PURPOSE: Prompt vascular access is crucial for resuscitating bleeding trauma casualties in prehospital settings but achieving peripheral intravenous (PIV) access can be challenging during hemorrhagic shock due to peripheral vessel collapse. Early intraosseous (IO) device use is suggested as an alternative. This study examines injury characteristics and factors linked to IO access requirements. METHODS: A registry-based cohort study from the Israel Defense Forces Trauma Registry (2010 - 2023) included trauma casualties receiving PIV or IO access prehospital. Casualties who had at least one documented PIV or IO access attempt were included, while those without vascular access were excluded. Casualties requiring both PIV and IO were classified in the IO group. Univariable logistic regression assessed the factors associated with IO access. Results were reported as odds ratios (OR) with 95% confidence intervals (CI), and significant difference was set at p < 0.05. RESULTS: Of 3462 casualties (86.3% male, the median age: 22 years), 3287 (94.9%) received PIV access and 175 (5.1%) had IO access attempts. In the IO group, 30.3% received freeze-dried plasma and 23.4% received low titer group O whole blood, significantly higher than that in the PIV group. Prehospital mortality was 35.0% in the IO group. Univariable analysis showed significant associations with IO access for increased PIV attempts (OR = 1.69; 95% CI: 1.34 - 2.13) and signs of profound shock (OR = 11.0; 95% CI: 5.5 - 23.3). CONCLUSION Profound shock signs are strongly linked to the need for IO access in prehospital settings with each successive PIV attempt increasing the likelihood of requiring IO conversion. IO access often accompanies low titer group O whole blood or freeze-dried plasma administration and higher prehospital mortality, indicating its use in emergent resuscitation situations. Early IO consideration is advised for trauma casualties with profound shock.
Humans ; Male ; Infusions, Intraosseous/methods* ; Female ; Registries ; Israel ; Emergency Medical Services/methods* ; Adult ; Young Adult ; Wounds and Injuries/mortality* ; Military Personnel ; Resuscitation/methods* ; Middle Aged ; Shock, Hemorrhagic/therapy* ; Cohort Studies

PURPOSE: To construct a decision-making app for pre-hospital damage control resuscitation (PHDCR) for severely injured patients, and to make a preliminary trial test on the effectiveness and usability aspects of the constructed app. METHODS: Decision-making algorithms were first established by a thorough literature review, and were then used to be learned by computer with 3 kinds of text segmentation algorithms, i.e., dictionary-based segmentation, machine learning algorithms based on labeling, and deep learning algorithms based on understanding. B/S architecture mode and Spring Boot were used as a framework to construct the app. A total of 16 Grade-5 medical students were recruited to test the effectiveness and usability aspects of the app by using an animal model-based test on simulated PHDCR. Twelve adult Bama miniature pigs were subjected to penetrating abdominal injuries and were randomly assigned to the 16 students, who were randomly divided into 2 groups (n = 8 each): group A (decided on PHDCR by themselves) and group B (decided on PHDCR with the aid of the app). The students were asked to complete the PHDCR within 1 h, and then blood samples were taken and thromboelastography, routine coagulation test, blood cell count, and blood gas analysis were examined. The lab examination results along with the value of mean arterial pressure were used to compare the resuscitation effects between the 2 groups. Furthermore, a 4-statement-based post-test survey on a 5-point Likert scale was performed in group B students to test the usability aspects of the constructed app. RESULTS: With the above 3 kinds of text segmentation algorithm, B/S architecture mode, and Spring Boot as the development framework, the decision-making app for PHDCR was successfully constructed. The time to decide PHDCR was (28.8 ± 3.41) sec in group B, much shorter than that in group A (87.5 ± 8.53) sec (p < 0.001). The outcomes of animals treated by group B students were much better than that by group A students as indicated by higher mean arterial pressure, oxygen saturation and fibrinogen concentration and maximum amplitude, and lower R values in group B than those in group A. The post-test survey revealed that group B students gave a mean score of no less than 4 for all 4 statements. CONCLUSION A decision-making app for PHDCR was constructed in the present study and the preliminary trial test revealed that it could help to improve the resuscitation effect in animal models of penetrating abdominal injury.
Animals ; Swine ; Resuscitation/methods* ; Mobile Applications ; Humans ; Algorithms ; Emergency Medical Services/methods* ; Male ; Decision Making ; Female

