Preparedness for mass gatherings : rescue and emergency medical services’ workloads during mass gathering events

Publisher Copyright: © 2022, The Author(s).Background: Mass gathering (MG) events may cause delayed emergency responses via various mechanisms and strain the resources of local emergency services. Therefore, preparedness, including adequate pre-planning and sufficient resourcing during MG events, is vital. The aim of this retrospective register study was to investigate the impact of MG events on the workload of rescue and emergency medical service (EMS) personnel during events to enable more precise and sufficient deployment of these authorities’ operative resources. Methods: The data from Finland covered of 25,124 EMS and rescue service missions during a three-year period (2015–2017), including data from nine MG events and reference material for the same weekdays two weeks before and after the event. The data were analysed through statistical and geospatial analyses. Results: Our findings showed that missions increased in most events included in this study. Analysis of the missions’ reasons showed that the categories of violence, traffic accidents and other accidents and injuries increased during events, with violence-related missions showing the highest relative risk (RR 1.87, 95% CI 1.43–2.44). In the four-grade (A–D) urgency grading, the analysis showed an increase in category C missions and a decrease in non-urgent category D missions. The analysis indicated an increase in missions during the evening and night-time. The geospatial analysis revealed dense hotspots of missions in the vicinity of the event area. Conclusion: The workload for EMS and rescue service personnel increases during MG events. Most of the increase is allocated to EMS staff, peaking in evening and night hours. The geospatial analysis showed hotspots of missions on the outskirts of the actual event area during events; thus, the workload can also increase for those authority resources that are not directly allocated to the event. Detailed information regarding workloads is valuable for the authorities that are responsible for resource planning and preparedness for MG events. Replicating the study internationally would improve the methodology for the future.Peer reviewe

Implementation of a new emergency medical communication centre organization in Finland - an evaluation, with performance indicators

<p>Abstract</p> <p>Background</p> <p>There is a great variety in how emergency medical communication centers (EMCC) are organized in different countries and sometimes, even within countries. Organizational changes in the EMCC have often occurred because of outside world changes, limited resources and the need to control costs, but historically there is often a lack of structured evaluation of these organization changes. The aim of this study was to evaluate if the performance in emergency medical dispatching changed in a smaller community outside Helsinki after the emergency medical call centre organization reform in Finland.</p> <p>Methods</p> <p>A retrospective observational study was conducted in the EMCC in southern Finland. The data from the former system, which had municipality-based centers, covered the years 2002-2005 and was collected from several databases. From the new EMCC, data was collected from January 1 to May 31, 2006. Identified performance indicators were used to evaluate and compare the old and new EMCC organizations.</p> <p>Results</p> <p>A total of 67 610 emergency calls were analyzed. Of these, 54 026 were from the municipality-based centers and 13 584 were from the new EMCC. Compared to the old municipality-based centers the new EMCC dispatched the highest priority to 7.4 percent of the calls compared to 3.6 percent in the old system. The high priority cases not detected by dispatchers increased significantly (p < 0.001) in the new EMCC organization, and the identification rate of unexpected deaths in the dispatched ambulance assignments was not significantly (p = 0.270) lower compared to the old municipality-based center data.</p> <p>Conclusion</p> <p>After implementation of a new EMCC organization in Finland the percentage and number of high priority calls increased. There was a trend, but no statistically significant increase in the emergency medical dispatchers' ability to detect patients with life-threatening conditions despite structured education, regular evaluation and standardization of protocols in the new EMCC organization.</p

Ohje ensihoitopalvelujen palvelutasopäätöksen laatimiseksi

Terveydenhuoltolaki (1326/2010) velvoittaa erikoissairaanhoidon järjestämisestä vastaavaa sairaanhoitopiirin kuntayhtymää tekemään alueensa ensihoitopalvelun palvelutasopäätöksen. Terveydenhuoltolain nojalla annetussa uudistetussa sosiaali- ja terveysministeriön asetuksessa ensihoitopalvelusta säädetään yksityiskohtaisemmin palvelutasopäätöksen laatimisesta. Tässä julkaisussa kuvataan ensihoitopalvelun palvelutasopäätöksen tausta, tavoitteet, sisältö ja raportointitavat. Ensihoitopalvelun suunnittelun lähtökohtana tulee olla samantasoisten palvelujen tarjoaminen riskeiltään ja palvelutarpeiltaan samanlaisilla alueilla. Sairaanhoitopiirit käyttävät tässä julkaisussa kuvattua valtakunnallista mallia palvelutasopäätöksen tekemisessä ja palvelutason seuraamisess

