The purpose of this study was to describe the regional locations of cardiac arrest, and to identify public locations and the annual incidence of arrests within the identified locations, in order to help to determine optimal placement of Automatic External Defibrillators (AEDs) under the regional Public Access Defibrillation (PAD) Program. This is a retrospective study.

The locations of cardiac arrest were abstracted from Ambulance Call Reports (ACRs) collected by the Essex-Kent Base Hospital Centre from regional ambulance services throughout the City of Windsor, and the Counties of Essex and Kent, Ontario, Canada, from 01 January 1994 through 31 December 2000. Arrest locations were grouped into five categories, and then the number of public venues was determined. Public sites were grouped into 28 Public Locations. Also included in the Public Sites were both General Industry and Outdoors categories. Categories identified but excluded from Public Sites were Institutions and Private Residences.

During the study, 2,295 arrests occurred, 152 cases were excluded, 2,142 arrests were categorized, (average annual incidence of 306 ±50.4 cardiac arrests), 329 (15.4%) of which were in Public Sites. Nineteen public venues had an average of >1 arrest/year, and nine public venues had an average of ≤1 arrest/year during the study, period. Calculations of the annual incidence of arrests for each public location were completed.

These findings have significant prehospital emergency cardiac care implications for communities that wish to strengthen/improve their responses to out-of-hospital cardiac arrests. Public Access Defibrillation Programs should identify the site-specific incidence of arrest within their communities in order to provide legitimacy for funding and planning of programs. Training and availability of AEDs will reduce the time to first shock, thus strengthening the chain-of-survival and will save more lives.

The Glasgow Coma Scale (GCS) is the standard measure used to quantify the level of consciousness of patients who have sustained head injuries. Rapid and accurate GCS scoring is essential.

To evaluate the effectiveness of a GCS teaching video shown to prehospital emergency medical services (EMS) providers.

Participants and setting—United States, Mid-Atlantic region EMS providers. Intervention—Each participant scored all of the three components of the GCS for each of four scenarios provided before and after viewing a video-tape recording containing four scenarios. Design—Before-and-after single (Phase I) and parallel Cohort (Phase II). Analysis— Proportions of correct scores were compared using chi-square, and relative risk was calculated to measure the strength of the association.

75 participants were included in Phase I. In Phase II, 46 participants participated in a parallel cohort design: 20 used GCS reference cards and 26 did not use the cards. Before observing the instructional video, only 14.7% score all of the scenarios correctly, where as after viewing the video, 64.0% scored the scenarios results were observed after viewing the video for those who used the GCS cards (p = 0.001; RR = 2.0; 95% CI = 1.29 to 3.10) than for those not using the cards (p <0.0001; RR = 10.0; 95% CI = 2.60 to 38.50).

Post-video viewing scores were better than those observed before the video presentation. Ongoing evaluations include analysis of longterm skill retention and scoring accuracy in the clinical environment.

Diversion of ambulances by hospital emergency departments has become a day-to-day occurrence in many jurisdictions within Canada. Yet, despite the increasing prevalence of this phenomenon, its impact on transported patients, on the EMS system, and on the health care system overall has not, to date, been well quantified. Despite the increasing sophistication and capabilities of North American EMS systems, it is difficult to argue with the principle that unstable or potentially unstable patients are best served by expeditious transport for definitive care to acute care facilities. T o this end, this study represents an effort to assess the systemic and patient care impacts of ambulance diversions.

Patient-care and corresponding ambulance trip records for all patients transported by this EMS system for a five week period were abstracted to identify those patients in which an ambulance was diverted from its initial destination. Adverse events include hypotensive episodes, airway compromise, changes in level of consciousness, and the onset of violent behavior. Response and transport times also were abstracted, comparisons utilized student's t-test and 95% Confidence Intervals. Results: Ambulance diversions increased EMS response times and prehospital transport times. Adverse medical events occurred during 4.3% of diverted ambulance runs. Patients, when faced with the prospect of transport to other than their hospital of choice, not infrequently cancelled EMS transport and sought other means of transport. Subsequent interfacility transport was required for 4.3% of the diverted patients.

