The association of scene-access delay and survival with favourable neurological status in patients with out-of-hospital cardiac arrest

Sinden, Sean; Heidet, Matthieu; Scheuermeyer, Frank; Kawano, Takahisa; Helmer, Jennie; Christenson, Jim; Grunau, Brian

doi:10.1016/j.resuscitation.2020.05.047

Cited by 10 publications

(7 citation statements)

References 20 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%

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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%

“…This difference remained significant after adjustment for confounders. Sinden et al similarly reported lower rates of survival to hospital discharge in OHCA patients when EMS arrival at scene to patient’s side was delayed [ 29 ].…”

Section: Resultsmentioning

confidence: 99%

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

Han

Yeo

Ong

et al. 2021

JCM

View full text Add to dashboard Cite

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“…The important part of the overall emergency call-to-care interval is the patient access time interval (PATI) measured from EMS vehicle arrival at the incident site to the time EMS personnel contact the patient. This time interval accounts for 10 to 44% of the overall emergency call-to-care interval [ 38 ]. Although reducing PATI may improve patient outcomes, it is not affected by the locations of ambulance base stations.…”

Section: Discussionmentioning

confidence: 99%

Coverage versus response time objectives in ambulance location

et al. 2021

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Background This paper deals with the location of emergency medical stations where ambulances waiting to be dispatched are parked. The literature reports a lot of mathematical programming models used to optimize station locations. Most studies evaluate the models only analytically applying the same simplifying assumptions that were used in the modelling phase. In addition, they concentrate on systems operating one type of emergency units in homogeneous urban areas. The goal of our study is to identify which optimization criterion the emergency medical service (EMS) outcomes benefit from the most and which model should be used to design tiered systems in large urban–rural areas. Methods A bi-criteria mathematical programming model is proposed. The criteria include the accessibility of high-priority patients within a short time limit and average response time to all patients. This model is being compared to the p-median model with a single response time objective and to a hierarchical pq-median model that considers two different vehicle types. A detailed computer simulation model is used to evaluate the solutions. The methodology is verified in the conditions of the Slovak Republic using real historical data on 149,474 ambulance trips performed in 2015. Results All mathematical models improve EMS performance by relocating some stations compared to the current distribution. The best results are achieved by the hierarchical median-type model. The average response time is reduced by 58 s, the number of calls responded to within 15 min is increased by 5% and the number of high-priority calls responded to within 8 min by 6%. Conclusions The EMS systems operating in heterogeneous areas should be designed to minimize response times, and not to maximize the number of calls served within a given time limit.

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“…PATI is the time interval between vehicle arrival at scene and hands on patient, and OSTI is the time interval between arrival at patient and beginning moving patient. Similar to STI and TTI, PATI and OSTI are known to significantly impact health outcomes [10,11,19,26]. The total travel time for trip 1 and trip 2, represented by the sum of SIT and TTI, is clearly related to geographic proximity (both of ambulance to patient and then patient to hospital), but will also depend on the road quality, real-time traffic and weather conditions among other factors.…”

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confidence: 99%

Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals

et al. 2020

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Background Access as a primary indicator of Emergency Medical Service (EMS) efficiency has been widely studied over the last few decades. Most previous studies considered one-way trips, either getting ambulances to patients or transporting patients to hospitals. This research assesses spatiotemporal access to EMS at the shequ (the smallest administrative unit) level in Wuhan, China, attempting to fill a gap in literature by considering and comparing both trips in the evaluation of EMS access. Methods Two spatiotemporal access measures are adopted here: the proximity-based travel time obtained from online map services and the enhanced two-step floating catchment area (E-2SFCA) which is a gravity-based model. First, the travel time is calculated for the two trips involved in one EMS journey: one is from the nearest EMS station to the scene (i.e. scene time interval (STI)) and the other is from the scene to the nearest hospital (i.e. transport time interval (TTI)). Then, the predicted travel time is incorporated into the E-2SFCA model to calculate the access measure considering the availability of the service provider as well as the population in need. For both access measures, the calculation is implemented for peak hours and off-peak hours. Results Both methods showed a marked decrease in EMS access during peak traffic hours, and differences in spatial patterns of ambulance and hospital access. About 73.9% of shequs can receive an ambulance or get to the nearest hospital within 10 min during off-peak periods, and this proportion decreases to about 45.5% for peak periods. Most shequs with good ambulance access but poor hospital access are in the south of the study area. In general, the central areas have better ambulance, hospital and overall access than peripheral areas, particularly during off-peak periods. Conclusions In addition to the impact of peak traffic periods on EMS access, we found that good ambulance access does not necessarily guarantee good hospital access nor the overall access, and vice versa.

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The association of scene-access delay and survival with favourable neurological status in patients with out-of-hospital cardiac arrest

Cited by 10 publications

References 20 publications

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

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

Coverage versus response time objectives in ambulance location

Spatiotemporal access to emergency medical services in Wuhan, China: accounting for scene and transport time intervals

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