Scale, average Revised Trauma Score (RTS), and survival rate were significantly lower in the helicopter group than in the ambulance group. Of the variables that demonstrated statistical significance in the univariate analysis and classification of transportation and included in the multivariate analysis, the following were identified as significant predictors of survival outcomes: younger age, lower ISS, female sex, and greater RTS. HEMS was not a significant predictor of survival.Conclusion: The present study revealed no effect of HEMS transport on the outcomes of patients who experienced severe isolated head trauma compared with ground ambulance transportation. Further prospective studies, including an analysis of the operation time or distance traveled by the HEMS and the functional outcome(s) of patients with severe head injury transported by HEMS, are warranted.

Simulation study on quality of CPR between manual chest compression and mechanical chest compression devices performed in ambulance

@#Background: Maintaining good quality CPR while transporting out-of-hospital cardiac arrest patients is very challenging. We aim to determine how different ambulance speed can affect the quality of chest compression performed either manually or mechanically. Methods: This was an observational manikin-based study. A total of 96 participants as well as two types of mechanical compression devices: Lucas-2 and AutoPulse, performed one minute of continuous chest compression on BT-CPEA programmed manikin while the ambulance travelled at different speeds, i.e., idle state, 30km/hr and 60km/hr. Seven outcome variables of chest compression were measured. Performance data of different groups of compressor were compared and analysed using repeated measures analysis of variance (ANOVA). Results: In manual chest compression, significant variation were noted among different speeds in term of average compression rate (p<0.001), average compression depth (p=0.007), fraction of adequate/insufficient compression depth and fraction of normal hands positioning with p=0.018, 0.022 and 0.034 respectively. Overall, AutoPulse and Lucas-2 were not affected by ambulance speed. Lucas2 showed more consistent average compression rate, higher fraction of adequate compression depth and reduced fraction of insufficient compression depth as compared to manual compression with p<0.001, 0.001 and 0.043 respectively. Conclusion: In this study we found that ambulance speed significantly affected certain aspects of manual chest compression most notably compression depth, rate and hand positioning. AutoPulse and Lucas-2 can improve these aspects by providing more consistent compression rate, depth and fraction of adequate compression depth during transport.

Investigating age and regional effects on the relation between the incidence of heat-related ambulance transport and daily maximum temperature or WBGT

BACKGROUND@#Although age and regional climate are considered to have effects on the incidence ratio of heat-related illness, quantitative estimation of age or region on the effect of occurring temperature for heat stroke is limited.@*METHODS@#By utilizing data on the number of daily heat-related ambulance transport (HAT) in each of three age groups (7-17, 18-64, 65 years old, or older) and 47 prefectures in Japan, and daily maximum temperature (DMT) or Wet Bulb Globe Temperature (DMW) of each prefecture for the summer season, the effects of age and region on heat-related illness were studied. Two-way ANOVA was used to analyze the significance of the effect of age and 10 regions in Japan on HAT. The population-weighted average of DMT or DMW measured at weather stations in each prefecture was used as DMT or DMW for each prefecture. DMT or DMW when HAT is one in 100,000 people (T@*RESULTS@#HAT of each age category and prefecture was plotted nearly on the exponential function of corresponding DMT or DMW. Average R@*CONCLUSIONS@#Age and regional differences affected the incidence of HAT. Thus, it is recommended that public prevention measures for heat-related disorders take into consideration age and regional variability.

Pre-hospital assistance by ambulance in the context of coronavirus infections / Asistencia pré hospitalaria em ambulância em el contexto de las infecciones por coronavirus / Assistência pré-hospitalar por ambulância no contexto das infecções por coronavirus

ABSTRACT Objective: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. Method: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. Results: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. Final considerations: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.

RESUMEN Objetivo: Reflexionar sobre el cuidado seguro realizado por el equipo de atención prehospitalaria en ambulancia en época de infección por coronavirus. Método : se trata de una reflexión y descripción de cómo brindar un cuidado seguro al paciente y al profesional durante una atención prehospitalaria en época de infección por coronavirus. Resultados: para garantizar la salud de todos los implicados en la atención prehospitalaria, los profesionales sanitarios que trabajan en ambulancia deben utilizar el equipo de protección personal (EPP) recomendado, como el uso de mascarillas quirúrgicas N95, N99, N100, PFF2 o PFF3, delantal o capa, gafas de seguridad y protector facial o face shield , guantes y gorro. Todo el personal debe recibir formación y demostrar su capacidad para utilizar los EPPs de forma correcta y segura. Consideraciones finales: el profesional que trabaja en la atención prehospitalaria en ambulancia está expuesto a una serie de riesgos ocupacionales que deben ser discutidos y minimizados a través de la formación profesional.