With the gradual development and popularization of extracorporeal membrane oxygenation (ECMO) in China, some prefecture-level medical institutions in China have carried out and formed their own pre-hospital extracorporeal cardiopulmonary resuscitation (ECPR) model. Although the development levels of various prefecture-level cities are uneven and the start times vary, at present, the prefecture-level hospitals in China generally go through the development process of ECMO-in-hospital ECPR-pre-hospital ECPR-professional medical recovery center. Among them, in-hospital ECPR has the advantages of timely resuscitation, guaranteed quality of resuscitation, and fast activation speed of the ECPR team, and currently has a high success rate, with a low proportion of patients with neurological complications. However, pre-hospital ECPR is more challenging, requiring the coordination between pre-hospital and in-hospital emergency forces, multidisciplinary cooperation, and the quality of resuscitation before ECPR cannot be fully guaranteed, the long duration of patient's low perfusion, and other factors make the survival rate of patients without neurological damage obviously lower than that of in-hospital ECPR. China has a large population base, and comprehensive domestic and foreign data show that there should be no less than several million cases of out-of-hospital cardiac arrest under the age of 60 every year, so there is much to be done to improve the survival rate of pre-hospital ECPR. Pre-hospital ECPR is a project of concentrated resources and technology, which has high requirements for the multidisciplinary diagnosis and treatment capabilities of medical institutions. The optimization of the implementation process of in-hospital and pre-hospital ECPR teams, the advancement of the timing of ECPR intervention, the selection of patients, the support and construction of multidisciplinary diagnosis and treatment capabilities after ECPR, and the management of related complications and risk factors are closely related to the prognosis of ECPR patients. The recoverability of the brain and heart is currently the key factor restricting the further improvement of the survival rate of patients after ECPR. Considering that the recovery of neurological function mainly depends on the duration of the early low perfusion, the in-hospital treatment after the implementation of ECPR is mainly the low-temperature brain protection strategy, the effect of which is still controversial, so the recovery of cardiac function is the key that seriously restricts the survival of patients after ECPR in addition to neurological prognosis. The recoverability of the heart after ECPR can be implemented from multiple angles: the research on pathophysiological issues such as the matching of the heart itself after the implementation of ECPR, and the matching between the heart and ECMO, and the proposal of corresponding countermeasures will help to improve the survival rate of patients after ECPR. The large population and the potential salvageable population make the development of ECPR technology in China's tertiary hospitals urgent and necessary, with challenges and opportunities coexisting.
Humans ; Cardiopulmonary Resuscitation/methods* ; China ; Extracorporeal Membrane Oxygenation/methods* ; Emergency Medical Services ; Risk Factors ; Prognosis

Prehospital emergency care is the primary stage in the treatment of critically ill patients, where efficient and accurate monitoring methods are crucial for patient survival and prognosis. End-tidal carbon dioxide (EtCO₂) monitoring is a real-time, non-invasive method that can sensitively capture the status of respiratory, circulatory, and metabolic functions, particularly in the urgent and complex pre-hospital environment, a immediate detection and non-invasive method, can sensitively capture the respiratory, circulatory, and metabolic status of patients. It provides valuable guidance for rapid decision-making and precise interventions. This is particularly valuable in the complex and urgent prehospital environment, providing critical data for rapid decision-making and precise intervention. This paper systematically reviews the advancements in the application of EtCO₂ monitoring across various fields, including sepsis identification, trauma assessment, cardiac arrest, respiratory critical care, endotracheal intubation confirmation, and management of metabolic diseases, aiming to explore its application value and prospects in pre-hospital emergency care.
Humans ; Emergency Medical Services/methods* ; Carbon Dioxide/analysis* ; Monitoring, Physiologic/methods* ; Critical Illness ; Capnography/methods*

