Assessing the Risk of Interfacility Transport in Pregnant Patients Due to Progression of Labor: Lessons From a Specialized Maternal-Fetal Transport Program.

Background Pregnant laboring patients sometimes require interfacility transfer to a higher level of care. There is a paucity of evidence to inform when it is safe to transfer a laboring patient and when delivery may be too imminent to transfer. Methods This is a retrospective study of pregnant patients undergoing interfacility transfer with a specialized obstetric transport team deployed from a large Midwest regional healthcare system. The primary outcome was delivery prior to or within one hour of arrival at the receiving institution due to progression of labor. Data collected included basic demographics, vital signs, gravidity, parity, gestational age, contraction frequency if contractions were present, and cervical dilation. We sought to define the association between these variables and the primary outcome to inform risk assessment for precipitous delivery among patients being considered for interfacility transfer. Results Of the 370 pregnant patients for whom the specialized transfer team was requested, 11 (3%) met the primary outcome. Those with more advanced cervical dilation and those who did not receive regular prenatal care were more likely to meet the criteria for the primary outcome. For every centimeter of cervical dilation, the odds of meeting the primary outcome increased 2.3-fold (95% CI: 1.5-3.4). Conclusions We identified risk factors for early delivery among pregnant patients for whom an interfacility transfer was requested and described patients who were high-risk for obstetric interfacility transport due to the progression of labor. Our results can help inform risk assessments for transferring potentially high-risk laboring patients.

Impact of 4-to-3 Lane Conversions on Emergency Response.

4-to-3 lane conversions, often called road diets, have been implemented throughout the U.S. as a means to reduce crashes. However, the reduction in lanes has led to community wide concerns across the country regarding the possible negative effect on emergency responses. This study investigates the impact of 4-to-3-lane roadway conversions on emergency response in Iowa through surveys and a retrospective analysis of EMS data. The 170 survey responses were analyzed descriptively, and a text analysis was done on two open text survey questions. Generalized linear models were constructed to examine the impact of lane conversions on emergency response times. Over half of EMS respondents believed there was no effect or a positive effect on responses, while 40% believed there was a negative effect. The negative effect was often attributed to driver confusion on how to properly yield to EMS vehicles. Despite the differing perceptions, EMS response rates from before to after the implementation of 4-to-3 lane conversions did not meaningfully differ. Overall, there was a lack of evidence of an effect of 4-to-3 lane conversions on EMS response rates in Cedar Rapids, Iowa. However, survey results showed that public guidance on how to properly respond to the presence of EMS vehicles on these roadways may be needed. This study provides evidence for addressing local concerns about road diets and emergency response to add to other known safety benefits. Results of this analysis may be applicable to other lane conversion sites when appropriately combined with local context relevant to the target area.

From Response to Prevention: Enhancing EMS Impact With Harm Reduction and HIV Education.

EMS are crucial not only for immediate life-saving interventions but also for broader public health initiatives, particularly in harm reduction and HIV prevention. However, many EMS training programs lack comprehensive education and training in these areas, resulting in significant gaps in patient care and provider safety. As the opioid epidemic continues to devastate communities, the need for EMS personnel to be trained in harm reduction strategies, such as naloxone administration, and HIV prevention, has become increasingly urgent. Integrating harm reduction and HIV prevention into EMS training is essential for equipping first responders to effectively address the complex needs of individuals affected by addiction. This training is not only vital for improving public health outcomes but also for ensuring the safety and efficacy of EMS providers in their critical roles on the front lines. The evidence strongly supports the immediate inclusion of harm reduction and HIV prevention in EMS curricula to enhance care quality, reduce the spread of HIV, and combat the ongoing opioid crisis.

Rule-based energy management strategies for PEMFC-based micro-CHP systems: A comparative analysis.