RESUMO Objetivo: Refletir sobre o cuidado seguro exercido pela equipe de atendimento pré-hospitalar por ambulância em época de infecção por coronavírus. Método: trata-se de uma reflexão e descrição de como proporcionar um cuidado seguro ao paciente e ao profissional durante um atendimento pré-hospitalar em época de infecção por coronavírus. Resultados: para garantir a saúde de todos os envolvidos no cuidado, os profissionais de saúde que atuam no atendimento pré-hospitalar por ambulância devem fazer uso dos Equipamentos de Proteção Individual (EPI) preconizados, como o uso de máscaras cirúrgicas e N95, N99, N100, PFF2 ou PFF3, utilizar avental ou capote, óculos de proteção e protetor facial ou face shield, luvas e gorro. Toda a equipe deve receber capacitação e demonstrar capacidade de usar os EPIs de modo correto e seguro. Considerações finais: o profissional atuante no atendimento pré-hospitalar por ambulância está exposto a uma série de riscos ocupacionais que precisam ser discutidos e minimizados por meio de capacitação profissional.

Vivências dos enfermeiros em praticas avançadas nos serviços de atendimento móvel de urgência / Nurses living in advanced practices in mobile emergency care service

O atendimento pré-hospitalar (APH) no Brasil se dá através do serviço de atendimento móvel de urgência (SAMU). O SAMU é acionado gratuitamente pelo dígito 192 e presta assistência fora do ambiente hospitalar. É composto por dois tipos principais de ambulâncias: as de suporte básico de vida (SBV) tripulada por, no mínimo, um motorista e um técnico em enfermagem, caracterizado por não realizar manobras invasivas; e as de suporte avançado de vida (SAV), cuja equipe inclui motorista, médico e enfermeiro e realizam procedimentos invasivos de suporte ventilatório e circulatório. Desde a sua implantação em 2003, o SAMU mostrou-se como um novo campo de trabalho para os profissionais de enfermagem. Em março de 2011, com a resolução do COFEN nº 375 que dispõem da presença do enfermeiro no SBV foi criado o suporte básico de vida tripulada por enfermeiro intitulado em alguns SAMU por suporte Intermediário de vida (SIV), modalidade esta encontrada em outros países. Acredita-se que o SIV ajusta a lacuna entre o SBV e SAV, melhorando a assistência de enfermagem. Sendo assim, o APH vem se tornando um ambiente favorável para expansão da enfermagem em práticas avançadas (EPA) pela especificidade exigida no campo de atuação. O objetivo deste estudo é avaliar o SIV enquanto um campo de prática avançada pelos enfermeiros. Trata-se de uma pesquisa descritiva e exploratória, e abordagem qualiquantitativa. O estudo foi operacionalizado em duas fases: 1ª fase foi para quantificar os SAMU do Estado que possuem SIV, utilizando um questionário estruturado direcionado aos coordenadores de enfermagem. Na 2ª fase foi realizada uma entrevista com enfermeiros que atuam no SIV. Na primeira fase identificou-se quantas Centrais de Regulação de Urgências do SAMU existem em cada DRS do estado de São Paulo. Participaram deste estudo 17 serviços. Verificou-se que em 11 deles havia a modalidade SIV, esporádica ou não. Na segunda fase foi analisada a atuação do enfermeiro no SIV na perspectiva da enfermagem em pratica avançada, por meio da analise de expressões de diálogo durante entrevista. Após transcrição e leitura exaustiva identificou se as categorias das falas, as quais foram divididas em duas unidades temáticas, a saber, vivência e competência. Conclui-se que este estudo identificou a existência do SIV, sendo um serviço que vai ao encontro dos objetivos da OMS em relação ao aumento do acesso universal à saúde, oferece acesso oportuno em situação de urgência, além das vivencias e competências dos enfermeiros serem condizentes com as competências dos enfermeiros que atuam no campo da EPA. Há necessidade de certificação para enfermeiros em EPA, e o Brasil apresenta potencialidades para isso, seja pela robustez da lei do exercício profissional, seja pelos documentos do próprio Ministério da Saúde

