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.

Study on the influencing factors of turnover intention of pre-hospital emergency nurses in Beijing / 中华医院管理杂志

Objective:To explore the influencing factors of turnover intention of pre-hospital emergency nurses in Beijing, and provide references for reducing the turnover rate of pre-hospital emergency nurses and stabilizing the pre-hospital emergency nursing team.Methods:Pre-hospital emergency nurses from 2 emergency centers in Beijing were selected as the survey objects, and a self-designed questionnaire was used to conduct an online survey in September 2019. The questionnaire covered such aspects as the main demographic characteristics, workload, doctor-patient relationship, professional identity, job burnout and turnover intention. Descriptive analysis was conducted for the data, while rank-sum test and Kappa consistency test were used for univariate analysis, and ordered logistic regression analysis was used for multivariate analysis.Results:A total of 340 valid questionnaires were received, among which 41.5% (141) of the nurses said that they occasionally considered quitting, 11.7% (40) said they often considered quitting, while the scoring of professional identity was (33.29±6.00), and that of job burnout was (63.70±14.90). Univariate analysis showed that age, work units, self-rated health status, professional identity, job burnout, seniority, workload, doctor-patient relationship, and pressure of title promotion were significant ( P<0.05). The results of multivariate analysis showed that job burnout, average number of car trips per shift, and self-rated health status were positively correlated with turnover intention, while professional identity was negatively correlated with turnover intention ( P<0.05). Conclusions:The turnover intention of pre-hospital emergency nurses in Beijing was found at a high level. The authorities are recommended to rationalize the scheduling system and increase the staffing of pre-hospital emergency nurses; establish the diversion policy, title promotion system and post risk special allowance for such nurses; and train medical aid workers to undertake the transfer and lifting of patients, so as to reduce the turnover intention of these nurses.

Influencing factors associated with delayed time in pre-hospital emergency medical care for hypertensive emergency in the main urban area of Chongqing / 上海预防医学

ObjectiveTo investigate the influencing factors associated with delayed time in pre-hospital emergency medical care in patients with hypertensive emergency in the main urban area of Chongqing. MethodsA total of 1 246 patients with hypertension in the main urban area of Chongqing from March 2018 to August 2021 were included in this study. The delayed time in the pre-hospital emergency medical care was determined. A multivariate linear regression model was used to analyze the influencing factors. ResultsThe delayed time in the pre-hospital emergency medical care for the patients with hypertensive emergency was concentrated in 0‒12 h， with the average of （5.89±1.96） h. The delayed time differed significantly by gender， age， history of atrial fibrillation， diabetes， educational level， time of onset， mode of transportation， awareness of hypertensive emergency， blood pressure at the onset， and presence of persons at the onset of emergency （P<0.05）. Multivariate linear regression analysis showed that educational level， time of onset， blood pressure at the onset， awareness of hypertensive emergency， presence of persons at the onset were linearly correlated with delayed time in the pre-hospital medical care for hypertensive emergencies （P<0.05）. ConclusionDelay in pre-hospital medical care is prevalent for patients with hypertensive emergency in the main urban area of Chongqing. The delayed time is associated with multiple factors， such as educational level， time of onset， blood pressure at onset， awareness of hypertensive emergency， and presence of persons at onset. It warrants further improvement in the interventions to reduce the delay in the pre-hospital medical care.

Practice and thinking of pre-hospital emergency support for the 2022 Beijing Winter Olympic Games / 中华医院管理杂志

Under the leadership of the Beijing Winter Olympic Organizing Committee and the Beijing Municipal Health Commission, the Beijing Emergency Center, as the designated medical institution for the 2022 Beijing Winter Olympic Games, has completed the first aid support task of this Winter Olympic Games with other medical institutions. The author systematically analyzed the development of each link in the pre-hospital emergency support for the 2022 Beijing Winter Olympic Games, summarizes the key links of the entire Winter Olympics cycle, such as the construction of the organizational system, the formulation of support plans, and the training of support personnel, and analyzed the results of related work, so as to provide reference for the pre-hospital emergency support for China to host large-scale international events in the future.

