scholarly journals Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services: A Significant Step Forward and a Model for Other High-Risk Industries

2018 ◽  
Vol 22 (sup1) ◽  
pp. 110-112
Author(s):  
Hans P. A. Van Dongen
Keyword(s):  
Risk Management ◽  
High Risk ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
Significant Step ◽  
Evidence Based Guidelines

scholarly journals Evidence-Based Guidelines for Fatigue Risk Management in Emergency Medical Services

2018 ◽  
Vol 22 (sup1) ◽  
pp. 89-101 ◽  
Author(s):  
P. Daniel Patterson ◽  
J. Stephen Higgins ◽  
Hans P. A. Van Dongen ◽  
Daniel J. Buysse ◽  
Ronald W. Thackery ◽  
...  
Keyword(s):  
Risk Management ◽  
Emergency Medical Services ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
Evidence Based Guidelines

scholarly journals Contemporary evidence-based practice in Canadian emergency medical services: a vision for integrating evidence into clinical and policy decision-making

CJEM ◽  
2016 ◽  
Vol 19 (3) ◽  
pp. 220-229
Author(s):  
Jan L. Jensen ◽  
Andrew H. Travers
Keyword(s):  
Decision Making ◽  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Systems Of Care ◽  
National Level ◽  
Policy Decision ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
Patient Health

AbstractNationally, emphasis on the importance of evidence-based practice (EBP) in emergency medicine and emergency medical services (EMS) has continuously increased. However, meaningful incorporation of effective and sustainable EBP into clinical and administrative decision-making remains a challenge. We propose a vision for EBP in EMS: Canadian EMS clinicians and leaders will understand and use the best available evidence for clinical and administrative decision-making, to improve patient health outcomes, the capability and quality of EMS systems of care, and safety of patients and EMS professionals. This vision can be implemented with the use of a structure, process, system, and outcome taxonomy to identify current barriers to true EBP, to recognize the opportunities that exist, and propose corresponding recommended strategies for local EMS agencies and at the national level. Framing local and national discussions with this approach will be useful for developing a cohesive and collaborative Canadian EBP strategy.

Equity-constrained dispatching models for emergency medical services

2017 ◽  
Vol 23 (1/2) ◽  
pp. 28-45 ◽  
Author(s):  
Sreekanth V.K. ◽  
Ram Babu Roy
Keyword(s):  
High Risk ◽  
Emergency Medical Services ◽  
Decision Process ◽  
Agent Based Modeling ◽  
Medical Services ◽  
Content Type ◽  
Agent Based ◽  
Emergency Medical ◽  
Markov Decision ◽  
Risk Patients

Purpose The purpose of this paper is to apply agent-based modeling and simulation concepts in evaluating different approaches to solve ambulance-dispatching decision problems under bounded rationality. The paper investigates the effect of over-responding, i.e. dispatching ambulances even for doubtful high-risk patients, on the performance of equity constrained emergency medical services. Design/methodology/approach Agent-based modeling and simulation was used to evaluate two different dispatching policies: first, a policy based on maximum reward, and second, a policy based on the Markov decision process formulation. Four equity constraints were used: two from the patients’ side and two from the providers’ side. Findings The Markov decision process formulation, solved using value iteration method, performed better than the maximum reward method in terms of number of patients served. As the equity constraints conflict with each other, at most three equity constraints could be enforced at a time. The study revealed that it is safe to over-respond if there is uncertainty in the risk level of the patients. Research limitations/implications Further research is required to understand the implications of under-responding, where doubtful high-risk patients are denied an ambulance service. Practical implications The need for good triage system is apparent as over-responding badly affects the operational budget. The model can be used for evaluating various dispatching policy decisions. Social implications Emergency medical services have to ensure efficient and equitable provision of services, from the perception of both patients and service providers. Originality/value The paper applies agent-based modeling to equity constrained emergency medical services and highlights findings that are not reported in the existing literature.

scholarly journals State of the evidence for emergency medical services care of adult patients with sepsis: an analysis of research from the Prehospital Evidence-based Practice

