Correlation of age and rurality with low-urgency use of emergency medical services (LUEMS): A geographic analysis

CJEM ◽  
2017 ◽  
Vol 20 (6) ◽  
pp. 874-881 ◽  
Author(s):  
Mikiko Terashima ◽  
Alix J.E. Carter
Keyword(s):  
Emergency Medical Services ◽  
Public Transportation ◽  
Rural Areas ◽  
Tertiary Care ◽  
Incidence Rates ◽  
Medical Services ◽  
Older Population ◽  
Age Cohorts ◽  
Geographic Analysis ◽  
Emergency Medical

ABSTRACTObjectivesStudies suggest that addressing the needs of the older population in rural areas may substantially reduce their low-urgency use of emergency medical services (LUEMS). It may ultimately also help improve the efficiency in our health system. There is, however, a dearth of evidence substantiating geographic patterns in LUEMS by different age cohorts. This exploratory study was aimed to clarify the understanding of emergency medical services (EMS) use in Nova Scotia through a geographic analysis.MethodsRecords with Canadian Triage and Acuity Scale of 4 and 5 were considered as LUEMS. We assessed the distribution of LUEMS incidence rates (proportion of LUEMS out of all EMS uses) by age and rurality, using descriptive statistics and Geographic Information Systems mapping.ResultsNearly half of all EMS transports were individuals of 65+ years of age; 35% of those were LUEMS. The rates increased along with the level of rurality, and the older cohort had the highest incidence rates in non-metro communities. High rates were seen primarily in some rural communities farthest away from the capital/tertiary care centre.ConclusionHigh LUEMS incidence rates are rural phenomena but not specific to the older population. However, the absolute number of LUEMS by the older cohort is significant, and elder-specific interventions in rural regions could still lead to effective cost savings. Further investigation of other factors, such as distance to the emergency department, availability of public transportation, and socioeconomic conditions of EMS users, is needed.

scholarly journals Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043791
Author(s):  
Jan Bauer ◽  
Dieter Moormann ◽  
Reinhard Strametz ◽  
David A Groneberg
Keyword(s):  
Cost Effectiveness ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Medical Services ◽  
Secondary Outcome ◽  
Annual Average ◽  
Emergency Medical ◽  
Life Years ◽  
Timely Access ◽  
The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

Pediatric Prehospital Care in Urban and Rural Areas

PEDIATRICS ◽  
1991 ◽  
Vol 88 (4) ◽  
pp. 681-690 ◽  
Author(s):  
James S. Seidel ◽  
Deborah Parkman Henderson ◽  
Patrick Ward ◽  
Barbara Wray Wayland ◽  
Beverly Ness
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Pediatric Patients ◽  
Life Support ◽  
Prehospital Care ◽  
Advanced Life Support ◽  
Medical Services ◽  
Care Providers ◽  
Emergency Medical

There are limited data concerning pediatric prehospital care, although pediatric prehospital calls constitute 10% of emergency medical services activity. Data from 10 493 prehospital care reports in 11 counties of California (four emergency medical services systems in rural and urban areas) were collected and analyzed. Comparison of urban and rural data found few significant differences in parameters analyzed. Use of the emergency medical services system by pediatric patients increased with age, but 12.5% of all calls were for children younger than 2 years. Calls for medical problems were most common for patients younger than 5 years of age; trauma was a more common complaint in rural areas (64%, P = .0001). Frequency of vital sign assessment differed by region, as did hospital contact (P < .0001). Complete assessment of young pediatric patients, with a full set of vital signs and neurologic assessment, was rarely performed. Advanced life support providers were often on the scene, but advanced life support treatments and procedures were infrequently used. This study suggests the need for additional data on which to base emergency medical services system design and some directions for education of prehospital care providers.

The emergency medical system

2021 ◽  
pp. 65-75
Author(s):  
Olivier Hoogmartens ◽  
Michiel Stiers ◽  
Koen Bronselaer ◽  
Marc Sabbe
Keyword(s):  
Medical Care ◽  
Emergency Medical Services ◽  
Emergency Medical Service ◽  
Medical Service ◽  
Tertiary Care ◽  
Medical Services ◽  
High Quality ◽  
Emergency Medical ◽  
High Quality Medical Care ◽  
The Moment