Transfer of pre-hospital care and its potential risks for patient safety / Transferencia de atención prehospitalaria y sus riesgos potenciales para la seguridad del paciente / Transferência do cuidado pré-hospitalar e seus potenciais riscos para segurança do paciente

ABSTRACT Objective: to identify potential risks to patient safety during the transfer of pre-hospital care. Method: a descriptive-exploratory study, with a qualitative approach. Data collection occurred between April and June 2018, with non-participant observation and semi-structured interview, in a Mobile Emergency Care Service in the Southern Brazil. Twenty-eight professionals were interviewed, including nursing technicians/auxiliaries, nurses and physicians, and 135 hours of care were observed. The data were submitted to thematic analysis. Results: two interrelated categories emerged a) Stakeholders in patient and team safety; and b) The (inter) personal/professional dimension of the transfer of care. The study's findings showed that, in addition to the inherent vulnerabilities to traffic and urban violence, patients are exposed to circumstances that include potential risks related to falling on stretchers, medication errors and clinical judgment. The vertical communication by hierarchies, influenced by personal and emotional factors of each professional, generated implications for the continuity of care. Conclusion: given the potential risks to patient safety at the time of transfers of pre-hospital care, one should invest in effective communication strategies, as well as in forms of interpersonal relationships and links between services in the emergency network.

RESUMEN Objetivo: identificar riesgos potenciales para la seguridad del paciente durante la transferencia de la atención prehospitalaria. Método: estudio descriptivo-exploratorio, con enfoque cualitativo. La recopilación de datos se produjo entre abril y junio de 2018, con observación no participante y entrevista semiestructurada, en un Servicio móvil de atención de emergencia en el sur de Brasil. Se entrevistó a 28 profesionales, incluidos técnicos / auxiliares de enfermería, enfermeras y médicos, y se observaron 135 horas de atención. Los datos fueron sometidos a análisis temático. Resultados: surgieron dos categorías interrelacionadas a) Partes interesadas en la seguridad del paciente y del equipo; y b) La dimensión (inter) personal / profesional de la transferencia de atención. Los hallazgos del estudio mostraron que, además de las vulnerabilidades inherentes al tráfico y la violencia urbana, los pacientes están expuestos a circunstancias que incluyen riesgos potenciales relacionados con la caída en camillas, errores de medicación y juicio clínico. La comunicación vertical por jerarquías, influenciada por factores personales y emocionales de cada profesional, generó implicaciones para la continuidad de la atención. Conclusión: dados los riesgos potenciales para la seguridad del paciente en el momento de las transferencias de atención prehospitalaria, uno debe invertir en estrategias de comunicación efectivas, así como en formas de relaciones interpersonales y vínculos entre los servicios en la red de emergencia.

RESUMO Objetivo: identificar potenciais riscos para a segurança do paciente durante a transferência do cuidado pré-hospitalar. Método: estudo do tipo descritivo-exploratório, com abordagem qualitativa. A coleta de dados ocorreu entre abril e junho de 2018, com observação não-participante e entrevista semiestruturada, em um Serviço de Atendimento Móvel de Urgência da região Sul, Brasil. Foram entrevistados 28 profissionais incluindo técnicos/auxiliares de enfermagem, enfermeiros e médicos e observadas 135 horas de atendimentos. Os dados foram submetidos à análise temática. Resultados: emergiram duas categorias inter-relacionadas: a) Intervenientes na segurança do paciente e da equipe; e b) A dimensão (inter)pessoal/profissional da transferência do cuidado. Os achados do estudo mostraram que, além das vulnerabilidades inerentes ao trânsito e à violência urbana, os pacientes estão expostos a circunstâncias que incluem potenciais riscos relacionados à queda de macas, aos erros de medicação e de julgamento clínico. A comunicação verticalizada pelas hierarquias, influenciada por fatores pessoais e emocionais de cada profissional, geraram implicações para a continuidade do cuidado. Conclusão: diante dos potenciais riscos à segurança do paciente no momento das transferências do cuidado pré-hospitalar, deve-se investir em estratégias de comunicação eficaz, bem como em formas de melhorar as relações interpessoais e a articulação entre os serviços na rede de urgências.

