scholarly journals Tele-EMS physicians improve life-threatening conditions during prehospital emergency missions

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hanna Schröder ◽  
Stefan K. Beckers ◽  
Klaudia Ogrodzki ◽  
Christina Borgs ◽  
Sebastian Ziemann ◽  
...  
Keyword(s):  
Vital Signs ◽  
Improve Patient Care ◽  
Secondary Outcome ◽  
Telemedicine System ◽  
Threatening Condition ◽  
Life Threatening ◽  
Prehospital Emergency ◽  
Drug Doses ◽  
The City

AbstractAlmost seven years ago, a telemedicine system was established as an additional component of the city of Aachen’s emergency medical service (EMS). It allows paramedics to engage in an immediate consultation with an EMS physician at any time. The system is not meant to replace the EMS physician on the scene during life-threatening emergencies. The aim of this study was to analyze teleconsultations during life-threatening missions and evaluate whether they improve patient care. Telemedical EMS (tele-EMS) physician consultations that occurred over the course of four years were evaluated. Missions were classified as involving potentially life-threatening conditions based on at least one of the following criteria: documented patient severity score, life-threatening vital signs, the judgement of the onsite EMS physician involved in the mission, or definite life-threatening diagnoses. The proportion of vital signs indicating that the patient was in a life-threatening condition was analyzed as the primary outcome at the start and end of the tele-EMS consultation. The secondary outcome parameters were the administered drug doses, tracer diagnoses made by the onsite EMS physicians during the missions, and quality of the documentation of the missions. From January 2015 to December 2018, a total of 10,362 tele-EMS consultations occurred; in 4,293 (41.4%) of the missions, the patient was initially in a potentially life-threatening condition. Out of those, a total of 3,441 (80.2%) missions were performed without an EMS physician at the scene. Records of 2,007 patients revealed 2,234 life-threatening vital signs of which 1,465 (65.6%) were remedied during the teleconsultation. Significant improvement was detected for oxygen saturation, hypotonia, tachy- and bradycardia, vigilance states, and hypoglycemia. Teleconsultation during missions involving patients with life-threatening conditions can significantly improve those patients' vital signs. Many potentially life-threatening cases could be handled by a tele-EMS physician as they did not require any invasive interventions that needed to be performed by an onsite EMS physician. Diagnoses of myocardial infarction, cardiac pulmonary edema, or malignant dysrhythmias necessitate the presence of onsite EMS physicians. Even during missions involving patients with life-threatening conditions, teleconsultation was feasible and often accessed by the paramedics.

Effectiveness of a Dispatcher-Assisted Cardiopulmonary Resuscitation Program Developed by the Thailand National Institute of Emergency Medicine (NIEMS)

2021 ◽  
pp. 1-6
Author(s):  
Chuenruthai Angkoontassaneeyarat ◽  
Chaiyaporn Yuksen ◽  
Chetsadakon Jenpanitpong ◽  
Pemika Rukthai ◽  
Marisa Seanpan ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Medicine ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Health Care Providers ◽  
Care Providers ◽  
Chest Compressions ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background: Out-of-hospital cardiac arrest (OHCA) is a life-threatening condition with an overall survival rate that generally does not exceed 10%. Several factors play essential roles in increasing survival among patients experiencing cardiac arrest outside the hospital. Previous studies have reported that implementing a dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) program increases bystander CPR, quality of chest compressions, and patient survival. This study aimed to assess the effectiveness of a DA-CPR program developed by the Thailand National Institute for Emergency Medicine (NIEMS). Methods: This was an experimental study using a manikin model. The participants comprised both health care providers and non-health care providers aged 18 to 60 years. They were randomly assigned to either the DA-CPR group or the uninstructed CPR (U-CPR) group and performed chest compressions on a manikin model for two minutes. The sequentially numbered, opaque, sealed envelope method was used for randomization in blocks of four with a ratio of 1:1. Results: There were 100 participants in this study (49 in the DA-CPR group and 51 in the U-CPR group). Time to initiate chest compressions was statistically significantly longer in the DA-CPR group than in the U-CPR group (85.82 [SD = 32.54] seconds versus 23.94 [SD = 16.70] seconds; P <.001). However, the CPR instruction did not translate into better performance or quality of chest compressions for the overall sample or for health care or non-health care providers. Conclusion: Those in the CPR-trained group applied chest compressions (initiated CPR) more quickly than those who initiated CPR based upon dispatch-based CPR instructions.

