The mortality and morbidity due to road traffic crashes (RTCs) are increasing drastically world-wide. Poor prehospital care management contributes to dismal patient outcomes, especially in low- and middle-income countries (LMICs). This study aimed to assess the knowledge, attitude, and self-reported practice (KAP) of providing first aid for RTC victims by commercial motorcyclists. In addition, it determined the relationship between sociodemographic characteristics and the level of KAP, then the predicting factors of outcome variables.

A cross-sectional study of 200 randomly selected commercial motorcyclists was conducted in May 2021. A chi-square test and multivariate analysis were used to analyze data.

The findings showed that most participants had a poor knowledge level (87.5 %), positive attitudes (74.5%), and poor self-reported practice (51.5%). Previous first-aid training and knowing an emergency call number for the police were predictors of good knowledge (AOR = 3.7064; 95% CI, 1.379-9.956 and AOR = 6.132; 95% CI,1.735-21.669, respectively). Previous first-aid training was also a predictor of positive attitudes (AOR = 3.087; 95% CI, 1.033-9.225). Moreover, the likelihood of having an excellent self-reported practice was less among participants under 40 years of age (AOR = 0.404; 95% CI, 0.182-0.897) and those who cared for up to five victims (AOR = 0.523; 95% CI, 0.282-0.969). Contrary, previous first-aid training (AOR = 2.410; 95% CI, 1.056-5.499) and educational level from high school and above increased the odds of having good self-reported practice (AOR = 2.533; 95% CI, 1.260-5.092).

Considering the study findings, training should be provided to improve the knowledge and skills of commercial motorcyclists since they are among the primary road users in Rwanda and involved in RTCs.

Disasters pose significant challenges globally, affecting millions of people annually. In Saudi Arabia, floods constitute a prevalent natural disaster, underscoring the necessity for effective disaster preparedness among Emergency Medical Services (EMS) workers. Despite their critical role in disaster response, research on disaster preparedness among EMS workers in Saudi Arabia is limited.

The study aimed to explore the disaster preparedness among EMS workers in Saudi Arabia. This study applied an explanatory sequential mixed-methods design to explore disaster preparedness among EMS workers in Saudi Arabia, focusing on the qualitative phase. Semi-structured interviews were conducted with 15 EMS workers from National Guard Health Affairs (NGHA) and Ministry of Health (MOH) facilities in Riyadh, Dammam, and Jeddah. Thematic analysis was conducted following Braun and Clarke’s six-step process, ensuring data rigor through Schwandt, et al’s criteria for trustworthiness.

The demographic characteristics of participants revealed a predominantly young, male workforce with varying levels of experience and educational backgrounds. Thematic analysis identified three key themes: (1) Newly/developed profession, highlighting the challenges faced by young EMS workers in acquiring disaster preparedness; (2) Access to opportunities and workplace resources (government versus military), indicating discrepancies in disaster preparedness support between government and military hospitals; and (3) Workplace policies and procedures, highlighting the need for clearer disaster policies, training opportunities, and role clarity among EMS workers.

The study underscores the importance of addressing the unique challenges faced by EMS workers in Saudi Arabia to enhance disaster preparedness. Recommendations include targeted support for young EMS professionals, standardization of disaster training across health care facilities, and improved communication of disaster policies and procedures. These findings have implications for policy and practice in disaster management and EMS training in Saudi Arabia.

The project aimed to characterize the exposure to seismic hazard in the emergency area of a high-complexity hospital in Cali, Colombia.

The occupancy of the emergency area was analyzed over 6 months, determining the value of material elements exposed to the seismic hazard. Four phases were executed: search for pre-existing information, occupancy analysis, evaluation of exposed assets, and results analysis. The information was analyzed using a Geographic Information System (GIS), which allowed the visualization of demographic behavior in different locations and times.

The results confirmed that the seismic hazard is high, exacerbated by local geomechanical characteristics. It was observed that the average occupancy of most studied areas exceeded capacity. The value of the exposed assets was estimated at COP 3 221 008 640 (USD 959 844.76), the demolition value at COP 10 582 770 000 (USD 3 153 613.49), and the reconstruction value at COP 30 293 640 275 (USD 9 027 356.03). In the worst-case scenario, the losses were equivalent to 12.4% of the hospital’s annual budget.