Pre-hospital care (APH) in Brazil takes place through the mobile emergency care service (SAMU). SAMU is activated free of charge by calling 192 and provides assistance outside the hospital environment. It consists of two main types of ambulances, those of basic life support (BLS) manned by at least one driver and a nursing technician, characterized by not performing invasive maneuvers, and those of advanced life support (FAS), whose team includes driver, doctor and nurse and perform invasive procedures for ventilatory and circulatory support. Since its implementation in 2003, SAMU has shown itself as a new field of work for nursing professionals. In March 2011, with COFEN Resolution No. 375 that have the presence of nurses in the BLS, basic life support manned by a nurse was created, entitled in some SAMU's unit as Intermediate Life Support (SIV), a modality found in other countries. It is believed that SIV bridges the gap between BLS and VAS, improving nursing care. Thus, the APH has become a favorable environment for the expansion of nursing in advanced practices (EPA) due to the specificity required in the field of activity. The aim of this study is to evaluate SIV as a field of advanced practice by nurses. This is a descriptive and exploratory research, with a qualitative and quantitative approach. The study was carried out in two phases: 1st phase was to quantify the SAMU of the State that have SIV, using a structured questionnaire directed to the nursing coordinators. In the 2nd phase, an interview was conducted with nurses who work at SIV. In the first phase, it was identified how many SAMU Emergency Regulation Centers exist in each DRS in the state of São Paulo. Seventeen services participated in this study, it was found that in 11 there was the SIV modality, either sporadic or not. In the second phase, the role of nurses in the SIV was analyzed from the perspective of nursing in advanced practice, through the analysis of expressions of dialogue during an interview. After transcription and exhaustive reading, the categories of speeches were identified, which were divided into two thematic units, namely, experience and competence. It is concluded that this study identified the existence of SIV, being a service that meets the objectives of WHO in relation to the increase of universal access to health, offers timely access in urgent situations, in addition to the experiences and skills of nurses to be consistent with the skills of nurses working in the EPA field. There is a need for certification for nurses in EPA, and Brazil has the potential to do so, either because of the robustness of the law of professional practice or by the documents of the Ministry of Health itself

Thirty-six critical cases of emergency helicopter transferring between hospitals / 中华危重病急救医学

Objective:To summarize critical cases of emergency helicopter transferring between hospitals and improve the quality and safety of critical care.Methods:The task records of Guangxi Aviation Medical Rescue Training Base from September 2017 to September 2020 were retrieved. The mission acceptance, implementation results, disease spectrum composition, pre-transfer preparation and medical intervention on board were summarized.Results:① General information: a total of 168 patients of helicopter transfer requests were registered, of which 36 patients were transferred, 35 patients were successful, 1 patient had cardiac arrest during the landing phase, and died several hours after continuous resuscitation. Of the 36 patients 30 were males and 6 were females, with median age of 50.5 (29.8, 66.0) years old, the average transfer time was (54.95±17.89) minutes, and the average transfer distance was (205.74±74.68) km. ② Disease spectrum included 11 cases of stroke (30.55%), 7 cases of trauma (19.45%), 5 cases of severe pneumonia (13.89%), 5 cases of heart and macro-vascular diseases (13.89%), 5 cases of abdominal emergency (13.89%), and 3 other conditions (8.33%).③ Severity: 31 patients (86.11%) were severe (≥15) according to acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score; 19 patients (52.78%) were high-risk emergency transport (≥6) according to Hamilton early warning score (HEWS); 6 patients (85.71% of trauma patients) were severe trauma (≥16) according to injury severity score (ISS). ④ Preparation before transfer: remote consultation was carried out to evaluate the latest state of the patient's condition, especially the respiratory and circulatory conditions. Relevant items were reviewed and emergency treatments were implemented when necessary. Targeted preparation was made for accidents that might occur during transfer, such as electrocardiogram (94.44%), blood gas analysis (94.44%), brain CT (36.11%) and other auxiliary examinations, endotracheal intubation or tracheotomy (72.22%), deep vein catheterization (91.67%), placement of gastric tube (86.11%) and urinary tube (88.89%), adjustment of sedative (38.89%), vasoactive drugs (58.33%) and drugs for dehydration and lowering intracranial pressure (33.33%), and fixation of fracture (11.11%), etc. ⑤ On-board medical intervention: cardiac monitoring, blood pressure, respiration and blood oxygen monitoring were carried out in all patients. The parameters of patients using ventilator were adjusted in time (66.67%). The dosage of patients using micropump was adjusted in time (91.67%). Other aspects included the use of sedative and analgesics (38.89%), sputum suction nursing (75.00%), all kinds of catheter nursing (endotracheal intubation/incision nursing of 72.22%, indwelling catheter nursing of 88.89%), and cardiopulmonary resuscitation for patient with cardiac arrest (2.78%).Conclusion:As the patients transferred by helicopter are mainly those of critically ill at this stage, the requirements for airborne medical equipment and rescue technology are high, and there is an urgent need to establish technical specifications and personnel training standards.