Commercial PEMFC-based micro-CHP systems are operated by rule-based energy management strategies. Each of these strategies constitutes a different way to meet the household energy demand (following the heat demand, following the electricity demand, the maximum of the two, etc.). Previous studies demonstrate that which of them is the best -i.e. the one that manages to meet the demand at the lowest operating cost- depends on the particular scenario in which the micro-CHP system works (gas and electricity prices, annual energy demands, ability to export electricity to the grid, etc.). This paper aims to explore this dependence relationship and to deepen our understanding of it. To this end, a parametric analysis is conducted and the performances achieved by four rule-based operating strategies are compared. The parameters whose influence is studied, and through which the scenario is jointly characterized, are: (1) energy prices (electricity and natural gas), (2) feed-in tariff, (3) stack degradation, (4) climate and (5) heat to power ratio of the demand. The results show this dependence relationship in a clear and more comprehensive way, and offer a better understanding of its nature. From this improved understanding it can be inferred, among other things, that adapting the strategy to the scenario can generate annual savings of up to 14.5 percentage points. Moreover, this enhanced characterization of that dependence relationship can be useful for the design of a new operating strategy, a strategy that, without falling into the complexity that an optimal energy management approach (based on linear programming) involves, manages to exploit the savings potential of micro-CHP systems, thus facilitating their future mass commercialization.

The Evaluation of Online Medical Consultation Use in Pediatric Out-of-hospital Cardiac Arrest.

OBJECTIVES: Our study details Online medical consultation (OLMC) usage for Pediatric out-of-hospital cardiac arrest (P-OHCA), including proportion of P-OHCA utilizing OLMC, the characteristics of cases using OLMC, the types of information exchanged during OLMC calls, and the outcomes in patients where Emergency Medical Services (EMS) contacted OLMC. METHODS: The study included P-OHCA patients treated by EMS agencies participating in the regional cardiac registry with total catchment population of approximately 1.5 million residents. We reviewed linked calls and EMS charts for P-OHCA cases treated from January 1st, 2018 through December 31st, 2022. RESULTS: In total, 112 cases from January 2018 to December 2022 were included in the final analysis. Twenty-two out of 112 utilized OLMC with a mean time from 9-1-1 call to OLMC of 28.8 minutes. The no OLMC group had a significantly higher transport rate than OLMC group as well as higher percentages of ROSC at any time and ROSC upon arrival at the ED. Both survival to admission and survival to discharge were more prevalent in the no OLMC group, while there were no instances of survival to discharge in the OLMC group. During the calls, the discussion of crucial prognostic factors, including witness status, initial rhythm, ETCO2, and arrest duration, appears inconsistent. CONCLUSIONS: Pediatric-OHCA cases with OLMC tend to contact OLMC late in the resuscitation, have poor prognostic factors, and have poor survival outcomes. The information exchanged during OLMC calls was highly variable, representing a clear opportunity for improvement. Future studies should explore the potential effect of early OLMC contact on patient outcomes and if a standardized template for OLMC data exchange improves consistency in recommendations for P-OHCA.

Endogeneity of pedestrian survival time and emergency medical service response time: Variations across disadvantaged and non-disadvantaged communities.

The Vision Zero-Safe Systems Approach prioritizes fast access to Emergency Medical Services (EMS) to improve the survivability of road users in transportation crashes, especially concerning the recent increase in pedestrian-involved crashes. Pedestrian crashes resulting in immediate or early death are considerably more severe than those taking longer. The time gap between injury and fatality is known as survival time, and it heavily relies on EMS response time. The characteristics of the crash location may be associated with EMS response and survival time. A US Department of Transportation initiative identifies communities often facing challenges. Six disadvantaged community (DAC) indicators, including economy, environment, equity, health, resilience, and transportation access, enable an analysis of how survival and EMS response times vary across DACs and non-DACs. To this end, this study created a unique and comprehensive database by linking DACs data with 2017-2021 pedestrian-involved fatal crashes. This study utilizes two-stage residual inclusion models with segmentation for DACs and non-DACs accounting for the endogenous relationship between EMS response and pedestrian survival time. The results indicate that EMS response time is higher and pedestrian survival time is lower in DACs than in non-DACs. A delayed EMS response time is associated with a greater reduction in survival time in DACs compared to non-DACs. Factors, e.g., nighttime and interstate crashes, contribute to higher EMS response time, while pedestrian drugs, driver speeding, and hit-and-run behaviors are associated with a greater reduction in survival time in DACs than non-DACs. The implications of the findings are discussed in the paper.

