EMS Access Constraints And Response Time Delays For Deprived Critically Ill Patients Near Paris, France

Heidet, Matthieu; Cunha, Thierry Da; Brami, Elise; Mermet, Éric; Dru, M.; Simonnard, Béatrice; Lecarpentier, Éric; Chollet-Xémard, C.; Bergeron, Corinne; Khalid, M.; Grunau, Brian; Marty, J.; Audureau, Étienne

doi:10.1377/hlthaff.2019.00842

Cited by 6 publications

(5 citation statements)

References 27 publications

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“…A further seven articles were removed after review of full texts. Finally, 23 articles were included in the scoping review [ 4 , 5 , 6 , 7 , 8 , 11 , 12 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. The characteristics of included studies are summarised in Table 1 .…”

Section: Resultsmentioning

confidence: 99%

“…Furthermore, the studies by Lateef and Park found that this finding remained applicable to the time interval between leaving the patient’s location and the commencement of the ambulance’s journey to the hospital, known as T6 and T7, respectively [ 8 , 26 ]. In Heidet et al’s Parisian study, it was found that the number of floors in a patient’s residence significantly affected EMS response times [ 22 ]. This was particularly prevalent in the most deprived areas of the precinct with more multistorey dwellings.…”

Section: Resultsmentioning

confidence: 99%

“…In particular, the study by Chi et al reported an odds ratio of 0.40 (95% CI 0.17–0.98) for ROSC in a vertical OHCA location. Heidet et al reported that ROSC rates were significantly poorer only for the most deprived areas in a densely populated Parisian precinct, with 33% of buildings being multistorey residential blocks [ 22 ]. Contrarily, Choi et al reported anomalous findings of a significantly higher rate of ROSC for residential OHCAs occurring at higher floors of three storeys and above as compared to lower floors [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…As an extension to unique prehospital OHCA datasets, a linkage of OHCA data registries with other data repositories such as socioeconomic data or urban density data could prove useful in the analysis and evaluation of OHCA resuscitative performance. Heidet et al’s 2020 study successfully retrieved census data on socioeconomic status stratified by geographical areas, and linked that with a validated calculation of the degree of deprivation associated with each of these areas [ 22 ]. If such linkage of data is replicated in more EMS systems worldwide, the findings could provide important insight to the unique but less-reported-on barriers EMS systems face in different geographical contexts and demographic groups, hence informing policy changes and improvements.…”

Section: Discussionmentioning

confidence: 99%

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Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review

Han

Yeo

Ong

et al. 2021

JCM

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Out-of-hospital cardiac arrests (OHCAs) occurring in high-rise buildings are a challenge to Emergency Medical Services (EMS). Contemporary EMS guidelines lack specific recommendations for systems and practitioners regarding the approach to these patients. This scoping review aimed to map the body of literature pertaining to OHCAs in high-rise settings in order to clarify concepts and understanding and to identify knowledge gaps. Databases were searched from inception through to 6 May 2021 including OVID Medline, PubMed, Embase, CINAHL, and Scopus. Twenty-three articles were reviewed, comprising 8 manikin trials, 14 observational studies, and 1 mathematical modelling study. High-rise settings commonly have lower availability of bystanders and automatic external defibrillators (AEDs), while height constraints often lead to delays in EMS interventions and suboptimal cardiopulmonary resuscitation (CPR), scene access, and extrication. Four studies found return of spontaneous circulation (ROSC) rates to be significantly poorer, while seven studies found rates of survival-to-hospital discharge (n = 3) and neurologically favourable survival (n = 4) to be significantly lower in multistorey settings. Mechanical chest compression devices, transfer sheets, and strategic defibrillator placement were suggested as approaches to high-rise OHCA management. A shift to maximising on-scene treatment time, along with bundling novel prehospital interventions, could ameliorate some of these difficulties and improve clinical outcomes for patients.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Cardiac Arrest Occurring in High-Rise Buildings: A Scoping Review

Han

Yeo

Ong

et al. 2021

JCM

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“…Response time is widely recognized as a key parameter for determining EMS operational efficiency and is used globally 11 . In general, various factors can prolong response time, including time of incidents, road conditions, weather, 12 area of incidents, 13 and the occurrence of mass casualty incidents 14 . During the COVID‐19 pandemic period, poor response times were attributed to several factors, including the need for dispatchers to request additional information about potential COVID‐19 infections and symptoms when responding to an emergency call, 15 an increase in dispatcher workload due to an increase in emergency calls 16–18 .…”

Section: Discussionmentioning

confidence: 99%

Impact of the coronavirus disease 2019 (COVID‐19) pandemic on the operational efficiency of emergency medical services and its association with out‐of‐hospital cardiac arrest survival rates: A population‐based cohort study in Kobe, Japan

Sugiyama,

Inoue,

Inada

et al. 2023

Acute Medicine & Surgery

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AimTo identify whether the coronavirus disease 2019 (COVID‐19) pandemic affects the operational efficiency of emergency medical services (EMS) and the survival rate of out‐of‐hospital cardiac arrest (OHCA) in prehospital settings.MethodsWe conducted a population‐based cohort study in Kobe, Japan, between March 1, 2020, and September 31, 2022. In study 1, the operational efficiency of EMS, such as the total out‐of‐service time for ambulances, the daily occupancy rate of EMS, and response time, was compared between the pandemic and nonpandemic periods. In study 2, the impacts of the changes in EMS operational efficiency were investigated among patients with OHCA, with 1‐month survival as the primary outcome and return of spontaneous circulation, 24‐h survival, 1‐week survival, and favorable neurological outcomes as the secondary outcomes. Logistic regression analysis was conducted to identify the factors associated with survival among patients with OHCA.ResultsThe total out‐of‐service time, occupancy rate, and response time significantly increased during the pandemic period (p < 0.001). The response time during the pandemic period increased significantly per pandemic wave. Regarding OHCA outcomes, 1‐month survival rates during the pandemic period significantly decreased compared with those during the nonpandemic period (pandemic 3.7% vs. nonpandemic 5.7%; p < 0.01). Similarly, 24‐h survival (9.9% vs. 12.8%), and favorable neurological outcomes significantly decreased during the pandemic period. In the logistic regression analysis, response time was associated with lower OHCA survival in all outcomes (p < 0.05).ConclusionThe COVID‐19 pandemic has been associated with reduced operational efficiency of EMS and decreased OHCA survival rates. Further research is required to improve the efficiency of EMS and OHCA survival rates.

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