The National Capital District (NCD) is unique within Papua New Guinea in having a professional ambulance service which provides emergency care during transfer to hospital. This service has been run by St John Ambulance, who have maintained records of their work during their first ten years of operation. To review the operation of the service and to consider its potential for other parts of Papua New Guinea these records were transferred to a database and analyzed. The results of this analysis, together with relevant background, are presented and some of the issues which emerge are discussed. There have been heavy demands on the ambulance service to provide a taxi service for transferring patients between health facilities. Cancelled calls have also been a heavy drain on the service. Pregnancy-related requests for transport, including home deliveries, constitute the major group of emergency calls. Requests for transfer of patients with an acute medical or surgical condition requiring skilled attention provide an important part of the nonobstetrical work of the service, though this group makes up only 10% of the total number of requests. Trauma contributed 26% of the nonobstetrical emergency work of the service. The rate of requests for the population of the NCD has decreased and it is suggested that this is due to greater access to private vehicles rather than a decrease in demand for emergency transport. It is apparent that a skilled ambulance service cannot be provided cheaply, although for 1993 at 15 kina per request, or 30 kina if only the emergency requests are considered, the service is clearly efficient. Providing a similar service to other parts of Papua New Guinea with lower population densities and less sealed road would be very much more expensive. It is unlikely that the health services could approximate a similar degree of cost-efficiency to that of St John.
Emergency Medical Services - methods ; Emergency Medical Services - statistics & ; numerical data

INTRODUCTIONThe location of ambulance stations are of great importance, as location is a determining factor of whether ambulances are able to respond to emergency calls within the critical period. The aim of the present study was to determine whether the ambulance stations in the provincial centre of Samsun, Turkey, were able to cover their entire operational area within 10 mins of receiving an emergency call.

METHODSThis study was based on emergency calls received by the emergency medical services of the study area. Detailed address data from the calls was used to produce thematic maps using the geographic information system (GIS). Buffer analysis was used to determine the adequacy of the stations' locations in relation to the time taken to respond to the emergency calls.

RESULTSIn the study area, there were a total of 11,506 emergency ambulance calls made in 2009, which revealed a call density of 0.7 calls per ha and 23.8 calls per 1,000 population. A total of 75.8% of the calls were made due to medical reasons, while 11.6% were related to traffic accidents. The GIS-based investigation revealed that the 10-min coverage areas for the four ambulance stations in the provincial centre of Samsun served 76.9% of the area and 97.9% of its population. Of the 10,380 calls for which detailed address data were available, 99.2% were within the stations' 10-min coverage areas.

CONCLUSIONAccording to the buffer analysis, the ambulance stations in the provincial centre of Samsun are able to reach 97.9% of the population within the critical 10-min response time. This study demonstrates that GIS is an indispensable tool for processing and analysing spatial data, which can in turn aid decision-making in the field of geographical epidemiology and public health.

Ambulances ; statistics & numerical data ; Emergency Medical Service Communication Systems ; Emergency Medical Services ; statistics & numerical data ; Geographic Information Systems ; Humans ; Risk Factors ; Rural Health Services ; Time Factors ; Turkey

BACKGROUND AND PURPOSE: Process improvement (PI) is an approach for enhancing the existing quality improvement process by making changes while keeping the existing process. We have shown that implementation of a stroke code program using a computerized physician order entry system is effective in reducing the in-hospital time delay to thrombolysis in acute stroke patients. We investigated whether implementation of this PI could further reduce the time delays by continuous improvement of the existing process. METHODS: After determining a key indicator [time interval from emergency department (ED) arrival to intravenous (IV) thrombolysis] and conducting data analysis, the target time from ED arrival to IV thrombolysis in acute stroke patients was set at 40 min. The key indicator was monitored continuously at a weekly stroke conference. The possible reasons for the delay were determined in cases for which IV thrombolysis was not administered within the target time and, where possible, the problems were corrected. The time intervals from ED arrival to the various evaluation steps and treatment before and after implementation of the PI were compared. RESULTS: The median time interval from ED arrival to IV thrombolysis in acute stroke patients was significantly reduced after implementation of the PI (from 63.5 to 45 min, p=0.001). The variation in the time interval was also reduced. A reduction in the evaluation time intervals was achieved after the PI [from 23 to 17 min for computed tomography scanning (p=0.003) and from 35 to 29 min for complete blood counts (p=0.006)]. CONCLUSIONS: PI is effective for continuous improvement of the existing process by reducing the time delays between ED arrival and IV thrombolysis in acute stroke patients.
Blood Cell Count ; Emergency Medical Services ; Emergency Service, Hospital ; Humans ; Medical Order Entry Systems ; Quality Improvement ; Statistics as Topic ; Stroke*