Communication between pre-hospital and intra-hospital emergency medical services: literature review / La comunicación entre los servicios médicos de emergencia pre-hospitalaria e intra-hospitalaria revisión de literatura / A comunicação entre os serviços médicos de emergência pré-hospitalar e intra-hospitalar: revisão de literatura

ABSTRACT Objectives: to analyze, according to the scientific literature, communication strategies in the transfer of cases between pre-hospital and in-hospital services and their contributions to patient safety. Methods: this is a literature review study, that is, one that aims to gather and synthesize research results on the subject in a systematic and orderly manner. Results: ten articles were published, published between 2010 and 2018, and two points of discussion emerged: use of mnemonics; and barriers to transferring a case. Conclusions: studies point to the need to standardize the case transfer process, as well as integrative training of professionals, regular assessment of the teams involved in emergency medical services and the need for research on the subject.

RESUMEN Objetivos: analizar, de acuerdo con la literatura científica, estrategias de comunicación en la transferencia de caso entre los servicios pre-hospitalaria e intra-hospitalariae sus contribuciones para la seguridad del paciente. Métodos: se trata de un estudio de revisión de literatura, es decir, aquel que tiene como finalidad reunir y sintetizar resultados de investigaciones sobre la temática de manera sistemática y ordenada. Resultados: han sido recogidos diez artículos, publicados entre 2010 y 2018, emergiendo dos puntos de discusión: uso de nemotécnicos; y barreras para la transferencia de caso. Conclusiones: los estudios apuntan para la necesidad de estandarización del proceso de transferencia de caso, así como entrenamiento integrador de los profesionales, evaluación regular de los equipos envueltos en los servicios médicos de emergencia y necesidad de investigación acerca de la temática.

RESUMO Objetivos: analisar, de acordo com a literatura científica, estratégias de comunicação na transferência de caso entre os serviços pré-hospitalar e intra-hospitalar e suas contribuições para a segurança do paciente. Métodos: trata-se de um estudo de revisão de literatura, isto é, aqueleque tem como finalidade reunir e sintetizar resultados de pesquisas sobre a temática de maneira sistemática e ordenada. Resultados: foram selecionados dez artigos, publicados entre 2010 e 2018, emergindo dois pontos de discussão: uso de mnemônicos; e barreiras para a transferência de caso. Conclusões: os estudos apontam para a necessidade de padronização do processo de transferência de caso, bem como treinamento integrativo dos profissionais, avaliação regular das equipes envolvidas nos serviços médicos de emergência e necessidade de pesquisa acerca da temática.

Factors Associated With Delayed Ambulance Response Time In Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan

@#Ambulance response time is one of the key performance of ambulances services. The objective of this study is to determine the factors associated with delayed ambulance response time in Hospital Universiti Sains Malaysia (HUSM). This was a cross sectional study conducted in Department of Emergency Medicine, Hospital Universiti Sains Malaysia (EDHUSM) between January 2016 to January 2017. A total of 300 ambulance calls were included in our analysis. Data were collected by ambulance paramedic using validated ambulance form. All ambulance forms with missing data were excluded from this study. Of the 300 ambulance calls within the study periods, 254 cases (84.7%) were determined to have delayed ambulance response time. Current ambulance response time is 14 minutes with interquartile range of 5 minutes. Factors which showed significant association delayed ambulance response time include distance from hospital, location, type of emergency and ambulance mechanism. The odd of delayed ambulance response time by every increase in distance unit was 1.59 (95% CI, 1.37 to 1.85). For location type, the odd of delayed ambulance response time for public location as compared to road was 0.13 (95% CI, 0.04 to 0.45). For ambulance mechanism, the odd of delayed ambulance response time for beacon type as compared to siren type was 0.22 (95% CI, 0.01 to 0.69). Further intervention should be initiated based on our findings to improve current ambulance response time.

