Can emergency dispatch communication research go deeper?

EDITORIA

Outcomes of different health care contexts for direct transport to a trauma center versus initial secondary center care: A systematic review and meta-analysis

Introduction: Within a trauma system, pre-hospital care is the first step in managing the trauma patient. Timely and appropriate transport of the injured patient to the most appropriate facility is important. Many trauma systems mandate that serious trauma cases are transported directly to a level I trauma center unless transfer to a closer hospital is deemed necessary to resuscitate and stabilize the patient prior to onward transfer to definitive care. Statistical and clinical heterogeneity is often high and is likely to be influenced by the heath care context.Methods: We conducted a systematic review and meta-analysis to compare patient outcomes for patients with serious trauma transported directly to a Level I/II trauma center (‘direct’ group) to those transported to a healthcare facility before transfer to the Level I/II trauma center (‘transfer’ group). A search of bibliographic databases and secondary sources that focus on trauma was made. Studies were grouped by region: United States of America, Canada, Europe, Asia, Australia and New Zealand and South Africa.Results: The review included 43,554 patients from the 30 studies that met the selection criteria. Heterogeneity of the studies was high (I2 71%) overall but low for European, Asian, and Australian and New Zealand studies. There was considerable variation between studies in the structure, policies and practices of the respective trauma systems. The effect of “directness” on patient outcomes was inconsistent.Conclusion: The current research evidence does not support nor refute a position that all serious trauma patients be routinely transported directly to a level I/II trauma center. As this is a complex issue, local health-care context and injury profile influence trauma policy and practice

Using linked hospitalisation data to detect nursing sensitive outcomes: A retrospective cohort study

Background: Nursing sensitive outcomes are adverse patient health outcomes that have been shown to be associated with nursing care. Researchers have developed specific algorithms to identify nursing sensitive outcomes using administrative data sources, although contention still surrounds the ability to adjust for pre-existing conditions. Existing nursing sensitive outcome detection methods could be improved by using look-back periods that incorporate relevant health information from patient’s previous hospitalisations. Design and setting: Retrospective cohort study at three tertiary metropolitan hospitals in Perth, Western Australia.Objectives: The objective of this research was to explore the effect of using linked hospitalisation data on estimated incidence rates of eleven adverse nursing sensitive outcomes by retrospectively extending the timeframe during which relevant patient disease information may be identified. The research also explored whether patient demographics and/or the characteristics of their hospitalisations were associated with nursing sensitive outcomes.Results: During the 5 year study period there were 356,948 hospitalisation episodes involving 189,240 patients for a total of 2,493,654 inpatient days at the three tertiary metropolitan hospitals. There was a reduction in estimated rates for all nursing sensitive outcomes when a look-back period was applied to identify relevant health information from earlier hospitalisations within the preceding 2 years. Survival analysis demonstrates that the majority of relevant patient disease information is identified within approximately 2 years of the baseline nursing sensitive outcomes hospitalisation. Compared to patients without, patients with nursing sensitive outcomes were significantly more likely to be older (70 versus 58 years), female, have Charleson comorbidities, be direct transfers from another hospital, have a longer inpatient stay and spend time in intensive care units (p 0.001).Conclusions: The results of this research suggest that nursing sensitive outcome rates maybe over-estimated using current detection methods. Linked hospitalisation data enables the use of look-back periods to identify clinically relevant diagnosis codes recorded prior to the hospitalisation in which a nursing sensitive outcome is detected. Using linked hospitalisation data to incorporate look-back periods offers an opportunity to increase the accuracy of nursing sensitive outcome detection when using administrative data sources

Cardiopulmonary resuscitation quality: Widespread variation in data intervals used for analysis

AIM: There is a growing body of evidence for the relationship between CPR quality and survival in cardiac arrest patients. We sought to describe the characteristics of the analysis intervals used across studies. METHODS: Relevant papers were selected as described in our recent systematic review. From these papers we collected information about (1) the time interval used for analysis; (2) the event that marked the beginning of the analysis interval; and (3) the minimum amount of CPR quality data required for a case to be included in the analysed cohort. We then compared this data across papers. RESULTS: Twenty-one studies reported on the association between CPR quality and cardiac arrest patient survival. In two thirds of studies data from the start of the resuscitation episode was analysed, in particular the first 5minutes. Commencement of the analysis interval was marked by various events including ECG pad placement and first chest compression. Nine studies specified a minimum amount of data that had to have been collected for the individual case to be included in the analysis; most commonly one minute of data. The use of shorter intervals allowed for inclusion of more cases as it included cases that did not have a complete dataset. CONCLUSION: To facilitate comparisons across studies, a standardized definition of the data analysis interval should be developed; one that maximises the amount of cases available without compromising the data's representability of the resuscitation effort

