OBJECTIVES: Patients are the most common source of violence against EMS personnel. This study aims at elucidating specific clinical features in patients with mental alteration and aggressive behaviour increasing risk of violence. MATERIAL AND METHODS: This consecutive cross-sectional retrospective study analysed consecutive patients treated for prespecified list of primary diagnoses by one EMS provider in the Czech Republic between 1 January 2021 and 31 December 2023. The effect of individual features of medical history and present symptoms on the occurrence of violence, need for the Police assistance and use of restraints was evaluated, using linear regression model. RESULTS: 410 patients were evaluated. Verbal and brachial violence was present in 21.5 and 12.9 %, respectively. Police assistance was needed in 48.3 %, restraints were used in 4.6 %. The most significant predictor for violence, need for Police or restraints was agitation (OR 7.02, CI 4.14 - 11.90; OR 2.60, CI 1.60 - 4.24, OR 11.02, CI 3.49 - 34.80 respectively). Other predictors of violence included history of acute psychotic attacks and psychotic disorders, or outpatient psychiatry care. Among other predictors for Police assistance was presence of delusions, paranoia and history of outpatient psychiatry care. CONCLUSION: Prehospital care for patients with mental status alteration and aggressive behaviour is complex. Some clinical features seem to increase the risk of violence. Future research in the evaluation of agitated and violent patients is warranted to find strategies of risk mitigation for EMS personnel.
- MeSH
- Aggression * psychology MeSH
- Adult MeSH
- Mental Disorders epidemiology therapy MeSH
- Restraint, Physical statistics & numerical data MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Violence statistics & numerical data psychology MeSH
- Police MeSH
- Cross-Sectional Studies MeSH
- Retrospective Studies MeSH
- Aged MeSH
- Emergency Medical Services * statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
- MeSH
- COVID-19 * epidemiology mortality nursing therapy MeSH
- Humans MeSH
- Extracorporeal Membrane Oxygenation statistics & numerical data MeSH
- Hospitals, Teaching MeSH
- Life Support Care statistics & numerical data MeSH
- Emergency Medical Services methods statistics & numerical data MeSH
- Check Tag
- Humans MeSH
We performed a randomized pre-hospital clinical study to compare two different techniques of ultrasound-guided peripheral venous catheter (PVC) insertion and the conventional cannulation technique in the pre-hospital emergency setting, with a specific focus on the procedural success rate and the time required to introduce PVC. This pre-hospital prospective controlled randomized clinical trial allocated patients treated by emergency medical service to undergo PVC insertion fully controlled by ultrasound (ultrasound guidance of the PVC tip until it penetrates the lumen, group A), PVC insertion partially controlled by ultrasound (target vein identification only, group B) or to receive PVC without any ultrasound guidance (group C). The study outcomes were monitored until the patient was admitted to the hospital. A total of 300 adult patients were enrolled. The success of the first attempt (group A: 88%, group B: 94%, group C: 76%, p < 0.001) and overall success rate (A: 99%, B: 99%, C: 90%, p < 0.001) were significantly higher in the group A, followed by group B when compared to group C. The number of attempts was significantly lower (A: 1.18 ± 0.54, B: 1.05 ± 0.22, C: 1.22 ± 0.57, p < 0.001) and the time required for the procedure shorter (A: 75.3 ± 60.6, B: 43.5 ± 26.0, C: 82.3 ± 100.9 s, p < 0.001) in group B compared to groups A and C. Both techniques of ultrasound-guided PVC placement were associated with higher success rates than the conventional method. However, PVC insertion partially controlled by ultrasound was superior to full ultrasound guidance in terms of time and number of cannulation attempts required.
