Powered equipment for patient handling was designed to alleviate Emergency Medical Service (EMS) clinician injuries while lifting patients. This project evaluated the organizational rationale for purchasing powered equipment and the outcomes from equipment use.

This project analyzed secondary data obtained via an insurance Safety Intervention Grant (SIG) program in Ohio USA. These data were primarily in reports from EMS organizations. Investigators applied a mixed-methods approach, analyzing quantitative data from 297 grants and qualitative data from a sample of 64 grants. Analysts abstracted data related to: work-related injuries or risk of musculoskeletal-disorders (MSD), employee feedback regarding acceptance or rejection, and impact on quality, productivity, staffing, and cost.

A total of $16.67 million (2018 adjusted USD) was spent from 2005 through 2018 for powered cots, powered loading systems, powered stair chairs, and non-patient handling equipment (eg, chest compression system, powered roller). Organizations purchased equipment to accommodate staff demographics (height, age, sex) and patient characteristics (weight, impairments). Grantees were fire departments (n = 254) and public (n = 19) and private (n = 24) EMS organizations consisting of career (45%), volunteer (20%), and a combination of career and volunteer (35%) staff. Powered equipment reduced reported musculoskeletal injuries, and organizations reported it improved EMS clinicians’ safety. Organization feedback was mostly positive, and no organization indicated outright rejection of the purchased equipment. Analyst-identified design advantages for powered cots included increased patient weight capacity and hydraulic features, but the greater weight of the powered cot was a disadvantage. The locking mechanism to hold the cot during transportation was reported as an advantage, but it was a disadvantage for older cots without a compatibility conversion kit. Around one-half of organizations described a positive impact on quality of care and patient safety resulting from the new equipment.

Overall, organizations reported improved EMS clinicians’ safety but noted that not all safety concerns were addressed by the new equipment.

Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers’ first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.

This study’s aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.

This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 (n = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at P < .05.

Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; P < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; P = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; P < .001) and 2021 (n = 87; 70.7%; P < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; P = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; P = .0072).

Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency’s decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers’ proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.

Patients with thoracic trauma require rapid decision making and early intervention, especially during natural disasters when the influx of patients complicates hospitalization decisions. Identifying the characteristics of these patients can improve triage protocols, optimize resource allocation, and enhance outcomes in future disaster scenarios.

The aim of this study was to determine the characteristics of hospitalized patients after the February 2023 earthquakes in Türkiye and to contribute to Disaster Medicine.

This retrospective, cross-sectional study was conducted in a university hospital’s emergency department (ED) located in the earthquake area. All patients over 18 years old with earthquake-related thoracic trauma were included. Demographic information, mechanisms of injury, associated injuries, laboratory results, and treatments were recorded. Patients were divided into two groups: discharged and hospitalized.

The study included 179 patients, with a median age of 45 years. Overall, 80.4% were trapped under debris, and 43.8% were rescued on the first day. Hospitalization rates were higher in patients trapped under debris and those rescued after the first day. Blunt thoracic trauma was observed in 95.5% of patients. One hundred and three patients (57.5%) underwent Extended Focused Assessment with Sonography in Trauma (E-FAST) in the ED, 152 patients (84.9%) underwent x-ray, and 129 patients (72.1%) underwent computed tomography (CT). Imaging studies revealed rib fractures in 49.7% and lung parenchymal injuries in 48.6% of patients. Patients with lung parenchymal injury had higher hospitalizations rates. Hospitalized patients had higher levels of white blood cells (WBCs), potassium, blood urea nitrogen (BUN), creatinine, creatinine kinase (CK), creatine kinase-myocardial band (CKMB), and troponin I.

This study highlights the prevalence of blunt thoracic trauma and the importance of imaging in the assessment of thoracic injuries following earthquakes. While few patients needed surgery, many required hospitalizations and had abnormal laboratory results, emphasizing the need for careful monitoring for complications like muscle damage and infection.

Non-traumatic back pain commonly leads people to seek health care from paramedics via triple-zero (emergency phone number in Australia), yet the management approaches by providers of ambulance services remain unclear.

