Navid Kalani; Naser Hatami; Sajed Ali; Neema John Mehramiz; Fatemeh Rahmanian; Esmaeel Raeyat doost; Marzieh Haghbeen; Samaneh Abiri; Mahdi Foroughian; Mohsen Ebrahimi
Volume 10, Issue 1 , January 2022, , Pages 21-26
Abstract
Objective: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, ...
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Objective: To compare the characteristics of the emergency medical services (EMS) brought COVID-19 patients versus self-referred walk-in patients. Methods: This was a Cross-sectional study of COVID-19 infected cases in Jahrom, south of Iran. Age, sex, the symptoms of beginning days’ passing, respiratory distress, PO2 at arrival, admission length and inhospital death were retrieved for confirming COVID-19 cases in the whole 2020 year. Respiratory distress was considered as the sign that agitates the patient to call EMS care. Survival analysis was used to evaluate the possible difference of the hospitalization outcome in EMS brought or Self-referred walk-in (SRW) patients. Results: There was 704 (27.1%) registries patients transfer to the hospital by EMS and 1895 (72.9%) cases with SRW referred to the hospital. The survival distributions for the EMS group were statistically significant and lower than SRW group (p <0.05). Despite the SRW patients, respiratory distress was associated with lower survival in EMS group (p <0.05). Days passing the symptom’s beginning was significantly different between EMS group (6.1±5.3 days) and SRW group (6.9±4.6 days). Cox regression showed higher mortality rate in patients higher than 75 years old in both groups (p <0.05). Higher PO2 at arrival was associated with lower mortality rate of Hazard Ratio of 0.959 (p <0.001) and 0.903 (p <0.001) in EMS and SRW groups, respectively. The history of heart disease and hypertension were associated with 1.011 and 1.088 times more than mortality risk in EMS group; while cancer history was associated with 2.74 times more of mortality risk in SRW group. Conclusion: It seems that severe acute respiratory syndrome occurs soon in some patients that lead to the need for an ambulance to transfer the patient to the hospital. Therefore, EMS transfer patients should be considered for more risk of severe COVID-19; considering comorbidities of heart disease and hypertension as red flags.
Adel Efftekhari; Abbas Ali Dehghani Tafti; Khadijeh Nasiriani; Majid Hajimaghsoudi; Hossein Fallahzadeh; Davoud Khorasani-Zavareh
Volume 7, Issue 4 , October 2019, , Pages 381-389
Abstract
Objective: To identify and prioritize the key Components of prehospital emergency system to prevent mortality in road traffic injuries. Methods: A total of 25 emergency medicine practitioners, emergency ward nurses, and managers of prehospital emergency centers participated in this adjusted Delphi study ...
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Objective: To identify and prioritize the key Components of prehospital emergency system to prevent mortality in road traffic injuries. Methods: A total of 25 emergency medicine practitioners, emergency ward nurses, and managers of prehospital emergency centers participated in this adjusted Delphi study in three rounds. After extracting the primary components through reviewing systematic studies and interviewing experts, the Delphi rounds were performed with the presence of experts. The data were analyzed with both qualitative content analysis and quantitative analysis using SPSS20 software. For the analysis and selection of the final priorities, the coefficient of agreement of over 70% was used. Results: After doing three Delphi rounds, in the final Delphi round, 10 superior components were selected respectively as follows: correct history taking of the victim, examining possible cervical injury, the time spent from the first call to arrival of technicians to the scene, the time spent from arriving at the scene to the time of hospital transport, passing of re-education courses by EMS technicians, coordination among the rescue organizations, police, the Red Crescent, fire station, and healthcare organizations, integrated commandership at scene, police attendance in the scene before EMS arrival at the scene, proper ambulance equipment with respect to the required equipment (A, B, C) on the basis of victim’s condition, and coordination with the target hospital for patient transport. Conclusion: This study determined the most applicable managerial methods of prehospital emergency components pertaining to preventable fatal road traffic injuries through empowerment of EMS systems in the fields of victim assessment, time management indices, personnel training, coordination between the involved organs, and the presence of the main commander in the scene.