Prevalence and prediction of pre-hospital medical trauma in Urumqi / 中华急诊医学杂志

Objective@#To investigate the current situation of pre-hospital trauma emergency medical care of Urumqi in 2011-2018 and predict the situation in the next five years, so as to provide a basis for rational allocation of pre-hospital emergency resources and improvement of health service system.@*Methods@#A total of 427 754 pre-hospital emergency patients were collected from January 1, 2011 to December 31, 2008 in Urumqi. Epidemiological methods were performed for statistical description and analysis. The single-factor gray model [GM (1,1)], multi-factor grey model and moving average model (MA1) was established for predicting the number of pre-hospital trauma patients each year. The single-factor gray model [GM (1,1)] and SARIMA model were used for the seasonal prediction.@*Results@#The male-female ratio of pre-hospital trauma patients was 1.98:1 and the incidence rate of male patients (534.91/100 000) was significantly higher than that of female patients (274.88/100 000) (χ2=7 659.707, P<0.01), and the incidence rate of male patients was 1.95 times higher than that of female patients. The trauma patients aged 35-59 years accounted for the largest proportion (42%), and the incidence of the disease was the highest among those aged≥ 60 years old (644.23/100 000). The incidence of pre-hospital trauma increased year by year (from 408.86/100 000 in 2011 to 550.02/100 000 in 2017), with a high incidence in summer (27 123, 31.03%), especially in August (9 535, 10.91%), most of which occurred in the new urban area (high-tech zone) (23 157, 26.50%). The single-factor gray model [GM (1,1)] , multi-factor gray model, and moving average model (MA1) predicted that the total number of pre-hospital trauma patients in 2023 was 13 118, 11 715 and 13 305, respectively, and the MAE were 451.125 0, 607.428 6, and 205.125 0, respectively. The single-factor gray model [GM (1,1)] and SARIMA model predicted the value in the summer of 2023 would be 3 638 and 4 999, respectively, and the MAE were 47.129 0 and 110.370 4, respectively.@*Conclusions@#The pre-hospital trauma in Urumqi is mainly male and young work-age adults, the incidence of the elderly is the highest, summer is the season of high incidence, and the new urban area (high-tech zone) is the primary district. The moving average model (MA1) model has a more accurate annual prediction, and the single-factor gray model [GM (1,1)] is the best model for seasonal prediction. The pre-hospital trauma emergency medical care demand will continue to increase in the next five years. The health administrative department should enlarge the allocation of pre-hospital emergency resources and improve the emergency service capabilities and efficiencies.

Using of pre-hospital emergency resources by acute alcoholism patients in a hospital in Guangzhou: a data survey from 2009 to 2018 / 中华危重病急救医学

