Abstract
Background
With millions of unscheduled patient contacts every year and increasing call outs clustered around the most deprived communities, it is clear the ambulance sector could have a ...role to play in improving population health. However, the application and value of a public health approach within the ambulance sector has not been comprehensively explored.
A scoping review was undertaken to explore the role of the ambulance sector in the delivery of public health interventions and what impact this has on population health and ambulance sector outcomes.
Methods
A search strategy was developed on MEDLINE and translated to other major medical and health related bibliographic databases (Embase; CINAHL; HMIC; Science and Social Sciences Citation Index; Cochrane Library) to identify literature published since 2000 in OECD countries. Targeted grey literature, reference list, and citation searching was also carried out.
Search results were downloaded to Microsoft Excel and screened by three reviewers according to pre-determined inclusion / exclusion criteria. Data from included studies, such as the type of activity noted within the paper, the population involved and the public health approach that was utilised, was extracted from within the paper using a data extraction form and narratively synthesised.
Results
Fifty-two references were included in the final review (37 database searching; 9 reference list searching; 6 grey literature).
Included articles were categorised according to the relevant public health domains and subdomains as articulated by the UK Faculty of Public Health:
Health improvement domain:
Public health education and advice (Health promotion sub-domain) (
n
=13)
Emergency Services personnel providing vaccines (Disease prevention sub-domain) (
n
=1)
Health care public health domain
Paramedicine (Service delivery sub-domain) (
n
=30)
Screening tools and referral pathways used by the ambulance sector (Service delivery sub-domain) (
n
=28)
Health intelligence using ambulance sector data (population health management sub-domain) (
n
=26)
Of note, some domains (e.g. health protection) returned nil results.
Discussion
The scoping review demonstrates the breadth of public health related activities in which the ambulance sector is involved. However, an overemphasis on demand management outcomes precludes definitive conclusions on the impact of ambulance sector-led public health initiatives on public health outcomes. Future evaluations of public health initiatives should incorporate wider health system perspectives beyond the immediately apparent remit of the ambulance sector.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives
During the first wave of the COVID‐19 pandemic in the United Kingdom (UK), to describe volume and pattern of calls to emergency ambulance services, proportion of calls where an ambulance ...was dispatched, proportion conveyed to hospital, and features of triage used.
Methods
Semistructured electronic survey of all UK ambulance services (n = 13) and a request for routine service data on weekly call volumes for 22 weeks (February 1–July 3, 2020). Questionnaires and data request were emailed to chief executives and research leads followed by email and telephone reminders. The routine data were analyzed using descriptive statistics, and questionnaire data using thematic analysis.
Results
Completed questionnaires were received from 12 services. Call volume varied widely between services, with a UK peak at week 7 at 13.1% above baseline (service range ‐0.5% to +31.4%). All services ended the study period with a lower call volume than at baseline (service range ‐3.7% to ‐25.5%). Suspected COVID‐19 calls across the UK totaled 604,146 (13.5% of all calls), with wide variation between services (service range 3.7% to 25.7%), and in service peaks of 11.4% to 44.5%. Ambulances were dispatched to 478,638 (79.2%) of these calls (service range 59.0% to 100.0%), with 262,547 (43.5%) resulting in conveyance to hospital (service range 32.0% to 53.9%). Triage models varied between services and over time. Two primary call triage systems were in use across the UK. There were a large number of products and arrangements used for secondary triage, with services using paramedics, nurses, and doctors to support decision making in the call center and on scene. Frequent changes to triage processes took place.
Conclusions
Call volumes were highly variable. Case mix and workload changed significantly as COVID‐19 calls displaced other calls. Triage models and prehospital outcomes varied between services. We urgently need to understand safety and effectiveness of triage models to inform care during further waves and pandemics.
Aims: To assess the prevalence of burnout among emergency ambulance service workers in one ambulance station; to determine if there are any variances based on socio-demographic information such as ...gender, clinical grade and length of service; to examine
the distinctions between personal, work-related and patient-related burnout; to identify current workplace interventions to reduce stress and burnout that will improve mental health and well-being. Methods: Mixed methods - the Copenhagen
Burnout Inventory (CBI) was utilised, measuring burnout across three domains (personal, work-related and patient-related) alongside collecting demographic information such as gender, role, full-time or part-time employment and length of service. A free-text space was available to provide opinions
on causes of burnout and on how current practice can be improved; these were analysed via thematic analysis. Results: Seventy-eight staff members completed the questionnaire. These were: 16 emergency care assistants, 15 technicians and 47 paramedics.