The effects of animal-assisted interactions on quality of life in children with life-threatening conditions and their parents

2021 ◽  
Vol 27 (10) ◽  
pp. 524-530
Author(s):  
Haley Walker ◽  
Mary Chapman Miller ◽  
Brittany Cowfer ◽  
Terrah Akard ◽  
Mary Jo Gilmer
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Palliative Care ◽  
Primary Caregivers ◽  
Randomised Clinical Trial ◽  
Severe Stress ◽  
Quality Of Life Research ◽  
Threatening Condition ◽  
Life Threatening

Background: Children with advanced cancer and their primary caregivers may experience severe stress and anxiety in coping with their life-threatening condition. As a way to help reduce these stressors and increase overall quality of life, research suggests that animal-assisted interactions may be beneficial when integrated into palliative care. Aims: This pilot study aims to provide evidence for the feasibility and efficacy of a randomised clinical trial using animal-assisted interactions to help improve the quality of life for children with an advanced life-threatening condition and their primary caregivers. This protocol paper outlines the basis of the research, goals, experimental design and methodology.

scholarly journals Considerations for Continuing Semielective and Emergency Otolaryngological Procedures During the COVID-19 Pandemic

2020 ◽  
Vol 100 (1) ◽  
pp. 19-25
Author(s):  
Sarina K. Mueller ◽  
Maximilian Traxdorf ◽  
Konstantinos Mantsopoulos ◽  
Antoniu-Oreste Gostian ◽  
Matti Sievert ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Emergency Surgery ◽  
Transmission Rate ◽  
Medical Personnel ◽  
Human Beings ◽  
Threatening Condition ◽  
Long Time ◽  
Life Threatening

Introduction: During the COVID-19 pandemic, worldwide over 600,000 human beings died due to the cause of the disease. In order to deescalate the transmission rate and to avoid crush loading the countries medical health systems social distancing, face masks, and lockdowns have been considered essential by the majority of governments. Whereas some countries have highly reduced or completely stopped otorhinolaryngological procedures, other countries have continued selected surgeries. The objective of this study was to analyze procedures and outcomes of continuing semielective and emergency surgeries during the COVID-19 pandemic. Methods: Retrospective analysis of n = 750 patients who received semi-elective or emergency surgery between March 26 and June 16, 2020, in the Otolaryngology Department of the Friedrich-Alexander-University of Erlangen-Nürnberg. All patients were screened for COVID symptoms and swabbed for SARS-CoV-2 prior to surgery. Results: Of the n = 750 patients, n = 699 patients received semielective surgery and n = 51 emergency surgery. For 27 patients, the swab result could not be awaited due to a life-threatening condition. In these cases, surgery was performed in full protective equipment. No patient was tested positive during or after the surgery (follow-up 45 to 127 days). No member of the medical personnel showed symptoms or was tested positive after contact with patients. Due to the continuation of surgeries, patients’ lives were saved and improvement of long-term quality-of-life and outcomes is anticipated. Conclusions: Continuing selected otorhinolaryngological surgeries is crucial for patients’ health, survival, and long-time quality of life, yet, the protection of the medical personnel has to be granted.

(A77) Should Response Times continue to be used for Performance Measurement and Targets?

2011 ◽  
Vol 26 (S1) ◽  
pp. s21-s21
Author(s):  
J. Turner
Keyword(s):  
Response Time ◽  
Response Times ◽  
Vital Signs ◽  
Clinical Intervention ◽  
Evidence Base ◽  
Ambulance Service ◽  
Rapid Review ◽  
The Usa ◽  
Life Threatening

PurposeResponse time performance for emergency calls has been used as an indicator of ambulance service quality in England since 1974. It was revised in 1996 with targets set of eight minutes for life-threatening (category A) and 19 minutes for urgent (category B) calls. Internationally, response time has been used as the benchmark for emergency medical services (EMS) performance. The evidence to support use of response times as a quality measure has been examined.MethodsA rapid review was used to assess the evidence base for the eight minute response time target. Also, a descriptive observational study of the clinical characteristics of category B calls was performed using two months patient report form data from one English ambulance service.ResultsFive papers were identified that have examined the relationship between response time and mortality for 911/999 emergency call populations. Four papers were from the USA, and in all cases no survival benefit was found for response times > 5 minutes even after adjustment for variables including age, sex and illness severity. This finding was replicated in one UK study. The descriptive study examined call characteristics for 26,882 category B calls. Half of the patients received no intervention other than basic vital signs measurement and 75% had assessment only. Twenty-five percent required some clinical intervention with the majority only requiring oxygen. Less than 5% received significant intervention such as drugs, intravenous cannula, or airway management.ConclusionsWith the exception of cardiac arrest there is consistent evidence that response time has no impact on mortality for EMS calls. Alternative indicators of quality of care should be developed that allow less focus on time targets and more effort on innovation and development of services which could better meet the needs of the majority of patients who do not have a life-threatening problem.