Limitations of Blood Pressure Measurements in Pediatric Trauma Patients During Field Triage.

INTRODUCTION: Recent revisions of national field triage guidelines recommend the addition of age-specific systolic blood pressure (SBP) measurement for identifying the most severely injured children requiring transport to a trauma center. The purpose of this study was to determine the frequency in which blood pressures are documented by Emergency Medical Service (EMS) providers and the role this measurement has had, among other factors, in triage decisions. METHODS: This is an exploratory descriptive study with a retrospective review from the trauma registry database of all pediatric trauma admissions that arrived by EMS at a level II pediatric trauma center from January 1, 2019 to December 31, 2022. RESULTS: Two hundred ninety-eight patient records of patients aged 0 to 14 were included. EMS providers documented blood pressure in 70.1% of the total sample. A significant difference in the frequency of this documentation was seen between ages zero to nine and = > 10 years (χ2(1,298) = 28.98 p <0.001). No children ages zero to nine years had SBP of < 70 mmHg + (2x age in years) documented by EMS. There were two children aged = > 10 who had a documented SBP < 90 and 12 children with documented EMS heart rate > SBP. CONCLUSION: Many children transported by EMS in this hospital's catchment area did have a field blood pressure measurement documented, but the frequency was significantly less in younger-aged children. The blood pressure measurements of children determined to have severe injuries in the sample did not meet the inclusion criteria for high risk of serious injury by the newly established national guidelines. This suggests other prehospital criteria, such as mechanism of injury or visual cues, prompted EMS to transport these pediatric trauma patients to a regional trauma center for specialized care.

Dynamic impact analysis of the time-delay levitation control system on maglev vehicle system after adding smith predictor.

The time delay (TD) in the levitation control system significantly affects the dynamic performance of the closed-loop system in electromagnetic suspension (EMS) maglev vehicles. Excessive TD can cause levitation instability, making it essential to explore effective mitigation methods. To address this issue, a Smith Predictor (SP) is integrated into the traditional PID levitation control system. The combination of theoretical analysis and numerical simulation is employed to assess the stability of the time-delay levitation control system after the integration of the Smith Predictor. Theoretical analysis reveals that when TD exceeds a critical threshold, the levitation system becomes unstable. The addition of SP alters the root trajectory of the system characteristic equation from positive to negative, and recovers the levitation system to stable status. Assuming complete knowledge of the dynamic system, the TD compensation value in the SP becomes a key parameter that determines its performance. A minimum effective value (MEV) for TD compensation is identified, correlating with the system's stability region. Under the influence of TD, more complex systems and higher running speeds of the maglev vehicle lead to a narrower stable region and a larger MEV for TD compensation. Given the simulation parameters in this paper, with a system TD of 15 ms and a maximum vehicle speed of 160 km/h, the MEV for TD compensation in the SP should be set at 12 ms.

Derivation of a clinical decision rule for termination of resuscitation in non-traumatic pediatric out-of-hospital cardiac arrest.