Diversion of ambulances impacts the EMS system by increasing response and transport times; the region, by generating subsequent interfacility transports; and patients, as adverse medical events can occur during the diverted transport.

The prehospital 12-lead electrocardiogram (ECG) has become a standard of care. For the prehospital 12-lead ECG to be useful clinically, however, cardiologists and emergency physicians (EP) must view the test as useful. This study measured physician attitudes about the prehospital 12-lead ECG.

This study tested the hypothesis that physicians had “no opinion” regarding the prehospital 12-lead ECG.

An anonymous survey was conducted to measure EP and cardiologist attitudes toward prehospital 12-lead ECGs. Hypothesis tests against “no opinion” (VAS = 50 mm) were made with 95% confidence intervals (CIs), and intergroup comparisons were made with the Student-t-test.

Seventy-one of 87 (81.6%) surveys were returned. Twenty-five (67.6%) cardiologists responded and 45 (90%) EPs responded. Both groups of physicians viewed prehospital 12-lead ECGs as beneficial (mean = 69 mm; 95% CI = 65–74mm). All physicians perceived that ECGs positively influence preparation of staff (mean = 63 mm; 95% CI = 60–72mm) and that ECGs transmitted to hospitals would be beneficial (mean = 66 mm; 95% CI = 60–72mm). Cardiologists had more favorable opinions than did EPs. The ability of paramedics to interpret ECGs was not seen as important (mean = 50 mm; 95% CI = 43–56mm). The justifiable increase in field time was perceived to be 3.2 minutes (95% CI = 2.7–3.8 minutes), with 23 (32.8%) preferring that it be done on scene, 46 (65.7%) during transport, and one (1.4%) not at all.

Prehospital 12-lead ECGs generally are perceived as worthwhile by cardiologists and EPs. Cardiologists have a higher opinion of the value and utility of field ECGs. Since the reduction in mortality from the 12-lead ECG is small, it is likely that positive physician attitudes are attributable to other factors.

To evaluate three prototype versions of semi-quantitative end-tidal CO2 monitors with different alarm features during prehospital or inter-facility use.

Subjects were 43 adult, non-pregnant patients requiring intubation, or who already were intubated and required transport. Teams at one AirEvac and seven Advanced Life Support (ALS) paramedic stations were trained in the use of the monitors. Team members at each station evaluated each model for eight days. Participants completed questionnaires following each use.

The monitors performed properly in all cases, but in one case, vomit in the airway adapter tube prevented obtaining a readout. The monitors aided management in 40 of 43 cases (93%); in one, the monitor reading was reported as variable (between 20 and 30 mmHg) although the teams knew the monitors were semi-quantitative; in another, the monitor was not required, but performed properly; and the third was the one in which vomit in the tube prevented a reading. In 26 of 43 cases (60.4%), the monitor was used to confirm endotracheal tube placement (there were no instances of incorrect placement). In all cases, the devices were used to monitor respiration and oxygen saturation. Alarms were audible in the environment, but only preferred in the AirEvac situation. The “breath beep” feature was useful, particularly in patients in whom chest movements during respiration were difficult to observe.

“Breath beeps” were clearly audible and were a useful feature in all prehospital and transport environments, while audible alarms were desired only in the AirEvac situation. Semi-quantitative CO2 detection is valuable in the ALS/AirEvac environment, even for teams with high intubation success rates.

About one million accidents occur yearly in Finland (population 5.2 million), resulting in over 3,000 deaths, annually. The governmental and municipal authorities are responsible for the healthcare services that respond to these accidents. So far, resources for these services have been allocated according to regional equality, or in some cases, on the basis of population numbers. However, economical and effective resource allocation should be based on detailed risk analysis of the accidents.