Objective@#To analyze the using of pre-hospital emergency resources and treatment characteristics of acute alcoholism patients in Guangzhou.@*Methods@#The pre-hospital emergency data of the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from January 1st in 2009 to December 31st in 2018 were obtained from the database of the Guangzhou Emergency Medical Command Center. The related data of patients with acute alcoholism were collected, including gender, age, poisoning severity, treatment results, caller type, number of empty vehicles (empty vehicle was defined as the empty vehicle return caused by the ambulance who did not receive or refused to come to the hospital after the ambulance leaved), departure time (from the ambulance to the completion time), on-site time (from the ambulance to the patient boarding time) and the distribution of pre-hospital emergency time in 24 hours on weekdays and weekends. The relationship between acute alcoholism patients and the peak of in-hospital emergency treatment was analyzed.@*Results@#A total of 2 408 acute alcoholism patients were recorded, among whom 2 109 patients (87.58%) with acute alcoholism, 126 (5.23%) with drug poisoning, 67 (2.78%) with chemical poisoning, 3 (0.13%) with pesticide poisoning, and 103 (4.28%) with other poisoning. Acute alcoholism patients were mainly male, with a total of 1 862 cases (88.29%), and the ratio between males and females was 7.54∶1. In 2 109 patients with acute alcoholism, 93.41% were in the age range of 18-59 years old. The number of mild patients was 1 717 (81.41%), 1 178 (55.86%) needed further treatment, and no patient died. For the occupation of pre-hospital emergency resources, 43.24% (912/2 109) of acute alcoholism called 120 through 110 with empty vehicles of 36.79% (776/2 109), which were significantly higher than the acute cerebrovascular disease [3.83% (362/9 461), 5.80% (549/9 461), both P < 0.01], acute trauma [24.29% (1 708/7 033), 7.96% (560/7 033), both P < 0.01], acute circulation system disease [2.44% (90/3 694), 2.87% (106/3 694), both P < 0.01], and acute respiratory system disease [0.86% (31/3 606), 1.58% (57/3 606), both P < 0.01]. Furthermore, empty vehicles were more likely to happen through 110 with empty vehicles rate of 51.75% (472/912), which was significantly higher than that through the witness [40.82% (60/147), P < 0.01] and relatives and friends [23.24% (244/1 050), P < 0.01]. The driving time and on-site time of acute alcoholism were significantly shorter than those of acute cerebrovascular disease, acute circulation system disease, and acute respiratory system disease [driving time (minutes): 26 (20, 34) vs. 34 (26, 45), 38 (29, 49), 38 (29, 50); on-site time (minutes): 6 (4, 10) vs. 10 (7, 14), 10 (7, 15), 10 (8, 15), all P < 0.01], but there was no statistical difference as compared with acute trauma [driving time (minutes): 26 (20, 34) vs. 29 (20, 42), on-site time (minutes): 6 (4, 10) vs. 7 (4, 11), both P > 0.05]. The regularity of variation in number of critically acute alcoholism patients was distinctive, which peaked in the period of 21:00-00:00 and bottomed out in the period of 09:00-13:00, which overlapped with the peak flow in the hospital emergency department (17:00-22:00).@*Conclusions@#Acute alcoholism patients occupy excessive pre-hospital emergency resources, and overlap with the hospital emergency treatment peak. It is necessary to strengthen the public propaganda and education on the rational usage of 120 emergency resources and reduce waste.

Design and construction of an intelligent pre-hospital emergency synergy system / 中华医院管理杂志

As a key part of the emergency medical system, pre-hospital emergency service proves critical for critical care, higher pre-hospital care success rate, improvement of patient outcome, and promotion of health recovery. This paper analyzed the status quo of pre-hospital emergency services information, discussed the application of information technology in pre-hospital industries including command and dispatch system, ambulance real-time positioning and tracking system, pre-hospital emergency video surveillance system, medical record system, electronic patient health file system, electronic payment system, and data mining and analysis system.Furthermore, it also discussed the prospect of sizably upgrading pre-hospital emergency service and building intelligent pre-hospital emergency coordination system.

Design and construction of an intelligent pre-hospital emergency synergy system / 中华医院管理杂志

As a key part of the emergency medical system,pre-hospital emergency service proves critical for critical care,higher pre-hospital care success rate,improvement of patient outcome,and promotion of health recovery.This paper analyzed the status quo of pre-hospital emergency services information,discussed the application of information technology in pre-hospital industries including command and dispatch system,ambulance real-time positioning and tracking system,pre-hospital emergency video surveillance system,medical record system,electronic patient health file system,electronic payment system,and data mining and analysis system.Furthermore,it also discussed the prospect of sizably upgrading prehospital emergency service and building intelligent pre-hospital emergency coordination system.