Association between physician's case volume in prehospital advanced trauma care and 30-day mortality: a registry-based analysis of 4,032 patients

BACKGROUND: Seriously injured patients may benefit from prehospital interventions provided by a critical care physician. The relationship between case volume and outcome has been established in trauma teams in hospitals, as well as in prehospital advanced airway management. In this study, we aimed to assess if a volume-outcome relationship exists in prehospital advanced trauma care.METHODS: We performed a retrospective cohort study using the national helicopter emergency medical services database, including trauma patients escorted from scene to hospital by a helicopter emergency medical services physician during January 1, 2013, to August 31, 2019. In addition, similar cases during 2012 were used to determine case volumes. We performed a multivariate logistic regression analysis, with 30-day mortality as the outcome. Age, sex, Glasgow Coma Scale, shock index, mechanism of injury, time interval from alarm to the patient and duration of transport, level of receiving hospital, and physician's trauma case volume were used as covariates. On-scene times, interventions performed, and status at hospital arrival were assessed in patients who were grouped according to physician's case volume.RESULTS: In total, 4,032 escorted trauma patients were included in the study. The median age was 40.2 (22.9-59.3) years, and 3,032 (75.2%) were male. Within 30 days, 498 (13.2%) of these patients had died. In the highest case volume group, advanced interventions were performed more often, and patients were less often hypotensive at handover. Data for multivariate analysis were available for 3,167 (78.5%) of the patients. Higher case volume was independently associated with lower mortality (odds ratio, 0.59; 95% confidence interval, 0.38-0.89).CONCLUSION: When a prehospital physician's case volume is higher in high-risk prehospital trauma, this seems to be associated with more active practice patterns and significantly lower 30-day mortality. The quality of prehospital critical care could be increased by ensuring sufficient case volume for the providers of such care. (J Trauma Acute Care Surg. 2023;94: 425-432. Copyright (c) 2022 The Author(s). Published by Wolters Kluwer Health, Inc.) LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.Peer reviewe

Standardised data collection in prehospital critical care : a comparison of medical problem categories and discharge diagnoses

Background Prehospital medical problem reporting is essential in the management of helicopter emergency medical services (HEMS) operations. The consensus-based template for reporting and documenting in physician-staffed prehospital services exists and the classification of medical problems presented in the template is widely used in research and quality improvement. However, validation of the reported prehospital medical problem is lacking. This study aimed to describe the in-hospital diagnoses, patient characteristics and medical interventions in different categories of medical problems. Methods This retrospective, observational registry study examined the 10 most common in-hospital International Statistical Classification of Disease (ICD-10) diagnoseswithin different prehospital medical problem categories, defined by the HEMS physician/paramedic immediately after the mission was completed. Data were gathered from a national HEMS quality registry and a national hospital discharge registry. Patient characteristics and medical interventions related to different medical problem categories are also described. Results A total of 33,844 patients were included in the analyses. All the medical problem categories included a broad spectrum of ICD-10 diagnoses (the number of diagnosis classes per medical problem category ranged from 73 to 403). The most frequent diagnoses were mainly consistent with the reported medical problems. Overlapping of ICD-10 diagnoses was mostly seen in two medical problem categories: stroke and acute neurology excluding stroke. Additionally, typical patient characteristics and disturbances in vital signs were related to adequate medical problem categories. Conclusions Medical problems reported by HEMS personnel have adequate correspondence to hospital discharge diagnoses. However, the classification of cerebrovascular accidents remains challenging.Peer reviewe