This study aims to investigate paramedic management of non-traumatic back pain in New South Wales (NSW), Australia, including the call characteristics, provisional diagnoses, and the clinical care being delivered by paramedics.

This study is a retrospective analysis of NSW Ambulance computer-aided dispatch and electronic medical records from January 1, 2017 through December 31, 2022. Adults who sought ambulance service with a chief complaint of back pain, were triaged as non-traumatic back pain, and subsequently received treatment by paramedics were included. Multivariable logistic regression models were used to explore factors associated with primary outcomes; ambulance transport, opioid use, and use of medication combinations were reported as odds ratios (ORs).

There were 73,128 calls to NSW Ambulance with a chief complaint of back pain that were triaged as non-traumatic back pain. Of these, 54,444 (74.4%) were diagnosed with spinal pain, of which 52,825 (97.1%) were categorized by the paramedic as back or neck pain, 1,573 (2.9%) as lumbar radicular pain, and 46 (0.1%) as serious spinal pathology. Eight out of ten patients with spinal pain were transported to emergency departments. The medicine most administered by a paramedic was an opioid (37.4% of patients with spinal pain). Older patients (OR = 1.36; 95% CI, 1.30 to 1.44) were more likely to be transported to an emergency department. Patients with moderate (OR = 4.39; 95% CI, 4.00 to 4.84) and severe pain (OR = 18.90; 95% CI, 17.18 to 20.79) were more likely to be administered an opioid.

Paramedic management of non-traumatic back pain in NSW typically results in the administration of an opioid and transport to an emergency department.

Anaphylactic reactions can lead to life-threatening situations. Therefore, a rapid diagnosis and therapy are indicated. Various guidelines recommend immediate treatment with intramuscular adrenaline in severe anaphylaxis. Based on study data from different countries, it has been shown that therapy of anaphylaxis is often not carried out according to existing guidelines.

The aim of the study was an analysis of the emergency treatment and outcome of anaphylaxis in children and adults according to its severity. Focus was placed on the recommended first-line therapy with adrenaline in cases of severe reactions. Further demographic data, triggers, symptoms, and hospitalization rates of anaphylaxis were analyzed.

Data from Emergency Medical Services from Dresden/Germany in cases of anaphylaxis from the start of 2012 through the end of 2016 were retrospectively analyzed. The data of the air rescue were not considered. The severity of the anaphylaxis, the therapy, the further monitoring, and the outcome were analyzed.

A total of 1,131 adults and 223 children with anaphylactic reactions (Grade I-IV) were analyzed. Overall, 591 adults and 102 children showed a severe anaphylaxis. The most common trigger for severe anaphylactic reactions was food in children (61%) and medication in adults (33%). Seven percent of adults and eight percent of children with Grade II or higher anaphylactic reactions received adrenaline. There is a significant correlation between adrenaline therapy and improved condition/outcome in adults and children. Sixty-six percent of adults and 83% of children with severe anaphylaxis were hospitalized. Twenty-one percent of the adults and 13% of the children did not receive further medical observation despite a severe reaction.

The guideline-compliant first-line therapy with adrenaline was not carried out in the majority of the cases analyzed. However, the study shows that treatment with adrenaline for anaphylaxis leads to a significant improvement in the patients’ condition.

This study aimed to design and validate a measurement tool in Turkish to assess the challenges perceived by individuals involved in the disaster response process, such as volunteers, health care personnel, firefighters, and members of nongovernmental organizations (NGOs).

This methodological study was conducted from November 2023 through March 2024. The scale development process comprised item development, expert reviews, and language control, followed by the creation of a draft survey, pilot testing, application of the final scale, and statistical analyses. All stages, including validity and reliability analyses, were conducted in Turkish. While reliability analysis used Cronbach’s alpha, item-total correlations, intraclass correlation coefficients, test-retest reliability, Tukey’s additivity, and Hotelling’s T-squared tests, validity analysis included Exploratory and Confirmatory Factor Analyses (EFA/CFA). Software such as AMOS 22.0 and SPSS 22.0 were used to perform statistical analysis.

