Suporte imediato de vida na pessoa em situação crítica: Contributos da intervenção do enfermeiro / Immediate life support to critical patients: Nursing care contributions / Soporte vital inmediato en situaciones críticas: Contribuciones de la intervención de enfermería

Resumo Enquadramento: As ambulâncias de suporte imediato de vida (SIV) possibilitam ao enfermeiro capacidade de intervenção em contexto pré-hospitalar, suportada pelo seu conhecimento técnico-científico, protocolos complexos de atuação e regulação médica por telemedicina. Objetivo: Analisar os contributos da intervenção dos enfermeiros SIV, na evolução do estado clínico da pessoa em situação crítica (PSC). Metodologia: Estudo quantitativo, descritivo-correlacional, retrospetivo, realizado em meios SIV, na região norte de Portugal. Analisados 574 registos clínicos eletrónicos, entre 01 de novembro e 31 de dezembro de 2019, que correspondem ao mesmo número de pessoas avaliadas. Utilizada a escala National Early Warning Score (NEWS) para avaliar a evolução clínica da PSC. Resultados: Observou-se uma evolução positiva do score NEWS da PSC, após a intervenção do enfermeiro SIV (M = 4,43 ± 3,901 vs 3,34 ± 3,329; sig < 0,001). Em sentido inverso, o risco clínico diminuiu significativamente após a intervenção do enfermeiro. Conclusão: Demonstrou-se a relevância da intervenção do enfermeiro SIV no contexto pré-hospitalar, enquanto garantia de segurança, qualidade e melhoria contínua dos cuidados à PSC.

Abstract Background: Immediate life support (ILS) ambulances allow nurses to intervene in pre-hospital settings, supported by their technical-scientific knowledge and complex protocols of action and regulation through telemedicine. Objective: To analyze the contributions of nursing interventions in the evolution of the clinical state of critical patients. Methodology: Quantitative, descriptive-correlational, retrospective, and observational study conducted in ILS settings in northern Portugal. A total of 574 electronic clinical records were analyzed between 1 November and 31 December 2019, corresponding to the same number of people evaluated. The National Early Warning Score (NEWS) was used to assess the clinical evolution of critical patients. Results: There was a positive evolution of the NEWS score of critical patients after the intervention of ILS nurses (M = 4.43 ± 3.901 vs. 3.34 ± 3.329; sig < 0.001). Similarly, the clinical risk of critical patients decreased after the nurse's intervention. Conclusion: This study demonstrated the importance of nurses in prehospital care, as a guarantee of safety, quality, and continuous improvement of care for critical patients.

Resumen Marco contextual: Las ambulancias de soporte vital inmediato (SVI) permiten al personal de enfermería intervenir en un contexto prehospitalario, con el apoyo de sus conocimientos técnico-científicos y de complejos protocolos de actuación y regulación médica a través de la telemedicina. Objetivo: Analizar las aportaciones de la intervención del personal de enfermería del SVI en la evolución del estado clínico de la persona en situación crítica (PSC). Metodología: Estudio cuantitativo, descriptivo-correlacional, retrospectivo, realizado en centros de SVI del norte de Portugal. Se analizaron 574 historias clínicas electrónicas entre el 1 de noviembre y el 31 de diciembre de 2019, correspondientes al mismo número de personas evaluadas. Se utilizó la escala National Early Warning Score (NEWS) para evaluar la evolución clínica de la PSC. Resultados: Se observó una evolución positiva en el score NEWS de la PSC, tras la intervención del personal de enfermería del SVI (M = 4,43 ± 3,901 vs 3,34 ± 3,329; sig < 0,001). Por el contrario, el riesgo clínico disminuyó significativamente tras la intervención del personal de enfermería. Conclusión: Se demostró la relevancia de la intervención del personal de enfermería del SVI en el contexto prehospitalario, como garantía de seguridad, calidad y mejora continua en la atención a la PSC.

Ambulance Transports from NCAA Division 1 Football Games.

