19,595 research outputs found

    Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) - a programme of research to facilitate recognition of stroke by emergency medical dispatchers

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    Background: Rapid access to emergency stroke care can reduce death and disability by enabling immediate provision of interventions such as thrombolysis, physiological monitoring and stabilisation. One of the ways that access to services can be facilitated is through emergency medical service (EMS)dispatchers. The sensitivity of EMS dispatchers for identifying stroke is < 50%. Studies have shown that activation of the EMSs is the single most important factor in the rapid triage and treatment of acute stroke patients. Objectives: To facilitate recognition of stroke by emergency medical dispatchers (EMDs). Design: An eight-phase mixed-methods study. Phase 1: a retrospective cohort study exploring stroke diagnosis. Phase 2: semi-structured interviews exploring public and EMS interactions. Phases 3 and 4: a content analysis of 999 calls exploring the interaction between the public and EMDs. Phases 5–7: development and implementation of stroke-specific online training (based on phases 1–4). Phase 8: an interrupted time series exploring the impact of the online training. Setting: One ambulance service and four hospitals. Participants: Patients arriving at hospital by ambulance with stroke suspected somewhere on the stroke pathway (phases 1 and 8). Patients arriving at hospital by ambulance with a final diagnosis of stroke (phase 2). Calls to the EMSs relating to phase 1 patients (phases 3 and 4). EMDs (phase 7). Interventions: Stroke-specific online training package, designed to improve recognition of stroke for EMDs. Main outcome measures: Phase 1: symptoms indicative of a final and dispatch diagnosis of stroke. Phase 2: factors involved in the decision to call the EMSs when stroke is suspected. Phases 3 and 4: keywords used by the public when describing stroke and non-stroke symptoms to EMDs. Phase 8: proportion of patients with a final diagnosis of stroke correctly dispatched as stroke by EMDs. Results: Phase 1: for patients with a final diagnosis of stroke, facial weakness and speech problems were significantly associated with an EMD code of stroke. Phase 2: four factors were identified – perceived seriousness; seeking and receiving lay or professional advice; caller’s description of symptoms and emotional response to symptoms. Phases 3 and 4: mention of ‘stroke’ or one or more Face Arm Speech Test (FAST) items is much more common in stroke compared with non-stroke calls. Consciousness level was often difficult for callers to determine and/or communicate. Phase 8: there was a significant difference (p = 0.003) in proportions correctly dispatched as stroke – before the training was implemented 58 out of 92 (63%); during implementation of training 42 out of 48 (88%); and after training implemented 47 out of 59 (80%). Conclusions: EMDs should be aware that callers are likely to describe loss of function (e.g. unable to grip) rather than symptoms (e.g. weakness) and that callers using the word ‘stroke’ or describing facial weakness, limb weakness or speech problems are likely to be calling about a stroke. Ambiguities and contradictions in dialogue about consciousness level arise during ambulance calls for suspected and confirmed stroke. The online training package improved recognition of stroke by EMDs. Recommendations for future research include testing the effectiveness of the Emergency Stroke Calls: Obtaining Rapid Telephone Triage (ESCORTT) training package on the recognition of stroke across other EMSs in England; and exploring the impact of the early identification of stroke by call handlers on patient and process outcomes. Funding: The National Institute for Health Research Programme Grants for Applied Research programme

    Understanding The Decision-Making Process of Local Level Emergency Managers and Future Impacts of Social Data

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    During the course of a natural disaster, affected populations turn to different avenues to attempt to communicate their needs and locations while emergency managers are faced with the task of making quick decisions to aid in the response effort. The decisions that emergency managers face are affected by factors such as available resources, responder safety, and source of information. In this research, we interview emergency managers about the 2009 North American Ice Storm and a flooding event in late April of 2017 to understand the decisions made and the factors that affected these decisions. Using these interviews, a list of interview questions using the Critical Decision Method were created that could be used to more deeply understand the decisions and decision-making process of a local-level emergency manager during a disaster response event. Additionally, animations were created to illustrate the comparative effectiveness of disaster response routing plans developed with and without the consideration of social data based on data inspired by a real event