Short-term effects of ambient air pollution and cause-specific emergency department visits in Guangzhou / 中华疾病控制杂志

Objective To understand the relationship between the concentration of air pollutants and daily emergency department visits for different diseases (circulatory system disease, digestive system disease, nervous system disease and respiratory system disease) in Guangzhou, Guangdong Province. Methods The daily average concentrations of sulfur dioxide (SO2), nitrogen dioxide (NO2, carbon monoxide (CO) and PM2.5 and the daily maximum 8-hour concentrations of O3, the daily average temperature, the relative humidity and cause -specific emergency department visits of the four major diseases from 2015 to 2017 were collected in Guangzhou. Semi-parametric generalized additive model was used to analyze the relationship between the concentration of pollutants and daily cause-specific emergency department visits. Results The daily average concentrations of SO2, NO2, CO, O3 and PM2.5 during the study period were 13.24 μg /m3, 45.96 μg /m3, 0.97 mg /m3, 123.77 μg /m3 and 36.22 μg /m3, respectively. For circulatory system disease，the independently significant associations of SO2 with emergency department visits in single-pollutant models (2.91%, 95% CI: 1.00%-4.85%), and multipollutant models (4.39%, 95% CI: 1.22%-7.67%) were observed. Conclusion The ambient SO2 increases the risk of emergency department visits due to circulatory diseases in Guangzhou. Comprehensive prevention and control measures should be taken to reduce the emission of SO2.

Association between gaseous pollutants and emergency ambulance dispatches for asthma in Chengdu, China: a time-stratified case-crossover study

OBJECTIVES@#The association between concentrations of sulfur dioxide (SO), nitrogen dioxide (NO), carbon monoxide (CO), ozone (O), and emergency ambulance dispatches (EADs) for asthma was explored in the central Sichuan Basin of southwestern China for the first time.@*METHODS@#EADs for asthma were collected from the Chengdu First-Aid Command Center. Pollutant concentrations were collected from 24 municipal environmental monitoring centers and including SO, NO, CO, daily 8-h mean concentrations of O (O-8 h), and particulate matter less than 2.5 μm in aerodynamic diameter (PM). The climatic data were collected from the Chengdu Municipal Meteorological Bureau. All data were collected from years spanning 2013-2017. A time-stratified case-crossover design was used to analyze the data.@*RESULTS@#After controlling for temperature, relative humidity, and atmospheric pressure, IQR increases in SO (13 μg/m), NO (17 μg/m), and CO (498 μg/m) were associated with 18.8%, 11.5%, and 3.1% increases in EADs for asthma, respectively. The associations were strongest for EADs and SO, NO, and CO levels with 3-, 5-, and 1-day lags, respectively.@*CONCLUSIONS@#This study provides additional data to the limited body of literature for potential health risks arising from ambient gaseous pollutants. The results of the study suggest that increased concentrations of SO, NO, and CO were positively associated with emergency ambulance dispatches for asthma in Chengdu, China. Further studies are needed to investigate the effects of individual air pollutants on asthma.

Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands / 世界急诊医学杂志（英文）

@#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.[4] However, not all patients who call for an ambulance and where an ambulance is dispatched are in need for conveyance to an emergency department, despite the acute nature of the healthcare problems of these patients.[5] A significant part of those patients are treated and left on-scene. Non- conveyance is an appropriate ambulance deployment where the patient after on-scene assessment and/or treatment does not require conveyance with medical personnel and equipment to a healthcare facility.[6]Non-conveyance can be initiated by the professional, the patient or through shared decision making.[7]Non- conveyance has an impact on ambulance availability and system efficiency, and the safety of non-conveyance is questioned.[8]

Selección de hospital destino para el traslado de urgencia de pacientes / Selecting the Destination Hospital to Carry Emergency Patients / Escolha de hospital alvo para traslado de urgência de pacientes

Resumen El tiempo total de atención prehospitalaria (APH) es el tiempo que transcurre desde que ingresa la llamada al operador hasta que la ambulancia queda disponible para atender otra emergencia. Esta investigación pretende demostrar que la selección del hospital destino afecta de manera significativa el tiempo total de APH, lo que influye en la supervivencia del paciente que es trasladado y en el tiempo de liberación del recurso (ambulancias). En consecuencia, se propone una técnica de selección de hospital destino que incluye dimensiones relacionadas con el paciente (diagnóstico, especialidad y asegurador) y el hospital (ocupación y cercanía). Se evalúa su desempeño por medio de una simulación de eventos discretos y se concluye que la técnica propuesta obtiene un mejor tiempo de APH en el 73% de los casos estudiados, con una reducción media entre 40 y 80 minutos, en comparación con la técnica más comúnmente usada (selección hospital más cercano).