INTRODUCTION: There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings. METHODS: Patient care reports (PCRs) from ambulance transports originating from varsity collegiate football games at the University of Minnesota across six years were examined. Pertinent information was abstracted from each PCR. RESULTS: Across the six years of data, there were a total of 73 patient transports originating from NCAA collegiate football games: 45.2% (n = 33) were male, and the median age was 22 years. Alcohol-related chief complaints were involved in 50.7% (n = 37) of transports. In total, 31.5% of patients had an initial Glasgow Coma Scale (GCS) of less than 15. The majority (65.8%; n = 48; 0.11 per 10,000 attendees) were transported by Basic Life Support (BLS) ambulances. The remaining patients (34.2%; n = 25; 0.06 per 10,000 attendees) were transported by Advanced Life Support (ALS) ambulances and were more likely to be older, have abnormal vital signs, and have a lower GCS. CONCLUSIONS: This analysis of ambulance transports from NCAA Division 1 collegiate football games emphasizes the prevalence of alcohol-related chief complaints, but also underscores the likelihood of more life-threatening conditions at mass gatherings. These results and additional research will help inform emergency preparedness at mass-gathering events.

Exploring Prehospital Data for Pandemic Preparedness: A Western Brazilian Amazon Case Study on COVID-19.

BACKGROUND: The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios. METHODS: This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020. RESULTS: A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30-67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6-67.7) (p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 (p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase (p = 0.0007). CONCLUSION: The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.

Automatic external defibrillator (AED) location - seconds that save lifes.

INTRODUCTION AND OBJECTIVE: Sudden cardiac arrest (SCA) is a significant cause of adult mortality, categorized into in-hospital (IHCA) and out-of-hospital (OHCA). Survival in OHCA depends on early diagnosis, alerting Emergency Medical Service (EMS), high-quality bystander resuscitation, and prompt Automatic External Defibrillator (AED) use. Accelerating technological progress supports faster AED retrieval and use, but there are barriers in real-life OHCA situations. The study assesses 6th-year medical students' ability to locate AEDs using smartphones, revealing challenges and proposing solutions. MATERIAL & METHODS: The study was conducted in 2022-2023 at the Medical University of Lodz, Poland. Respondents completed a survey on AED knowledge and characteristics, followed by a task to find the nearest AED using their own smartphones. As common sources did not list the University AEDs, respondents were instructed to locate the nearest AED outside the research site. RESULTS: A total of 300 6th-year medical students took part in the study. Only 3.3% had an AED locating app. Only 32% of students claimed to know where the AED nearest to their home is. All 300 had received AED training, and almost half had been witness to a resuscitation. Out of the 291 medical students who completed the AED location task, the median time to locate the nearest AED was 58 s. Most participants (86.6%) found the AED within 100 s, and over half (53%) did so in under 1 min. CONCLUSIONS: National registration of AEDs should be mandatory. A unified source of all AEDs mapped should be created or added to existing ones. With a median of under one minute, searching for AED by a bystander should be considered as a point in the chain of survival.

Delayed admission to hospital with proper prehospital treatments prevents severely burned patients from sepsis in China: A retrospective study.

BACKGROUND: Sepsis is one of the major causes of morbidity and mortality in burn patients. However, the optimal timing of admission which can minimize the probability of sepsis is still unclear. This study aims to determine the optimal time period of admission for severely burned patients and find out the possible reasons for it. METHOD: 185 victims to the Kunshan factory aluminum dust explosion accident, which happened on August 2nd, 2014, were studied. The optimal cutpoint for continuous variables in survival models was determined by means of the maximally selected rank statistic. Univariate and multivariate analyses were further conducted to verify that admission time was not a risk factor for sepsis. Subgroup analyses were performed to find out possible contributing factors for the result. RESULT: The cutoff point for admission time was determined as seven hours, which was supported by the survival curve (p < 0.001). Multivariate analysis showed that, in our study population, delayed admission time was not a risk factor for sepsis (HR = 0.610, 95 %CI = 0.415 - 0.896, p = 0.012). Subgroup analyses showed that "Tracheotomy before admission" (p = 0.002), "Whole blood transfusion" (p < 0.001), "Hemodynamic instability before admission" (p = 0.02), "Has a burn department in the hospital" (p = 0.009), "Has a burn ICU in the hospital" (p < 0.001), "Acute heart failure (AHF)" (p = 0.05), "acute respiratory distress syndrome (ARDS)" (p = 0.05) and "GI bleeding" (p = 0.04) were all statistically significant. CONCLUSION: In our study population, we found that delayed admission time was not a risk factor associated with a reduced incidence of sepsis among severely burned patients. This might be attributed to variations in prehospital treatments (whole blood transfusion and tracheotomy), whether the hospital had a burn department/ICU, and certain complications (AHF, ARDS and GI bleeding). It can be inferred that early prehospital care plays a crucial role in reducing sepsis risk among severe burn patients.