2021 ◽  
Vol 18 ◽  
Author(s):  
Jennifer Greene ◽  
Judah Goldstein ◽  
Daniel Lane ◽  
Jan Jensen ◽  
Yves Leroux ◽  
...  
Keyword(s):  
Septic Shock ◽  
Emergency Medical Services ◽  
Evidence Based Practice ◽  
Temperature Monitoring ◽  
Adult Patients ◽  
Medical Services ◽  
Evidence Based ◽  
Emergency Medical ◽  
High Flow Oxygen ◽  
Balanced Crystalloids

Introduction The Prehospital Evidence-Based Practice (PEP) program is an online, freely accessible, continuously updated emergency medical services evidence repository. This PEP summary describes the research evidence for the identification and management of adult patients with sepsis or septic shock. Methods A systematic search of the literature on sepsis or septic shock was conducted. Studies were scored by trained appraisers on a three-point level of evidence scale (based on study design and quality) and a three-point direction of evidence scale (supportive, neutral or opposing findings based on the studies’ primary outcome for each intervention). Results One hundred forty-three studies (80 existing and 63 new) were included for 16 interventions listed in PEP for adult patients with sepsis. The evidence matrix rank for supported interventions (n=16) were supportive-high quality (n=2, 12.5%) for crystalloid infusion and vasopressors, supportive-moderate quality (n=8, 50%) for identification tools, pre-notification, point-of-care lactate, titrated oxygen, temperature monitoring and balanced crystalloids. The benefit of pre-hospital antibiotics, colloids, Trendelenburg position and early goal-directed therapy remain inconclusive with a neutral direction of evidence. There is moderate level evidence opposing the use of high flow oxygen. Conclusion Several standard treatments are well supported by the evidence including fluid resuscitation, using balanced crystalloids, vasopressors and titrating oxygen. Tools for identifying and guiding treatment are also supported (eg. pre-notification, temperature monitoring and lactate). The evidence for antibiotic use is inconclusive. This PEP state of the evidence analysis can be used to guide selection of appropriate pre-hospital therapies during the development of pre-hospital protocols or clinical practice guidelines.

Business Intelligence applied to Emergency Medical Services in the Lombardy region during SARS-CoV-2 epidemic (Preprint)

2020 ◽  
Author(s):  
Giuseppe Maria Sechi ◽  
Maurizio Migliori ◽  
Gabriele Dassi ◽  
Andrea Pagliosa ◽  
Rodolfo Bonora ◽  
...  
Keyword(s):  
Emergency Medical Services ◽  
Business Intelligence ◽  
First Aid ◽  
Medical Services ◽  
Evidence Based ◽  
Time Data ◽  
Lombardy Region ◽  
Emergency Medical ◽  
Real Time Data ◽  
The Impact

BACKGROUND Background: In Italy on the 21st of February, the first patient was tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at Codogno hospital in the Lombardy region. From that date, the Regional Emergency Medical Services (EMS) Trust (Azienda Regionale Emergenza Urgenza, AREU) of the Lombardy region decided to apply Business Intelligence (BI) to the management of EMS during the epidemic. OBJECTIVE Objective: The aim of the study is to assess in this context the impact of BI on EMS management outcomes. METHODS Methods: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, in February 2020, AREU is using BI daily to track the number of first aid requests received from 112 (Public Safety Answering Point 1). BI analyses the number of requests that have been classified as respiratory and/or infectious episodes during the telephone dispatch interview. Moreover, BI allows analysing the pattern of the epidemic, identifying the numerical trend of episodes in each municipality (increasing, stable, decreasing). RESULTS Results: AREU decides to reallocate in the territory the resources based on real-time data recorded and elaborated by BI. Indeed, based on that data, the numbers of vehicles and personnel have been implemented in the municipalities that registered more episodes and where the clusters are supposed to be. BI has been of paramount importance in taking timely decisions on the management of EMS during COVID-19 outbreak in the Lombardy region. CONCLUSIONS Conclusion: Even if there is little evidence-based literature focused on BI impact within the health care, this study suggests that BI can be usefully applied to promptly identify clusters and patterns of the SARS-CoV-2 epidemic and, consequently, make informed decisions that can improve the EMS management response to the outbreak.

Sign in / Sign up

Export Citation Format

Share Document