Evaluation of telephone cardiopulmonary resuscitation performance in current practice in Saudi Arabia

Objectives: out-of-hospital cardiac arrest (OHCA) is a global health problem with a low survival rate. Telephone cardiopulmonary resuscitation (T-CPR) guidance by emergency medical services (EMS) dispatchers can improve CPR performance and, consequently, survival rates. Accordingly, the American Heart Association (AHA) has released performance standards for T-CPR in current practice to improve its quality. However, no study has examined T-CPR performance in Saudi Arabia. Therefore, this study aims to evaluate T-CPR performance in the Saudi Arabian EMS system.Methods: a retrospective observation of OHCA calls in current practice was conducted in Riyadh, Saudi Arabia. OHCA calls were reviewed to identify those that met the selection criteria. Variables collected included return of spontaneous circulation (ROSC), OHCA recognition rate, time from EMS call receipt to location acquisition, to OHCA recognition and to commencement of CPR.Results: a total of 308 OHCA cases were reviewed, and 100 calls were included. ROSC was identified in 10% of the included calls. OHCA was correctly recognized in 62% of the calls. The time to OHCA identification and CPR performance from EMS call receipt were found to be 303 s and 367 s, respectively.Conclusion: T-CPR performance in Saudi Arabia is below AHA standards. However, this is similar to what has been reported in the literature. Avoiding any unnecessary call transfer during OHCA calls and prompt identification of callers’ locations could improve T-CPR performance

Incidence and predictors of adverse events and outcomes for adult critically ill patients transferred by paramedics to a tertiary care medical facility

Objective: The aim of this study was to determine the incidence of adverse events and patients’ outcomes in inter‑facility critical care transfers by paramedics. Methods: We conducted a retrospective cohort study of adults undergoing inter‑facility transfer to a tertiary medical facility by paramedics. We included all patients transferred between 1st June, 2011 and 31st December, 2014. The primary outcome is in‑transit adverse event and the secondary outcome is in‑hospital mortality. Multiple logistic regression models were fitted to assess predictor variables for adverse events and in‑hospital mortality. Results: The incidence of adverse events was 13.7% (31/227 patients had in‑transit adverse event); the most common adverse events reported were desaturation and hypotension. A unit increase in risk score for transported patients (RSTP) significantly increased the occurrence of adverse events (adjusted odds ratio [OR]: 1.36, 95% confidence interval [CI]: 1.07–1.72 and adjusted P = 0.01). Compared to medical patients, cardiac patients were less likely to develop adverse events (adjusted OR: 0.117, 95% CI: 0.02–0.52 and adjusted P < 0.01). The in‑hospital mortality was 30.4% and 30-day survival was 68.1%. For two patients whose age differed by 1 year, the older patient was more likely to die (adjusted OR: 1.03, 95% CI: 1.01–1.05 and P < 0.01) and a unit increase in RSTP significantly increased occurrence of in‑hospital mortality (adjusted OR: 1.30, 95% CI: 1.0–1.60 and P = 0.01). Conclusion: The incidence of adverse events was 13.7%. The most common observed adverse events were desaturation and hypotension. In‑hospital mortality was 30.4% and 30-day survival was 68.1%

Evaluation of Change in Knowledge and Attitude of Emergency Medicine Residents after Introduction of a Rotation in Emergency Medical Services and Disaster Medicine

Background: Saudi Board of Emergency Medicine (SBEM) graduates are involved in a 1-month rotation in emergency medical services (EMSs) and disaster medicine. The purpose of this study was to evaluate change in knowledge and attitude of EM residents after the introduction of the EMS and disaster medicine rotation. Materials and Methods: The study included 32 3rd-year SBEM residents. A pretest/posttest design and a five-point Likert scale were used. The data included a response to a questionnaire developed by EMS and disaster experts. The questionnaire was distributed on the 1st day of the rotation and 45 days after. Satisfaction questionnaires were distributed after the rotation. The data were analyzed using SPSS 20. Results: Twenty-five residents responded to the satisfaction survey (75%). The overall satisfaction with the course modules was high; the course content showed the highest level of satisfaction (96%), and the lowest satisfaction was for the air ambulance ride outs (56%). The results of the pre-/post-test questionnaire showed an increase of 18.5% in the residents mean score (P < 0.001). In the open-ended section, the residents requested that the schedule is distributed before the course start date, to have more field and hands-on experience, and to present actual disaster incidents as discussion cases. The residents were impressed with the organization and diversity of the lectures, and to a lesser extent for the ambulance ride outs and the mass casualty incident drill l. Seventy-one percent indicated that they would recommend this course to other residents. Conclusion/Recommendation: This study showed that a structured course in EMS and disaster medicine had improved knowledge and had an overall high level of satisfaction among the residents of the SBEM. Although overall satisfaction and improvement in knowledge were significant, there are many areas in need of better organization