- MeSH
- Analysis of Variance MeSH
- Ultrasonography, Interventional instrumentation methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Catheterization, Peripheral instrumentation methods MeSH
- Prospective Studies MeSH
- Chi-Square Distribution MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Emergency Medical Services methods standards statistics & numerical data MeSH
- Jugular Veins diagnostic imaging MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND: Blood products are a lifesaving commodity in the treatment of major trauma. Although there is little evidence for use of pre-hospital blood products (PHBP) in seriously injured patients, an increasing number of emergency medical services have started using PHBP for treatment of major haemorrhage. The primary aim of this survey was to establish the degree of prehospital blood product use throughout Europe and discover main indications. The secondary aim was to evaluate opinions about PHBP and also the experience and the personal views of its users. METHODS: The subcommittee for Critical Emergency Medicine of the European Society of Anaesthesiology (ESA) held an online survey of European Helicopter Emergency Services (HEMS) and all French Services d'Aide Médicale Urgente (SAMU) regions. It contained 13 questions both open and multiple-choice about the frequency transfusions are carried out, the PHBP used and the perceived benefit. The survey was distributed to the corresponding HEMS leads in 14 European countries. RESULTS: In total there were 172 valid responses; overall 48% of all respondents have prehospital access to packed red cells, 22% to fresh plasma and 14% use lyophilised plasma. Besides blood product administration, 94% of all services use tranexamic acid. Sixty five percent of all replies came from French and from German services (37 and 28% respectively). PHBP were mainly used for trauma related emergencies. France has the highest uptake of use of blood products at 89%, whereas the rate in Germany was far lower at 6%. Fifty five percent of the service leads felt that PHBP are beneficial, and even lifesaving in individual cases despite being needed infrequently. CONCLUSIONS: We found remarkable dissimilarities in practice between the different European countries. Even if there is not an absolute consensus amongst providers on the benefit of PHBP, the majority feel they are beneficial. The difference in practice is possibly related to the perceived lack of evidence on prehospital blood transfusion. We suggest to include the use of PHBP in trauma registries in order to consolidate the existing evidence.
- MeSH
- Antifibrinolytic Agents administration & dosage MeSH
- Blood Transfusion statistics & numerical data MeSH
- Hemorrhage therapy MeSH
- Tranexamic Acid administration & dosage MeSH
- Humans MeSH
- Surveys and Questionnaires MeSH
- Emergency Medical Services statistics & numerical data MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
INTRODUCTION: Prehospital and emergency medical services (EMS) providers are usually the first to respond to an individual's urgent health needs, sometimes in emotionally charged circumstances. Because violence toward EMS providers in the Czech Republic is often overlooked and under-reported, we do not have a complete understanding of the extent of such violence, nor do we have recommendations from EMS professional organizations on how to resolve this problem in prehospital emergency medicine. METHODS: We conducted this study to explore the process of violence against EMS providers, using the Strauss/Corbin systematic approach of grounded theory to create a paradigm model. The participants in this research included personnel who had at least two years experience in the EMS systems of the city of Prague and the Central Bohemian Region, and who had been victims of violence. Our sample included 10 registered paramedics and 10 emergency medical technicians ages 23-33 (mean ± standard deviation: 27.7). The impact of communication during EMS delivery, in the context of violence from patients or their relatives, emerged as the core category and the main focus of our study. The five main groups of the paradigm model of violence against EMS personnel included causal, contextual and intervening conditions, strategies, and consequences. RESULTS: Of the 20 study participants, 18 reported experiencing an attack during the night shift. Ten participants experienced violence on the street, and 10 inside an ambulance. The perpetrators in all 18 cases were men. The behavior of EMS personnel plays a crucial role in how violent confrontations play out: nonprofessional behavior with drunken or addict patients increases the possibility of violence in 70% of cases. CONCLUSION: We found that paramedics and EMTs were exposed to verbal abuse and physical violence. However, in 10 of the violent encounters reported by our 20 participants, the attack was perpetrated by otherwise-ordinary people (ie, individuals with strong family support and good jobs) who found themselves in a very stressful situation. Thanks to grounded theory we learned that for all 20 participants there was a potential opportunity to prevent the conflict.
- MeSH
- Adult MeSH
- Qualitative Research MeSH
- Humans MeSH
- Workplace Violence * prevention & control psychology statistics & numerical data MeSH
- Dissent and Disputes MeSH
- Allied Health Personnel * psychology statistics & numerical data MeSH
- Professionalism MeSH
- Risk Factors MeSH
- Emergency Medicine MeSH
- Emergency Medical Services statistics & numerical data MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
BACKGROUND: In Europe, survival rates after out-of-hospital cardiac arrest (OHCA) vary widely. Presence/absence and differences in implementation of systems dispatching First Responders (FR) in order to arrive before Emergency Medical Services (EMS) may contribute to this variation. A comprehensive overview of the different types of FR-systems used across Europe is lacking. METHODS: A mixed-method survey and information retrieved from national resuscitation councils and national EMS services were used as a basis for an inventory. The survey was sent to 51 OHCA experts across 29 European countries. RESULTS: Forty-seven (92%) OHCA experts from 29 countries responded to the survey. More than half of European countries had at least one region with a FR-system. Four categories of FR types were identified: (1) firefighters (professional/voluntary); (2) police officers; (3) citizen-responders; (4) others including off-duty EMS personnel (nurses, medical doctors), taxi drivers. Three main roles for FRs were identified: (a) complementary to EMS; (b) part of EMS; (c) instead of EMS. A wide variation in FR-systems was observed, both between and within countries. CONCLUSIONS: Policies relating to FRs are commonly implemented on a regional level, leading to a wide variation in FR-systems between and within countries. Future research should focus on identifying the FR-systems that most strongly influence survival. The large variation in local circumstances across regions suggests that it is unlikely that there will be a 'one-size fits all' FR-system for Europe, but examining the role of FRs in the Chain of Survival is likely to become an increasingly important aspect of OHCA research.