AIM: Prehospital termination of resuscitation (ToR) rules are used to predict medical futility in adult out-of-hospital cardiac arrest (OHCA), however, the available evidence for pediatric patients is limited. The primary aim of this study is to derive a Pediatric Termination of Resuscitation (PToR) prediction rule for use in pediatric non-traumatic OHCA patients. METHODS: We analyzed a retrospective cohort of pediatric OHCA patients within the CARES database over a 10-year period (2013-2022). We split the dataset into training and test datasets and fit logistic regressions with Least Absolute Shrinkage and Selection Operator (LASSO) to select predictor variables and estimate predictive test characteristics for the primary outcome of death and a secondary composite outcome of death or survival to hospital discharge with unfavorable neurologic status. RESULTS: We analyzed a sample of 21,240 children where 2,326 (11.0%) survived to hospital discharge, and 1,894 (8.9%) survived to hospital discharge with favorable neurologic status. We derived a PToR rule for death demonstrating a specificity of 99.1% and a positive predictive value (PPV) of 99.8% and a PToR rule for death or survival with poor neurologic status with a specificity of 99.7% and PPV of 99.9% within the test dataset. CONCLUSION: We derived a clinical prediction rule with high specificity and positive predictive value in prehospital settings utilizing Advanced Life Support (ALS) providers which may inform termination of resuscitation considerations in pediatric patients. Further prospective and validation studies will be necessary to define the appropriateness and applicability of these PToR criteria for routine use.

Physio-morphological and molecular characterization of ethyl methanesulfonate-derived mutant population of Gossypium herbaceum L. cv. (Wagad) for drought tolerance.

This study investigates the response of ethyl methanesulfonate-derived twenty mutant lines of Gossypium herbaceum, along with the parent type Wagad cultivar, to drought stress. Physiological parameters, such as relative water content (RWC), net photosynthesis (A), stomatal conductance (g s), transpiration rate (E), and water use efficiency (WUE), were examined. The mutant line mut_3219 exhibited superior drought tolerance, maintaining high RWC and water retention capacity, with minimal reductions in A, g s, and E, leading to higher WUE than parent type and other mutant lines. Chlorophyll pigments declined in all the mutants under drought. However, mut_3219 retained higher levels than mut_4785. Anthocyanin accumulation indicated a protective response. Chlorophyll fluorescence showed mut_3219 is less sensitive to drought-induced PSII damage than mut_4785, with better membrane stability and higher proline accumulation, among all other mutant lines and parent type. The morphological parameters were less affected in mut_3219 compared to mut_4785 and parent type. Molecular analyses under control and drought conditions revealed significant variations in the expression of seven drought-related genes (GhbHLH, GhMYB5, GhWRKY33, GhRAF4, GhRAF19, GhNAC2, and GhCAMTA). The relative expression of GhbHLH, GhNAC2, GhRAF4, GhRAF19, and GhCAMTA increased under drought conditions, with notable changes in mut_3219 compared to parent type and all other mutant lines, indicating its enhanced drought tolerance. These findings provide valuable insights into the molecular and physiological mechanisms underlying drought tolerance in cotton. Supplementary Information: The online version contains supplementary material available at 10.1007/s13205-024-04089-1.

Examining Emergency Medical Services: Delay Time, Response Time, On-Scene Time In Six Peaks of the COVID-19 Pandemic in Eastern Iran.

BACKGROUND: Time indices are key elements in prehospital medical emergencies. The number of calls to Emergency Medical Services (EMS) and the number of missions they have undertaken have been impacted by the COVID-19 epidemic. OBJECTIVES: This study's goal was to evaluate prehospital EMS time indices at the apex of the COVID-19 outbreak. METHODS: Data were extracted retrospectively from the Asayar Automation System, which records details on all emergency medical calls resulting in patient transport. The study period was from March 2018 to March 2021, covering the pre-COVID period and the first through sixth peaks of the pandemic in Iran. Standardized data extraction procedures were used to minimize bias in this retrospective review. RESULTS: In this study, most transport missions occurred during the fifth peak (n = 2811). In addition, the most missions were related to the age group above 60 years (31.1%), and the highest rate of patient transport (65.9%) was observed in male patients. Traumatic events, cardiac emergencies, impaired consciousness, and psychiatric disorders were, respectively, the main causes of patient transport. Moreover, a significant difference was observed between time indices of various COVID-19 peaks (p < 0.001). CONCLUSIONS: Even though the structure of Iran's emergency system is based on the American-Anglo model, and rapid patient transfers to medical facilities are prioritized, the COVID-19 epidemic resulted in increased calls and missions and affected time indices. Therefore, it is suggested that the method and type of service provision be modified during similar crises.