Findings indicated six dimensions with 23 items, with factor loadings ranging from 0.478 to 0.881. The CFA demonstrated acceptable fit indices. Test-retest analysis showed a robust positive correlation (r = 0.962) between the measurements. The scale’s total Cronbach’s alpha coefficient was 0.913. Sub-dimension reliability scores were calculated as follows: 0.865 for environmental and health, 0.802 for communication and information, 0.738 for organizational, 0.728 for logistical, 0.725 for individual, and 0.809 for other factors.

This study showed that the Perceived Challenges in Disaster Response Scale (PCDRS), developed and validated in Turkish, is a reliable and valid measurement tool. It offers a foundation for understanding the challenges faced by disaster response teams and for formulating improvement strategies.

Mass-casualty incidents (MCIs) are overwhelming events which generate a surge in casualties, exceeding local capacity and stressing emergency services. Significant mortality, morbidity, and economic impact is often caused. They attract responses from both local and international governmental and non-governmental medical responders. To improve professional standards and accountability, there has been much recent focus on record-keeping by teams in these contexts. This paper seeks to further understand what data are gathered and shared as a result of MCIs to outline current practice and help move towards improved minimum standards of documentation.

A structured database search and abstract screening process was conducted utilizing PRISMA guidelines for scoping reviews. Data were then collected from all papers identified. To ensure all relevant data were gathered, authors of each included study were contacted to clarify their approach to data collection for their work.

From 154 included manuscripts, 64 data categories were found and recorded, capturing MCIs over a period of 32 years located in 42 countries from all World Health Organization (WHO) global regions. Retrospective and contemporaneous data collection was equally prevalent. In-hospital or research team data collection was most common. The ten most common data categories collected were: number of injuries (94.8%), number of deaths (89.6%), injury type (81.2%), cause of injury (79.9%), age (63.0%), sex (63.0%), treatment (62.3%), severity of injury (61.7%), outcome of injury (59.1%), and investigations/treatments given (55.8%). Of the contactable authors, only 29 responded. Sixteen reported reviewing notes retrospectively or using follow-up patient interviews.

There was significant variety in what data were collected, who collected it, and how it was done. The most common data categories were descriptive pieces of information or related to demographics. Only one-half of papers discussed treatments given. Information on both prehospital care and longer-term rehabilitation was much less prevalent.

Terrorism and shooting related MCIs were the largest by paper number. Predominantly made up of more recent MCIs in higher income countries, these findings potentially reflect more organized health care systems.

Overall, data collection in MCIs is challenging and heavily reliant on retrospective analysis. Current practice lacks standardization. If professionalism and accountability for health care delivery in MCIs is to be improved, so must the methods of data collection and minimum standards of documentation.

Mountain Rescue Services (MRS) are a vital link in the chain of survival when it comes to emergencies at high altitudes. Cognitive impairment in hypobaric hypoxic conditions is known, and previous studies have shown suboptimal performance of MRS members after a steep ascent. These impairments may be linked to regional cerebral oxygenation (rSO2). Therefore, this study aimed to investigate whether there are dynamics in rSO2 between “baseline” and “working” altitudes after climbing up to a potential patient.

In this alpine proof-of-concept field study, experienced mountaineers of the Austrian MRS had to perform an active rapid ascent of 1,200 meters on foot to 3,454 meters above sea level. Near-infrared spectroscopy (NIRS) was used to measure rSO2 before and after the climb. Continuous data were compared among subgroups using Mann-Whitney-U tests, and categorical data were compared with χ2-square tests. Statistical significance was defined by two-tailed P values of <.05.

Twenty MRS members were assessed. Their rSO2 values at baseline altitude were significantly higher than at working altitude (70 [SD = 1]% versus 60 [SD = 1]%; absolute difference 10 [95% CI, 6-15]; P <.001). When assessing the single dynamics of each mountain rescuer, there was a wide variability in delta rSO2, ranging from a minimum of 0% to a maximum of 32% (mean 10 [SD = 8]%).