Abstract Total time of prehospital care (PHC) is the time elapsing from the inbound call up to the moment when the ambulance is available for serve in another emergency event. This research aims to show that selecting the destination hospital impacts significantly the total PHC time, which influences the survival of the patient being transported as well as the time to make the resource available again (the ambulance). Consequently, a technique for selecting the destination hospital is proposed herein including some dimensions related both to the patient (diagnosis, specialty and insurance company) and to the hospital (occupancy and closeness). The performance was evaluated based on a simulation of discrete events. It is concluded that the proposed technique provides a better PHC time in 73% of the studied cases, with a mean decrease between 40 and 80 minutes as compared to the most commonly used technique (selecting the closest hospital).

Resumo O tempo total de atendimento pré-hospitalar (APH) é o tempo decorrente desde que a ligação for feita para o telefonista até a ambulância se disponibilizar para atender outra emergência. Esta pesquisa visa demostrar que a escolha do hospital alvo afeta significativamente o tempo total de APH, o que influi na sobrevida do paciente trasladado e no tempo de liberação do recurso (ambulâncias). Consequentemente, propõe-se uma técnica de escolha de hospital alvo que inclui dimensões relacionadas com paciente (diagnóstico, especialidade e assegurador) e hospital (ocupação e proximidade). Avalia-se o desempenho por meio de simulação de eventos discretos e conclui-se que a técnica proposta obtém melhor tempo de APH em 73% dos casos estudados com redução media entre 40 e 80 minutos, em comparação com a técnica mais comumente usada (escolha hospital mais próximo).

Experience of transportation of mass severe burn patients for long distance by air ambulance with fixed wing / 中华烧伤杂志

Objective@#To explore the experience of transportation of mass severe burn patients for long distance by air ambulance with fixed wing.@*Methods@#The organization and implementation process of transportation of 5 patients in the devastating forest fire of Greater Khingan on 2nd, May 2017, for long distance by air ambulance with fixed wing were reviewed and analyzed. All the patients were severely burned and complicated with inhalation injury. Four hours after accident, the relevant authority dispatched national medical team with 2 specialists of burn, 1 specialist of intensive care medicine, 1 head nurse of burn intensive care unit (ICU) to treat and cure the patients before transportation. Three patients had tracheotomy and four patients had escharotomy. Patients and their relatives, expert group of transportation, and aircrew members were arranged according to the scheme before transportation. Patients were monitored and treated with the equipments of air ambulance during the transportation. Patients were transferred to the burn ICU in our hospital from the airport through the green channel.@*Results@#All the five patients were transported to the destination safely for long distance of 1 700 kilometres and air flight 3.5 hours one way by air ambulance with fixed wing in 4 batches at 26 to 44 hours post burn, and transported from tarmac to burn ICU of our hospital. All the patients were in stable condition during the transportation and had successful subsequent rescue. All the patients were discharged in three months.@*Conclusions@#It is feasible to transfer mass severe burn patients for long distance by air ambulance with fixed wing, and it is safer and more effective to transfer according to the standardization process, and the opportunity of transportation of severe burn patients can be moved up to shock stage.

Annoyance-rate-and-casualty-reality-based method of comfort evaluation of military ambulance / 医疗卫生装备

Objective To explore an method for comfort evaluation of the military ambulance to enhance ride comfort during casualty transport. Methods The method executed quantitative evaluation of vibrational comfort by the existing vibration comfortableness evaluation ways for non-ambulatory casualty, different reactions of casualty to vibrational excitement and annoyance rate analysis based on psychophysics, which took considerations on the ratio of injured sites at war or natural disaster conditions as well as susceptibility analysis. Trials of the the method were carried out on the vibrational comfort analysis of some military ambulance during the road test.Results The method had feasibility for vibration comfortableness evaluation of non-ambulatory casualty,and improved the traditional ways in quantitative analysis.Conclusion The method gains advantages over the international ways, and contributes to the related researches on vibration reduction.