Analysis on effect of using pre-hospital propafenone emergency treatment for rescuing patients with paroxysmal supraventricular tachycardia / 中国中西医结合急救杂志

Objective To observe the effect of propafenone for patients with paroxysmal supra-ventricular tachycardia (PSVT) during pre-hospital emergency rescue treatment. Methods A retrospective study was conducted. Seventy-six patients with occurrence of PSVT in the process of pre-hospital emergency treatment in Tianjin Hongqiao Hospital from March 2018 to March 2019 were selected. The patients were divided into amiodarone group and propafenone group according to the difference in medications, 38 cases in each group. The effective rate of rescue, the time of recovery of normal heart rate, the total time of treatment, the levels of heart rate before and after treatment and the incidence of adverse reactions were observed in both groups. Results The total effective rate of propafenone group was significantly higher than that of amiodarone group [94.74% (36/38) vs. 73.68% (28/38), P<0.05]. The times of recovery of normal heart rate and total treatment of propafenone group were significantly lower than those of amiodarone group [times of recovery of normal heart rate (hours): 7.14±1.84 vs. 12.56 ± 2.56, times of total treatment (days): 6.14 ± 2.20 vs. 8.87±2.48, both P<0.05].Before treatment, there was no statistical significant difference in heart rate between propafenone group and amiodarone group (hpm: 171.8 ± 24.4 vs. 173.7 ± 25.5, P>0.05), but after treatment, the heart rate of propafenone group was significantly lower than that in amiodarone group (hpm: 112.9±7.5 vs. 138.4 ± 9.0, P<0.05). The incidence of adverse reactions in propafenone group was significantly lower than that of amiodarone group [2.63% (1/38) vs. 15.79% (6/38), P<0.05]. Conclusion Application of propafenone in the pre-hospital emergency treatment of patients with PSVT can effectively improve their clinical efficacy, and its therapeutic safety is high.

Using of pre-hospital emergency resources by acute alcoholism patients in a hospital in Guangzhou: a data survey from 2009 to 2018 / 中华危重病急救医学