Lääkärihelikopteritoiminnan vaikuttavuus ja kustannustehokkuuden kehittäminen

Selvityksen tavoitteena oli arvioida lääkärihelikopteritoiminnan vaikuttavuutta ja tunnistaa menetelmiä sen kehittämiseksi. Lääkärihelikopteritoiminta on perustunut alueellisiin tarpeisiin ja ohjaukseen eikä ole muodostanut valtakunnallisesti yhtenäistä kokonaisuutta. Kun suunniteltu kahdeksan lääkärihelikopterien tukikohdan verkosto on toiminnassa, kattaa palvelu 90 % väestöstä 30 minuutissa. Silloin toiminta on suunniteltava ja toteutettava yli hallinnollisten rajojen. Laadukkaan elinvuoden hinta asettuu yhteiskunnan maksuhalukkuuden raameihin. Kustannusvaikuttavuutta voidaan merkittävästi parantaa sisällyttämällä uusia potilasryhmiä palvelun piiriin. Lentotoiminnan kehittämisellä voidaan parantaa palvelun saatavuuden yhdenvertaisuutta, samalla kuitenkin hieman kustannusvaikuttavuutta heikentäen. Tutkimuksen perusteella lääkärihelikoptereiden käyttöä ohjaamaan on perustettava valtakunnallinen koordinaatiokeskus. Toiminnan on muodostettava valtakunnallisesti yhtenäinen osa ensihoitojärjestelmää. Lisäksi on luotava muuttuvat palvelutarpeet ja kansallisen yhteistyön huomioiva lääkärihelikopteritoiminnan strategia. Neljänneksi akuuttihoitoketjujen tiedolla johtaminen on saatettava konkreettiseksi toiminnaksi.Tämä julkaisu on toteutettu osana valtioneuvoston selvitys- ja tutkimussuunnitelman toimeenpanoa.(tietokayttoon.fi) Julkaisun sisällöstä vastaavat tiedon tuottajat, eikä tekstisisältö välttämättä edusta valtioneuvoston näkemystä

Valtakunnallinen selvitys ensihoitopalvelun toiminnasta : Väliraportti 2

Sosiaali- ja terveysministeriön päätöksellä käynnistettiin valtakunnallinen selvitys ensihoitopalvelun tehtävistä. Selvityksen perustana on maan kaikki hätäkeskuksista tulleet ensihoitotehtävät viiden vuoden ajalta. Tällä hetkellä emme pysty kansallisesti tuottamaan ensihoitopalvelun toiminnan keskeisiä tun-nuslukuja, eikä järjestelmässä tapahtuneiden muutosten vaikuttavuutta voida siten myöskään luotettavasti arvioida. On välttämätöntä luoda kansallinen ensihoitopalvelun tietovaranto, jotta pystymme suunnittelemaan ja ohjaamaan resurssien käyttöä tarkoituksenmukaisesti ja reaaliaikaisesti. Siihen tulee kerätä sekä ensihoitopalvelua kuvaavat kansalliset operatiiviset tiedot (hätäkeskustietojärjestelmä, viranomaisten kenttäjärjestelmä) että niihin yhdistettyinä kansallisesti kerätyt potilastiedot (kansallinen ensihoitokertomus, Potilastiedon arkisto). Ensihoitopalvelun suunnittelussa tulee huomioida sekä tehtävävolyymin muuttuminen pelkäs-tään hätätilapotilaista kohti laajempaa päivystyspotilaiden kirjoa että nykyistä paremmin verkottumisesta muihin sosiaali- ja terveydenhuollon lähipalveluihin. Hätäkeskusten toiminta on päivystyksellisten potilasvirtojen ohjauspaikkana aliarvioitu. Sosiaali- ja terveystoimen rakenneuudistuksen yhteydessä tulee uudelleen arvioida hätäkeskusten rajapinnassa oleva toiminta. Tehtävien riskinarviointi ja tarkoituksenmukainen resurssien käyttö edellyttävät sosiaali- ja terveystoimen päivystystoiminnan johto- ja koordinaatiokeskusten perustamista. Näihin keskuksiin keskitettäisiin myös kansallinen kansalaisten terveydenhuollon puhelinneuvonta ja -ohjaus