In vitro fertilization is associated with an increased risk of borderline ovarian tumours

Objectives: To compare the risk of borderline ovarian tumours in women having in vitro fertilization (IVF) with women diagnosed with infertility but not having IVF. Methods: This was a whole-population cohort study of women aged 20–44 years seeking hospital infertility treatment or investigation in Western Australia in 1982–2002. Using Cox regression, we examined the effects of IVF treatment and potential confounders on the rate of borderline ovarian tumours. Potential confounders included parity, age, calendar year, socio-economic status, infertility diagnoses including pelvic inflammatory disorders and endometriosis and surgical procedures including hysterectomy and tubal ligation. Results: Women undergoing IVF had an increased rate of borderline ovarian tumours with a hazard ratio (HR) of 2.46 (95% confidence interval [CI] 1.20–5.04). Unlike invasive epithelial ovarian cancer, neither birth (HR 0.89; 95% CI 0.43–1.88) nor hysterectomy (1.02; 0.24–4.37) nor sterilization (1.48; 0.63–3.48) appeared protective and the rate was not increased in women with a diagnosis of endometriosis (HR 0.31; 95% CI 0.04–2.29). Conclusions: Women undergoing IVF treatment are at increased risk of being diagnosed with borderline ovarian tumours. Risk factors for borderline ovarian tumours appear different from those for invasive ovarian cancer

Epidemiology of population mortality related to falls in california 2000–2016: an increasing challenge for EMS

Background: Falls mortality increases with age and the U.S. population is aging steadily. This study examined the epidemiology of mortality in California this century due to unintentional falls. Method: Deaths caused by falls were extracted from California Department of Public Health data. Yearly Californian population estimates from the California Department of Finance were used to calculate the incidence of falls mortality. Results: There were 32 276 deaths attributed to falls, out of 618,589,117 person-years. Deaths at age ≥60 years accounted for 26 669 (83%). There were 15% more deaths during winter months, compared with summer. From age 70 mortality approximately doubled every five additional years of age. The age-adjusted falls mortality rate per 1 00 000 person-years (against the 2000 U.S. Standard Population) increased over 2000–2016 from 3.0 to 4.5 in females and from 8.9 to 9.8 in males. The number of falls deaths increased by a mean 77 per year, (95% CI 72, 83, R2=0.98, p<0.0001), doubling from 1251 in 2000 to 2582 in 2016. Conclusion: It may be prudent for EMS in California to anticipate continued increases in falls mortality. If the annual number of falls-related deaths continues to climb by an average of 77 deaths per year, then California will experience more than 3000 falls deaths per year sometime between 2025 and 2030. Recent increases were partly driven by a combination of increasing population and changes in the age distribution, however, age-adjusted mortality rates also increased, especially in females and older age groups. Conflict of interest None. Funding None

A scoping review to determine the barriers and facilitators to initiation and performance of bystander cardiopulmonary resuscitation during emergency calls

Background: To maximise out-of-hospital cardiac arrest (OHCA) patients’ survival, bystanders should perform continuous, good quality cardiopul- monary resuscitation (CPR) until ambulance arrival. Objectives: To identify published literature describing barriers and facilitators between callers and call-takers, which affect initiation and perfor- mance (continuation and quality) of bystander CPR (B-CPR) throughout the OHCA emergency call. Eligibility criteria: Studies were included if they reported on the population (emergency callers and call-takers), concept (psychological, physical and communication barriers and facilitators impacting the initiation and performance of B-CPR) and context (studies that analysed OHCA emergency calls). Sources of evidence: Medline, CINAHL, Cochrane CENTRAL, Embase, Scopus and ProQuest were searched from inception to 9 March 2022. Charting methods: Study characteristics were extracted and presented in a narrative format accompanied by summary tables. Results: Thirty studies identified factors that impacted B-CPR initiation or performance during the emergency call. Twenty-eight studies described barriers to the provision of CPR instructions and CPR initiation, with prominent themes being caller reluctance (psychological), physical ability (phys- ical), and callers hanging up the phone prior to CPR instructions (communication). There was little evidence examining barriers and facilitators to ongoing CPR performance (2 studies) or CPR quality (2 studies). Conclusions: This scoping review using emergency calls as the source, described barriers to the provision of B-CPR instructions and B-CPR ini- tiation. Further research is needed to explore facilitators and barriers to B-CPR continuation and quality throughout the emergency call, and to exam- ine the effectiveness of call-taker strategies to motivate callers to perform B-CPR