Thirty-eight (48.7%) staff members experienced personal burnout, 42 (53.8%) experienced work-related burnout and 29 (37.1%) experienced patient-related burnout. It was found that those most at risk of burnout were full-time male employees with more than 10 years' experience and employed
within a paramedic position. Six themes were identified through thematic analysis: unnecessary callouts, shift patterns, support options, management, sickness absence and job demands. Conclusion: Findings suggest that burnout is prevalent within
the ambulance service environment and can result in long-term sickness absences and declining mental health. This requires further investigation into causation alongside consideration of preventative measures and interventions to improve ambulance service staff well-being while increasing
staff resilience to prevent burnout. Support for managers in recognising symptoms of burnout is also imperative because providing them with the training to recognise a mental health issue, interpret it and promptly treat it can mean the difference between sickness absences, future PTSD, unwell
staff presenting at work and staff feeling valued and supported by management. The introduction of mandatory counselling and well-being sessions was also recommended by participants to improve staff mental health and well-being and reduce instances of work-related burnout, while providing
financial advantages to the ambulance service with a reduction in additional overtime and sickness payments.
Background: Emergency medical services (EMS) are often patients' first point of contact for urgent and emergency care needs. Patients are triaged over the phone and may receive an ambulance response, ...with potential conveyance to the hospital. A recent scoping review suggested
disparities in EMS patient care in the United States. However, it is unknown how health inequalities impact EMS care in other developed countries and how inequalities are being addressed.Objectives: This rapid evidence map of published literature aims to map known health inequalities
in EMS patients and describe interventions reducing health inequalities in EMS patient care.Methods: The search strategy consisted of EMS synonyms and health inequality synonyms. The MEDLINE/PubMed database was searched from 1 January 2010 to 26 July 2022. Studies were included
if they described empirical research exploring health inequalities within ambulance service patient care. Studies were mapped on to the EMS care interventions framework and Core20PLUS5 framework. Studies evaluating interventions were synthesised using the United Kingdom Allied Health Professions
Public Health Strategic Framework.Results: The search strategy yielded 771 articles, excluding duplicates, with two more studies added from hand searches. One hundred studies met the inclusion criteria after full-text review. Inequalities in EMS patient care were predominantly situated
in assessment, treatment and conveyance, although triage and response performance were also represented. Studies mostly explored EMS health inequalities within ethnic minority populations, populations with protected characteristics and the core issue of social deprivation. Studies evaluating
interventions reducing health inequalities (n = 5) were from outside the United Kingdom and focused on older patients, ethnic minorities and those with limited English proficiency. Interventions included community paramedics, awareness campaigns, dedicated language lines and changes to EMS
protocols.Conclusions: Further UK-based research exploring health inequalities of EMS patients would support ambulance service policy and intervention development to reduce health inequality in urgent and emergency care delivery.
Background:
The coronavirus disease 2019 (COVID-19) pandemic has highlighted the reliance on antigen detection rapid diagnostic tests (Ag-RDTs). Their evaluation at point of use is a priority.
...Methods:
Here, we report a multi-centre evaluation of the analytical sensitivity, specificity, and clinical accuracy of the Mologic COVID-19 Ag-RDT by comparing to reverse transcriptase polymerase chain reaction (RT-qPCR) results from individuals with and without COVID-19 symptoms. Participants had attended hospitals in Merseyside, hospital and ambulance services in Yorkshire, and drive-through testing facilities in Northumberland, UK.
Results:
The limit of detection of the Mologic COVID-19 Ag-RDT was 5.0 x 10
2
pfu/ml in swab matrix with no cross-reactivity and interference for any other pathogens tested. A total of 347 participants were enrolled from 26
th
of November 2020 to 15
th
of February 2021 with 39.2% (CI 34.0-44.6) testing RT-qPCR positive for SARS-CoV-2. The overall sensitivity and specificity of the Mologic Ag-RDT compared to the reference SARS-CoV-2 RT-qPCR were 85.0% (95% CI 78.3-90.2) and 97.8% (95.0-99.3), respectively. Sensitivity was stratified by RT-qPCR cycle threshold (Ct) and 98.4% (91.3-100) of samples with a Ct less than 20 and 93.2% (86.5-97.2) of samples with a Ct less than 25 were detected using the Ag-RDT. Clinical accuracy was stratified by sampling strategy, swab type and clinical presentation. Mologic COVID-19 Ag-RDT demonstrated highest sensitivity with nose/throat swabs compared with throat or nose swabs alone; however, the differences were not statistically significant.
Conclusions:
Overall, the Mologic test had high diagnostic accuracy across multiple different settings, different demographics, and on self-collected swab specimens. These findings suggest the Mologic rapid antigen test may be deployed effectively across a range of use settings.
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