The data allow the hospital to take preventive measures and educate the staff to identify and mitigate critical areas. It also contributes to the knowledge of the approximate value of economic losses and the impact of potential human losses.

Terrorist attacks on the aviation sector represent a significant security challenge due to the high-profile status of airports and aircraft. These attacks not only jeopardize global security but also have severe public health repercussions, leading to widespread casualties and psychological distress.

This study conducted a comprehensive retrospective analysis using data from the Global Terrorism Database to explore the patterns, frequencies, and impacts of terrorist attacks on the aviation sector worldwide. The analysis spanned incidents from 1970 to 2020, focusing on attack types, affected regions, and the direct and indirect health consequences arising from these incidents.

Over the 50-year period, the study identified 1183 terrorist attacks targeting the aviation sector. Bombings and explosions emerged as the most common and deadliest forms of attack, responsible for the majority of fatalities and injuries. The data also highlighted significant regional disparities, with certain areas experiencing higher frequencies of attacks and more severe outcomes. Notably, North America bore a disproportionately high number of fatalities, primarily due to the events of September 11, 2001.

The findings emphasize the ongoing and evolving threat of terrorism in the aviation industry, underscoring the critical need for a proactive and comprehensive approach to security and public health preparedness. Future strategies should prioritize the integration of advanced technological solutions, enhanced international cooperation, and thorough public health planning to mitigate the impact of terrorist attacks on aviation effectively.

Mass Casualty Incidents (MCIs) involving high-speed passenger ferries (HSPFs) may result in the dual-wave phenomenon, in which the emergency department (ED) is overwhelmed by an initial wave of minor injuries, followed by a second wave of more seriously injured victims. This study aimed to characterize the time pattern of ED presentation of victims in such accidents in Hong Kong.

All HSPF MCIs from 2005 to 2015 were reviewed retrospectively, with the time interval from accident to ED registration determined for each victim. Multivariable linear regression was used to identify independent factors associated with the time of ED presentation after the accidents.

Eight MCIs involving 492 victims were identified. Victims with an Injury Severity Score (ISS) ≥ 9 had a significantly shorter median time interval compared to those with minor injuries. An ISS ≥ 9 and evacuation by emergency service vessels were associated with a shorter delay in ED arrival, whereas ship sinking, accident at nighttime, and a longer linear distance between the accident and receiving ED were associated with a longer delay.

The dual-wave phenomenon was not present in HSPF MCIs. Early communication is the key to ensure early resource mobilisation and a well-timed response.

Mass-casualty incidents (MCIs) place extraordinary demands on prehospital medical response. However, there remains limited evidence on best practices in managing MCIs, and therefore, there is a need to systematically synthetize experiences from them to build further evidence.

This study aimed to analyze common challenges in prehospital MCI management.

Seventeen case studies or reports describing 15 MCIs (ie, terrorist attacks, chemical incidents, traffic accidents, weather-related incidents, and fires) were subject to a systematic integrative review.

Common challenges in prehospital MCI management include victim and responder safety- and security-related issues; the need to develop and communicate situational awareness; to develop and apply a prehospital response plan; the ability to deliver care under severe circumstances; and the need for an extended prehospital medical response management strategy.

Resilient prehospital MCI response demands both a clear strategy and improvisation and should be integrated into the overall medical response strategy. Responders must understand the main concepts of prehospital MCI management, have a situational awareness that foresees the event’s medical consequences, and have the experience required to interpret the situation. Emergency Medical Services (EMS) personnel and medical incident commanders require specific training and mental preparation to be able to provide care under severe security threats, to improvise beyond routines and guidelines, and to provide care in ways different from their everyday work.

This study assesses the operational challenges and clinical outcomes encountered by a university-based Emergency Medical Team (EMT) during the medical search and rescue (mSAR) response to the February 2023 earthquakes in Kahramanmaraş, Turkey.

In this observational study, data were retrospectively collected from 42 individuals who received mSAR services post-earthquake. The challenges were categorized as environmental, logistical, or medical, with detailed documentation of rescue times, patient demographics, injury types, and medical interventions.