To analyze the using of pre-hospital emergency resources and treatment characteristics of acute alcoholism patients in Guangzhou. Methods The pre-hospital emergency data of the emergency department of the Second Affiliated Hospital of Guangzhou Medical University from January 1st in 2009 to December 31st in 2018 were obtained from the database of the Guangzhou Emergency Medical Command Center. The related data of patients with acute alcoholism were collected, including gender, age, poisoning severity, treatment results, caller type, number of empty vehicles (empty vehicle was defined as the empty vehicle return caused by the ambulance who did not receive or refused to come to the hospital after the ambulance leaved), departure time (from the ambulance to the completion time), on-site time (from the ambulance to the patient boarding time) and the distribution of pre-hospital emergency time in 24 hours on weekdays and weekends. The relationship between acute alcoholism patients and the peak of in-hospital emergency treatment was analyzed. Results A total of 2 408 acute alcoholism patients were recorded, among whom 2 109 patients (87.58%) with acute alcoholism,126 (5.23%) with drug poisoning, 67 (2.78%) with chemical poisoning, 3 (0.13%) with pesticide poisoning, and 103 (4.28%) with other poisoning. Acute alcoholism patients were mainly male, with a total of 1 862 cases (88.29%), and the ratio between males and females was 7.54∶1. In 2 109 patients with acute alcoholism, 93.41% were in the age range of 18-59 years old. The number of mild patients was 1 717 (81.41%), 1 178 (55.86%) needed further treatment, and no patient died. For the occupation of pre-hospital emergency resources, 43.24% (912/2 109) of acute alcoholism called 120 through 110 with empty vehicles of 36.79% (776/2 109), which were significantly higher than the acute cerebrovascular disease [3.83% (362/9 461), 5.80% (549/9 461), both P < 0.01], acute trauma [24.29% (1 708/7 033), 7.96% (560/7 033), both P < 0.01], acute circulation system disease [2.44% (90/3 694), 2.87% (106/3 694), both P < 0.01], and acute respiratory system disease [0.86% (31/3 606), 1.58% (57/3 606), both P < 0.01]. Furthermore, empty vehicles were more likely to happen through 110 with empty vehicles rate of 51.75% (472/912), which was significantly higher than that through the witness [40.82% (60/147), P < 0.01] and relatives and friends [23.24% (244/1 050), P < 0.01]. The driving time and on-site time of acute alcoholism were significantly shorter than those of acute cerebrovascular disease, acute circulation system disease, and acute respiratory system disease [driving time (minutes): 26 (20, 34) vs. 34 (26, 45), 38 (29, 49), 38 (29, 50); on-site time (minutes): 6 (4, 10) vs. 10 (7, 14), 10 (7, 15), 10 (8, 15), all P < 0.01], but there was no statistical difference as compared with acute trauma [driving time (minutes):26 (20, 34) vs. 29 (20, 42), on-site time (minutes): 6 (4, 10) vs. 7 (4, 11), both P > 0.05]. The regularity of variation in number of critically acute alcoholism patients was distinctive, which peaked in the period of 21:00-00:00 and bottomed out in the period of 09:00-13:00, which overlapped with the peak flow in the hospital emergency department (17:00-22:00). Conclusions Acute alcoholism patients occupy excessive pre-hospital emergency resources, and overlap with the hospital emergency treatment peak. It is necessary to strengthen the public propaganda and education on the rational usage of 120 emergency resources and reduce waste.

Prevalence and prediction of pre-hospital medical trauma in Urumqi / 中华急诊医学杂志

Objective To investigate the current situation of pre-hospital trauma emergency medical care of Urumqi in 2011-2018 and predict the situation in the next five years,so as to provide a basis for rational allocation of pre-hospital emergency resources and improvement of health service system.Methods A total of 427 754 pre-hospital emergency patients were collected from January 1,2011 to December 31,2008 in Urumqi.Epidemiological methods were performed for statistical description and analysis.The single-factor gray model [GM (1,1)],multi-factor grey model and moving average model (MA1) was established for predicting the number of pre-hospital trauma patients each year.The single-factor gray model [GM (1,1)] and SARIMA model were used for the seasonal prediction.Results The male-female ratio of pre-hospital trauma patients was 1.98:1 and the incidence rate of male patients (534.91/100 000) was significantly higher than that of female patients (274.88/100 000) (x2=7 659.707,P＜0.01),and the incidence rate of male patients was 1.95 times higher than that of female patients.The trauma patients aged 35-59 years accounted for the largest proportion (42％),and the incidence of the disease was the highest among those aged ≥ 60 years old (644.23/100 000).The incidence ofpre-hospital trauma increased year by year (from 408.86/100 000 in 2011 to 550.02/100 000 in 2017),with a high incidence in summer (27 123,31.03％),especially in August (9 535,10.91％),most of which occurred in the new urban area (high-tech zone) (23 157,26.50％).The single-factor gray model [GM (1,1)],multi-factor gray model,and moving average model (MA1) predicted that the total number of pre-hospital trauma patients in 2023 was 13 118,11 715 and 13 305,respectively,and the MAE were 451.125 0,607.428 6,and 205.125 0,respectively.The single-factor gray model [GM (1,1)] and SARIMA model predicted the value in the summer of 2023 would be 3 638 and 4 999,respectively,and the MAE were 47.129 0 and 110.370 4,respectively.Conclusions The pre-hospital trauma in Urumqi is mainly male and young work-age adults,the incidence of the elderly is the highest,summer is the season of high incidence,and the new urban area (high-tech zone) is the primary district.The moving average model (MA1) model has a more accurate annual prediction,and the single-factor gray model [GM (1,1)] is the best model for seasonal prediction.The pre-hospital trauma emergency medical care demand will continue to increase in the next five years.The health administrative department should enlarge the allocation of pre-hospital emergency resources and improve the emergency service capabilities and efficiencies.