- MeSH
- Databases, Factual MeSH
- Emergency Responders * MeSH
- Cardiopulmonary Resuscitation MeSH
- Middle Aged MeSH
- Humans MeSH
- Survival Rate MeSH
- Surveys and Questionnaires MeSH
- Aged MeSH
- Emergency Medical Services * statistics & numerical data MeSH
- Out-of-Hospital Cardiac Arrest therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
Objectives: Emergency medical events are not randomly distributed over a certain area. Many hidden patterns may influence this distribution due to several socioeconomic, demographic, and geospatial factors. Identifying these patterns will help health policy makers have a better planning for emergency medical services (EMS) in finding high-risk places, and people at high risk. Methods: Mashhad city EMS calls records have been analyzed retrospectively. The data came from a city wide registry including 154528 calls to EMS from March 21, 2013 to March 20, 2014. To recognize the location of the requests all the recorded addresses were mapped into a single number representing the municipality district of the call. Pearson correlation coefficient is used to represent the association between ambulance calls and socioeconomic factors (e.g. income level, house ownership). Results: The average of age of the patients is 42.43 years (S.D=21.7) with 50.5% male, 40.7% female and 8.8% of the sex are not registered. 64% of the calls are medical related and the remaining 36% are trauma related requests. Although the regions with lower socioeconomic status are more vulnerable, they request ambulances less frequently than the regions with higher socioeconomic status. The ambulance requests are more frequent in regions with higher education (university studies) than the regions with lower education. In addition, there is a relationship between the economic status of people and their ambulance requests that regions with higher economic status request ambulances more frequently. Conclusion: Results of the study shows that there is a relationship between the socioeconomic status of people and their calls to EMS that can help policy makers in finding people in potentially high risk locations and provide services to reduce mortality and morbidity.
- MeSH
- Humans MeSH
- Health Care Reform MeSH
- Quality Control MeSH
- Hospital Administration * MeSH
- Health Services Administration * MeSH
- Emergency Medical Services statistics & numerical data MeSH
- Health Policy * MeSH
- Health Personnel organization & administration MeSH
- Check Tag
- Humans MeSH
- Publication type
- Newspaper Article MeSH
AIMS: The ESCAPE-NET project ("European Sudden Cardiac Arrest network- towards Prevention, Education and New Effective Treatments") aims to study: (1) risk factors and mechanisms for the occurrence of sudden cardiac arrest (SCA) in the population, and (2) risk factors and treatment strategies for survival after SCA on a European scale. METHODS: This is an Horizon2020 funded program of the European Union, performed by a European public-private consortium of 16 partners across 10 EU countries. There are 11 deep-phenotyped SCA cohorts for the study of risk factors and treatment strategies for survival after SCA, and 5 deep-phenotyped observational prospective population cohorts for the study of risk factors for occurrence of SCA. Personalized risk scores for predicting SCA onset and for predicting survival after SCA will be derived and validated. RESULTS: The 11 clinical studies with SCA cases comprise 85,790 SCA cases; the 5 observational prospective population cohorts include 53,060 subjects. A total of 15,000 SCA samples will be genotyped for common and rare variants at the Helmholtz Zentrum München (Germany) using the Illumina Global Screening Array which contains > 770,000 SNPs, and after imputation, a database of an estimated > 9 million variants will be available for genome wide association studies. Standardization of risk factors definition and outcomes is ongoing. An Executive Committee has been created along with a Collaboration Policy document. CONCLUSION: ESCAPE-NET will complement ongoing efforts on SCA outside Europe and within Europe including the EuReCa project.
- MeSH
- Databases, Factual MeSH
- Risk Assessment MeSH
- Cohort Studies MeSH
- Comorbidity MeSH
- Humans MeSH
- Death, Sudden, Cardiac epidemiology MeSH
- Risk Factors MeSH
- Population Surveillance methods MeSH
- Emergency Medical Services statistics & numerical data MeSH
- Out-of-Hospital Cardiac Arrest etiology mortality MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Observational Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