    Urban Air Mobility Fleet Manager Gap Analysis and System Design

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    NASA's Urban Air Mobility (UAM) Sub-Project is engaged in research to support the introduction of air taxis into the National Airspace System. Such operations will require a range of communication, navigation, and surveillance systems. Air vehicles for UAM are under development and will initially have human pilots. Separation from other aircraft, obstacles, and weather may be a pilot responsibility or provided by an operator's ground-based systems. Eventually, air taxis may be flown from the ground or fly autonomously. There will be a need for dispatch services for UAM. This report presents a gap analysis, data and capability requirements, and workstation design concepts for the UAM dispatcher or Fleet Manager (FM) position

    Challenge Patient Dispatching in Mass Casualty Incidents

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    Efficient management of mass casualty incidents is complex, since regular emergency medical services struc-tures have to be switched to a temporary “disaster mode” involving additional operational and tactical struc-tures. Most of the relevant decisions have to be taken on-site in a provisional and chaotic environment. Data gathering about affected persons is one side of the coin; the other side is on-site patient dispatching requiring information exchange with the regular emergency call center and destination hospitals. In this paper we extend a previous conference contribution about the research project e-Triage to the aspect of patient data and on-site patient dispatching. Our considerations reflect the situation in Germany, which deserves from our point of view substantial harmonization

    Situational Awareness Support to Enhance Teamwork in Collaborative Environments

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    Modern collaborative environments often provide an overwhelming amount of visual information on multiple displays. The multitude of personal and shared interaction devices leads to lack of awareness of team members on ongoing activities, and awareness of who is in control of shared artefacts. This research addresses the situational awareness (SA) support of multidisciplinary teams in co-located collaborative environments. This work aims at getting insights into design and evaluation of large displays systems that afford SA and effective teamwork

    Anytime Cognition: An information agent for emergency response

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    Planning under pressure in time-constrained environments while relying on uncertain information is a challenging task. This is particularly true for planning the response during an ongoing disaster in a urban area, be that a natural one, or a deliberate attack on the civilian population. As the various activities pertaining to the emergency response need to be coordinated in response to multiple reports from the disaster site, a user finds itself cognitively overloaded. To address this issue, we designed the Anytime Cognition (ANTICO) concept to assist human users working in time-constrained environments by maintaining a manageable level of cognitive workload over time. Based on the ANTICO concept, we develop an agent framework for proactively managing a user’s changing information requirements by integrating information management techniques with probabilistic plan recognition. In this paper, we describe a prototype emergency response application in the context of a subset of the attacks devised by the American Department of Homeland Security

    Broadening Responsibilities: Consideration Of The Potential To Broaden The Role Of Uniformed Fire Service Employees

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    What is this report about? This report, commissioned by the National Joint Council for Local Authority Fire and Rescue Services (NJC), aims to identify what impact, if any, firefighters can have on the delivery of emergency medical response and wider community health interventions in the UK. What are the overall conclusions? Appropriately trained and equipped firefighters co-responding1 to targeted, specific time critical medical events, such as cardiac arrest, can improve patient survival rates. The data also indicate that there is support from fire service staff – and a potential need from members of the public, particularly the elderly, isolated or vulnerable – to expand ‘wider work’. This includes winter warmth assessments, Safe and Well checks, community defibrillator training and client referrals when staff believe someone may have dementia, are vulnerable or even, for example, have substance dependencies such as an alcohol addiction. However, there is currently insufficient data to estimate the net benefit of this work

    Labour Administration Reforms in China

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    [Excerpt] This publication provides an explanation of the comprehensive labour administration system in China, including its recent advances, with emphasis on its public services functions, such as public employment, labour inspection and social insurance services. With the recent improvements to both the legal framework and the institutions of labour administration, it is believed that these public services will play bigger and more active roles in ensuring compliance with legislation and protecting the legitimate rights and interests of employers and workers alike
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