BACKGROUNDDue to the floating of the guideline, there is no evidence-based evaluation index on when to start the blood transfusion for patients with hemoglobin (Hb) level between 7 and 10 g/dl. As a result, the trigger point of blood transfusion may be different in the emergency use of the existing transfusion guidelines. The present study was designed to evaluate whether the scheme can be safely and effectively used for emergency patients, so as to be supported by multicenter and large sample data in the future.

METHODSFrom June 2013 to June 2014, patients were randomly divided into the experimental group (Peri-operative Transfusion Trigger Score of Emergency [POTTS-E] group) and the control group (control group). The between-group differences in the patients' demography and baseline information, mortality and blood transfusion-related complications, heart rate, resting arterial pressure, body temperature, and Hb values were compared. The consistency of red blood cell (RBC) transfusion standards of the two groups of patients with the current blood transfusion guideline, namely the compliance of the guidelines, utilization rate, and per-capita consumption of autologous RBC were analyzed.

RESULTSDuring the study period, a total of 72 patients were recorded, and 65 of them met the inclusion criteria, which included 33 males and 32 females with a mean age of (34.8 ± 14.6) years. 50 underwent abdomen surgery, 4 underwent chest surgery, 11 underwent arms and legs surgery. There was no statistical difference between the two groups for demography and baseline information. There was also no statistical differences between the two groups in anesthesia time, intraoperative rehydration, staying time in postanesthetic care unit, emergency hospitalization, postoperative 72 h Acute Physiologic Assessment and Chronic Health Evaluation II scores, blood transfusion-related complications and mortality. Only the POTTS-E group on the 1 st postoperative day Hb was lower than group control, P < 0.05. POTTS-E group was totally (100%) conformed to the requirements of the transfusion guideline to RBC infusion, which was higher than that of the control group (81.25%), P < 0.01.There were no statistical differences in utilization rates of autologous blood of the two groups; the utilization rates of allogeneic RBC, total allogeneic RBC and total RBC were 48.48%, 51.5%, and 75.7% in POTTS-E group, which were lower than those of the control group (84.3%, 84.3%, and 96.8%) P < 0.05 or P < 0.01. Per capita consumption of intraoperative allogeneic RBC, total allogeneic RBC and total RBC were 0 (0, 3.0), 2.0 (0, 4.0), and 3.1 (0.81, 6.0) in POTTS-E groups were all lower than those of control group (4.0 [2.0, 4.0], 4.0 [2.0, 6.0] and 5.8 [2.7, 8.2]), P < 0.05 or P < 0.001.

CONCLUSIONSPeri-operative Transfusion Trigger Score-E evaluation scheme is used to guide the application of RBC. There are no differences in the recent prognosis of patients with the traditional transfusion guidelines. This scheme is safe; Compared with doctor experience-based subjective assessment, the scoring scheme was closer to patient physiological needs for transfusion and more reasonable; Utilization rate and the per capita consumption of RBC are obviously declined, which has clinical significance and is feasible. Based on the abovementioned three points, POTTS-E scores scheme is safe, reasonable, and practicable and has the value for carrying out multicenter and large sample clinical researches.

Adolescent ; Adult ; Emergency Medical Services ; statistics & numerical data ; Female ; Humans ; Male ; Transfusion Reaction ; Young Adult

OBJECTIVEThis study aimed to study the characteristics of injuries in the Emergency Departments.

METHODSAcute injuries of the Emergency Department attendants from Jury 1, 2001 to June 30, 2002 were selected.