In this mSAR study, 42 patients from 30 operations were analyzed and divided into environmental (26.2%), logistical (52.4%), and medical (21.4%) challenge groups. Median rescue times were 29 (IQR 28–30), 36.5 (IQR 33.75–77.75), and 30.5 (IQR 29.5–35.5) hours for each group, respectively (P = .002). Age distribution did not significantly differ across groups (P = .067). Hypothermia affected 18.2%, 45.5%, and 66.7% in the respective groups. Extremity injuries were most common in the medical group (88.9%). Intravenous access was highest in the medical group (88.9%), while splinting was more frequent in the medical (55.6%) and logistical (18.2%) groups. Hypothermia was most prevalent in the medical group (66.7%), followed by the logistical group (45.5%). Ambulance transport post-rescue was utilized for a minority in all groups.

The study concludes that logistical challenges, more than environmental or medical challenges, significantly prolong the duration of mSAR operations and exacerbate clinical outcomes like hypothermia, informing future enhancements in disaster response planning and execution.

There is significant public health interest towards providing medical care at mass-gathering events. Furthermore, mass gatherings have the potential to have a detrimental impact on the availability of already-limited municipal Emergency Medical Services (EMS) resources. This study presents a cross-sectional descriptive analysis to report broad trends regarding patients who were transported from National Collegiate Athletic Association (NCAA) Division 1 collegiate football games at a major public university in order to better inform emergency preparedness and resource planning for mass gatherings.

Patient care reports (PCRs) from ambulance transports originating from varsity collegiate football games at the University of Minnesota across six years were examined. Pertinent information was abstracted from each PCR.

Across the six years of data, there were a total of 73 patient transports originating from NCAA collegiate football games: 45.2% (n = 33) were male, and the median age was 22 years. Alcohol-related chief complaints were involved in 50.7% (n = 37) of transports. In total, 31.5% of patients had an initial Glasgow Coma Scale (GCS) of less than 15. The majority (65.8%; n = 48; 0.11 per 10,000 attendees) were transported by Basic Life Support (BLS) ambulances. The remaining patients (34.2%; n = 25; 0.06 per 10,000 attendees) were transported by Advanced Life Support (ALS) ambulances and were more likely to be older, have abnormal vital signs, and have a lower GCS.

This analysis of ambulance transports from NCAA Division 1 collegiate football games emphasizes the prevalence of alcohol-related chief complaints, but also underscores the likelihood of more life-threatening conditions at mass gatherings. These results and additional research will help inform emergency preparedness at mass-gathering events.

Little is known about how mass gatherings affect emergency response intervals. Previous research suggests that college football games increase ambulance transport intervals, but their impact on emergency response intervals is unexplored. This study examines how collegiate home football games in College Station, Texas (USA) affect emergency vehicle response intervals.

The study determined the impact of collegiate football games on emergency response intervals using incident data provided by the College Station Fire Department (CSFD). Home games during the 2021-2023 Texas A&M University (TAMU) football seasons were the period of interest. Responses for a 72-hour period (Friday-Sunday) on home game weekends (HGWs) and non-home game weekends (NHGWs) were included (n = 5,095).

Response intervals on football HGWs were an average of 30 seconds faster than on NHGWs. Emergency vehicles were 16.5% less likely to respond from fire station locations on HGWs compared to NHGWs. There was also a 12.1% increase in the number of calls to campus locations and a 9.7% increase in calls to the local entertainment district on HGWs compared to NHGWs.

Home collegiate football games do not delay response intervals for emergency response vehicles. Further research is needed to determine if these findings can be reproduced in other communities.

The aim of this study was to summarize the literature on the applications of machine learning (ML) and their performance in Emergency Medical Services (EMS).

Four relevant electronic databases were searched (from inception through January 2024) for all original studies that employed EMS-guided ML algorithms to enhance the clinical and operational performance of EMS. Two reviewers screened the retrieved studies and extracted relevant data from the included studies. The characteristics of included studies, employed ML algorithms, and their performance were quantitively described across primary domains and subdomains.