Practice and discussion of the development of pre-hospital emergency standard in Dezhou city / 中华医院管理杂志

The paper covered in brief the process and achievements of the pre-hospital emergency service standardization in Dezhou. It is held that such development provides the emergency service with a scientific service management appraisal system, and contributes to efficient implementation of such emergency service, making it an effective means for rational resources deployment. The authors recommended to build an effective and standardized operational mechanism and a mechanism for appraisal and supervision, to elevate primary level pre-hospital emergency capability and promote the use standardized tools extensively as well as the formulation and enforcement of such standards at provincial level.

The design and implementation of real-time transmission system for pre-hospital emergency ECG / 中国医学装备

Objective:To design real-time transmission system for pre-hospital emergency electrocardiogram(ECG) so as to provide specialty and accurate diagnostic analysis about ECG before patient achieved at hospital and to shorten the waiting time for diagnosis and treatment after they achieved at hospital.Methods: 4G network and virtual private dial-up network(VPDN) were used to real-time transmit ECG data of patient from ambulance to hospital so as to doctors of ECG department and emergency room can analyze the detecting reporter, choose plan of emergency guidance and prepare operation and treatment for patientsaccording to the received ECG data in time.Results: The situations of emergency patients have been grasped and been primarily confirmed before they achieved hospital, therefore, the doctors could made relative preparation for fast and specially treating patients after they once achieved hospital.Conclusion: The real-time transmission system of pre-hospital emergency ECG can remedy the shortage of technical strength of pre-hospital emergency team, and shorten the treating time of emergency patients, and increase the success rate of rescue.

Safety of optimized pre-hospital emergency transfer system for critically ill children / 中国小儿急救医学

Objective To study the influence of the optimized pre-hospital emergency transfer sys-tem on the safety, success rate and prognosis of pediatric patients. Methods A clinical data analysis was made of 1 015 cases of critically ill children delivered with the not-optimized pre-hospital emergency transfer system as group Ⅰ( Jan. 2007-Dec. 2009 ) and those of 1 431 with the optimized pre-hospital emergency transfer system as group Ⅱ(Jun. 2010-Dec. 2012). The preparation time for dispatch,critical illness scores before and after transport,transfer success rates and outcomes were compared between the two groups. Re-sults Before transfer,the critical illness score for group Ⅰ was 81. 73 ± 18. 11,for group Ⅱ78. 45 ± 20. 96, with groupⅡ being more critical(t=4. 154,P<0. 001) and needing respirator supporting and more vasoac-tive agents(50. 5%vs. 30. 2%;60. 8% vs. 51. 6%;P<0. 01). The dispatch delay for groupⅠand groupⅡwere(19. 34 ± 6. 45)min and (16. 19 ± 5. 89)min,respectively,actual time out for groupⅡwas shorter than that for groupⅠ(P<0. 001). The critical illness scores on arrival of ward were 83. 01 ± 16. 73 in groupⅠ, 83. 97 ± 17. 50 in group Ⅱ,the score for group Ⅱ being more improved than that for group Ⅰ( P<0. 05 ) . The transfer success rates, cure and improvement rates were higher in group Ⅱ compared with group Ⅰ(97. 6% vs. 94. 8%;94. 5% vs. 91. 0%;P<0. 01). Conclusion The application of the optimized pre-hos-pital emergency care system can improve the transfer efficiency and success rate,safety and treatment effect, reduce the mortality rate of pediatric patients.