Prehospital neurological emergencies- a survey on the state of prehospital neurological assessment by emergency medical professionals.

BACKGROUND: Neurological emergencies are one of the major diagnosis groups in the Emergency Medical Services (EMS) with the highest rate of misdiagnosis. Despite the knowledge of time sensitivity and the importance of prehospital factors, prehospital delay is common. Although several stroke triage scales have been developed, a gold standard in the prehospital setting is lacking. OBJECTIVES: Our aim was to evaluate the perception of neurological emergencies by EMS personnel and to identify current problems, difficulties and opportunities for improvement in the prehospital management of stroke, seizure, non-specific neurological symptoms, and paediatric neurological emergencies. METHODS: The study was conducted as an online survey through SoSci Survey and was made available from March 1st to June 30th 2023 to all personnel working in emergency medical services. The access link was distributed through snowballing, social media, and through a QR code on a promotional poster. The survey was completed anonymously. The final survey consisted of 30 questions in German on the topics of neurological emergencies, general neurological assessment, specific neurological examination including paediatric assessment, stroke, and seizures, and finally suggestions for improvement. RESULTS: The largest group of participants were paramedics, who estimated to encounter neurological emergencies at a general rate of 20-60%. When unease was felt, the main reasons were ambiguity of symptoms and insufficient admission capacity of hospitals. The biggest challenges were highly varied. Almost 80% of participants assumed that the neurological assessment would be omitted in difficult patient groups such as demented, intoxicated or children. 75% felt uncomfortable making a paediatric assessment, 50% were unfamiliar with the Paediatric Glasgow Coma Scale. CONCLUSIONS: Support through more standardized practical training and defined, uniform guidelines is needed. There was also a clear need for peer collaboration, feedback and case sharing. Digitalization, the usage of telemedicine and updated versions of the documentation protocols including paediatric adaptations to current guidelines could further improve current neurological assessment in the prehospital setting.

Assessment of the In Vitro Phosphatidylinositol Glycan Class A (PIG-A) Gene Mutation Assay Using Human TK6 and Mouse Hepa1c1c7 Cell Lines.

Gene mutations linked to diseases like cancer may be caused by exposure to environmental chemicals. The X-linked phosphatidylinositol glycan class A (PIG-A) gene, required for glycosylphosphatidylinositol (GPI) anchor biosynthesis, is a key target locus for in vitro genetic toxicity assays. Various organisms and cell lines may respond differently to genotoxic agents. Here, we compared the mutagenic potential of directly genotoxic ethyl methane sulfonate (EMS) to metabolically activated pro-mutagenic polycyclic aromatic hydrocarbons (PAHs). The two classes of mutagens were compared in an in vitro PIG-A gene mutation test using the metabolically active murine hepatoma Hepa1c1c7 cell line and the human TK6 cell line, which has limited metabolic capability. Determination of cell viability is required for quantifying mutagenicity. Two common cell viability tests, the MTT assay and propidium iodide (PI) staining measured by flow cytometry, were evaluated. The MTT assay overestimated cell viability in adherent cells at high benzo[a]pyrene (B[a]P) exposure concentrations, so PI-based cytotoxicity was used in calculations. The spontaneous mutation rates for TK6 and Hepa1c1c7 cells were 1.87 and 1.57 per million cells per cell cycle, respectively. TK6 cells exposed to 600 µM and 800 µM EMS showed significantly higher mutation frequencies (36 and 47 per million cells per cell cycle, respectively). Exposure to the pro-mutagen benzo[a]pyrene (B[a]P, 10 µM) did not increase mutation frequency in TK6 cells. In Hepa1c1c7 cells, mutation frequencies varied across exposure groups (50, 50, 29, and 81 per million cells per cell cycle when exposed to 10 µM B[a]P, 5-methylcholanthrene (5-MC), chrysene, or 16,000 µM EMS, respectively). We demonstrate that the choice of cytotoxicity assay and cell line can determine the outcome of the Pig-A mutagenesis assay when assessing a specific mutagen.