Symptom Management in Pediatric Palliative Care

2019 ◽  
pp. 699-707
Author(s):  
Joan “Jody” Chrastek ◽  
Camara van Breemen
Keyword(s):  
Palliative Care ◽  
Symptom Management ◽  
Cultural Norms ◽  
Healthcare Team ◽  
Pharmacological Interventions ◽  
Disease Treatment ◽  
Disease Trajectory ◽  
Threatening Condition ◽  
Life Threatening

Pediatric symptom management can be complex and challenging, but, when done well, it improves quality of life significantly. Assessment of symptoms should be started at the diagnosis of a life-threatening condition and continued throughout the trajectory of the condition or disease. Treatment methods of each symptom depend on the reversibility of the symptom, disease trajectory, and family goals of care. Both nonpharmacological and pharmacological interventions should be employed. Decisions should be made jointly between the healthcare team and the parents/caregivers. Cultural norms and traditions need to be respected and adhered to when possible. Palliative care should be holistic, addressing not only the physical but also the spiritual, emotional, and social aspects. This chapter provides an overview of managing common symptoms of dyspnea, excessive secretions, nausea/vomiting, constipation, and neurological issues. A list of websites, guidelines, and sample algorithms are included for further information.

The usefulness of the virtual patient program in the nursing care of patients with anaphylactic shock – case report

2018 ◽  
Vol 8 (1) ◽  
pp. 219-224
Author(s):  
P. Więch ◽  
P. Rozborska ◽  
D. Bazaliński ◽  
I. Sałacińska ◽  
P. Januszewicz
Keyword(s):  
Case Report ◽  
Nursing Care ◽  
Anaphylactic Shock ◽  
Virtual Patient ◽  
Real Situation ◽  
Risk Of Death ◽  
Threatening Condition ◽  
Life Threatening ◽  
Progressive Course

Anaphylactic shock is a life-threatening condition characterized by a severe and rapid course causing disorders in the digestive, cardiovascular and respiratory systems. The paper presents a virtual patient program. It allows to analyze each phase of the shock safely, which is often impossible in the real situation due to the fast and progressive course. Right actions and proper patterns of care by nursing staff will help to reduce the risk of death and increase the quality of care.

scholarly journals Utilization, Safety, and Technical Performance of a Telemedicine System for Prehospital Emergency Care: Observational Study

10.2196/14907 ◽  
2019 ◽  
Vol 21 (10) ◽  
pp. e14907 ◽  
Author(s):  
Marc Felzen ◽  
Stefan Kurt Beckers ◽  
Felix Kork ◽  
Frederik Hirsch ◽  
Sebastian Bergrath ◽  
...  
Keyword(s):  
Emergency Service ◽  
Medical Service ◽  
Prehospital Emergency Care ◽  
Reliable System ◽  
Telemedicine System ◽  
System Failures ◽  
Technical Performance ◽  
Voice Communications ◽  
Prehospital Emergency ◽  
The City

Background As a consequence of increasing emergency medical service (EMS) missions requiring an EMS physician on site, we had implemented a unique prehospital telemedical emergency service as a new structural component to the conventional physician-based EMS in Germany. Objective We sought to assess the utilization, safety, and technical performance of this telemedical emergency service. Methods We conducted a retrospective analysis of all primary emergency missions with telemedical consultation of an EMS physician in the City of Aachen (250,000 inhabitants) during the first 3 operational years of our tele-EMS system. Main outcome measures were the number of teleconsultations, number of complications, and number of transmission malfunctions during teleconsultations. Results The data of 6265 patients were analyzed. The number of teleconsultations increased during the run-in period of four quarters toward full routine operation from 152 to 420 missions per quarter. When fully operational, around the clock, and providing teleconsultations to 11 mobile ambulances, the number of teleconsultations further increased by 25.9 per quarter (95% CI 9.1-42.6; P=.009). Only 6 of 6265 patients (0.10%; 95% CI 0.04%-0.21%) experienced adverse events, all of them not inherent in the system of teleconsultations. Technical malfunctions of single transmission components occurred from as low as 0.3% (95% CI 0.2%-0.5%) during two-way voice communications to as high as 1.9% (95% CI 1.6%-2.3%) during real-time vital data transmissions. Complete system failures occurred in only 0.3% (95% CI 0.2%-0.6%) of all teleconsultations. Conclusions The Aachen prehospital EMS is a frequently used, safe, and technically reliable system to provide medical care for emergency patients without an EMS physician physically present. Noninferiority of the tele-EMS physician compared with an on-site EMS physician needs to be demonstrated in a randomized trial.

