Articles: emergency-medical-services.
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Observational Study
Epidemiology and outcomes of severe injury patients related to suicide attempt or self-harm in Korea: Nationwide community-based study, 2016-2020.
Suicide is a major social issue in Korea. Suicide attempt or self-harm (SA/SH)-a risk factor for suicides-is in itself a major public health problem. Investigating vulnerable populations is the first step for designing an effective prevention program. This study aimed to investigate the epidemiology and outcomes of patients with severe injuries related to suicide attempts or self-harm (SA/SH) by age groups, using a nationwide database. ⋯ More than 20 % of EMS treated patients with severe injury were SA/SH-related, and the mortality was over 20 %. Although poisoning was the most common mechanism, the high proportions of jumping and hanging with high mortality, resulted in adolescents and the older adults groups having high mortality. Therefore, designing target-specific SA/SH prevention programs based on age, sex, and common SA/SH mechanisms are necessary.
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While ambulance transport decisions guided by artificial intelligence (AI) could be useful, little is known of the accuracy of AI in making patient diagnoses based on the pre-hospital patient care report (PCR). The primary objective of this study was to assess the accuracy of ChatGPT (OpenAI, Inc., San Francisco, CA, USA) to predict a patient's diagnosis using the PCR by comparing to a reference standard assigned by experienced paramedics. The secondary objective was to classify cases where the AI diagnosis did not agree with the reference standard as paramedic correct, ChatGPT correct, or equally correct. ⋯ In this study, overall accuracy of ChatGPT to diagnose patients based on their emergency medical services PCR was 75.0%. In cases where the ChatGPT diagnosis was considered less likely than paramedic diagnosis, most commonly the AI diagnosis was more critical than the paramedic diagnosis - potentially leading to over-triage. The under-triage rate was less than 1%.
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Opioids kill tens of thousands of patients each year. While only a fraction of people with opioid use disorder (OUD) have accessed treatment in the last year, 30% of people who died from an overdose had an Emergency Medical Services (EMS) encounter within a year of their death. Prehospital buprenorphine represents an important emerging OUD treatment, yet limited data describe barriers to this treatment. Our objectives were to quantify the number of patients encountered by EMS who were eligible for prehospital buprenorphine, and to examine characteristics of patients who did or did not receive treatment. ⋯ One-in-three EMS patients with suspected opioid use disorder were ineligible for treatment with buprenorphine due to altered mental status. The second largest group consisted of patients who were eligible but not offered buprenorphine, highlighting potential gaps in paramedic training, logistical challenges in field administrations, and other factors that warrant further exploration.
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In out-of-hospital cardiac arrest (OHCA), prehospital time is crucial and can be divided into response time, from emergency call to emergency medical service (EMS) contact, and time from EMS contact to hospital arrival. To improve prehospital strategies for pediatric OHCA, it is essential to understand the association between these time intervals and patient outcomes; however, detailed investigations are lacking. The current study aimed to examine the association between response time and time from EMS contact to hospital arrival as well as survival and neurological outcomes in pediatric OHCA. ⋯ A response time of <15 minutes can be associated with better survival and neurological outcomes. However, there is no significant association between time from EMS contact to hospital arrival as well as survival and favorable neurological outcomes.
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Out-of-hospital births are associated with a 2- to 11-fold increased risk of death compared to in-hospital births and are growing. Emergency Medical Services (EMS) clinicians have limited exposure to hospital birth emergencies, and there is no standardized prehospital neonatal resuscitation curriculum. Neonatal Resuscitation Program (NRP) guidelines are the standard of care for infants born in the United States but focuses on in-hospital births and is not easily applied to EMS. There is a need for tailored NRP training to meet EMS clinicians' specific needs, context, and systems. ⋯ A virtual EMS-tailored, NRP-based educational curriculum improved neonatal resuscitation knowledge immediately and was sustained at 3 months compared to baseline. The curriculum is feasible and acceptable to EMS clinicians.