Screening and Validation of Leaf Width-Related Genes in Inbred Maize Lines.

Leaf width is a key determinant of planting density and photosynthetic efficiency. In an effort to determine which genes regulate maize plant leaf width, we performed a genome-wide association study (GWAS) of 1.49 × 106 single nucleotide polymorphisms (SNPs) in 80 sequenced backbone inbred maize lines in Jilin Province, China, based upon phenotypic leaf width data from two years. In total, 14 SNPs were identified as being significantly related to leaf width (p < 0.000001), with these SNPs being located on chromosomes 1, 2, 3, 5, 6, 7, 8, and 9. A total of five candidate genes were identified within a mean linkage disequilibrium (LD) distance of 9.7 kb, with a significant SNP being identified within the Zm00001d044327 candidate gene. RNA was then isolated from 12 different inbred maize lines from this GWAS study cohort and was used to conduct qPCR analyses which revealed significant differences in Zm00001d044327 expression among strains exhibiting significant differences in leaf width. Based on an assessment of EMS mutant lines harboring a conserved amino acid stop mutation and two non-synonymous mutations in Zm00001d044327 that exhibited a narrow leaf width, these data suggested that Zm00001d044327 is a key regulator of maize leaf width.

Inhaled analgesics for the treatment of prehospital acute pain-A systematic review.

BACKGROUND: Many prehospital emergency patients receive suboptimal treatment for their moderate to severe pain. Various factors may contribute. We aim to systematically review literature pertaining to prehospital emergency adult patients with acute pain and the pain-reducing effects, adverse events (AEs), and safety issues associated with inhaled analgetic agents compared with other prehospital analgesic agents. METHODS: As part of an initiative from the Scandinavian Society of Anaesthesia and Intensive Care Medicine, we conducted a systematic review (PROSPERO CRD42018114399), applying the PRISMA guidelines, Grading of Recommendations Assessment, Development, and Evaluation (GRADE), and Cochrane methods, searching the Cochrane Library, Epistemonikos, Centre for Reviews and Dissemination, PubMed, and EMBASE databases (updated March 2024). Inclusion criteria were the use of inhaled analgesic agents in adult patients with acute pain in the prehospital emergency care setting. All steps were performed by minimum of two individual researchers. The primary outcome was pain reduction; secondary outcomes were speed of onset, duration of effect, and relevant AEs. RESULTS: We included seven studies (56,535 patients in total) that compared inhaled agents (methoxyflurane [MF] and nitrous oxide [N2O]) to other drugs or placebo. Study designs were randomized controlled trial (1; n = 60), randomized non-blinded study (1; n = 343), and randomized open-label study (1; n = 270). The remaining were prospective or retrospective observational studies. The evidence according to GRADE was of low or very low quality. No combined meta-analysis was possible. N2O may reduce pain compared to placebo, but not compared to intravenous (IV) paracetamol, and may be less effective compared to morphine and MF. MF may reduce pain compared to paracetamol, ketoprofen, tramadol, and fentanyl. Both agents may be associated with marked but primarily mild AEs. CONCLUSION: We found low-quality evidence suggesting that both MF and N2O are safe and may have a role in the management of pain in the prehospital setting. There is low-quality evidence to support MF as a short-acting single analgesic or as a bridge to IV access and the administration of other analgesics. There may be occupational health issues regarding the prehospital use of N2O.