Assistance time and peripheral oxygen saturation in prehospital emergency data as predictors of COVID19 hospital outcomes.

To verify if data obtained in the prehospital evaluation of patients with severe acute respiratory syndrome (SARS) during the initial response to the COVID-19 pandemic is associated with clinical outcomes: mechanical ventilation, hospital discharge, and death. This is a retrospective analysis involving secondary data from the Emergency Medical Service (EMS) records and the Health Surveillance Information System of patients assisted by the EMS in Manaus, from January to June 2020, the period of the first peak of COVID-19 cases. The combination of the two databases yielded a total of 1.190 patients, who received a first EMS response and were later admitted to hospital with SARS and had data on clinical outcomes of interest available. Patients were predominantly male (754, 63.4%), with a median age of 66 (IQR: 54.0-78.0) years. SARS illness before medical assistance was associated to need for invasive mechanical ventilation (IMV, p < 0.001). Lower pre-hospital SpO2 was associated to death (p = 0.025). Death was more common among patients with respiratory support needs, especially in the invasive ventilation group (262/287; 91.3%) (p < 0.001). In addition, IMV was more common among elderly individuals (p < 0.001). Patients admitted to ICU had a greater chance of dying when compared to non-ICU admitted patients (p < 0.001), and closely related to IMV (p < 0.001). Patients in ICU were also older (p = 0.003) and had longer hospital stay (p < 0.001). Mortality was associated with mechanical ventilation (p < 0.001), ICU admission (p < 0.001), and older age (p < 0.001). Patients who died had a shorter length of both ICU and total hospital stay (p < 0.001). Prehospital EMS may provide feasible and early recognition of critical patients with SARS in strained healthcare systems, such as in low-resource settings and pandemics.

Use of artificial intelligence to support prehospital traumatic injury care: A scoping review.

Background: Artificial intelligence (AI) has transformative potential to support prehospital clinicians, emergency physicians, and trauma surgeons in acute traumatic injury care. This scoping review examines the literature evaluating AI models using prehospital features to support early traumatic injury care. Methods: We conducted a systematic search in August 2023 of PubMed, Embase, and Web of Science. Two independent reviewers screened titles/abstracts, with a third reviewer for adjudication, followed by a full-text analysis. We included original research and conference presentations evaluating AI models-machine learning (ML), deep learning (DL), and natural language processing (NLP)-that used prehospital features or features available immediately upon emergency department arrival. Review articles were excluded. The same investigators extracted data and systematically categorized outcomes to ensure consistency and transparency. We calculated kappa for interrater reliability and descriptive statistics. Results: We identified 1050 unique publications, with 49 meeting inclusion criteria after title and abstract review (kappa 0.58) and full-text review. Publications increased annually from 2 in 2007 to 10 in 2022. Geographic analysis revealed a 61% focus on data from the United States. Studies were predominantly retrospective (88%), used local (45%) or national level (41%) data, focused on adults only (59%) or did not specify adults or pediatrics (27%), and 57% encompassed both blunt and penetrating injury mechanisms. The majority used machine learning (88%) alone or in conjunction with DL or NLP, and the top three algorithms used were support vector machine, logistic regression, and random forest. The most common study objectives were to predict the need for critical care and life-saving interventions (29%), assist in triage (22%), and predict survival (20%). Conclusions: A small but growing body of literature described AI models based on prehospital features that may support decisions made by dispatchers, Emergency Medical Services clinicians, and trauma teams in early traumatic injury care.

Disparities in Emergency Medical Services Use, Prehospital Notification, and Symptom Onset to Arrival in Patients With Acute Stroke.