The mission of the emergency medical services is to promote and support a system that provides timely, professional and state-of-the art emergency medical care, including ambulance services, to anyone who is victim of a sudden injury or illness, at any time and any location. A medical emergency has five different phases, namely: population awareness and behaviour, occurrence of the problem and its detection, alarming of trained responders and help rendered by bystanders and trained pre-hospital providers, transport to the nearest or most appropriate hospital, and, if necessary, admission or transfer to a tertiary care centre which provides a high degree of subspecialty expertise. In order to meet these goals, emergency medical services must work aligned with local, state officials; with fire and rescue departments; with other ambulance providers, hospitals, and other agencies to foster a high performance network. The term emergency medical service evolved to reflect a change from a straightforward system of ambulances providing nothing but transportation, to a complex network in which high-quality medical care is given from the moment the call is received, on-scene with the patient and during transportation. Medical supervision and/or participation of emergency medicine physicians (EP) in the emergency medical service systems contributes to the quality of medical care. This emergency medical services network must be capable to respond instantly and to maintain efficacy around the clock, with well-trained, well-equipped personnel linked through a strong communication system. Research plays a pivotal role in defining necessary resources and in continuously improving the delivery of high-quality care. This chapter gives an overview of the different aspects of emergency medical services and calls for high quality research in pre-hospital emergency care in a true partnership between cardiologists and emergency physicians.

scholarly journals IMPACT OF AGING POPULATIONS ON MUNICIPAL EMERGENCY MEDICAL SERVICES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S956-S956
Author(s):  
Nidya Velasco Roldan ◽  
Caitlin E Coyle ◽  
Michael Ward ◽  
Jan Mutchler
Keyword(s):  
Emergency Medical Services ◽  
Assisted Living ◽  
Local Governments ◽  
Emergency Services ◽  
Medical Services ◽  
Assisted Living Facilities ◽  
Older Population ◽  
Emergency Medical ◽  
Age Related ◽  
Aging Populations

Abstract The services that residents require from their local governments vary depending on the demographics of their populations. While municipalities have long sought to consider how changes in the young population may impact their school system needs, few systematic considerations have been developed relating to how aging populations may impact municipal service provision. This study aims to address this issue by focusing on demands on emergency services at the municipal level. Using data from the Massachusetts Ambulance Trip Record Information System (MATRIS) we explore the association between emergency medical services (EMS) demand and population age-structure. The data shows an overrepresentation of older people among EMS users. People age 65 and older represent 16% of Massachusetts’ population but account for 31% of the transported emergent calls —e.g., 911 calls— and 60% of the scheduled transports. Results from the OLS regression analysis suggest that communities with larger shares of older residents have significantly higher numbers of EMS calls. The type of community and other age-related community features such as the percentage of older residents living alone and the percentage of older population dually eligible for Medicare and Medicaid are also significantly associated with the number of EMS calls. Contrary to our expectations, other resources available in the community such nursing homes or assisted living facilities were not significantly associated with number of EMS calls. Our research indicates that if growth in the older population occurs as projected, the demand placed on the EMS system by older populations will grow considerably in coming decades.

scholarly journals Standard Precautions Among Emergency Medical Services in Urban and Rural Areas

2019 ◽  
Vol 68 (2) ◽  
pp. 73-80
Author(s):  
Riyadh A. Alhazmi ◽  
R. David Parker ◽  
Sijin Wen
Keyword(s):  
West Virginia ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Services ◽  
Cross Sectional Survey ◽  
Standard Precautions ◽  
Cross Sectional ◽  
Emergency Medical ◽  
Rural And Urban

Backround: Emergency medical services (EMS) workers are at risk of exposure to bloodborne pathogens and frequently exposed to blood and bodily fluids through percutaneous injuries. This study aimed to assess the consistency with which standard precautions (SPs) among rural and urban EMS providers were used. Methods: This study consisted of a cross-sectional survey conducted with a sample of certified EMS providers in West Virginia in which we ascertained details about sociodemographic characteristics, and the frequency of consistent SP. An email invitation was sent to a comprehensive list of agencies obtained from the Office of West Virginia EMS. Findings: A total of 248 out of 522 (47%) EMS providers completed the survey. The majority of the EMS providers (76%) consistently complied with SPs; however, more than one third (38%) of urban EMS providers indicated inconsistent use compared with 19% of rural EMS providers ( p = .002). Most EMS providers reported low prevention practices to exposure of blood and body fluids in both areas. Conclusion/Application to Practice: The results emphasize the need to enhanced safe work practices among EMS providers in both rural and urban areas through education and increasing self-awareness. Occupational health professional in municipalities that serve these workers are instrumental in ensuring these workers are trained and evaluated for their compliance with SPs while in the field.