BACKGROUND: Team-based learning is known for its effective and satisfying education methods in the study of various medical schools. This study was prepared to confirm the satisfaction of applying this team-based learning to the training course of emergency medical technician.METHODS: A total of 165 new members of the course of second grade National Emergency medical technician at 2019 were finally enrolled in the study. Data were collected with a self-administered questionnaire. The team-based learning method was organized with eight students per group to conduct pre-learning and then proceed to open book to encourage active discussion among individuals. The questionnaire consisted of questions about the satisfaction of the discussion process, such as whether the knowledge gained from the discussion was appropriate, and whether collaboration between colleagues was successful during the discussion, and about the benefits of team-based learning, how well knowledge transfer compared to existing lectures, and the replacement of existing lectures. The questionnaire used a Likert 5 point scale, and the data obtained were analyzed using the SPSS version 22.0.RESULTS: The overall rating of team-based learning was 7.8 ± 1.5 out of 10. Many students answered positively (88.5%) for benefits, while 87.9% responded positively to whether the knowledge transfer effect was better compared to existing lectures. In addition, the satisfaction of team-based learning was generally high, with more than 90 percent of education students giving positive answers to the replacement of other lectures with team-based learning.CONCLUSION: The learners gave positive answers to the satisfaction, usefulness and learning effects of team-based learning. Team-based learning is a discussion-based study, so it is a good way to improve communication skills. Since communication and teamwork are important in first aid activities, the characteristics of team-based learning could lead to improvements in first aid services, leading to high-quality emergency medical services.
Cooperative Behavior ; Education ; Emergencies ; Emergency Medical Services ; Emergency Medical Technicians ; First Aid ; Humans ; Learning ; Lectures ; Methods ; Schools, Medical

INTRODUCTION: This study aimed to compare instrumental vaginal deliveries (IDs) and Caesarean sections (CSs) performed at full cervical dilatation, including factors influencing delivery and differences in maternal and neonatal outcomes. METHODS: A retrospective review was conducted of patients who experienced a prolonged second stage of labour at Singapore General Hospital from 2010 to 2012. A comparison between CS and ID was made through analysis of maternal/neonatal characteristics and peripartum outcomes. RESULTS: Of 253 patients who required intervention for a prolonged second stage of labour, 71 (28.1%) underwent CS and 182 (71.9%) underwent ID. 5 (2.0%) of the patients who underwent CS had failed ID. Of the maternal characteristics considered, ethnicity was significantly different. Induction of labour and intrapartum epidural did not influence delivery type. 70.4% of CSs occurred outside office hours, compared with 52.7% of IDs (p = 0.011). CS patients experienced a longer second stage of labour (p < 0.001). Babies born via CS were heavier (p < 0.001), while the ID group had a higher proportion of occipitoanterior presentations (p < 0.001). Estimated maternal blood loss was higher with CSs (p < 0.001), but neonatal outcomes were similar. CONCLUSION More than one in four parturients requiring intervention for a prolonged second stage of labour underwent emergency CS. Low failed instrumentation rates and larger babies in the CS group suggest accurate diagnoses of cephalopelvic disproportion. The higher incidence of CS after hours suggests trainee reluctance to attempt ID. There were no clinically significant differences in maternal and neonatal morbidity.
Adult ; Cesarean Section ; methods ; statistics & numerical data ; Databases, Factual ; Delivery, Obstetric ; Emergency Medical Services ; Extraction, Obstetrical ; methods ; statistics & numerical data ; Female ; Humans ; Labor Stage, First ; Labor Stage, Second ; Obstetrical Forceps ; Pregnancy ; Retrospective Studies ; Risk Factors ; Singapore ; Young Adult