BACKGROUND: Disparities in time to hospital presentation and prehospital stroke care may be important drivers in inequities in acute stroke treatment rates, functional outcomes, and mortality. It is unknown how patient-level factors, such as race and ethnicity and county-level socioeconomic status, affect these aspects of prehospital stroke care. METHODS: Cross-sectional study of patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage in the Get With the Guidelines-Stroke registry, presenting from July 2015 to December 2019, with symptom onset <24 hours. Multivariable logistic regression and quantile regression were used to investigate the outcomes of interest: emergency medical services (EMS) transport (versus private vehicle), EMS prehospital notification (versus no prehospital notification), and stroke symptom onset to time of arrival at the emergency department. Prespecified covariates included patient-level, hospital-level, and county-level characteristics. RESULTS: The inclusion criteria was met by the 606 369 patients. Of the patients, 51.2% were men and 69.9% White, with a median National Institutes of Health Stroke Severity of 4 (IQR, 2-10), and median social deprivation index (SDI) of 51 (IQR, 27-75). Median symptom onset to arrival time was 176 minutes (IQR, 64-565). Black race was significantly associated with prolonged symptom onset to emergency department arrival time (+28.21 minutes [95% CI, 25.59-30.84]), and decreased odds of EMS prehospital notification (OR, 0.80 [95% CI, 0.78-0.82]). SDI was not associated with differences in EMS use but was associated with lower odds of EMS prehospital notification (upper SDI tercile versus lowest, OR, 0.79 [95% CI, 0.78-0.81]). SDI was also significantly associated with stroke symptom onset to emergency department arrival time (upper SDI tercile versus lowest +2.56 minutes [95% CI, 0.58-4.53]). CONCLUSIONS: In this national cross-sectional study, Black race was associated with prolonged onset to time of arrival intervals and significantly decreased odds of EMS prehospital notification, despite similar use of EMS transport. Greater county-level deprivation was also associated with reduced odds of EMS prehospital notification and slightly prolonged stroke symptom onset to emergency department arrival time. Efforts to reduce place-based disparities in stroke care must address significant inequities in prehospital care of acute stroke and continue to address health inequities associated with race and ethnicity.

Saving lives with statistics.

Healthcare is awash with numbers, and figuring out what knowledge these numbers might hold is worthwhile in order to improve patient care. Numbers allow for objective mathematical analysis of the information at hand, but while mathematics is objective by design, our choice of mathematical approach in a given situation is not. In prehospital and critical care, numbers stem from a wide range of different sources and situations, be it experimental setups, observational data or data registries, and what constitutes a "good" statistical analysis can be unclear. A well-crafted statistical analysis can help us see things our eyes cannot, and find patterns where our brains come short, ultimately contributing to changing clinical practice and improving patient outcome. With increasingly more advanced research questions and research designs, traditional statistical approaches are often inadequate, and being able to properly merge statistical competence with clinical knowhow is essential in order to arrive at not only correct, but also valuable and usable research results. By marrying clinical knowhow with rigorous statistical analysis we can accelerate the field of prehospital and critical care.

Rethinking Prehospital Response to Mass Casualty Events: Move, Treat, and Transport.

Herein, we present a simplified approach to prehospital mass casualty event (MASCAL) management called "Move, Treat, and Transport." Prior publications demonstrate a disconnect between MASCAL response training and actions taken during real-world incidents. Overly complex algorithms, infrequent training on their use, and chaotic events all contribute to the low utilization of formal triage systems in the real world. A review of published studies on prehospital MASCAL management and a recent series of military prehospital MASCAL responses highlight the need for an intuitive MASCAL management system that accounts for expected resource limitations and tactical constraints. "Move, Treat, and Transport" is a simple and pragmatic approach that emphasizes speed and efficiency of response; considers time, tactics, and scale of the event; and focuses on interventions and evacuation to definitive care if needed.

Limb Hemorrhage Control Failure with Counterfeit Tourniquet: A Ukrainian War MEDEVAC Case Report.

Rapid and effective tourniquet application is crucial in life-threatening limb hemorrhage to minimize mortality. However, the widespread availability of counterfeit tourniquets is a growing concern, as these devices may lack essential quality control measures, potentially compromising patient care. We describe one case where the delayed mechanical failure of a Combat Application Tourniquet (CAT)-like tourniquet caused the death of a Ukrainian soldier during evacuation to an urban trauma center. In April 2022, a 19-year-old male underwent a bilateral below-the-knee amputation from an antipersonnel landmine. Massive hemorrhage prompted the use of bilateral CAT-like tourniquets. During transportation, the right tourniquet's windlass broke, resulting in a brisk hemorrhage. Due to the high patient-to-healthcare-personnel ratio, the bleeding remained unaddressed for an unknown amount of time, resulting in death from hemorrhagic shock. This study underscores the need for robust quality control measures and the establishment of strict regulations against deploying counterfeit tourniquets to avoid preventable deaths.

Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services.

INTRODUCTION: Prolonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate the evidence base for 10 urgent and emergency care high-impact initiatives identified by the National Health Service (NHS) England. METHODS: A two-stage approach was employed. First, a comprehensive search for reviews (2018-2023) was conducted across PubMed, Epistemonikos and Google Scholar. Additionally, full-text searches using Google Scholar were performed for studies related to the key outcomes. In the absence of sufficient review-level evidence, relevant available primary research studies were identified through targeted MEDLINE and HMIC searches. Relevant reviews and studies were mapped to the 10 high-impact initiatives. Reviewers worked in pairs or singly to identify studies, extract, tabulate and summarise data. RESULTS: The search yielded 20 771 citations, with 48 reviews meeting the inclusion criteria across 10 sections. In the absence of substantive review-level evidence for the key outcomes, primary research studies were also sought for seven of the 10 initiatives. Evidence for interventions improving ambulance response times was generally scarce. ED wait times were commonly studied using ED length of stay, with some evidence that same day emergency care, acute frailty units, care transfer hubs and some in-patient flow interventions might reduce direct and indirect measures of wait times. Proximal evidence existed for initiatives such as urgent community response, virtual hospitals/hospital at home and inpatient flow interventions (involving flow coordinators), which did not typically evaluate the NHS England outcomes of interest. CONCLUSIONS: Effective interventions were often only identifiable as components within the NHS England 10 high-impact initiative groupings. The evidence base remains limited, with substantial heterogeneity in urgent and emergency care initiatives, metrics and reporting across different studies and settings. Future research should focus on well-defined interventions while remaining sensitive to local context.

Poisoning with table salt while treating drug poisoning.

Hypernatremia is an increase in serum sodium concentration above 145 mmol/L. There are many causes of elevated sodium levels in the blood serum. One is incorrect actions performed by medical staff. The symptoms of excessively high serum sodium levels depend on the severity of hypernatremia, the rate of its increase and the accompanying volume disorders. Severe symptoms include altered consciousness, increased muscle tone and reflexes, convulsions, psychomotor hyperactivity or drowsiness (up to coma), respiratory failure, and even death. We present the case of a 45-year-old man who took seven tablets of a blood pressure-lowering drug, and paramedics subsequently administered a concentrated solution of table salt to induce vomiting. However, vomiting did not occur, leading to hypernatremia. Ultimately, the man survived but developed persistent cognitive dysfunction, including disordered short-term memory and encoding and retrieval of information from long-term memory, weakening of attention function and fatigue, and disorders in abstract thinking. The patient's family went to the prosecutor's office to investigate the possibility of medical malpractice. Experts found that the paramedics' actions were incorrect. Although it has been known for many years that table salt solutions should not be used to induce vomiting, unfortunately, both laypeople and medical professionals are still using this technique. Iatrogenic salt poisoning may end not only in serious health complications but also in legal consequences.

Prevalence, predictors and outcomes of self-reported feedback for EMS professionals: a mixed-methods diary study.