Overall, low rSO2 values were found in mountain rescuers at high altitudes, and there were considerable interpersonal differences of changes in cerebral oxygenation after an ascent. Using rSO2 to assess performance-readiness in mountain rescuers and individual proneness to potential cognitive dysfunction or acute mountain sickness (AMS) could be further research goals.

The aim of this study was to systematically review evidence that supports best practice post-crash response emergency care.

The research questions to achieve the study objective were developed using the Patient, Intervention, Control, Outcome standard following which a systematic literature review (SLR) of research related to prehospital post-road-crash was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

A total of 89 papers were included in the analysis, presented according to the PRISMA guidelines.

This research explored and identified key insights related to emergency care post-road-crash response. The findings showed that interservice coordination and shared understanding of roles was recommended. Application of traditional practice of the “Golden Hour” has been explored and contested as a standard for all care. Notwithstanding this, timeliness of provision of care remains important to certain patient groups suffering certain injury types and is supported as part of a trauma system approach for patient care.

Mass-gathering events (MGEs) such as sporting competitions and music festivals that take place in stadiums and arenas pose challenges to health care delivery that can differ from other types of MGEs. This scoping review aimed to describe factors that influence patient presentations to in-event health services, ambulance services, and emergency departments (EDs) from stadium and arena MGEs.

This scoping review followed the Preferred Reporting Items of Systematic Reviews and Meta-Analysis for Scoping Reviews (PRISMA-ScR) checklist and blended both Arksey and O’Malley methodology and the Joanna Briggs Institute’s (JBI’s) approach. Four databases (CINAHL, Embase, PubMed, and Scopus) were searched using keywords and terms about “mass gatherings,” “stadium” or “arena,” and “in-event health services.” In this review, the population pertains to the spectators who seek in-event health services, the concept was MGEs, and the context was stadiums and/or arenas.

Twenty-two articles were included in the review, most of which focused on sporting events (n = 18; 81.8%) and music concerts (n = 3; 13.6%). The reported patient presentation rate (PPR) ranged between one and 24 per 10,000 spectators; the median PPR was 3.8 per 10,000. The transfer to hospital rate (TTHR) varied from zero to four per 10,000 spectators, and the median TTHR was 0.35 per 10,000. Key factors reported for PPR and TTHR include event, venue, and health support characteristics.

There is a complexity of health care delivery amid MGEs, stressing the need for uniform measurement and continued research to enhance predictive accuracy and advance health care services in these contexts. This review extends the current MGE domains (biomedical, psychosocial, and environmental) to encompass specific stadium/arena event characteristics that may have an impact on PPR and TTHR.

The escalation of the armed Ukrainian conflict forced millions of refugees to cross borders into neighboring countries, such as Poland, Czech Republic, Republic of Moldova, and Romania. The objective of this manuscript is to report the mission of an Italian Emergency Medical Team (EMT), named CUAMM EMT, deployed to assist Ukrainian refugees sheltered in the Republic of Moldova.

A total of 1,173 patients were admitted to the CUAMM EMT during the period of observation covered in this report (June - December 2022). The majority of patients (88.7%; n = 1,040) had health problems not directly related to the conflicts, while only 3.2% (n = 38) of patients presented diseases directly related to the event. With reference to the World Health Organization (WHO) Minimum Data Set (MDS), the most prevalent diagnosis (66.8%; n = 783) referred to “other diseases, not specified above” (Code 29). Among this group, the majority of diagnosis were attributable to non-communicable diseases (NCDs) such as cardiovascular diseases (23.4%; n = 177), gastrointestinal diseases (7.4%; n = 56), chronic musculoskeletal diseases (6.1%; n = 46), and cancer (4.7%; n = 36).

The most prevalent diagnoses faced by CUAMM EMT during its deployment referred to health problems not directly related to the conflict. Among them, the majority of cases registered were attributable to NCDs, raising interesting points of discussion concerning the management of these conditions during EMTs disaster deployment.