This review included a total of 164 studies published from 2005 through 2024. Of those, 125 were clinical domain focused and 39 were operational. The characteristics of ML algorithms such as sample size, number and type of input features, and performance varied between and within domains and subdomains of applications. Clinical applications of ML algorithms involved triage or diagnosis classification (n = 62), treatment prediction (n = 12), or clinical outcome prediction (n = 50), mainly for out-of-hospital cardiac arrest/OHCA (n = 62), cardiovascular diseases/CVDs (n = 19), and trauma (n = 24). The performance of these ML algorithms varied, with a median area under the receiver operating characteristic curve (AUC) of 85.6%, accuracy of 88.1%, sensitivity of 86.05%, and specificity of 86.5%. Within the operational studies, the operational task of most ML algorithms was ambulance allocation (n = 21), followed by ambulance detection (n = 5), ambulance deployment (n = 5), route optimization (n = 5), and quality assurance (n = 3). The performance of all operational ML algorithms varied and had a median AUC of 96.1%, accuracy of 90.0%, sensitivity of 94.4%, and specificity of 87.7%. Generally, neural network and ensemble algorithms, to some degree, out-performed other ML algorithms.

Triaging and managing different prehospital medical conditions and augmenting ambulance performance can be improved by ML algorithms. Future reports should focus on a specific clinical condition or operational task to improve the precision of the performance metrics of ML models.

Medical resuscitations in rugged prehospital settings require emergency personnel to perform high-risk procedures in low-resource conditions. Just-in-Time Guidance (JITG) utilizing augmented reality (AR) guidance may be a solution. There is little literature on the utility of AR-mediated JITG tools for facilitating the performance of emergent field care.

The objective of this study was to investigate the feasibility and efficacy of a novel AR-mediated JITG tool for emergency field procedures.

Emergency medical technician-basic (EMT-B) and paramedic cohorts were randomized to either video training (control) or JITG-AR guidance (intervention) groups for performing bag-valve-mask (BVM) ventilation, intraosseous (IO) line placement, and needle-decompression (Needle-d) in a medium-fidelity simulation environment. For the interventional condition, subjects used an AR technology platform to perform the tasks. The primary outcome was participant task performance; the secondary outcomes were participant-reported acceptability. Participant task score, task time, and acceptability ratings were reported descriptively and compared between the control and intervention groups using chi-square analysis for binary variables and unpaired t-testing for continuous variables.

Sixty participants were enrolled (mean age 34.8 years; 72% male). In the EMT-B cohort, there was no difference in average task performance score between the control and JITG groups for the BVM and IO tasks; however, the control group had higher performance scores for the Needle-d task (mean score difference 22%; P = .01). In the paramedic cohort, there was no difference in performance scores between the control and JITG group for the BVM and Needle-d tasks, but the control group had higher task scores for the IO task (mean score difference 23%; P = .01). For all task and participant types, the control group performed tasks more quickly than in the JITG group. There was no difference in participant usability or usefulness ratings between the JITG or control conditions for any of the tasks, although paramedics reported they were less likely to use the JITG equipment again (mean difference 1.96 rating points; P = .02).

This study demonstrated preliminary evidence that AR-mediated guidance for emergency medical procedures is feasible and acceptable. These observations, coupled with AR’s promise for real-time interaction and on-going technological advancements, suggest the potential for this modality in training and practice that justifies future investigation.

Hemodynamic collapse in multi-trauma patients with severe traumatic brain injury (TBI) poses both a diagnostic and therapeutic challenge for prehospital clinicians. Brain injury associated shock (BIAS), likely resulting from catecholamine storm, can cause both ventricular dysfunction and vasoplegia but may present clinically in a manner similar to hemorrhagic shock. Despite different treatment strategies, few studies exist describing this phenomenon in the early post-injury phase. This retrospective observational study aimed to describe the frequency of shock in isolated TBI in prehospital trauma patients and to compare their clinical characteristics to those patients with hemorrhagic shock and TBI without shock.

All prehospital trauma patients intubated by prehospital medical teams from New South Wales Ambulance Aeromedical Operations (NSWA-AO) with an initial Glasgow Coma Scale (GCS) of 12 or less were investigated. Shock was defined as a pre-intubation systolic blood pressure under 90mmHg and the administration of blood products or vasopressors. Injuries were classified from in-hospital computed tomography (CT) reports. From this, three study groups were derived: BIAS, hemorrhagic shock, and isolated TBI without shock. Descriptive statistics were then produced for clinical and treatment variables.