scholarly journals Overview of Palliative Care

2014 ◽  
Vol 9 (2) ◽  
pp. 3-10
Author(s):  
B D Paudel ◽  
G Dangal ◽  
D Munday
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
Symptom Control ◽  
Oral Morphine ◽  
Common Symptom ◽  
Depression And Anxiety ◽  
Threatening Condition ◽  
Life Threatening ◽  
The 1960S

Patients diagnosed with a life threatening condition like cancer suffer physically, socially and mentally. Their quality of life can be improved by effective communication and good symptom control even when the disease is incurable. Pain is the most common symptom and can be controlled by optimal use of analgesics especially oral morphine if severe. Psychosocial issues like depression and anxiety can be minimized by counseling and use of medicines. Death is more painful than birth but can be minimized by understanding the reality and by honest sharing which will help to minimize unnecessary sufferings. Palliative care is the care of these patients and their family members to make their life comfortable. Modern palliative care has developed around the world since the 1960s and in Nepal, since the beginning of 21st century. Much remains to be done before palliative care can be an integrated part of health care in Nepal. In this context gynaecologist having knowledge and skills in palliative care, have an important role in improving the quality of life of patients with life threatening condition and their family members.DOI: http://dx.doi.org/10.3126/njog.v9i2.11724

scholarly journals Clinical Report of Probable Catastrophic Antiphospholipid Syndrome in Pregnancy

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Eryk Hakman ◽  
Sasha Mikhael
Keyword(s):  
Early Recognition ◽  
Vital Signs ◽  
Adverse Outcomes ◽  
Laboratory Evaluation ◽  
Clinical Report ◽  
Elevated Liver Enzymes ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
In Pregnancy

Background. Catastrophic APS (CAPS) is a rare but life-threatening form of APS defined as multiorgan thrombosis affecting a minimum of three organs with confirmation by histopathology of small vessel occlusions in at least one organ or tissue. The development of CAPS in pregnancy poses many diagnostic challenges as a result of its broad range of clinical presentations and its overlap with other obstetric complications and microangiopathic diseases. Because of the high associated mortality rate, prompt recognition and treatment are paramount. Case. A twenty-five-year-old G3P0111 with a history of multiple thromboembolisms presented at 21 weeks and 3 days of gestation with complaints of right upper quadrant pain, visual disturbances, headache, and syncopal episodes. Laboratory evaluation demonstrated microangiopathic disease with hemolysis (confirmed on peripheral smear), elevated liver enzymes, and abnormal 24-hour urine protein with vital signs within the normal range. Presence of significantly elevated antiphospholipid antibodies was noted, facilitating the diagnosis of probable CAPS. Proper workup was achieved based on clinical suspicion, allowing immediate and appropriate management. Conclusion. CAPS is a life-threatening condition rarely seen in pregnancy making early recognition difficult. A low threshold to initiate urgent and aggressive treatment should be maintained to minimize the risk of adverse outcomes.

Late Outcomes of Adult Survivors of Childhood Acute Lymphoblastic Leukemia (ALL) Diagnosed Between 1963-2002: A Report from the St. Jude Lifetime (SJLIFE) Cohort Study

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 853-853
Author(s):  
Daniel A. Mulrooney ◽  
Kendra E. Jones ◽  
Kirsten K. Ness ◽  
Deborah B. Crom ◽  
Matthew J. Ehrhardt ◽  
...  
Keyword(s):  
Executive Function ◽  
Adult Survivors ◽  
Chronic Health Conditions ◽  
Age At Diagnosis ◽  
Health Conditions ◽  
Childhood All ◽  
Threatening Condition ◽  
Life Threatening ◽  
And Gender