BACKGROUND: Providing feedback to healthcare professionals and organisations on performance or patient outcomes may improve care quality and professional development, particularly in Emergency Medical Services (EMS) where professionals make autonomous, complex decisions and current feedback provision is limited. This study aimed to determine the content and outcomes of feedback in EMS by measuring feedback prevalence, identifying predictors of receiving feedback, categorising feedback outcomes and determining predictors of feedback efficacy. METHODS: An observational mixed-methods study was used. EMS professionals delivering face-to-face patient care in the United Kingdom's National Health Service completed a baseline survey and diary entries between March-August 2022. Diary entries were event-contingent and collected when a participant identified they had received feedback. Self-reported data were collected on feedback frequency, environment, characteristics and outcomes. Feedback environment was measured using the Feedback Environment Scale. Feedback outcomes were categorised using hierarchical cluster analysis. Multilevel logistic regression was used to assess which variables predicted feedback receipt and efficacy. Qualitative data were analysed using content analysis. RESULTS: 299 participants completed baseline surveys and 105 submitted 538 diary entries. 215 (71.9%) participants had received feedback in the last 30 days, with patient outcome feedback the most frequent (n = 149, 42.8%). Feedback format was predominantly verbal (n = 157, 73.0%) and informal (n = 189, 80.4%). Significant predictors for receiving feedback were a paramedic role (aOR 3.04 [1.14, 8.00]), a workplace with a positive feedback-seeking culture (aOR 1.07 [1.04, 1.10]) and white ethnicity (aOR 5.68 [1.01, 29.73]). Feedback outcomes included: personal wellbeing (closure, confidence and job satisfaction), professional development (clinical practice and knowledge) and service outcomes (patient care and patient safety). Feedback-seeking behaviour and higher scores on the Feedback Environment Scale were statistically significant predictors of feedback efficacy. Solicited feedback improved wellbeing (aOR 3.35 [1.68, 6.60]) and professional development (aOR 2.58 [1.10, 5.56]) more than unsolicited feedback. CONCLUSION: Feedback for EMS professionals was perceived to improve personal wellbeing, professional development and service outcomes. EMS workplaces need to develop a culture that encourages feedback-seeking to strengthen the impact of feedback for EMS professionals on clinical decision-making and staff wellbeing.

Emergency Medical Service in the Elderly Population in Iran: A Cross-sectional Study Before and During the COVID-19 Pandemic.

This research examines the impact of an aging population in Eastern Iran on prehospital emergency medical services (EMS), with a focus on changes before and during the COVID-19 pandemic. A descriptive cross-sectional analysis was performed on data from 10,264 elderly individuals using EMS in Torbat-e Heydarieh County from March 2019 to March 2022. Statistical analyses, including t-tests and Chi-square tests, were conducted using SPSS software. Findings indicate that 30% of the 33,847 EMS calls received were from older adults. The nature of emergencies evolved from cardiovascular issues pre-pandemic to predominantly impaired consciousness during COVID-19, a statistically significant shift (p < .001). The study concludes with a call for research targeted at this demographic and suggests setting up dedicated EMS response units to cater to the elderly, responding to the increase in elderly-related EMS needs.

Key performance indicators and benchmarks in MCI prehospital response using technological tools: a qualitative study assessing the perception of practitioners and tool developers.

PURPOSE: The aim of this study is to investigate the opinions and perspectives of The Novel Integrated Toolkit for Enhanced Prehospital Life Support and Triage in Challenging and Large Emergencies (NIGHTINGALE) end-users and tool developers regarding Key Performance Indicators (KPIs) and benchmarks that assess the prehospital response to Mass Casualty Incidents (MCIs) enhanced by the NIT-MR. METHODS: A qualitative study employing focus group discussions was conducted to collect opinions and perspectives of end-users and tool developers regarding KPIs and benchmarks in MCI response using the NIT-MR. The criteria considered for the selection and distribution of participants within the groups was the nature of their involvement within the NIGHTINGALE project and their familiarity with the tools to be discussed. RESULTS: Thirty-one participants from different countries were included. Four themes emerged during data analysis which are: definition/explanation is the personal understanding of participants of the term KPI, process of KPI development and relationship with User Requirements is the decision process for assigning KPIs to user requirements, benchmarking is the mental process of associating a benchmark to a KPI or for developing a benchmark, and technical/medical gap is the gap of understanding between each sides' fields. CONCLUSION: This study emphasized the need for a structured approach to using KPIs and bridging the gap between technological and medical worlds, taking the NIGHTINGALE project, funded by the European Union, which aims to develop a technological toolkit for first responders in mass casualty incidents as an example. These insights are crucial for enhancing disaster response.

Injury severity bias in missing prehospital vital signs: Prevalence and implications for trauma registries.