Analysis of pre-hospital emergency resources allocation in Liaoning province / 中华医院管理杂志

Objective To learn the present pre-hospital emergency resources allocation in Liaoning province.Methods Site survey and questionnaire survey were used to survey the basic information,number of pre-hospital emergency ambulances,human resources,and communication/control systems of 19 pre-hospital emergency centers in Liaoning province in 2014.Results The number of pre-hospital emergency sub-stations,ambulances and human resource fall short of demand.Furthermore,these resources are found with such problems as greater service radius of average pre-hospital emergency service and longer average pre-hospital response time in countryside than cities,insufficient and obsolete ambulances short of onboard equipment and communication systems,not to mention shortage of medical workers of higher degrees and academic titles.Conclusions A great gap is found between urban and rural pre-hospital emergency resource allocation in Liaoning province,with poor resources in the countryside.The government is recommended to step up financial support in increasing pre-hospital emergency substations and resources allocation,regularly update pre-hospital emergency vehicles,set up independent title promotion mechanism,perfect communication scheduling system,in order to satisfy the demands of pre-hospital first aid.

The calculation method and pre-hospital emergency physician allocation gap in Shanghai / 中国卫生政策研究

This study aimed to develop the calculation method of pre-hospital emergency physician allocation gap and apply it to Shanghai.In order to reduce the ambulance dispatch lag frequency, through the analysis of its da-ta in the Shanghai urban area, the research group obtained the gap and extended the data to Shanghai city.The peak method establishes the association between pre-hospital emergency physician increment and the ambulance dispatch lag decrement.Based on descriptive statistics, the peak method by which the Shanghai ambulance dispatch lag data were analyzed uses the SAS programming software.This method of using programming software provides it with good reliability and validity.After an increase of 40 duty vehicles (381 pre-hospital emergency physicians), the ambu-lance dispatch lag ratio would drop from 25.61 percent to 0.22.Therefore, the association between the pre-hospital emergency physician increment and the ambulance dispatch lag decrement was established and can provide a scientif-ic evidence for the policy formulation.

Clinical application of modified early warning scores assessing the conditions and prognosis of pre-hospital acute poisoning / 中华急诊医学杂志

Objective To study the significance and feasibility of modified early warning scores (MEWS) assessing the conditions and death prediction among the pre-hospital acute poisoning patients.Methods We performed a prospective,observational study of the pre-hospital acute poisoning patients between January 1,2010 and December 31,2010.Data was collected to calculate the MEWS.Numeration data was presented in percentage by using chi-square test,and measurement data was expressed in mean with standard deviation,and P ＜ 0.05 was considered to be different with statistical significance.Observation lasted for 90 days after admission to get the results as observation index and ROC was drew and the area under the curve and the predicting index were calculated.The patients without vital signs and unsuccessful resuscitation were not included in this study.Results It showed 287 person times with 0 ～ 6 scores,accounting 94.4％,17 person times with 7-13 scores,accounting 5.59％,among the dead patients,MEWS were more than those of the survival group with statistical significance (P ＜ 0.05).The area under ROC was 0.99 indicating that MEWS≥7 was the board line for severe pre-hospital acute poisoning patients with sensitivity of 91.7％,specificity of 97.9％,accuracy of 97.7％ and Youden of 0.896 for predicting death.It showed high significance of the application of MEWS in assessing acute poisoning patients and death prediction.Conclusions MEWS assess pre-hospital acute poisoning patients and predict death with good resolution and strong application significance,which is simple,practical and applicable.

Adjustment and Experience of the Pre-hospital Emergency Charging Method / 中国卫生经济

Pre-hospital care is an important part of the health care system. Nowadays , there are many defects in the pre-hospital emergency charging method in China. It analyzes the effectiveness and impact of adjustment the charging method. There will be a preliminary study of hospital first aid fees adjustment of changing the current method from front-line staff receiving cash to entrusting the local hospital, charge with real-time settlement of health insurance for the convenience of the patient and reduce the workload of health insurance agencies, make financial emergency center management more standardized and efficient.

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.