Abstract Introduction: Treatment for childhood ALL has evolved over the last five decades and transformed a once fatal disease to one with 5-year survival rates in excess of 90%. However, aging survivors of ALL are at risk for adverse health and social outcomes that significantly impact overall quality of life. Comprehensive clinical assessments of adults previously treated for childhood ALL are lacking, with most reports relying upon registry or self-reported data. To evaluate the impact of changes in therapy for ALL on the risk of late effects, we systematically screened and clinically assessed the largest cohort to date of adult survivors of childhood ALL treated over the last five decades. Our aim was to determine the occurrence of and risk factors for late chronic health conditions, neurocognitive deficits, and physical function limitations. Methods: History/physical examination, laboratory analysis, neurocognitive testing, and physical fitness were assessed among 934 (65.7% of eligible) survivors of pediatric ALL ≥ 18 years of age, treated at St. Jude Children’s Research Hospital ≥ 10 years ago, and participating in the SJLIFE cohort study. Chronic health conditions were graded per CTCAE criteria (v4.03). Neurocognitive function was measured in the domains of attention and executive function using standard clinical tests. Using national norms, age-adjusted z-scores were calculated. Mild impairment was defined as a z-score between -1 to -2, severe as ≤ -2. Aerobic function was measured with the 6-minute walk test [6MWT] (abnormal ≤ 490 meters) and mobility by the timed up and go test [TUG] (abnormal > 6 seconds to rise from a chair, walk 3 meters, return, and sit). Log-binomial linear models were used to evaluate relative risk (RR) and 95% confidence intervals (CI) for associations between treatment and outcome. Results: Survivors (50% female, 90% white) had a median age at diagnosis of 5.1 years (range 0.2-19.5), 31.2 years (18.4-59.7) at evaluation, and were 25.0 years (10.5-47.7) from diagnosis. Three hundred twenty-one (34.4%) received ≥ 24 Gy cranial radiation (CRT), 224 (24%) < 24 Gy, and 389 (41.6%) no CRT, of whom 373 were treated with high dose methotrexate (HDMTX). Nearly the entire cohort had at least one chronic condition (98%) and 59% a severe/life-threating condition (grades 3-4). The most common were obesity (70%), hypertension (70%), and peripheral sensory neuropathy (51.6%). Chronic conditions were more common in males (52% vs. 48%, p=0.003). By age 40, the cumulative prevalence of at least one chronic condition was 90% and 69% for a severe/life-threatening condition. After adjusting for age at diagnosis, age at evaluation, and gender, survivors exposed to CRT were more likely to have a severe/life-threatening condition (RR 1.3 95% CI 1.1-1.5) than those not exposed to CRT. One hundred sixty-eight survivors had 228 second neoplasms (121 malignant [79 non-melanoma skin cancers], 107 benign). Attention and executive function deficits (mild and severe) were identified across each category of CNS directed therapy (≥ 24 Gy CRT, < 24 Gy CRT, HDMTX) [table]. After adjustment for age at diagnosis and gender, those treated with CRT only were more likely to have mild (RR 1.4 95% CI 1.0-1.9) and severe (RR 2.2 95% CI 1.7-3.0) attention and executive function (RR 1.4 95% CI 1.1-1.8, RR 1.7 95% CI 1.4-2.2) deficits compared to those treated with HDMTX. Abnormal 6MWT was identified among 20.5% of the ALL survivors, 26.7% of those treated with CRT and 15.1% HDMTX. TUGS was abnormal in 35.5% of the cohort, 41.6% treated with CRT, 27.3% HDMTX. Adjusting for age at diagnosis, age at evaluation, gender, BMI, and educational attainment, CRT was significantly associated with impaired 6MWT (RR 1.8 95% CI 1.1-2.9) but not TUGS (RR 1.1 95% CI 0.9-1.4). Conclusions: Systematic evaluation identified a substantial number of medical conditions, deficits in attention and executive function, and functional impairments in adult survivors of childhood ALL at a young age. Removal of CRT has significantly reduced, but not eliminated, the occurrence of late effects. Maintaining health and quality of life in this population requires significant medical surveillance, counseling, and lifestyle modifications. Table CNS Directed Threapy Neurocognitive Deficit ≥ 24 Gy < 24 Gy HDMTX Attention Mild 19.3% 20.6% 17.1% Severe 31.6% 22.8% 14.1% Executive Function Mild 28.3% 28.2% 24.4% Severe 35.4% 24.1% 20.3% Disclosures No relevant conflicts of interest to declare.

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