Emotions in telephone calls to emergency medical services involving out-of-hospital cardiac arrest: A scoping review

Aims: The purpose of this scoping review was to identify and synthesise existing research evidence on emotions in the context of emergency phone calls to emergency medical services (EMS) involving out-of-hospital cardiac arrest (OHCA). The specific objectives were to identify studies that (1) described emotions during emergency OHCA calls; (2) specified an instrument or method for measuring/assessing emotions; and (3) examined the relationship between emotions and call outcomes or patient outcomes. Methods/Data sources: Five databases were searched on 18 November 2021: Medline, Embase, PsycInfo, CINAHL, and the Cochrane Review Database. Included studies required the following three concepts to be addressed: emotions in the context of EMS calls that involved OHCA. Calls also needed to be made by a ‘second-party’ caller; and each study needed to address at least one of the three specific objectives, as outlined above. The review was conducted in accordance with the Joanna Briggs Institute guidelines for evidence synthesis for scoping reviews. Results: Thirteen eligible studies were included for synthesis. All studies met Objective 1; six studies met Objective 2; and seven met Objective 3. One study reported patient fatality due to heightened emotions and ensuing ineffective communications between callers and call-takers. Conclusion: The review highlights a significant gap in the evidence base of emotions in emergency OHCA-related calls, and the need for a more comprehensive and effective method in assessing and measuring emotions in this context. Relationships between emotions (their expressions and perceptions) and call outcomes (including patient outcomes) also need more rigorous investigation

Trends in out-of-hospital cardiac arrest incidence, patient characteristics and survival over 18 years in Perth, Western Australia

Objectives: To investigate trends in the incidence, characteristics, and survival of out-of-hospital cardiac arrests (OHCA) in the Perth metropolitan area between 2001 and 2018. Methods: We calculated the crude incidence rate, age-standardised incidence rate (ASIR) and age- and sex-specific incidence rates (per 100,000 population) for OHCA of presumed cardiac aetiology. ASIRs were calculated using the direct method of standardisation using the 2001 Australian Population standard. Survival was assessed at return of spontaneous circulation at emergency department arrival and at 30 days. Temporal trends in patient and arrest characteristics were assessed with logistic regression, while trends in incidence were assessed using Joinpoint regression. Survival trends were assessed using binary logistic regression. Results: A total of 18,417 OHCAs of presumed cardiac aetiology were attended by emergency medical services in Perth between 2001 and 2018. Overall, there were no significant changes in the crude or ASIR of OHCA over the study period, although OHCA incidence in 15–39 year-old males increased by 12.5% annually between 2011 and 2018. Both bystander cardiopulmonary resuscitation and bystander defibrillation increased over the study period, while the proportion of shockable arrests declined. Thirty-day OHCA survival improved significantly over time, with the odds of survival (in bystander-witnessed, initial shockable rhythm arrests) improving 12% (95% CI, 9.0% to 14.0%) annually, from 8.4% in 2001 to 44.0% in 2018. Conclusion: Overall, there were no significant trends in OHCA incidence over the study period, although arrests in 15–39 year-old males increased significantly after 2011. There were significant improvements in 30-day survival between 2001 and 2018

Evaluating the impact of air pollution on the incidence of out-of-hospital cardiac arrest in the Perth Metropolitan Region: 2000–2010

Background: Out-of-hospital cardiac arrest (OHCA) remains a major public health issue. Several studies have found that an increased level of ambient particulate matter (PM) smaller than 2.5 microns (PM2.5) is associated with an increased risk of OHCA. We investigated the relationship between air pollution levels and the incidence of OHCA in Perth, Western Australia.Methods: We linked St John Ambulance OHCA data of presumed cardiac aetiology with Perth air pollution data from seven monitors which recorded hourly levels of PM smaller than 2.5 and 10 microns (PM2.5/PM10), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3). We used a case-crossover design to estimate the strength of association between ambient air pollution levels and risk of OHCA.Methods: We linked St John Ambulance OHCA data of presumed cardiac aetiology with Perth air pollution data from seven monitors which recorded hourly levels of PM smaller than 2.5 and 10 microns (PM2.5/PM10), carbon monoxide (CO), sulfur dioxide (SO2), nitrogen dioxide (NO2) and ozone (O3). We used a case-crossover design to estimate the strength of association between ambient air pollution levels and risk of OHCA.Conclusions: Elevated ambient PM2.5 and CO are associated with an increased risk of OHCA