Loppuraportti: Valtakunnallinen selvitys ensihoitopalvelun toiminnasta

Selvitys perustuu pääasiassa Hätäkeskuslaitokselta saatuun ensihoitotehtäviä koskevaan aineistoon vuosilta 2010 – 2014. Tavoitteena oli tuottaa tietoa ensihoitopalvelun toiminnasta sekä toiminnan muutoksista. Selvityksessä todettiin, että ensihoitopalvelun nykyiset tiedot eivät ole kansallisella tasolla luotettavia, mikä haittaa toiminnan analysointia ja kehittämistä merkittävästi. Nykyinen päivystyksellisten potilasvirtojen ohjaus ja ensihoitoresurssien käyttö toteutuvat epätarkoituksenmukaisesti. Ensihoitopalveluun näyttää tulleen pysyvänä mallina potilaiden hoidon tarpeen tarkempi arvio ja palvelun kohdistuminen myös hoito- ja hoivalaitoksiin. Ensihoitopalveluiden kustannuskehitys ei ole johtunut yksinomaan ensihoidon järjestämisvastuun siirrosta kunnilta sairaanhoitopiireille. Ensihoitopalveluun tarvitaan kansallinen tietovaranto, josta saadaan luotettavasti toiminta- ja kustannustiedot ja johon perustuen voidaan toimintaa johtaa tiedolla. Tietovarannon avulla on kyettävä yhdistämään päivystyksellisten potilaiden koko hoitoketjun tiedot hätäkeskustoiminnasta lopulliseen hoitopaikkaan ja hoitojaksoon hoidon vaikuttavuuden ja tuloksellisuuden seuraamiseksi. Resurssien käyttöä tulee parantaa johtamalla toimintaa yhteistyöalueittain ja toteuttamalla kansallinen toimialan puhelinneuvontapalvelu. Myös ensihoitohenkilöstön koulutussuunnittelussa on huomioitava muuttunut toimintakenttä. Sosiaali- ja terveydenhuollon päivystysjärjestelmää on kehitettävä tärkeänä osana yhteiskunnan kokonaisturvallisuutta

Driving Speeds in Urgent and Non-Urgent Ambulance Missions during Normal and Reduced Winter Speed Limit Periods&mdash;A Descriptive Study

Objective: Most traffic research on emergency medical services (EMS) focuses on investigating the time saved with emergency response driving. Evidence regarding driving speed during non-urgent ambulance missions is lacking. In contrast, this descriptive study compared registered driving speeds to the road speed limit in urgent A-missions and non-urgent D-missions. Specifically, the study examined driving speeds during normal speed limits, periods of reduced winter speed limits, and speeding during non-urgent D-missions. Methods: Urgent A-missions and non-urgent D-missions were included. Registered ambulance locations and speed data from Pirkanmaa Hospital District, Finland between 1 January 2018 and 31 December 2018 were used. Ambulance locations were linked to OpenStreetMap digital road network data. The registered driving speed distribution was reported as quartiles by the effective road speed limit. Furthermore, the results during the normal speed limit and reduced winter speed limit periods were reported separately. Driving speeds in non-urgent missions were compared with current Finnish traffic violation legislation. Results: As expected, the urgent A-missions exceeded the speed limits during both the normal speed limit and reduced winter speed limit periods. On the smallest streets with speed limits of 30 km/h, the driving speeds in urgent missions were lower than the speed limit. The driving speeds in non-urgent D-missions were broadly similar throughout the whole year on high-speed roads, and mostly on lower speed limit roads. However, within the 30 km/h speed limits, the mean speed in non-urgent missions appeared to increase during the winter. One-fifth of the registered non-urgent D-missions were speeding. Conclusions: Speeding is common in urgent A-missions and non-urgent D-missions throughout the year. Stricter guidelines for EMS are needed to increase driving safety

Consultation Processes With Helicopter Emergency Medical Service Physicians in Finnish Prehospital Emergency Care: The Paramedics’ Perspective

Objective The Finnish emergency medical services operates mainly with highly educated paramedic-staffed units. Helicopter emergency medical services (HEMS) physicians alongside other physicians provide consultations to paramedics on the scene without the physician physically participating in the mission. We examined the Finnish paramedics’ views regarding the consultation processes involving HEMS physicians. Methods This was a cross-sectional survey study among paramedics (n = 200). Assessments of the performance of HEMS physicians and other physicians in the consultation process were analyzed descriptively. The effect of the physician being expressly part of the HEMS was analyzed with inductive content analysis. Results Overall, consultations with the HEMS physician were well received among paramedics, and the HEMS physicians received higher assessments than other physicians. The familiarity with the prehospital environment, limitations, and local possibilities was valued. Expertise is particularly valuable in challenging emergency medical services missions but unnecessary in many nonurgent missions. There is scope for improvement in the attitudes and technical fluency of the consultation processes of HEMS physicians. Conclusion Using HEMS physicians in prehospital consultations could be recommended. Further studies are still needed to ensure the efficacy and efficiency of the consultation process and explore the integration of video connections into current consultation practices.Peer reviewe