In areas with more dense populations, the level of social activity is greater, which leads to an increased risk for accidents (traffic, civil disturbance, etc.).

The number of accidents was estimated on the basis of registered emergency trauma patients using the Finnish healthcare statistics for the year 1999. The emergency visits were compared to the populations and populations’ densities of the regional sub-units. The rate of emergency injuries was analysed by regression analysis according to varying population density in Finland.

The number of accidents per inhabitants was related directly to population density. There was a correlation between emergency visits per inhabitant and population density (p <0.0001). According to estimates, each 1% increase in population density is associated with a 0.4% increase in the risk of accidents.

The relationship between population density and rate of emergency visits is decisive for the planning of emergency services. Services should be placed in areas of high population densities where there are more people with greater risk of accidents.

To evaluate characteristics and outcome of out-of-hospital cardiac arrest (OHCA) patients presenting to the Emergency Department (ED), and to examine factors that could be used to determine to prolong or abort resuscitation for these patients.

All OHCA patients presenting to the ED were studied over a three-month period from November 2001 through January 2002. Patient with traumatic cardiac arrest were excluded. Data were collected from the ambulance case records, ED resuscitation charts, and the ED Very High Frequency (VHF) radio case-log sheet. Information collected included the patient's demographic characteristics, timings (time from call to ambulance arrival on scene, time from arrival at scene to departure from scene, time from scene to arrival in the ED) recorded in the pre-hospital setting, the outcome of the resuscitation, and the final outcome for patients who survived ED resuscitation.

Ninety-three non-traumatic patients with an OHCA were studied during the three-month period. Of the 93 patients, 15 (16.1%) survived ED resuscitation, and one survived to hospital discharge. There were no statistically significant differences for age, race, or gender with regards to the outcome of the resuscitation. The initial cardiac rhythms were asystole (65), pulseless electrical activity (21), and ventricular fibrillation (7). Fourteen (15%) received bystander cardiopulmonary resuscitation (CPR). All seven patients with return of spontaneous circulation (ROSC) on arrival in the ED survived ED resuscitation. The ambulance took an average of 11.80 ±3.36 minutes for the survivors and 11.8 ±4.22 minutes for the non-survivors from the time of call to get to these patients. The average of the scene times was 12.5 ±4.61 minutes for the survivors and 12.0 ±4.02 minutes for the non-survivors. Transport time from the scene to the ED took an average of 39.1 ±8.32 minutes for the survivors and 37.2 ±9.00 minutes for the non-survivors.

The survival rate for patients with OHCA after ED resuscitation is similar to the results from other studies. There is a need to increase the awareness and delivery of basic life support by public education. Automatic External Defibrillators (AED) should be available widely to ensure that the chance of early defibrillation is increased. Prolonged resuscitation efforts appear to be futile for OHCA patients if the time from cardiac arrest until arrival in the ED is ≥30 minutes coupled with no ROSC, and if continuous asystole has been documented for >10 minutes.

St John Ambulance Operations Branch Volunteers have been providing first-aid services at the Royal Adelaide Show for 90 years. The project arose from a need to more accurately predict the workload for first-aid providers at mass gathering events. A formal analysis of workload patterns and the determinants of workload had not been performed.

Casualty presentation workload would be predicted by factors including day of the week, weather, and crowd size.

Collated and analyzed casualty reports over a seven-year period representing >7,000 patients who presented for first-aid assistance for that period (63 show days) were reviewed retrospectively.

Casualty presentations correlated significantly with crowd size, maximum daily temperature, humidity, and day of the week. Patient presentation rate had heterogeneous determinants. The most frequent presentation was minor medical problems with Wednesdays attracting higher casualty presentations and more major medical categories.

Individual event analysis is a useful mechanism to assist in determining resource allocation at mass gathering events providing an evidence base upon which to make decisions about future needs. Subsequent analysis of other events will assist in supporting accurate predictor models.