South African palliative care provider perspectives on emergency medical services in palliative situations.

Introduction: Due to the frequent intersection of Emergency Medical Services (EMS) with palliative situations and the increasing global need for palliative care, there has been increased recognition of the need for palliative care integration with EMS. However, EMS and palliative care systems remain segregated in many Low-to-Middle Income Country contexts, as in South Africa (SA). The aim of this study was to gather perspectives of palliative care providers in SA concerning EMS in palliative situations. Methods: A qualitative design employing individual semi-structured interviews was implemented. Ten interviews with experienced doctors and nurses holding post-graduate palliative medicine qualifications were conducted. Verbatim transcriptions of interviews were subjected to content analysis with an inductive-dominant approach to develop codes and categories. Results: Four categories were developed: (1) Disposition towards EMS, (2) Perceived EMS challenges, (3) Positive EMS impact across patients' palliative care journeys and (4) Methods of EMS and palliative care system integration. Participants maintained an overall positive view of EMS and palliative care integration, noting the beneficial impact of EMS and suggesting various methods of integration, while also highlighting challenges and concerns. Conclusion: EMS and palliative care integration would be mutually beneficial to both systems while benefiting patient well-being and the broader healthcare system. Potentially low-cost, high-impact interventions suggested by participants, such as palliative care cards for patients and enhancing EMS and palliative care system communication, represent efficacious and judicious use of limited resources within the SA context. Pilot studies investigating these suggestions should be conducted.

Grand theft ambulance: Media reports of stolen ambulances in the United States, 1980 to 2020.

BACKGROUND: Ambulance thefts are frequently reported in the media, particularly over the past decade, with increasing numbers of news stories on these events. Despite these media reports, there is a paucity of peer-reviewed literature describing details and themes of these events. METHODS: We performed a structured review of media reports published between 1980 and 2020 using publicly available databases EMS1.com and Newspaper Source Plus, with keywords "stolen" and "ambulance," with filters for date range, "1980 to 2020," and location, "US." The search was limited to English language articles and duplicate reports were excluded. RESULTS: 263 unique media reports of stolen ambulances were identified (n = 149 from EMS1.com and n = 114 from Newspaper Source Plus (NSP)). Texas (n = 19) and Pennsylvania (n = 15) had the most media-reported cases of stolen ambulances. Montana, North Dakota, Rhode Island, and Washington, District of Columbia (DC) had the fewest media-reported stolen ambulances. Most cases occurred at a hospital (n = 141), followed by theft on scene (n = 71). Males accounted for approximately two-thirds of alleged perpetrators (68 %, EMS1.com, 66 %, NSP). CONCLUSIONS: Media reports of ambulance thefts in the US have increased in recent years, highlighting the opportunity for improved education, standard policies and procedures, and increased security countermeasures to prevent the potential injuries and economic losses associated with these events.

Mapping Glasgow Coma scale to AVPU scores among adults in the prehospital setting.

OBJECTIVE: To develop a translation between the Glasgow Come Scale and the Alert-Verbal-Pain-Unresponsive (AVPU) scale among adults with out-of-hospital emergencies. METHODS: We performed a retrospective analysis of adults (≥18 years) from the 2022 National Emergency Medical Services (EMS) Information System with a ground scene encounter with a concurrently documented GCS and AVPU assessment. Using a training partition of 2.5 million encounters, we performed a grid search to identify all combinations of mutually exclusive cutpoints which divided the GCS into four segments. We identified the combination with the highest Kappa statistic and reported metrics of performance in this sample in the test partition. RESULTS: We identified 16,321,299 encounters with a concurrent AVPU and GCS. Using the AVPU scale, 93.3 % were classified as Alert; 2.9 % as Verbal; 1.5 % as Pain; and 2.3 % as Unresponsive. Using a grid-based search, optimal cutpoints were identified when using a GCS of 14-15 for Alert, 10-13 for Verbal, 7-9 for Pain, and 3-6 for Unresponsive. Cohen's Kappa was 0.63 in the test partition, indicating substantial agreement. Intraclass F1 score varied across different alertness levels and were 0.97 for "Alert", 0.43 for "Verbal", 0.49 for "Pain", and 0.83 for "Unresponsive". Findings were similar in analyses performed by age group and by the presence or absence of trauma. CONCLUSION: We report an optimal crosswalk between the AVPU and GCS scales. Performance in the Verbal and Pain categories was lower than the Alert and Unresponsive categories. These findings may facilitate clinician handovers between EMS and non-EMS clinicians.