Pediatric deaths and emergency medical services (EMS) in urban and rural areas

1989 ◽  
Vol 5 (3) ◽  
pp. 158-162 ◽  
Author(s):  
MARIANNE GAUSCHE ◽  
JAMES S. SEIDEL ◽  
DEBORAH P. HENDERSON ◽  
BEVERLY NESS ◽  
PATRICK MICHAEL WARD ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Medical Services ◽  
Emergency Medical ◽  
Urban And Rural Areas

scholarly journals The contribution of helicopter emergency medical services in the pre-hospital care of penetrating torso injuries in a semi-rural setting

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
M. Gavrilovski ◽  
J. E. Griggs ◽  
E. ter Avest ◽  
R. M. Lyon ◽  
Keyword(s):  
Emergency Medical Services ◽  
Rural Areas ◽  
Penetrating Trauma ◽  
Trauma Centre ◽  
Rural Setting ◽  
Medical Services ◽  
Hospital Treatment ◽  
Helicopter Emergency Medical Services ◽  
Emergency Medical ◽  
Major Trauma Centre

Abstract Background Although the merit of pre-hospital critical care teams such as Helicopter Emergency Medical Services (HEMS) has been universally recognized for patients with penetrating torso injuries who present with unstable physiology, the potential merit in patients initially presenting with stable physiology is largely undetermined. The ability to predict the required pre-hospital interventions patients may have important implications for HEMS tasking, especially when transport times to definitive care are prolonged. Methods We performed a retrospective cohort study of patients who sustained a penetrating torso injury and were attended by the Air Ambulance Kent Surrey Sussex (AAKSS) over a 6-year period. Primary outcome was defined as the percentage of patients with penetrating torso injuries requiring HEMS-specific interventions anytime between HEMS arrival and arrival at hospital. Secondary outcomes were the association of individual patient- and injury characteristics with the requirement for HEMS interventions. Results During the study period 363 patients met inclusion criteria. 90% of patients were male with a median age of 30 years. 99% of penetrating trauma incident occurred more than 10-min drive from a Major Trauma Centre (MTC). Presenting GCS was > 13 in 83% of patients. Significant hemodynamic- or ventilatory compromise was present in more than 25% of the patients. Traumatic cardiac arrest was present in 34 patients (9.4%), profound hypotension with SBP < 80 mmHg in 30 (8.3%) and oxygen saturations < 92% in 30 (8.3%). A total of 121 HEMS-specific interventions were performed. Although HEMS-specific interventions were associated with presenting physiology (TCA OR 1.75 [1.41–2.16], SBP < 80 mmHg (OR 1.40 [1.18–1.67] and SpO2 < 92% (OR 1.39 [1.17–1.65], a minority of the patients presented initially with stable physiology but deteriorated on route to hospital and required HEMS interventions (n = 9, 3.3%). Conclusion HEMS teams provide potentially important contribution to the pre-hospital treatment of patients with penetrating torso injuries in rural and semi-rural areas, especially when they present with unstable physiology. A certain degree of over-triage is inevitable in these patients, as it is hard to predict which patients will deteriorate on route to hospital and will need HEMS interventions. The results of this study showing a potentially predictable geographical dispersion of penetrating trauma could inform multi-agency knife crime prevention strategy.

scholarly journals Disparities between Rural and Urban Areas of the Central Region of Saudi Arabia in the Utilization and Time-Centeredness of Emergency Medical Services

2020 ◽  
Vol 17 (21) ◽  
pp. 7944
Author(s):  
Hassan N. Moafa ◽  
Sander Martijn Job van Kuijk ◽  
Dhafer M. Alqahtani ◽  
Mohammed E. Moukhyer ◽  
Harm R. Haak
Keyword(s):  
Saudi Arabia ◽  
Emergency Medical Services ◽  
Central Region ◽  
Rural Areas ◽  
Urban Areas ◽  
Medical Services ◽  
Utilization Rate ◽  
Rural And Urban Areas ◽  
Emergency Medical ◽  
Rural And Urban

The purpose of this study was to explore differences in characteristics of missions dispatched by Emergency Medical Services (EMS) between rural and urban areas of Riyadh province in Saudi Arabia (SA). It also aimed at identifying weaknesses related to utilization and Response Time (RT). The study retrospectively evaluated 146,639 completed missions in 2018 by measuring the utilization rate in rural and urban areas. The study shows there are six times more ambulance crews available for rural areas compared to urban. There were 22.1 missions per 1000 urban inhabitants and 11.2 missions per 1000 in rural areas. The median RT for high urgent trauma cases was 20.2 min in rural compared to 15.2 min in urban areas (p < 0.001). In urban areas, the median RT for high urgent medical cases was 16.1 min, while it was 15.2 min for high urgent trauma cases. Around 62.3% of emergency cases in urban and 56.5% in rural areas were responded to within 20.00 min. Women utilized EMS less frequently. The RT was increased in urban areas compared to previous studies. The RT in the central region of SA has been identified as equal, or less than 20.00 min in 62.4% of all emergency cases. To further improve adherence to the 20′ target, reorganizing the lowest urgent cases in the rural areas seems necessary.

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