RESULTS25,019 cases were sampled. Results showed that injured persons accounted for 17.46% of all emergent cases attending the above hospitals. 81.67% of the injuries were accidental. Sex ratio was 2.0. Young people aged 15-34 years accounted for 50.63% of all the injuries. The leading cause was mechanical injury, followed by traffic accidents and accidental falls. The leading occupation would include workers, followed by farmers and students. The fatality rate was 5.12 per thousand. The number of deaths for young people accounted for 79.69% of all deaths. The number of deaths for motor vehicle accidents took the first place and accounted for 46.88%. The characteristics due to mechanical injury and 11,151 cases of acute poisoning were analyzed.

CONCLUSIONTo develop a surveillance post on injuries in the Emergency Departments of general hospitals are not only necessary, urgent but feasible.

Accidental Falls ; statistics & numerical data ; Accidents, Occupational ; statistics & numerical data ; Accidents, Traffic ; statistics & numerical data ; Emergency Medical Services ; Emergency Service, Hospital ; statistics & numerical data ; Female ; Hospitals, General ; statistics & numerical data ; Humans ; Male ; Sex Factors ; Wounds and Injuries ; etiology

OBJECTIVETo investigate the sanitary working status in the districts for locating residents after earthquake in Dujiangyan municipality.

METHODSSome immediate measures were taken after the earthquake including water source surveillance, restoring immunization system and epidemic surveillance. A questionnaire survey was also conducted to collect information in 107 locating districts of 18 towns.

RESULTSGenerally, the sanitary working status was good. Temporary sheds in most districts were Tents (75.70%, 81/107) and simple sheds (19.63%, 21/107), and 69.16% (74/107) districts could use water supply and 94.39% (101/107) arrange specialized persons to disinfect the environment and kill pests. The fly density was 2 per eye-view. The proportions for the correct responds to health knowledge, action adopted and attitude of residents were all above 90%. According to the epidemic surveillance system and mobile syndrome surveillance system in disaster area, there was no increasing trend for the incidences of contagious diseases.

CONCLUSION20 days after earthquake, the whole situation of disease prevention in disaster area is stable.

China ; Disasters ; Earthquakes ; Emergency Medical Services ; statistics & numerical data ; Health Care Surveys ; Humans ; Sanitation ; Surveys and Questionnaires ; Universal Precautions

BACKGROUNDAppropriate planning and staffing for medical services at large-scale athletic events is essential to provide for a safe and successful competition. There are few well-documented accounts describing the demand for such services. The present study provided the data from the Beijing 2008 Olympics and Paralympics, with a view to provide the guidance for planning future events.

METHODSA total of 22 029 and 8046 patients, who received medical care from a physician at an Olympic or Paralympic medical station, were included. The patient proportion among different personnel, various disease proportions at different kinds of venues, and the disease spectrum at specified venues at the Olympics and Paralympics were analyzed.

RESULTSAt both games, the patient proportion varied by accreditation status. The staff accounted for the largest number of visits at the Olympics (44.83%) and Paralympics (36.95%), with respiratory diseases the most common. Various disease spectrums were discovered at the different kinds of venues. Surgical diseases were the most frequently listed reason for visits, both at competition and non-competition venues, especially during the Paralympics. The sport-related injuries accounted for a majority of the surgical cases during both games. At training venues, ear nose and throat diseases accounted for the greatest number of visits during both games.

CONCLUSIONSDuring both games, people contracted different diseases at different venues. Adequate surgeons should be designated to offer assistance mostly in trauma situations. Appropriate numbers of physicians in respiratory diseases and otorhinolaryngology is of great importance.

Anniversaries and Special Events ; China ; Emergency Medical Services ; utilization ; Humans ; Population Surveillance ; Public Health ; statistics & numerical data ; Sports

BACKGROUNDRoad traffic injuries (RTIs) are a worldwide issue associated with increasing development and motorization. However, statistical studies do not include any analyses of Beijing's geriatric population. Using data from the Beijing Emergency Medical Center, we present the main characteristics of traffic injuries involving the elderly in Beijing. We also provide objective information for those concerned with the safety of traffic systems and the prevention of traffic injuries.

METHODSIn a longitudinal, retrospective study, data were collected on 1706 victims aged 65 years and older who sustained traffic injuries in Beijing between 2004 and 2010. Personal information, time of injury event, emergency care response time, road user type, striking vehicle type, injury site, and severity of injury were analyzed using χ(2) tests and Logistic regression analysis.