Attacks on health care – which are potential war crimes – are increasingly observed in contemporary armed conflicts. The full-scale Russian invasion of Ukraine is no exception to this worrisome trend. War crime prosecutions of suspected deliberate attacks on health care facilities require proof that they were the intended target, which is extremely challenging. If health care facilities are attacked more than once, this may increase the likelihood of intent. The Ukrainian Healthcare Center (UHC) began documenting attacks on health infrastructure since the start of the full-scale Russian invasion of Ukraine. In this study, the aim was to assess repetitive attacks on Ukrainian health care facilities from February 24, 2022 through October 24, 2023.

The Berkeley Protocol on Digital Open Source Investigations was used to identify and document health care attacks. Data collection for this study included temporal factors, location and type of facility, attack and weapon type, the number of health care personnel and civilians killed and injured, and whether the afflicted facilities were damaged, destroyed, and/or repeatedly attacked.

During the study period, there were 397 attacks on 281 Ukrainian health care facilities, damaging 237 facilities and destroying another 44. Fifty-three facilities (18.9%) were attacked more than once (total: 163 attacks; mean 3.1; median 2; range 2-10 attacks), and 27.7% of all health care attacks (110/397) concerned repeat attacks. The median time between attacks was 18 days (range: 0-289 days).

From February 24, 2022 through October 24, 2023, one-in-five targeted health care facilities in Ukraine experienced repetitive attacks. Furthermore, one-in-four attacks on health care involved recurrent attacks. This observed pattern raises the possibility that health care facilities in Ukraine are being intentionally targeted.

The aim of this study was to describe the demographic characteristics, injury characteristics, and outcomes of individuals sustaining injuries during a hailstorm in Istanbul, Turkey.

In this study, the medical records of 76 patients who presented to the emergency department (ED) of a tertiary hospital after incurring injuries due to hailstorms were retrospectively reviewed. Analyses were performed to identify hailstorm-associated injury profiles, injury mechanisms, patient demographics, and ED resource use.

Of the 76 patients, 42 (55.3%) were male and 34 (44.7%) were female, with the ages of the patients ranging from five to 79 years. Of the patients, 93.4% presented to the ED within the first eight hours after a hailstorm. The most common injury mechanisms were the direct impact of hailstones on the body surface (36.8%) and slips and falls during escape (35.6%). The most frequently injured anatomical areas were skin (60.5%), head (44.7%), and extremities (16.7%). Significant injuries occurred in only 11.8% of the patients, of whom three were treated surgically and one died. The most common injuries were soft tissue and minor head injuries.

Severe hailstorms often strike suddenly and can be difficult to predict. In response, EDs must handle a large number of injured patients in the aftermath of a hailstorm. It is important to remember that hailstorms, like other natural disasters, can cause serious injuries.

To maintain procedural proficiency and certification according to the standards set by The Joint Commission—which accredits health care centers in the United States—thrombectomy-capable stroke centers (TSCs) must achieve a minimum annual procedural volume. The addition of thrombectomy-capable centers in a regional stroke care system has the potential to increase access but also to decrease patient presentations and procedural volume at nearby centers. This study sought to characterize the impact of certifying additional thrombectomy-capable centers on procedural volume by center in a large, urban Emergency Medical Services (EMS) system.

Data were collected from each designated thrombectomy-capable center in Los Angeles (LA) County from January 1, 2018 through June 30, 2022, during which a net total of five thrombectomy-capable centers were newly designated in the County. Per center volume for ischemic stroke presentations, intravenous (IV) thrombolysis administrations (IV tissue plasminogen activator [tPA]), and thrombectomy were tabulated by six-month interval. Median last-known-well-to-procedure times by LA County Public Health service planning area (SPA) were calculated. The effect of the number of designated centers on procedural volumes per center and median last-known-well-to-procedure times were analyzed via a linear mixed effects model with a log link function.

Procedural volume, ischemic stroke presentation volume, and last-known-well-to-procedure times had high variability over the time period studied. Nonetheless, the median values for each metric in this EMS system remained largely stable over the study period. There was no statistically significant association between the number of thrombectomy-capable centers and per center procedural volumes or times-to-procedure.

The designation of additional thrombectomy-capable centers in a regional stroke care system was not significantly associated with the volume of procedures by center or times-to-procedure, suggesting that additional centers may increase patient access to time-sensitive interventions without diluting patient presentations at existing centers.