OBJECTIVE: This study examined the clinical characteristics of suicide attempters who exposed their suicidal intension to suggest an active intervention strategy for suicide prevention based on the regional emergency medical service system. METHODS: A prospective database of suicide attempters who visited the emergency department of Chungbuk National University Hospital between October 2013 and December 2017 was used. All of the adult patients who provided consent for the initial assessment for suicidal attempters were eligible, excluding cases with unknown exposure of suicidal intension. The primary and secondary endpoints were the risk factors affecting exposure to the suicidal intension and characteristics of the exposure group. The adjusted odds ratios (AORs) of exposure to suicidal attempts after adjusting for potential confounders was calculated. RESULTS: Of a total 1,035 suicidal attempters enrolled, 332 (32.1%) were included in the exposure group. The exposure group was more likely to have an educational level above high school and no religion, and have suicidal characteristics at night time (18:00–08:00), under the influence of alcohol, suicidal plan before 1 week, and suicidal method involving asphyxia (P<0.05). The exposure group was more likely to have no guardian (AORs, 1.46; 95% confidence interval [CI], 1.00–2.12), use methods involving asphyxia (AORs, 2.07; 95% CI, 1.46–2.91), and attempt suicide at night (18:00 to 08:00) (AORs, 1.38; 95% CI, 1.05–1.83) compared to the no exposure group. CONCLUSION: Models need to be established, where regional mental health welfare center, local government, fire headquarter, and tele-communication companies can participate in the implementation of an active intervention strategy.
Adult ; Asphyxia ; Chungcheongbuk-do ; Emergency Medical Services ; Emergency Service, Hospital ; Fires ; Humans ; Local Government ; Mental Health ; Methods ; Odds Ratio ; Prospective Studies ; Risk Factors ; Suicidal Ideation ; Suicide ; Suicide, Attempted

Emergency physicians in the field are sometimes confronted with cases wherein patients cannot be intubated and ventilated. In some cases, cricothyrotomy, the method of choice for securing an emergency airway, may not have a successful outcome. We report a rare case of a 35-year-old male patient with avulsion of the larynx and a comminuted fracture of the jawbone, due to entrapment in a dung excavator. Prehospital tracheotomy was successfully performed. In cases with crush injuries to the larynx, anatomic structures, including the ligamentum conicum, are destroyed. In addition, massive subcutaneous emphysema blurs the anatomical key structures; hence, only a tracheotomy can prevent a lethal outcome.
Adult ; Emergencies ; Emergency Medical Services ; Fractures, Cartilage ; Fractures, Comminuted ; Humans ; Larynx ; Male ; Methods ; Subcutaneous Emphysema ; Tracheotomy

OBJECTIVE: This study aimed to achieve expert consensus for the development of strategies emergency medical services system (EMSS) after reunification of Korean using the Delphi method. METHODS: The Delphi study was performed through several rounds from January to February in 2017. Experts who have experiences of emergency medical support in North Korea and developing countries participated in the study. Respondents were asked to express their level of agreement following 7 categories: (1) emergency medical manpower, (2) communication system, (3) emergency facilities, (4) patient transfer system, (5) consumer participation and public education, (6) insurance system, (7) disaster planning. Score 1–3 was classified as disagreement, 4–6 as medium agreement, and 7–9 as agreement and consensus was considered being achieved when more than two thirds of respondents agreed in each question. RESULTS: Response rate were 80% in the first round and 75% in the second round. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, and disaster planning for the important factors immediately after reunification within 5 years. Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, consumer participation and public education, and disaster planning for the prior factors when the reunification would happen rapidly without enough preparation. CONCLUSION: Consensus was achieved in emergency medical manpower, communication system, emergency facilities, patient transfer system, disaster planning for the essential EMSS elements. The consensus was expected to utilize as a basic data for the development of EMSS preparing for reunification.
Consensus* ; Consumer Participation ; Delphi Technique* ; Democratic People's Republic of Korea ; Developing Countries ; Disaster Planning ; Education ; Emergencies* ; Emergency Medical Services* ; Expert Testimony ; Insurance ; Korea* ; Methods ; Patient Transfer ; Public Health ; Surveys and Questionnaires

Adult ; Aged ; Canada ; Child ; Decision Making ; Decision Support Systems, Clinical ; Emergency Medical Services ; methods ; Emergency Service, Hospital ; Emergency Treatment ; methods ; Female ; Humans ; Pneumonia ; diagnosis ; Retrospective Studies ; Severity of Illness Index ; Singapore