RESULTSThe annual rate of traffic injuries was 21.80 per 100 000 elderly people in Beijing, and the morbidity rate decreased from 2004 to 2010 (P < 0.001). The mean age was (72.92 ± 5.67) years, and 911 (53.40%) of the victims were male. The majority of victims sustained head and lower limb injuries and were classified as being of medium severity. Traffic collisions occurred most frequently in the daytime excluding rush hours; these collisions included being hit by a car (85.64%) and pedestrian victim injuries (79.19%). Our statistical analysis found three factors for injury severity: abdominal injuries (P < 0.001), number of injury sites (P = 0.027), and head injuries (P = 0.034). The decline in traffic injuries is due to a decrease in victims aged 65-74 years and pedestrians; the severity of RTIs also decreased.

CONCLUSIONSThis study highlights the declining trend in traffic injuries among older adults in Beijing. However, traffic injuries remain a serious public health problem for the elderly and effective measures are required to reduce their incidence.

Accidents, Traffic ; statistics & numerical data ; Aged ; China ; epidemiology ; Emergency Medical Services ; Female ; Humans ; Male ; Wounds and Injuries ; epidemiology

PURPOSE: Emergency endotracheal intubation (EEI) is a complex process that leads to various complications. Previous studies mainly demonstrated that the Medical Emergency Team (MET) intervention reduced the incidence of cardiac arrest, however, the impact of a MET on airway management has not been investigated in detail. Our purpose was to confirm the impact of a MET on airway management and compare the incidence of complications of EEI before and after MET intervention in a general ward. MATERIALS AND METHODS: We performed an observational study and reviewed 318 patients intubated by a MET in a general ward. RESULTS: The patients enrolled during the control (2007) and study (2009) periods were 103 and 215, respectively. Cardiopulmonary resuscitation requiring emergency intubation in a general ward was reduced after MET intervention at the Asan Medical Center (39.8% vs. 19.1%, p<0.001). Pre-intubation and post-intubation oxygen saturation levels were higher after MET intervention (pre-intubation, 80% before vs. 92% after MET, p<0.001; post-intubation, 95% before vs. 99% after MET, p<0.001). The use of vasopressors after intubation decreased as a result of MET intervention (62.1% before vs. 36.7% after MET, p<0.001). Hypotension was also reduced (34% before vs. 8.8% after MET, p<0.001). CONCLUSION: Early interventions of a MET changed the causes of emergency intubation in a general ward from cardiopulmonary resuscitation to respiratory distress or shock and improved hypoxemia and hypotension related to emergency intubation. The MET intervention is safe and effective system for emergency intubation in a general ward.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Emergency Medical Services/statistics & numerical data ; Female ; Humans ; Intubation, Intratracheal/*adverse effects ; Male ; Middle Aged ; Prevalence ; Young Adult

To determine the actual firefighter injury statistics in Korea, we conducted a survey on the nature of on-duty injuries among all male firefighters in Korea. We distributed questionnaires to all Korean male firefighters via email, and data from the 19,119 workers that responded were used for data analysis. The job types were categorized into fire suppression, emergency medical service (EMS) and officers. As estimated of age standardized injury prevalence per one thousand workers, 354 fire extinguishing personnel, 533 EMS workers, and 228 officers experienced one or more injuries during the previous 12 months. The odds ratio (95% confidence interval) of injuries was 1.86 (1.61-2.15) for fire suppression and 2.93 (2.51-3.42) for EMS personnel compared to officers after adjusting for age, marital status, smoking habit and career period. Age standardized absence days from work due to injuries per one thousand workers were 1,120, 1,337, and 676 for fire suppression, EMS and officers, respectively. Car accident (24.5%) was the most common cause and wound (42.3%) was the most common type of injuries. Our nationwide representative study showed that fire suppression and EMS workers are at greater risk of on-duty injuries compared to officers. We observed different injury characteristics compared to those reported in other countries.
Electronic Mail ; Emergency Medical Services ; Firefighters* ; Fires ; Humans ; Korea ; Male ; Marital Status ; Odds Ratio ; Prevalence ; Smoke ; Smoking ; Statistics as Topic ; Wounds and Injuries