Of 1,292 intubated patients, 423 had an initial GCS of 12 or less, 24 patients (5.7% of the original cohort) had shock with an isolated TBI, and 39 patients had hemorrhagic shock. The hemodynamic parameters were similar amongst these groups, including values of tachycardia, hypotension, and elevated shock index. Prehospital clinical interventions including blood transfusion and total fluids administered were also similar, suggesting they were indistinguishable to prehospital clinicians.

Hemodynamic compromise in the setting of isolated severe TBI is a rare clinical entity. Current prehospital physiological data available to clinicians do not allow for easy delineation between these patients from those with hemorrhagic shock.

Airway management is a cornerstone in the prehospital care of critically ill or injured patients. Surgical cricothyrotomy offers a rapid and effective solution when oxygenation and ventilation fail using less-invasive techniques. However, the exact indications, incidence, and success of prehospital surgical cricothyrotomy are unknown, with variable rates reported in the literature. This study aimed to examine prehospital indications and success rates for surgical cricothyrotomy within a large, suburban, ground-based Emergency Medical Services (EMS) system.

This is a retrospective analysis of 31 patients who underwent paramedic performed surgical cricothyrotomy from 2012 through 2022. Key demographic parameters were analyzed, including the incidence of cardiac arrest, call type (trauma versus medical), initial airway management attempts, number of endotracheal intubation (ETI) attempts before surgical airway, and average time to the establishment of a surgical airway in relation to the number of ETI attempts. Surgical cricothyrotomy success was defined as the acquisition of four-phase end-tidal capnography reading. The primary data sources were the EMS electronic medical records, and descriptive statistics were calculated.

A total of 31 patients were included in the final analysis. Of those who received a surgical cricothyrotomy, 42% (13/31) occurred in the trauma setting, while 58% (18/31) were medical calls. In all patients who underwent surgical cricothyrotomy, the median (IQR) time to the procedure was 17 minutes (IQR = 11-24). In trauma patients, the median time to surgical cricothyrotomy was 12 minutes (IQR = 9-19) versus 19 minutes (IQR = 14-33) in medical patients. End-tidal carbon dioxide (ETCO2) detection and placement success was confirmed in 94% (29/31) of patients. Endotracheal intubation was attempted in 55% (17/31) before subsequent surgical cricothyrotomy, with 29% (9/31) receiving more than one ETI attempt. The median time to surgical cricothyrotomy when multiple prior intubation attempts occurred was 33 minutes (IQR = 23-36) compared to 14.5 minutes (IQR = 6-19) in patients without a preceding intubation attempt.

Prehospital surgical airway can be performed by paramedics with a high degree of success. Identification of the need for surgical cricothyrotomy should be determined as soon as possible to allow for rapid securement of the airway and to ensure adequate oxygenation and ventilation.

Music festivals have become an increasingly popular form of mass-gathering event, drawing an increasing number of attendees across the world each year. While festivals exist to provide guests with an enjoyable experience, there have been instances of serious illness, injury, and in some cases death. Large crowds, prolonged exposure to loud music, and high rates of drug and alcohol consumption can pose a dangerous environment for guests as well as those looking after them.

A retrospective review of electronic patient records (EPRs) at the 2022 Glastonbury Festival was undertaken. All patients who attended medical services on-site during the festival and immediately after were included. Patient demographics, diagnosis, treatment received, and discharge destination were obtained and analyzed.

A total of 2,828 patients received on-site medical care. The patient presentation rate (PPR) was 13.47 and the transport-to-hospital rate (TTHR) was 0.30 per 1,000 guests. The most common diagnoses were joint injuries, gastrointestinal conditions, and blisters. Only 164 patients (5.48%) were diagnosed as being intoxicated. Overall, 552 patients (19.52%) were prescribed a medication to take away and 268 (9.48%) had a dressing for a minor wound. One patient (0.04%) underwent a general anesthetic and no patients required cardiopulmonary resuscitation. Most patients were discharged back to the festival site (2,563; 90.66%).

Minor conditions were responsible for many presentations and most patients only required mild or non-invasive interventions, after which they could be safely discharged back to the festival. Older adults were diagnosed with a different frequency of conditions compared to the overall study population, something not reported previously. Intoxicated patients only accounted for a very small amount of the medical workload.

In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders.

This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage.

Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states – Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri – have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it.

Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.