BACKGROUND: Vital signs are important factors in assessing injury severity and guiding trauma resuscitation, especially among severely injured patients. Despite this, physiological data are frequently missing from trauma registries. This study aimed to evaluate the extent of missing prehospital data in a hospital-based trauma registry and to assess the associations between prehospital physiological data completeness and indicators of injury severity. METHODS: A retrospective review was conducted on all adult trauma patients brought directly to a level 1 trauma center in Toronto, Ontario by paramedics from January 1, 2015, to December 31, 2019. The proportion of missing data was evaluated for each variable and patterns of missingness were assessed. To investigate the associations between prehospital data completeness and injury severity factors, descriptive and unadjusted logistic regression analyses were performed. RESULTS: A total of 3,528 patients were included. We considered prehospital data missing if any of heart rate, systolic blood pressure, respiratory rate or oxygen saturation were incomplete. Each individual variable was missing from the registry in approximately 20 % of patients, with oxygen saturation missing most frequently (n = 831; 23.6 %). Over 25 % (n = 909) of patients were missing at least one prehospital vital sign, of which 69.1 % (n = 628) were missing all four of these variables. Patients with incomplete data were more severely injured, had higher mortality, and more frequently received lifesaving interventions such as blood transfusion and intubation. Patients were most likely to have missing prehospital physiological data if they died in the trauma bay (unadjusted OR: 9.79; 95 % CI: 6.35-15.10), did not survive to discharge (unadjusted OR: 3.55; 95 % CI: 2.76-4.55), or had a prehospital GCS less than 9 (OR: 3.24; 95 % CI: 2.59-4.06). CONCLUSION: In this single center trauma registry, key prehospital variables were frequently missing, particularly among more severely injured patients. Patients with missing data had higher mortality, more severe injury characteristics and received more life-saving interventions in the trauma bay, suggesting an injury severity bias in prehospital vital sign missingness. To ensure the validity of research based on trauma registry data, patterns of missingness must be carefully considered to ensure missing data is appropriately addressed.

A novel learner driver first aid eLearning program: a mixed-method pre-post pilot test and evaluation.

BACKGROUND: Approximately 1.35 million people worldwide are killed in road accidents every year. Mandatory first aid training for learner drivers has been introduced in some European countries but no such requirements are in effect in Australia. The current study aimed to pilot and evaluate a first aid eLearning program for Australian learner drivers undertaking their mandated supervised driving hours. METHODS: A total of 103 participants (M age = 20.57; 52.4% female, 96% completion rate) responded to an online survey immediately before and two weeks after completing the Learner Driver First Aid program. Participants completed measures of first aid self-efficacy, first aid knowledge, and attitudes towards first aid, and provided qualitative feedback on the program. Paired samples t-tests and Mann-Whitney U tests assessed improvements in first aid self-efficacy, knowledge, and attitudes, and qualitative feedback were analysed thematically. RESULTS: Participants showed significant pre-post program improvements in first aid self-efficacy (p < .001) and first aid knowledge (p < .001); however, there were no significant changes in attitudes towards first aid (p = .028). Self-efficacy and knowledge improvements were significantly greater for those without prior first aid training (p < .001). Participants rated the usability of the online program favourably and most (93.2%) were satisfied or extremely satisfied with the program. Qualitative feedback suggested participants found the program to be accessible and interactive but noted concerns about the transfer of skills to the real-world context. CONCLUSIONS: The findings provide support for the efficacy of online first aid training for Australian learner drivers. However, further improvements to the eLearning program based on participant feedback should be considered. This study recommends the Learner Driver First Aid program be refined and rolled out to the Australian public.

Tannic acid coating gauze immobilized with thrombin with ultra-high coagulation activity and antimicrobial property for uncontrollable hemorrhage.

Rapid and safe hemostasis is crucial for the survival of bleeding patients in prehospital care. It is urgent to develop high performance hemostatic material to control the massive hemorrhage in the military field and accidental trauma. In this work, an efficient protein hemostat of thrombin was immobilized onto commercial gauze, which was mediated by self-polymerization and anchoring of tannic acid (TA). Through TA treatment, the efficient immobilization of thrombin was achieved, preserving both the biological activity of thrombin and the physical properties of the dressing, including absorbency, breathability, and mechanical performance. Moreover, in the presence of TA coating and thrombin, Gau@TA/Thr could obviously shortened clotting time and enriched blood components such as plasma proteins, platelets, and red blood cells, thereby exhibiting an enhanced in vitro coagulation effect. In SD rat liver volume defect and artery transection hemorrhage models, Gau@TA/Thr still had outstanding hemostatic performance. Besides, the Gau@TA/Thr gauze had inherent antibacterial property and demonstrated excellent biocompatibility. All results suggested that Gau@TA/Thr would be a potential candidate for treating uncontrollable hemorrhage in prehospital care.