Quality and safety in prehospital airway management - retrospective analysis of 18,000 cases from an air rescue database in Germany.

BACKGROUND: Prehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. Since then, much attention has been given to guideline development and training. This study evaluated the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective. METHODS: This was a retrospective analysis of a German helicopter-based EMS database from January 1, 2012, to December 31, 2020. All registered patients were included in the primary analysis. The results were analysed using SPSS 27.0.1.0. RESULTS: Out of 227,459 emergency medical responses overall, a total of 18,087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these patients, airway management devices were used by ground-based EMS staff, with an intubation rate of 96.6% (n = 7861), and alternative airways were used in 3.2% (n = 285). Overall, the rate of endotracheal intubation success was 94.7%, while adverse events in the form of tube misplacement were present in 5.3%, with a 1.2% rate of undetected oesophageal intubation. Overall tube misplacement and undetected oesophageal intubation occurred more often after intubation was carried out by paramedics (10.4% and 3.6%, respectively). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation, with rates of 5.6% and 6.4%, respectively. Difficult airways with a Cormack 4 status were present in 2.1% (n = 213) of HEMS patients, accompanied by three or more intubation attempts in 5.2% (n = 11). CONCLUSIONS: Prehospital airway management success has improved significantly in recent years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat to patient safety. TRIAL REGISTRATION: The study was registered in the German Register for Clinical Studies (number DRKS00028068).

Test preparation breeds success: Two quasi-experimental interventions in the context of the Swiss aptitude test for medical-school admissions.

BACKGROUND: In Switzerland, the scholastic aptitude test for medical-school selection takes place in three languages. This study examined the effects of two quasi-experimental interventions that aimed to reduce existing differences in test results between the French- and German-speaking language candidates. METHODS: Between 2018 and 2023, the population of applicants to Swiss medical schools consisted of N = 18'824 German- and French-speaking individuals. Based on a quasi-experimental design, we examined the effects of two interventions regarding preparatory material, in these cohorts. The first intervention (2022) consisting of practice trials in baccalaureate schools in the canton of Fribourg enabled French-speaking candidates primarily from the canton of Fribourg to prepare more intensively with official tasks. Practice trials enable future candidates to complete a published test version under original conditions and thus prepare how to approach the real test. The second intervention (2023) released new preparatory material in all languages for one group of tasks for which differences between the language groups were more pronounced than in the other tasks. The test provider offered this material for free download together with existing preparation materials and thereby enabled more intensive preparation. RESULTS: After the first intervention, the initially small to medium-sized mean differences in z-transformed test scores between French-speaking candidates from Fribourg and German-speaking candidates were nearly eliminated (from 0.39 to 0.05). Also for French-speaking candidates from outside of the canton of Fribourg, the mean differences were smaller than before the intervention (0.48 before, 0.39 after first intervention). After the second intervention, particularly the mean differences in test scores between German-speaking and French-speaking candidates from outside of Fribourg were further reduced (to 0.24). CONCLUSIONS: The two interventions regarding material for preparing to participate in the aptitude test affected candidates' test scores. They reduced the gap between German- and French-speaking candidates showing that the additional benefits of commercial offers for test preparation are limited. Hence, offering comparable official preparation material to all language groups enhances test fairness.